27.3 🩺 內科專科考前版

27.3.0.1 📌 䞀頁重點

  • 22E 匷調small fiber neuropathy 認可
  • Diabetic peripheral neuropathy 治療duloxetine, pregabalin first
  • Vasculitic neuropathy 早蟚識
  • Long COVID neuropathy 提

27.3.0.2 🧠 進階機蜉

27.3.0.2.1 Small Fiber Neuropathy
  • C, A-delta fibers
  • NCS 正垞䜆症狀有
  • Diagnosticskin biopsy with intraepidermal nerve fiber density (IENFD)
  • 病因DM, autoimmune, viral, idiopathic, sodium channelopathy
27.3.0.2.2 CIDP (Chronic Inflammatory Demyelinating Polyneuropathy)

  • 8 weeks progressive

  • Demyelinating on NCS
  • IVIG / plasmapheresis / steroid
27.3.0.2.3 Mononeuritis Multiplex
  • Multiple non-contiguous nerves
  • VasculiticPAN, EGPA, ANCA, RA, SLE, hep B/C, HIV
  • Nerve biopsy 確蚺
  • Treat underlying
27.3.0.2.4 Hereditary Neuropathy
  • CMT (Charcot-Marie-Tooth)
  • Type 1 demyelinating, type 2 axonal
  • PMP22 duplication (CMT1A 最垞)
  • Pes cavus + 高匓足

27.3.0.3 💊 治療

27.3.0.3.1 Painful Neuropathy
  • First-line: duloxetine, pregabalin, gabapentin, TCA
  • Second: tramadol
  • Topical: lidocaine, capsaicin
  • Avoid long-term opioid
27.3.0.3.2 CIDP
  • IVIG 2 g/kg load → maintenance
  • Plasmapheresis
  • Steroid
27.3.0.3.3 Carpal Tunnel
  • Splint > steroid > surgery
  • Open vs endoscopic release
27.3.0.3.4 Cord Compression
  • Steroid + surgery / RT

27.3.0.4 🌟 Pearls (8)

  1. NCS 正垞 + 症狀 = 想 small fiber
  2. Mononeuritis multiplex → vasculitic workup
  3. CMT 看 family + pes cavus
  4. CIDP > 8 wk distinguish from GBS
  5. Long-term metformin → B12 monitor
  6. PPI long-term → B12 ↓
  7. Vegans → B12 supplement
  8. Painful DPN: duloxetine first

27.3.0.5 🔍 特殊情境

  • HIV neuropathy: distal symmetric + treatment-related
  • Chemo (cisplatin, vincristine, paclitaxel)
  • Paraneoplastic (anti-Hu)
  • POEMS syndrome
  • Amyloid neuropathy

27.3.0.6 📍 台灣 Context

  • DPN 健保
  • IVIG for CIDP 健保
  • Skin biopsy 郚分䞭心
  • Nerve biopsy 限定䞭心
  • TFAP (transthyretin amyloidosis): patisiran, inotersen, vutrisiran

27.3.0.7 ⚠ 老闆地雷區

  1. Saddle 挏 cauda equina
  2. B12 䞍查
  3. Long-term metformin / PPI 䞍譊芺
  4. Painful DPN 絊 opioid 䞻治
  5. Vasculitic 䞍評䌰
  6. CIDP 當 GBS

27.3.0.8 🎓 內專重點

  1. Patterns 6 çš®
  2. Cord syndromes
  3. Painful neuropathy 治療
  4. CIDP / GBS 區分
  5. Small fiber
27.3.0.8.1 跚章節
  • Ch 26 Weakness
  • Ch 28 Gait
  • Ch 421 DPN
  • Ch 444 Peripheral neuropathy

27.3.0.9 📚 玢匕

⚠ AI 草皿。