34.2 📚 國考版醫垫國考 / PGY OSCE

34.2.0.1 📌 Cram Sheet

34.2.0.1.1 🔥 高 yield 8 條
  1. 5 殺手angle-closure glaucoma / CRAO / GCA / endophthalmitis / orbital cellulitis
  2. CRAO = painless monocular + cherry-red spot
  3. Angle-closure = 箅 + 痛 + 䞭等散瞳 + IOP > 40
  4. GCA > 50yo + ESR 高 + steroid 立即
  5. RAPD = afferent lesionCN II / retina
  6. DM retinopathy proliferativeneovascularization
  7. Papilledema = bilateral disc edema → 想 ↑ICP
  8. Optic neuritis = painful + RAPD + central scotoma → MS
34.2.0.1.2 🔢 必背
項目 æ•žå­—
Normal IOP 10-21 mmHg
Angle-closure IOP > 40
CRAO viability < 90 min
GCA prednisone 60-100 mg
Endophthalmitis intravitreal vancomycin + ceftazidime

34.2.0.2 ⭐ 高 yield

34.2.0.2.1 Pupil
  • RAPD = swinging flashlight; afferent (optic n.) lesion
  • Horner = ipsi ptosis + miosis + anhidrosis (sympathetic)
  • CN III palsy compressive = down/out + dilatedaneurysm rule out
  • Argyll-Robertson = accommodate but no light reaction (neurosyphilis)
34.2.0.2.2 Visual Field Defects
Loc Defect
Optic nerve Monocular
Optic chiasm Bitemporal hemianopia (pituitary tumor)
Optic tract Homonymous hemianopia
Optic radiation parietal Inferior quadrantanopia
Optic radiation temporal (Meyer’s loop) Superior quadrantanopia (“pie in the sky”)
Occipital cortex Homonymous + macular sparing
34.2.0.2.3 Red Eye Quick DDx
Cause Pain 芖力 Discharge
Bacterial conjunctivitis + OK Purulent
Viral conjunctivitis + OK Watery
Allergic itching OK Watery + LAP
Subconjunctival hem − OK −
Angle-closure +++ ↓ −
Anterior uveitis + ↓ −
34.2.0.2.4 Optic Neuritis
  • MS-related
  • Painful + RAPD + central scotoma + dyschromatopsia
  • IV methylprednisolone 1g × 3 days
  • MRI brain + spinal cord
34.2.0.2.5 Diabetic Retinopathy 治療
  • Anti-VEGF (ranibizumab, aflibercept, bevacizumab)
  • Laser
  • Vitrectomy

34.2.0.3 🎯 自我檢枬

  1. CRAO findings? → Cherry-red spot + pale retina
  2. RAPD localization? → Afferent (optic n. / retina)
  3. Bitemporal hemianopia? → Optic chiasm
  4. Angle-closure pupil? → Mid-dilated fixed
  5. GCA 立即? → Prednisone (侍等 biopsy)
  6. DM proliferative retinopathy? → Neovascularization
  7. Optic neuritis 治? → IV methylprednisolone

⚠ AI 草皿。