26.2 📚 國考版醫垫國考 / PGY OSCE

26.2.0.1 📌 䞀頁重點 (Cram Sheet)

26.2.0.1.1 🔥 高 yield 12 條
  1. UMN vs LMN = 必背
  2. 7 局定䜍cortex / 內囊 / brainstem / cord / anterior horn / nerve / NMJ / muscle
  3. GBS = ascending + areflexia + albuminocytologic dissociation
  4. MG = fluctuating + ptosis + fatigability
  5. ALS = UMN + LMN 同時
  6. Botulism = descending 4Ddiplopia/dysarthria/dysphagia/descending
  7. Stroke windowtPA < 4.5 hr / thrombectomy < 24 hr
  8. Cord compression = sensory level + 倧小䟿
  9. Hemiparesis face = arm > leg → MCAleg > arm → ACA
  10. Crossed signs = brainstem stroke
  11. MG trigger drugsaminoglycoside, BB, Mg, quinolones
  12. Lambert-Eaton (LEMS)opposite of MG匷床隚 use 改善
26.2.0.1.2 🔢 必背
項目 æ•žå­—
tPA window < 4.5 hr
Thrombectomy window < 24 hr (selected with imaging)
GBS vital capacity threshold < 20 mL/kg → intubate
GBS CSF protein > 45 mg/dL倚 60-100+
MG ice pack test 2 min → ptosis 改善
Pyridostigmine MG dose 60 mg q4-6h
Botulism antitoxin within 24h
26.2.0.1.3 ⚠ 陷阱
  • ALS 早期當 MS
  • GBS 䞍監枬 vital capacity
  • MG 絊 BB / aminoglycoside
  • Cord compression 拖
  • Stroke 過 window

26.2.0.2 ⭐ 高 yield 摘芁

26.2.0.2.1 UMN vs LMN
UMN LMN
Tone spasticity flaccid
Reflex ↑ ↓
Babinski + −
Atrophy 晚 disuse 顯著
Fasciculation − +
26.2.0.2.2 Stroke 血管領域 weakness
區域 無力 pattern
MCA Contralateral face + arm > leg + aphasia (dominant)
ACA Contralateral leg > arm
PCA Visual + 䞀些 sensory
Lacunar 內囊 Pure motor hemiparesis
Brainstem Crossed signs
Spinal cord Below lesion
26.2.0.2.3 GBS Variants
Variant 特埵
AIDP å…žåž‹ ascending demyelinating
AMAN Axonal motor only (Asia 倚)
AMSAN Axonal motor + sensory
Miller-Fisher Ophthalmoplegia + ataxia + areflexia
26.2.0.2.4 MG vs LEMS
MG LEMS
機蜉 AChR Ab postsynaptic VGCC Ab presynaptic
Strength Fatigue with use Improves with use
Reflex normal hyporeflexia
Autonomic − + (dry mouth)
Tumor thymoma SCLC
26.2.0.2.5 ALS
  • UMN + LMN
  • Asymmetric onset
  • Progressive
  • Riluzole + edaravone
26.2.0.2.6 Botulism 4 D’s
  • Diplopia
  • Dysarthria
  • Dysphagia
  • Descending paralysis
26.2.0.2.7 Periodic Paralysis
  • Hypokalemic / hyperkalemic
  • 突癌 episodic weakness
  • Cl channel / Na channel mutation

26.2.0.3 📝 高頻考題類型

  1. UMN vs LMN
  2. Stroke vascular territory
  3. GBS workup
  4. MG diagnosis + treatment
  5. ALS = UMN + LMN
  6. Cord compression urgency
  7. Drug trigger MG

26.2.0.4 🎯 自我檢枬

  1. ALS 神經孞 hallmark? → UMN + LMN 同時
  2. GBS CSF? → albuminocytologic dissociation
  3. MG ice pack test? → 2 min → ptosis 改善
  4. Botulism 4D? → diplopia / dysarthria / dysphagia / descending
  5. tPA window? → 4.5 hr
  6. LEMS 與 MG 差? → strength improves with use, VGCC Ab, SCLC
  7. Pyridostigmine? → AChE inhibitor for MG
  8. GBS 治療? → IVIG or plasmapheresis䞍甚 steroid alone
  9. Cord compression image? → emergent MRI
  10. Hemiparesis MCA pattern? → face + arm > leg

⚠ AI 草皿。