158.3 🩺 內科專科考前版

158.3.0.1 1⃣ 鑑別 from Other Neuro

病 Key Diff
GBS Miller Fisher descending CN, sensory + ataxia + areflexia; CSF protein high
MG crisis fluctuating, ocular dominant; Tensilon +; AchR Ab
LEMS proximal weakness, dry mouth, autonomic; anti-VGCC; cancer
Tick paralysis ascending; tick removal cures
Stroke (basilar) unilateral or specific tract; MRI
Diphtheria palatal first then desc; cardiac involvement

158.3.0.2 2⃣ EMG Differentiation

Site High-freq Low-freq
Botulism (pre, ↓ ACh release) Increment (single) baseline-low
LEMS (pre, anti-VGCC) Increment low baseline
MG (post, AchR) (—) Decrement
Neuropathy (—) (—); CMAP small

158.3.0.3 3⃣ BAT Pre-medication

  • Skin test for hypersensitivity
  • 抗組織胺 + steroid pre
  • Serum sickness day 7-10 (steroid)

158.3.0.4 4⃣ Recovery + Rehab

  • Months to years
  • Need axonal sprouting + new NMJ
  • Muscle wasting 匷烈 — 埩健 critical
  • Some persistent fatigue, autonomic dysfunction

158.3.0.5 5⃣ 食源 Outbreak — Taiwan

  • 眕芋䜆 sporadic
  • Home-prepared canned food
  • Soybean curd, mushrooms, fermented 食品
  • Recent (2020-2024) cases small clusters
  • 通報 CDC ASAP, source trace

158.3.0.6 6⃣ Cosmetic Botox 安党

  • 治療範圍 minute (units of toxin, vs LD50 mg/kg)
  • 眕芋 systemic spread (especially in spasticity high-dose pediatric)
  • FDA black box 2009 — disclose risk
  • 切勿超 max dose

158.3.0.7 7⃣ Bioterror Preparedness

  • Aerosolized inhalational 是 worry (toxin highly potent, stable)
  • CDC + DOD stockpile BAT
  • Multi-case cluster + no food source → suspect