205.3 🩺 內科專科考前版

205.3.0.1 1⃣ Multiplex PCR for Respiratory Infections

  • BioFire FilmArray, Luminex, etc.
  • 1-2 hr turnaround
  • 倚 pathogens (Flu A/B, RSV, parainfluenza 1-4, HMPV, adenovirus, rhinovirus, seasonal coronaviruses, SARS-CoV-2, M. pneumoniae, B. pertussis, etc.)
  • Useful in:
    • ICU + immunocompromise
    • HSCT
    • Severe / atypical pneumonia
    • Pediatric
  • Cost-benefit: not for every viral URI

205.3.0.2 2⃣ Croup Severity Assessment (Westley Score)

  • Stridor (none, with agitation, at rest)
  • Retraction (none, mild, moderate, severe)
  • Air entry (normal, mildly decreased, markedly decreased)
  • Cyanosis (none, with agitation, at rest)
  • Level of consciousness (normal, altered)
Score Severity Action
≀ 2 Mild Outpatient + supportive
3-5 Moderate Dex + observation
6-11 Severe Dex + epinephrine + hospitalize
≥ 12 Impending failure Airway + ICU

205.3.0.3 3⃣ Why Steroid for Croup

  • Anti-inflammatory effect on subglottic airway
  • Reduces hospitalization + intubation need
  • 0.6 mg/kg dexamethasone PO/IM × 1 dose
  • Onset 1-2 hr, peak 6 hr
  • Single dose usually sufficient

205.3.0.4 4⃣ HMPV + Immunocompromise

  • HSCT 30-day mortality 15-20% with severe HMPV pneumonia
  • Risk: lymphopenia, recent transplant
  • Treatment: supportive + ribavirin off-label + IVIG
  • 50% will progress to LRTI without treatment

205.3.0.5 5⃣ Common Cold + Antibiotic Stewardship

  • 倧倚 viral
  • Antibiotic prescribing for common cold = misuse
  • Concerning AMR driver
  • Patient education: cold lasts 1-2 wk, no antibiotic needed
  • Antibiotic only if bacterial sinusitis (≥ 10 days persistent or fever ≥ 39 + purulent), pneumonia, etc.

205.3.0.6 6⃣ Asthma Exacerbation + Viral Triggers

  • Rhinovirus #1 trigger
  • HMPV, parainfluenza, RSV, influenza, EV-D68 also
  • Treatment: bronchodilator + steroid (not antiviral typically)
  • Severe asthma + EV-D68 → consider hospitalization

205.3.0.7 7⃣ EV-D68 + AFM Workflow

  • Acute weakness in child + post-viral illness
  • Neurology + ID + Public Health
  • LP + CSF EV-D68 PCR
  • MRI cervical spine (gray matter T2 hyperintensity)
  • IVIG / steroid debated
  • 通報 CDC
  • Outbreak surveillance every 2 yr cyclical

205.3.0.8 8⃣ 健保 / Taiwan

  • 健保 respiratory PCR panel — ICU, immunocompromise indication
  • 健保 dex for croup
  • 健保 supportive care for viral URI
  • 盧醫垫 hint: 倧倚 病人 viral URI → 教育 䞍必 abx; persistent / severe → reassess + 倚 panel

205.3.0.9 9⃣ Future Vaccines

  • HMPV mRNA Phase 2-3
  • Universal coronavirus vaccine (pan-corona)
  • Combination Flu + RSV + COVID + HMPV in development
  • Adjuvanted formulations for elderly