158.2 📚 國考版

158.2.0.1 必背 — 鑑別 from Tetanus

項目 Botulism Tetanus
Paralysis Flaccid Spastic
入口 NMJ (ACh) CNS interneuron (GABA, glycine)
Toxin SNARE All SNAREs Synaptobrevin (Tetanospasmin)
Direction Descending, CN first Ascending or systemic spasm
Tx BAT + vent TIG + BZD + Mg

158.2.0.2 必背 — Cardinal Tetrad

4 D’s: Diplopia, Dysarthria, Dysphonia, Dysphagia

158.2.0.3 必背 — Sensorium

  • Clear (病人 alert, anxious about 呌吞)
  • No fever, no sensory loss

158.2.0.4 必背 — EMG

  • Incremental at high-frequency (50 Hz) — pre-synaptic
  • vs myasthenia: decremental low-freq
  • vs LEMS: also incremental (also pre-synaptic, anti-VGCC)

158.2.0.5 必背 — Infant

  • < 1 yr, honey classic, constipation first → floppy + descending
  • BabyBIG (human, not equine BAT)

158.2.0.6 必背 — Wound

  • IDU black tar heroin
    • debridement + metronidazole/PCN

158.2.0.7 必背 — No antibiotic in 食源/infant

(可胜 worsen — aminoglycoside NMJ block)