390.2 📚 國考版醫垫國考 / PGY OSCE

390.2.0.1 📌 Cram Sheet

390.2.0.1.1 🔥 高 yield 12
  1. Free hormone biologically active
  2. GPCR Gαs ↑ cAMP: ACTH/TSH/PTH/LH/FSH/glucagon/β-AR
  3. GPCR Gαq ↑ Ca²⁺/IP3: TRH/GnRH/α1/ADH-V1
  4. GPCR Gαi ↓ cAMP: somatostatin/α2
  5. RTK: insulin/IGF-1
  6. JAK/STAT: GH/PRL/leptin
  7. Nuclear receptor: steroid/thyroid/VitD/RA
  8. McCune-Albright: Gαs activating
  9. Pseudohypoparathyroidism (Albright): Gαs inactivating
  10. Laron syndrome: GH-R mutation, ↓ IGF-1
  11. GnRH continuous → suppress (䜿 GnRH agonist 治攝護腺 CA)
  12. Cortisol AM peak; GH sleep peak; TSH night peak
390.2.0.1.2 🔢 必背
項目 æ•žå­—
Cortisol AM 5-25 ÎŒg/dL
GnRH pulse ~90 min
Insulin pulse ~5-15 min
TBG % thyroid bound ~99.97%

390.2.0.2 ⭐ 高 yield

390.2.0.2.1 Carrier Proteins
Hormone Carrier 圱響因玠
Thyroid TBG/TTR/albumin Pregnancy/OCP ↑ TBG
Cortisol CBG Pregnancy/OCP ↑
Sex steroid SHBG Liver disease/hyperthyroidism ↑
Vit D DBP —
IGF-1 IGFBP-3 GH dependent
390.2.0.2.2 Activating vs Inactivating Mutations
突變 圱響 範䟋
Activating 過床激掻 McCune-Albright (Gαs), familial LH-R, Jansen PTH-R
Inactivating 倱胜 PHP (Gαs), Laron (GH-R), CAIS (AR), nephrogenic DI (V2R/AQP2)
390.2.0.2.3 McCune-Albright Triad
  • Polyostotic fibrous dysplasia
  • Café-au-lait (irregular border)
  • Early puberty (peripheral)
    • endocrine excess (acromegaly, Cushing’s, hyperthyroidism)
  • Mosaic GNAS
390.2.0.2.4 Resistance Syndromes
  • PHP, Laron, CAIS, Vit D resistance, thyroid hormone resistance (THRβ)
  • Treat: bypass receptor or symptomatic

390.2.0.3 🎯 自我檢枬

  1. ACTH receptor type? → GPCR Gαs
  2. Insulin receptor? → RTK
  3. GH/PRL signaling? → JAK/STAT
  4. Steroid hormone? → Nuclear receptor
  5. Free vs total: 哪個 biologically active? → Free
  6. Pregnancy 對 TBG? → ↑
  7. McCune-Albright Gαs which? → Activating mosaic
  8. PHP Gαs which? → Inactivating
  9. Laron syndrome? → GH-R loss
  10. CAIS gene? → AR
  11. GnRH continuous effect? → Suppress
  12. Cortisol peak? → 早晚 6-8 AM

⚠ AI 草皿。