37.2 📚 國考版醫垫國考 / PGY OSCE

37.2.0.1 📌 Cram Sheet

37.2.0.1.1 🔥 高 yield 10
  1. 90% URI viral, 䞍 routine antibiotic
  2. Centor Score for strep
  3. Sinusitis bacterial = > 10 d / double sickening / severe
  4. Strep first = penicillin / amoxicillin
  5. Epiglottitis = drooling + tripod + stridor → airway emergency
  6. Peritonsillar abscess = hot potato voice + uvula deviated
  7. Lemierre’s = Fusobacterium + IJV thrombosis + septic emboli
  8. Malignant OE = DM + Pseudomonas + skull base
  9. AOM 病原S. pneumoniae > H. influenzae > M. catarrhalis
  10. OE 病原Pseudomonas, Staph + topical antibiotic
37.2.0.1.2 🔢 必背
項目 æ•žå­—
Sinusitis bacterial threshold > 10 d
Centor max 4
Penicillin V dose 500 mg bid × 10 d
Amoxicillin children OM 80-90 mg/kg/d
Centor 4+ empiric / test
37.2.0.1.3 陷阱
  • Routine antibiotic
  • Suspected epiglottitis throat exam
  • OE oral antibiotic
  • Lemierre’s 挏

37.2.0.2 ⭐ 高 yield

37.2.0.2.1 Centor Score
  • F: Fever > 38
  • A: Absence of cough
  • N: Nodes (tender ant cervical)
  • T: Tonsillar exudate
  • Age modifier: 3-14 (+1), 45+ (-1)
37.2.0.2.2 Strep Throat 處眮
  • 1st: Penicillin V or amoxicillin × 10 d
  • Allergy: cephalexin, azithromycin, clindamycin
  • Prevent rheumatic fever (≀ 9 d window)
  • PSGN (post-streptococcal glomerulonephritis)
  • Scarlet fever
  • Septic complications: PTA, retropharyngeal abscess
37.2.0.2.3 Sinusitis Bacterial Treatment
  • Amox-clav 5-7 d
  • Doxycycline alternative
  • Nasal saline + decongestant
  • Topical steroid for chronic
37.2.0.2.4 Otitis Externa
  • Topical fluoroquinolone with steroid
  • Pseudomonas, Staph
  • 䞍芁 oral 䞻治
37.2.0.2.5 Malignant Otitis Externa
  • Risk: DM, immunocomp
  • Pseudomonas
  • Skull base osteomyelitis
  • IV antipseudomonal + ENT
37.2.0.2.6 Peritonsillar Abscess
  • Hot potato voice + 流口氎 + trismus + uvula deviated
  • I&D
  • Antibiotic: amox-clav, clindamycin
37.2.0.2.7 Lemierre’s Syndrome
  • Pharyngitis → IJV thrombophlebitis
  • Fusobacterium
  • Septic pulmonary emboli
  • β-lactam + metronidazole / carbapenem
  • Anticoagulation controversial
37.2.0.2.8 Epiglottitis
  • Drooling + tripod + stridor + dysphagia
  • HiB vaccine reduced incidence
  • Don’t examine throat directly if suspected
  • ICU + airway control + ceftriaxone

37.2.0.3 🎯 自我檢枬

  1. Strep first-line? → Penicillin / amoxicillin
  2. Epiglottitis triad? → drooling + tripod + stridor
  3. Lemierre 病原? → Fusobacterium
  4. Centor 4 means? → empiric or test
  5. Sinusitis bacterial criteria? → > 10 d / double / severe
  6. Malignant OE patient? → DM + Pseudomonas
  7. Peritonsillar key signs? → hot potato voice + uvula deviated

⚠ AI 草皿。