173.3 🩺 內科專科考前版

173.3.0.1 1⃣ Cholera Outbreak Management

  • 通報 immediately (notifiable globally)
  • Mass ORS distribution (cholera treatment centers)
  • WHO cholera kit (ORS, IV fluid, antibiotic, lab supplies)
  • Water + sanitation intervention (chlorination, sanitation)
  • Vaccine deployment (Shanchol, Euvichol-Plus from stockpile)
  • 兒童 + 老 priority

173.3.0.2 2⃣ V. vulnificus 預防 (Patient Education)

  • Cirrhotic / hemochromatosis 病人 NO raw oyster
  • æµ·æ°Ž wound → 立即 wash + abx if 玅腫
  • 暖月 (May-Oct in Gulf Coast)
  • 健保 / public health education campaigns
  • 盧醫垫 hint: 肝硬化 + 䞍明 sepsis + æµ·æ°Ž / 海鮮接觞 → 必 ID consult, suspect V. vulnificus

173.3.0.3 3⃣ Climate Change + Vibrio Expansion

  • Sea surface temp ↑ → V. vulnificus extending range
  • 2023 Baltic outbreak (NE Europe)
  • USA NE Coast (Connecticut, NY) — northern expansion
  • è­Š public health: high-risk patient education + clinician awareness

173.3.0.4 4⃣ Diagnostics (Modern)

  • BioFire GI panel includes V. cholerae + V. parahaemolyticus
  • MALDI-TOF lab ID
  • 倚 Vibrio species accurate ID
  • AST: doxy R rare; FQ R emerging

173.3.0.5 5⃣ Antimicrobial Resistance

  • O1 V. cholerae — TMP-SMX R common (older 1st-line)
  • FQ R in some endemic
  • Doxy generally still effective
  • Azithro reliable

173.3.0.6 6⃣ Pregnancy + Cholera

  • Single-dose doxy / azithromycin acceptable (urgent)
  • ORS 同 emphasis

173.3.0.7 7⃣ 健保 / Taiwan

  • Cholera — 通報 (rare local, imported)
  • V. parahaemolyticus — 高 incidence (æµ·é®® culture); 通報 outbreak
  • V. vulnificus — 通報 SSTI / sepsis; 持枯 occupational
  • 健保 doxy / ceftriaxone — admit indication
  • Cholera vaccine 自費 (旅遊 ID)

173.3.0.8 8⃣ ASP

  • 䞍 routine antibiotic for V. parahaemolyticus healthy
  • V. vulnificus suspected → broad empirical immediately (don’t wait culture)
  • De-escalate to doxy + ceftriaxone