36.2 📚 國考版醫垫國考 / PGY OSCE

36.2.0.1 📌 Cram Sheet

36.2.0.1.1 🔥 高 yield 8
  1. Conductive vs SNHL vs mixed
  2. Weberlateralize to affected ear in conductivegood ear in SNHL
  3. RinneBC > AC in conductiveAC > BC normal/SNHL
  4. Sudden SNHL = emergency, steroid within 14 days
  5. Acoustic neuroma = unilateral progressive + tinnitus → MRI
  6. Aminoglycoside, cisplatin, loop diuretic = ototoxic
  7. Hearing aid = #1 dementia prevention modifiable
  8. Presbycusis = high-frequency SNHL 老人
36.2.0.1.2 🔢 必背
  • Sudden SNHL window: 14 days
  • Audiogram thresholds: mild 26-40 / moderate 41-55 / severe 71-90 / profound > 90 dB
  • Ototoxic monitor: aminoglycoside trough/peak
36.2.0.1.3 易錯
  • Sudden SNHL 拖
  • Unilateral 䞍 MRI
  • Aminoglycoside 䞍 monitor
  • Hearing aid 拒絕

36.2.0.2 ⭐ 高 yield

36.2.0.2.1 Weber + Rinne è¡š
Weber Rinne
Normal Midline AC > BC
Conductive (left) Lateralize leftaffected BC > AC (left)
SNHL (left) Lateralize rightgood AC > BC normal
36.2.0.2.2 Acoustic Neuroma
  • CN VIII (vestibular branch)
  • Unilateral progressive SNHL + tinnitus + balance
  • MRI gadolinium
  • NF2 if bilateral
36.2.0.2.3 Ototoxic
  • Aminoglycoside (gent, tobra, amik) — irreversible
  • Cisplatin / carboplatin — irreversible
  • Loop diuretic high dose — usually reversible
  • Vancomycin high level
  • Aspirin / NSAID high dose — reversible
  • Quinine / chloroquine
36.2.0.2.4 Sudden SNHL Workup
  • Audiogram
  • MRI brain + IAC
  • Steroid (oral or intratympanic) within 14 days
  • Antiviral controversial

36.2.0.3 🎯 自我檢枬

  1. Conductive Weber? → To affected ear
  2. SNHL Weber? → To good ear
  3. Rinne in conductive? → BC > AC
  4. Acoustic neuroma image? → MRI gadolinium
  5. Sudden SNHL window? → 14 days
  6. Aminoglycoside ototoxicity reversible? → No
  7. Hearing aid + dementia? → Lancet 2024 #1 modifiable
  8. NF2? → Bilateral acoustic neuroma

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