111.2 📚 國考版醫垫國考 / PGY OSCE

111.2.0.1 📌 Cram Sheet

111.2.0.1.1 🔥 高 yield 12
  1. Pediatric ALL > 90% cure (modern era); B-ALL 85% / T-ALL 15%
  2. Pediatric peak 2-5 yr; adult worse outcome
  3. Best pediatric: t(12;21) ETV6-RUNX1, hyperdiploid
  4. Worst: hypodiploid, MLL/KMT2A (infant), Ph+
  5. Phases: induction → consolidation → CNS prophy → maintenance × 2-3 yr
  6. CNS prophylaxis mandatory (intrathecal MTX)
  7. Ph+ ALL: TKI + chemo OR blinatumomab + TKI + steroid (chemo-free)
  8. Inotuzumab ozogamicin (CD22-DM1) for R/R B-ALL (VOD risk)
  9. Blinatumomab (CD19 BiTE) for R/R / MRD+
  10. CAR-T: tisagenlecleucel (pediatric), brexucabtagene (adult B-ALL)
  11. Nelarabine for T-ALL R/R
  12. Revumenib for KMT2A-rearranged (FDA 2024)
111.2.0.1.2 🔢 必背
項目 æ•žå­—
Pediatric peak 2-5 yr
Pediatric cure > 90%
Adult 5-yr OS 30-40%
Maintenance 2-3 yr
Ph+ adult 20-30%
Ph+ pediatric 5%
Hyperdiploid > 50 chr
Hypodiploid < 44 chr

111.2.0.2 ⭐ 高 yield

111.2.0.2.1 Cytogenetics Quick
Marker Type Prognosis
t(12;21) ETV6-RUNX1 B-ALL pediatric Best
Hyperdiploid (> 50) B-ALL Good
Hypodiploid (< 44) B-ALL Poor
t(9;22) Ph+ BCR-ABL B-ALL Adverse (TKI rescue)
Ph-like B-ALL Adverse (TKI per fusion)
MLL/KMT2A Infant Poor
TCF3-PBX1 B-ALL Intermediate
ETP-ALL T-ALL Poor
NOTCH1 mutation T-ALL Common
111.2.0.2.2 Drugs Quick
Drug Mechanism Use
Vincristine Microtubule Induction
Dexamethasone Steroid Induction; CNS penetration
Asparaginase (PEG-ASP) Depletes ASN Pediatric/AYA
Daunorubicin Anthracycline Induction
Methotrexate (HD) Antimetabolite Consolidation + CNS
Cytarabine (HD) Antimetabolite Consolidation
6-MP Antimetabolite Maintenance
Cyclophosphamide Alkylator Hyper-CVAD
Rituximab CD20 mAb CD20+
Inotuzumab ozogamicin CD22-DM1 ADC R/R; VOD risk
Blinatumomab CD19 × CD3 BiTE R/R + MRD+
Tisagenlecleucel CAR-T (CD19) Pediatric R/R
Brexucabtagene CAR-T (CD19) Adult R/R
Nelarabine Antimetabolite (T-cell) T-ALL R/R
Imatinib/dasatinib/ponatinib TKI Ph+ ALL
Revumenib Menin inhibitor KMT2A/NPM1 R/R
111.2.0.2.3 Special CNS / Sanctuary
  • ALL CNS involvement common (vs AML rare)
  • LP at diagnosis
  • Intrathecal therapy + CNS-penetrating systemic (HD MTX, dex)
  • Cranial RT (less now; reserved for CNS+ disease)
111.2.0.2.4 Asparaginase Complications
  • Pancreatitis
  • Thrombosis (CNS sinus thrombosis)
  • Hyperbilirubinemia
  • Hyperglycemia
  • Hypoalbuminemia → swelling
  • Allergic reactions
  • Fibrinogen depletion

111.2.0.3 🎯 自我檢枬

  1. ALL pediatric peak age? → 2-5 yr
  2. Pediatric cure rate? → > 90%
  3. B-ALL %? → 85%
  4. Best pediatric translocation? → t(12;21) ETV6-RUNX1
  5. Worst? → Hypodiploid, MLL/KMT2A
  6. Ph+ adult vs ped? → 20-30% vs 5%
  7. CNS prophylaxis? → Intrathecal MTX
  8. Maintenance duration? → 2-3 yr
  9. Ph+ ALL Tx? → TKI + chemo OR blinatumomab + TKI + steroid
  10. CD22+ R/R? → Inotuzumab ozogamicin
  11. CD19+ R/R? → Blinatumomab + CAR-T
  12. CAR-T pediatric? → Tisagenlecleucel
  13. T-ALL R/R? → Nelarabine
  14. KMT2A R/R 22E? → Revumenib
  15. Inotuzumab unique SE? → Hepatic VOD

⚠ AI 草皿。