27.2 📚 國考版醫垫國考 / PGY OSCE

27.2.0.1 📌 Cram Sheet

27.2.0.1.1 🔥 高 yield 8 條
  1. Patternsstocking-glove / dermatomal / single nerve / hemibody / sensory level / saddle
  2. Large fibervibration, positionposterior column
  3. Small fiberpain, temperaturespinothalamic
  4. DPN = DM 最垞 peripheral neuropathystocking-glove
  5. B12 deficiencysubacute combined degenerationposterior column + corticospinal
  6. Carpal tunnel拇/食/äž­/環偎半 + 倜間
  7. Brown-Sequardcord half lesion = ipsi vibration/position + contra pain/temp
  8. Cauda equina = saddle + bladder = emergency
27.2.0.1.2 🔢 必背
項目 æ•žå­—
B12 deficiency cutoff < 200 pg/mL
MMA / homocysteine ↑ B12 functional def
HbA1c risk DPN poorly controlled
Carpal tunnel test Phalen, Tinel
Romberg posterior column / vestibular
27.2.0.1.3 ⚠ 陷阱
  • Saddle 挏 cauda equina
  • B12 䞍查
  • Long-term PPI / metformin → B12 ↓

27.2.0.2 ⭐ 高 yield 摘芁

27.2.0.2.1 感芺通路
Modality Pathway 病灶
Vibration / position Posterior column Cord (B12), brain
Pain / temp Spinothalamic Cord, brainstem
Light touch Both Mixed
27.2.0.2.2 呚邊神經病變病因TIDE
  • Toxic / drugschemo: cisplatin, vincristine, paclitaxel
  • Idiopathic / Hereditary (CMT)
  • Diabetic / Diet (B12, B1, B6)
  • Endocrine (hypothyroid)
    • Vasculitic, infectious (HIV, Lyme, leprosy), paraneoplastic, autoimmune
27.2.0.2.3 Cord Syndromes
Symptom
Brown-Sequard (half) Ipsi UMN/vibration/position; contra pain/temp
Anterior cord 雙偎 motor + spinothalamic; posterior 保留
Posterior cord (B12 SCD) Vibration/position loss + UMN
Central cord Cape distribution垞 hyperextension trauma
Complete transverse All loss below
27.2.0.2.4 Carpal Tunnel
  • Median nerve at wrist
  • Phalen + (1 min flexion)
  • Tinel + (tap)
  • NCS confirm
  • Wrist splint + steroid → surgery
27.2.0.2.5 Polyneuropathy 工䜜流皋
  1. NCS/EMG
  2. HbA1c, B12, TSH, BUN/Cr, hep, HIV
  3. SPEP / immunoelectrophoresis (paraprotein)
  4. ANA, RF
  5. Skin biopsy (small fiber)
  6. Genetic (suspected CMT)

27.2.0.3 🎯 自我檢枬

  1. B12 deficiency cord syndrome? → Subacute combined degeneration
  2. Stocking-glove? → Peripheral polyneuropathy
  3. Median nerve test? → Phalen, Tinel
  4. Brown-Sequard? → Cord half lesion ipsi vibration/contra pain/temp
  5. Cauda equina hallmark? → Saddle + bladder
  6. Long-term metformin → ? deficiency? → B12

⚠ AI 草皿。