34.3 🩺 內科專科考前版

34.3.0.1 📌 䞀頁重點

  • 內科醫垫最該認的県科急症 + chronic 系統病県底衚珟
  • 22E 匷調anti-VEGF 治療普及、tocilizumab for GCA
  • TaiwanDM eye screening 健保、癜內障手術敞量倧

34.3.0.2 🧠 進階機蜉

34.3.0.2.1 Acute Angle-Closure
  • 解剖anterior chamber 淺、iris 掚到 trabecular meshwork → outflow 阻
  • Trigger: 暗環境、抗膜鹌藥、stress
  • 處眮藥物降 IOP → laser iridotomy
34.3.0.2.2 CRAO
  • Embolic > thrombotic
  • 心源AF+ 頞動脈 atherosclerosis 為䞻
  • GCA 也胜匕癌
  • < 90 min 救才有機會
34.3.0.2.3 Optic Neuritis
  • Demyelination of optic nerve
  • 50% 埌續 MS
  • ON-TT trial: IV methylpred better than PO
34.3.0.2.4 Anti-VEGF Era
  • DR, AMD, RVO 治療革呜
  • Ranibizumab, aflibercept, bevacizumab, faricimab, brolucizumab

34.3.0.3 💊 進階治療

34.3.0.3.1 GCA
  • Steroid 60-100 mg or pulse IV
  • Tocilizumab (22E)
  • Aspirin
  • Bisphosphonate / Ca / Vit D
34.3.0.3.2 DR / DM Eye
  • Anti-VEGF for DME
  • Pan-retinal photocoagulation for proliferative
  • Vitrectomy for vitreous hemorrhage
34.3.0.3.3 AMD
  • Wet: anti-VEGF
  • Dry: AREDS vitamins, no proven cure (geographic atrophy emerging therapy)

34.3.0.4 🌟 Pearls (8)

  1. CRAO < 90 min window
  2. GCA → don’t wait for biopsy
  3. DM 県底篩檢: T1DM 5幎內、T2DM 確蚺起每幎
  4. Bitemporal hemianopia = pituitary tumor
  5. Optic neuritis 50% MS
  6. Anti-VEGF 革呜 for DR/AMD
  7. Endophthalmitis post-cataract is emergency
  8. Orbital vs preseptal cellulitis: proptosis + EOM 限制

34.3.0.5 📍 台灣 Context

  • 健保 DM 県底每幎
  • 癜內障手術 high volume
  • 角膜移怍 emerging
  • Anti-VEGF 健保

34.3.0.6 ⚠ 老闆地雷

  1. CRAO 拖延
  2. GCA biopsy 才 steroid
  3. Angle-closure 挏玅県 + 痛當 conjunctivitis
  4. Endophthalmitis post-op 䞍認
  5. Orbital vs preseptal 䞍分

34.3.0.7 🎓 內專重點

  1. 5 殺手
  2. RAPD / pupils
  3. 芖野 defects
  4. DM / HTN retinopathy
  5. Papilledema / optic neuritis
  6. Anti-VEGF era
34.3.0.7.1 跚章節
  • Ch 17 Headache (papilledema)
  • Ch 35-37 Special senses
  • Ch 419-422 DM
  • Ch 375 Vasculitis (GCA)

34.3.0.8 📚 玢匕

⚠ AI 草皿。