25.2 📚 國考版醫垫國考 / PGY OSCE

25.2.0.1 📌 䞀頁重點敎理 (Cram Sheet)

25.2.0.1.1 🔥 高 yield 8 條
  1. Fatigue ≠ Weaknesssubjective vs 肌力客觀降
  2. 5 倧類Medical / Psych / Sleep / Drug / Functional
  3. Most common = depression
  4. Workup basicsCBC, CMP, TSH, ferritin, B12, vit D, HbA1c, HIV, Hep
  5. OSA + STOP-BANG screen
  6. ME/CFS 栞心 = PEM (post-exertional malaise)
  7. ME/CFS > 6 個月 disabling
  8. Long COVID ≥ 12 週 fatigue + cognitive + dyspnea
25.2.0.1.2 🔢 必背
項目 æ•žå­—
Anemia (女/男) Hgb < 12 / 13
TSH normal 0.4-4.5
Vit D deficiency < 20 ng/mL
ME/CFS duration > 6 個月
Long COVID > 12 週
AHI severe > 30
OSA STOP-BANG threshold ≥ 3
PHQ-9 severe ≥ 20

25.2.0.2 ⭐ 高 yield 摘芁

25.2.0.2.1 5 倧病因
類別 代衚
Medical Anemia, hypothyroid, DM, HF, CKD, cancer, infection
Psych Depression (#1), anxiety, PTSD
Sleep OSA, insomnia, RLS, narcolepsy
Drug BB, antihistamine, opioid, BZD, polypharmacy
Functional ME/CFS, fibromyalgia, long COVID
25.2.0.2.2 Hypothyroidismfatigue 垞芋原因
  • Symptoms: fatigue + 冷 + 重 + 䟿秘 + 慢 reflex + bradycardia
  • TSH ↑ + FT4 ↓
  • Levothyroxine 1.6 ÎŒg/kg/d
25.2.0.2.3 OSA STOP-BANG
  • Snoring loud
  • Tired daytime
  • Observed apnea
  • Pressure (HTN)
  • BMI > 35
  • Age > 50
  • Neck > 40 cm
  • Gender male

≥ 3 → 進䞀步 sleep study

25.2.0.2.4 ME/CFS Diagnostic Criteria (IOM 2015)

3 必有 + 1 of 2 1. Substantial reduction in pre-illness function > 6 mo 2. PEM (post-exertional malaise) 3. Unrefreshing sleep + 1 of: - Cognitive impairment - Orthostatic intolerance

25.2.0.2.5 Long COVID

  • 12 週 post-acute COVID

  • Fatigue, cognitive dysfunction (brain fog), dyspnea, palpitation, POTS
  • Treatment: rehab + symptom-targeted
25.2.0.2.6 Depression Screen (PHQ-9)
  • ≀ 4 minimal
  • 5-9 mild
  • 10-14 moderate
  • 15-19 moderately severe
  • ≥ 20 severe
25.2.0.2.7 Fibromyalgia
  • Widespread pain + fatigue + tender points + sleep + cognitive
  • Treatment: SNRI (duloxetine), pregabalin, exercise, CBT

25.2.0.3 🎯 自我檢枬

  1. ME/CFS 栞心 hallmark? → PEM
  2. STOP-BANG ≥ 3 → ? → Sleep study
  3. Hypothyroidism TSH? → ↑
  4. PHQ-9 severe? → ≥ 20
  5. Most common psych cause of fatigue? → Depression
  6. Long COVID time threshold? → > 12 週
  7. Vit D deficiency 切點? → < 20 ng/mL

⚠ AI 草皿。