237.3 🩺 內科專科考前版

237.3.0.1 1⃣ Family Screening for Tapeworm Carriers

  • Patient with cysticercosis → check household members for adult T. solium (stool O+P, antigen)
  • Treat carriers (single-dose praziquantel)
  • Reduces ongoing transmission

237.3.0.2 2⃣ Treatment Algorithm — Single Brain Lesion

  • Single ring-enhancing brain lesion in adult from endemic area:
    • Differential: NCC (transitional), tuberculoma, primary CNS lymphoma, glioma, metastasis, Toxo (HIV)
    • Serology: EITB for NCC, TB workup, EBV PCR
    • Empirical treatment for NCC if EITB+ + clinical features
    • Biopsy if uncertain after empirical Tx

237.3.0.3 3⃣ Calcified NCC + Seizures

  • Calcified NCC = inactive cysts but seizure focus
  • Anticonvulsants only (no antiparasitic)
  • Long-term anticonvulsant management
  • Epilepsy specialty care

237.3.0.4 4⃣ Steroid in NCC

  • Critical adjunct (prevents inflammatory response to dying cysts)
  • Dexamethasone 6-12 mg/d for typical
  • Higher dose (24-48 mg/d) for severe / extraparenchymal / ventricular
  • Continue for 2-3 weeks
  • Taper after antiparasitic course

237.3.0.5 5⃣ B12 Deficiency from Diphyllobothrium

  • Megaloblastic anemia + neurologic deficits (rare but pathognomonic)
  • Worm competes for B12 absorption
  • Stool O+P for eggs
  • B12 supplementation + praziquantel eradication

237.3.0.6 6⃣ CE Imaging WHO Classification

  • US characteristic appearance
  • CE1: unilocular anechoic + double-line sign
  • CE2: multivesicular (daughter cysts visible)
  • CE3a: water-lily sign (detached endocyst)
  • CE3b: mostly solid + small cysts
  • CE4: heterogeneous solid (degenerated)
  • CE5: solid + calcified
  • Imaging-guided treatment decisions

237.3.0.7 7⃣ AE Diagnosis + Differential

  • Infiltrative liver mass
  • Mimics cholangiocarcinoma + hepatocellular CA + metastases
  • Em-specific serology + imaging + PET-CT
  • Biopsy only if uncertain (dissemination risk)
  • ID + hepatobiliary surgery consultation

237.3.0.8 8⃣ Echinococcosis in Endemic Regions

  • Sheep-raising areas (Mediterranean, Mid East, S America)
  • Don’t feed dogs raw offal
  • Dog deworming programs
  • Personal hygiene + food safety
  • WHO MDA programs

237.3.0.9 9⃣ 健保 / Taiwan

  • 眕芋 endemic
  • 通報 mandatory
  • 健保 praziquantel + albendazole + surgical management
  • ID + neurosurgery + hepatobiliary specialty

237.3.0.10 10. New Antiparasitics

  • Oxfendazole investigational
  • Combination therapies for refractory NCC
  • New imaging biomarkers