343.2 🩺 國考版

343.2.1 高頻考點

343.2.1.1 ARAS

  • Atherosclerotic, elderly
  • CORAL trial (2014): OMT first-line; stent reserved for refractory

343.2.1.2 FMD

  • Young women, “string of beads”
  • Balloon angioplasty
  • Bilateral 35%

343.2.1.3 CORAL Trial

  • ARAS + HTN
  • Stent + OMT vs OMT alone
  • No CV benefit
  • Stent only for select

343.2.1.4 RVT

  • Nephrotic (MN), hypercoagulable
  • LMWH or DOAC
  • Albumin < 2.5 → prophylaxis consideration

343.2.1.5 TTP

  • ADAMTS13 deficiency (< 10%) + inhibitor
  • PLASMIC score risk stratification
  • Plasma exchange + steroids + caplacizumab (HERCULES) + rituximab refractory
  • Avoid platelets

343.2.1.6 HUS Subtypes

  • Typical (STEC) HUS: O157:H7, supportive; avoid antibiotics
  • Atypical HUS (aHUS): complement dysregulation; eculizumab / ravulizumab

343.2.1.7 Cholesterol Embolism

  • Post-arterial procedure
  • Livedo, blue toes, eosinophilia
  • Hollenhorst plaques
  • No specific antidote

343.2.1.8 Hypertensive Nephropathy

  • Chronic HTN damage
  • BP < 130/80
  • ACE/ARB
  • Multi-drug

343.2.1.9 Malignant HTN

  • BP > 180/120 + end-organ damage
  • IV antihypertensives in ICU
  • Reduce 20-25% first hour
  • TMA features

343.2.1.10 Scleroderma Renal Crisis

  • ACE inhibitor (captopril) — lifesaving
  • Avoid prednisone
  • Recovery over months

343.2.1.11 Drug-Induced TMA

  • Calcineurin inhibitors (cyclo, tacro)
  • ICIs
  • VEGF inhibitors
  • Quinine
  • Mitomycin, gemcitabine

343.2.1.12 Key Trials

  • CORAL (2014): ARAS stent vs OMT
  • HERCULES: caplacizumab for TTP
  • PROTECT: aHUS eculizumab
  • PRAISE: ravulizumab for aHUS

343.2.2 易混淆比范

TMA Type Mechanism Key Lab Treatment
TTP ADAMTS13 deficiency ADAMTS13 < 10% + inhibitor PEX + steroids + caplacizumab
STEC HUS Shiga toxin E. coli O157:H7 Supportive
aHUS Complement dysregulation Genetic testing Eculizumab / ravulizumab
Drug-induced Drug-specific Temporal association Stop drug
Scleroderma HTN-mediated Sclerosis features ACE inhibitor
HELLP Pregnancy LFT + plt Delivery
Malignant HTN Severe HTN BP > 180/120 IV antihypertensives

343.2.3 Special Topics

343.2.3.1 Pre-Procedure TMA Workup

  • Required for all suspected TMA
  • ADAMTS13, complement studies, ANA, autoimmune
  • PLASMIC score for TTP probability
  • Don’t delay treatment

343.2.3.2 Hypertensive Emergency vs Urgency

  • Emergency: BP + end-organ damage → IV
  • Urgency: severe BP without acute damage → oral, slower