28.2 📚 國考版醫垫國考 / PGY OSCE

28.2.0.1 📌 Cram Sheet

28.2.0.1.1 🔥 高 yield 8 條
  1. 9 皮步態必認hemiparetic, spastic/scissoring, parkinsonian, ataxic, sensory ataxia, steppage, waddling, antalgic, magnetic
  2. NPH 䞉聯gait + cognitive + 尿倱犁wet/wacky/wobbly
  3. PD gaitshuffling + 䞍擺手 + festination + freezing
  4. Cerebellarwide-based + can’t tandem
  5. Sensory ataxiaRomberg + 顯著
  6. Steppage = foot drop (peroneal/L5)
  7. Waddling = proximal myopathy
  8. TUG > 12 秒 = 高 fall risk
28.2.0.1.2 🔢 必背
項目 æ•žå­—
65+ 跌倒比䟋/幎 30%
80+ 跌倒比䟋 50%
Hip fracture 1-yr mortality ~25%
TUG threshold > 12 秒
NPH MRI ventriculomegaly out of proportion
28.2.0.1.3 ⚠ 陷阱
  • 老化變慢當正垞挏 PD
  • NPH 當倱智
  • 跌倒䞍評䌰 polypharmacy
  • Cerebellar gait 䞍查 stroke

28.2.0.2 ⭐ 高 yield

28.2.0.2.1 步態 9 類
步態 病因 特埵
Hemiparetic Stroke Circumduction
Spastic / scissoring Cord, MS 雙腿剪刀
Parkinsonian PD Shuffling, 䞍擺手
Ataxic (cerebellar) Cerebellar Wide-based
Sensory ataxia B12, tabes Romberg + 看地
Steppage Foot drop 高抬腿 + 萜地拍
Waddling Proximal myopathy, hip 搖擺
Antalgic Pain 瞮短 stance
Magnetic / apraxic NPH, frontal 腳黏地
28.2.0.2.2 NPH (Wet/Wacky/Wobbly)
  • Wet 尿倱犁
  • Wacky 認知 ↓
  • Wobbly gait
  • MRI ventriculomegaly + LP tap test
  • → VP shunt 60-70% 改善
28.2.0.2.3 PD Gait
  • Shuffling
  • Decreased arm swing
  • Festination
  • Freezing
  • Postural instability
28.2.0.2.4 Sensory Ataxia 病因
  • B12 deficiency (SCD)
  • Tabes dorsalis
  • Diabetic
  • Friedreich ataxia
28.2.0.2.5 Cerebellar Gait 病因
  • Alcohol
  • MS
  • Stroke (cerebellar)
  • Tumor
  • Hereditary ataxia (SCA)
28.2.0.2.6 TUG (Timed Up & Go)
  • 埞怅子起身 → èµ° 3 m → 蜉身 → 回坐

  • 12 秒 = 高 fall risk

28.2.0.2.7 STEADI Algorithm (CDC)
  • Screen
  • Assess
  • Intervene
28.2.0.2.8 跌倒 Multi-domain Intervention
  • Polypharmacy review
  • Vit D
  • Strength + balance training
  • Vision
  • Home safety
  • Hearing
  • Hip protectors

28.2.0.3 🎯 自我檢枬

  1. NPH 䞉聯? → wet/wacky/wobbly
  2. PD gait 4 features? → shuffle / 䞍擺手 / festination / freezing
  3. Sensory ataxia hallmark? → Romberg +
  4. Cerebellar gait? → wide-based, can’t tandem
  5. Foot drop nerve? → Common peroneal / L5
  6. NPH 治療? → VP shunt
  7. TUG threshold? → > 12 秒
  8. Waddling 病因? → proximal myopathy / 髖

⚠ AI 草皿。