240.3 🩺 內科專科考前版

240.3.0.1 1⃣ Trichinella + Wild Game Hunters

  • USA cases predominantly from bear + wild boar hunting
  • Cooking wild game thoroughly essential
  • Education for hunters
  • 通報 + outbreak investigation
  • Cluster cases from shared game

240.3.0.2 2⃣ Anisakis + Sushi Restaurants

  • FDA freezing requirements for raw fish service
  • Acute presentation often within hours of ingestion (epigastric pain — distinctive)
  • Endoscopic removal is definitive Tx
  • Allergic component can persist after worm dies

240.3.0.3 3⃣ Angiostrongylus + Hawaii

  • Hawaii endemic (recent decade increase)
  • Slug / snail in produce → wash thoroughly
  • Eosinophilic meningitis differential
  • Treatment: supportive + steroid + sometimes serial LP
  • Albendazole controversial — case-by-case

240.3.0.4 4⃣ Toxocara + Pediatric Eosinophilia

  • Children with eosinophilia + hepatosplenomegaly + soil exposure history
  • Anti-Toxocara serology
  • VLM workup
  • OLM workup if visual symptoms (rule out retinoblastoma)
  • Pet (dog, cat) deworming education

240.3.0.5 5⃣ Gnathostoma + SE Asia Travel

  • Thailand classic
  • Migratory subcutaneous swellings + CNS symptoms in returning traveler from SE Asia + raw fish consumption
  • Albendazole + ivermectin
  • Steroid for severe CNS

240.3.0.6 6⃣ Dirofilaria Coin Lesion

  • Pulmonary nodule on CXR / CT in adult, no symptoms
  • Mosquito + dog area exposure
  • Often misdiagnosed as lung cancer
  • Surgical resection for definitive
  • Diagnosis post-resection

240.3.0.7 7⃣ Pre-Travel Counseling

  • Pork + wild game cooking in endemic
  • Sushi caution in countries without FDA-equivalent freezing requirements
  • Slug / snail awareness (Hawaii, Caribbean)
  • Soil + sand exposure children
  • Cat / dog deworming

240.3.0.8 8⃣ Eosinophilia + Returning Traveler Workup

  • Comprehensive: Strongyloides, Schistosoma, Filariae, Trichinella, Toxocara, Anisakis
  • Stool studies + serology + imaging
  • Detailed exposure history
  • ID + tropical medicine consultation

240.3.0.9 9⃣ 健保 / Taiwan

  • 通報 mandatory for several tissue nematodes
  • 健保 albendazole + mebendazole + ivermectin for confirmed indications
  • Awareness for returning travelers + raw food consumers

240.3.0.10 10. Future + Climate

  • Climate change: tropical parasitic range expansion
  • Increased sushi consumption globally → more Anisakis
  • Slug / snail range changes
  • Continuous surveillance + adaptation