28.3 🩺 內科專科考前版

28.3.0.1 📌 䞀頁重點

  • 22E 匷調multi-domain fall prevention、NPH 早蟚識
  • STEADI algorithm 普及
  • Taiwan 老人跌倒 統蚈 + 健保跌倒預防

28.3.0.2 🧠 進階機蜉

28.3.0.2.1 Gait Control 神經迎路
  • Cortex芏劃 + 啟動
  • Basal ganglia韻埋 + automatic
  • Cerebellum協調
  • Brainstem locomotor centersCPG
  • Cord motor neuron
  • Sensory feedback (proprioception, vision, vestibular)
28.3.0.2.2 NPH 機蜉
  • CSF resorption 受損 → 慢性 ventriculomegaly
  • Periventricular white matter compression
  • Frontal lobe predominance → 步態 + 行政功胜
  • LP tap test → 改善 = positive prognostic for shunt
28.3.0.2.3 Parkinsonian 機蜉
  • Substantia nigra dopamine 现胞 ↓ (60-80% loss before symptoms)
  • Basal ganglia 倱去調節
  • Levodopa response = clinical PD diagnosis 支持

28.3.0.3 💊 進階處眮

28.3.0.3.1 NPH
  • LP tap test (30-50 mL CSF removal)
  • Continuous lumbar drain (3-5 days) — 曎敏感
  • VP shunt: 60-70% 改善 gait
  • 3 components äž­ gait 改善最倧、cognition 䞭、incontinence 范少
28.3.0.3.2 PD
  • Carbidopa-levodopa
  • DA agonist (pramipexole, ropinirole)
  • MAO-B inhibitor (selegiline, rasagiline)
  • COMT inhibitor (entacapone, tolcapone)
  • DBS (deep brain stimulation) for advanced
28.3.0.3.3 Falls PreventionMultidisciplinary
  • Geriatric assessment
  • Pharmacist review
  • PT + OT
  • Home modification
  • Vit D + Ca

28.3.0.4 🌟 Pearls (8)

  1. NPH 早蟚識 — 可逆 dementia
  2. PD 早期 䞍擺手 + 埮 tremor
  3. Cerebellar gait + 突癌 = stroke
  4. Polypharmacy 是 fall #1 modifiable
  5. TUG 是 office quick screen
  6. Vit D + balance training prevents falls
  7. Hip protectors for nursing home high-risk
  8. Multi-domain intervention > single

28.3.0.5 🔍 特殊情境

  • Hospitalized fall: delirium + sleep loss + new med
  • Post-stroke gait: rehab key
  • Dementia + gait: Lewy body, vascular dementia
  • 劊嚠center of gravity shift, pelvic relaxin

28.3.0.6 📍 台灣 Context

  • 健保跌倒預防 program
  • PT + OT 埩健
  • Tai Chi 圚瀟區
  • 衛犏郚 65+ Vit D supplement
  • NPH VP shunt 健保
  • PD 藥物健保

28.3.0.7 ⚠ 老闆地雷

  1. NPH 當倱智
  2. PD 早期 missed
  3. Polypharmacy 䞍檢
  4. 跌倒䞍 multi-domain
  5. Cerebellar gait 䞍查 stroke

28.3.0.8 🎓 內專重點

  1. 9 皮步態
  2. NPH triad + tap test
  3. PD gait
  4. TUG / STEADI
  5. Multi-domain prevention
28.3.0.8.1 跚章節
  • Ch 26 Weakness
  • Ch 27 Numbness
  • Ch 31 Dementia
  • Ch 442 PD

28.3.0.9 📚 玢匕

⚠ AI 草皿。