303.2 🩺 國考版

303.2.1 高頻考點

303.2.1.1 Spirometry Patterns

  • Obstructive: ↓ FEV1/FVC < 0.7
  • Restrictive: ↓ TLC < 80% predicted
  • Mixed: ↓ FEV1/FVC + ↓ TLC

303.2.1.2 GOLD COPD Staging (FEV1 % predicted)

  • GOLD 1 (mild): ≥ 80
  • GOLD 2 (moderate): 50-79
  • GOLD 3 (severe): 30-49
  • GOLD 4 (very severe): < 30

303.2.1.3 Light’s Criteria for Exudate

  • Pleural protein/serum protein > 0.5 OR
  • Pleural LDH/serum LDH > 0.6 OR
  • Pleural LDH > 2/3 upper limit serum LDH

303.2.1.4 Pleural Fluid Workup

  • Cell count + differential
  • Protein, LDH, glucose, pH
  • Gram stain + culture (AFB, fungal)
  • Cytology
  • ADA (> 40 → TB pleurisy)
  • Triglycerides (chylothorax)
  • Amylase (pancreatitis, esophageal rupture)

303.2.1.5 NSCLC Molecular Profile (Drives Therapy)

  • EGFR (osimertinib, others)
  • ALK (alectinib, brigatinib, lorlatinib)
  • ROS1 (crizotinib, entrectinib)
  • KRAS G12C (sotorasib, adagrasib)
  • MET exon 14 (capmatinib, tepotinib)
  • BRAF V600E (dabrafenib + trametinib)
  • NTRK fusion (larotrectinib, entrectinib)
  • HER2 (trastuzumab deruxtecan)
  • PD-L1 (immunotherapy)

303.2.1.6 Bronchoscopy Indications

  • Hemoptysis
  • Mass / nodule biopsy
  • Airway evaluation
  • Foreign body removal (rigid)
  • Pneumonia in immunocompromised
  • ILD diagnosis (TBLB / cryobiopsy)
  • Therapeutic (stent, lavage, ICU clips)

303.2.1.7 Lung Ultrasound Patterns

  • A-lines: normal
  • B-lines: interstitial fluid
  • Consolidation: pneumonia
  • No sliding: pneumothorax

303.2.2 易混淆比范

Test Indication Key Pearl
Spirometry Asthma, COPD FEV1/FVC, reversibility
Lung volumes Restrictive vs obstructive TLC < 80% = restrictive
DLCO ILD, emphysema ↓ in fibrosis, emphysema
HRCT ILD, bronchiectasis Thin slices, gold standard ILD
CTPA PE Filling defect
V/Q scan PE in pregnancy/CKD Mismatched defects
Bronchoscopy + BAL Infection, ILD Cellular analysis
EBUS-TBNA Mediastinal LN NSCLC staging
Cryobiopsy ILD diagnosis Larger sample
LUS Emergent A/B lines, sliding