39.2 📚 國考版醫垫國考 / PGY OSCE

39.2.0.1 📌 Cram Sheet

39.2.0.1.1 🔥 高 yield 10
  1. 3 倧䟆源cardiac / pulmonary / 其他anemia, acid-base, NM
  2. 5 殺手MI / PE / Pneumothorax / Tamponade / Severe asthma
  3. HF acute = LMNOP + NIV
  4. COPD O2 target 88-92%避 CO2 retention
  5. PE Wells + CTA高or D-dimer 先䜎䞭
  6. Tension pneumothorax = needle decompression 侍等 CXR
  7. BNP > 400 favor HF, < 100 unlikely
  8. Asthma severe: nebulizer + steroid + MgSO4
  9. NIV indications: AECOPD hypercapnia / acute pulmonary edema
  10. Status asthmaticus ICU + 準備 intubation
39.2.0.1.2 🔢 必背
項目 æ•žå­—
O2 target normal SpO2 ≥ 92%
O2 target COPD 88-92%
BNP unlikely HF < 100
BNP likely HF > 400
MgSO4 asthma 2 g IV
Steroid prednisone exac 40-60 mg × 5 d
39.2.0.1.3 易錯
  • COPD 絊 100% O2
  • HF 䞍 NIV
  • PE 䞍分流
  • Tension PTX 等 CXR
  • Asthma severe 䞍準備 intubation

39.2.0.2 ⭐ 高 yield

39.2.0.2.1 Differential
Onset + Setting Likely
Sudden + pleuritic PE / Pneumothorax
Sudden + chest pain + diaphoresis MI
Progressive + orthopnea/PND HF
Wheeze + smoking COPD / asthma
Fever + cough + crackles Pneumonia
Stridor + drooling Epiglottitis
Kussmaul respiration Metabolic acidosis (DKA)
39.2.0.2.2 Wells Score (PE)
  • DVT signs 3
  • PE > other dx 3
  • HR > 100 1.5
  • 制動 / surgery 4 wk 1.5
  • Past PE/DVT 1.5
  • Hemoptysis 1
  • Cancer 1

≥ 4 → CTA< 4 → D-dimer

39.2.0.2.3 NIV (BiPAP)
  • AECOPD with hypercapnia
  • Acute cardiogenic pulmonary edema
  • Hypoxemic respiratory failure (cautious)
  • 犁忌意識差、埪環䞍穩、嘔吐、面郚創傷
39.2.0.2.4 COPD O2 Risk
  • 絊 high O2 → blunting hypoxic drive → CO2 retention
  • Target SpO2 88-92%
  • Venturi mask titrate
39.2.0.2.5 HF Acute Mx (LMNOP)
  • Lasix
  • Morphine郚分
  • Nitrates
  • O2
  • Position upright
    • BiPAP
39.2.0.2.6 Asthma Severe
  • Nebulizer albuterol + ipratropium
  • Steroid (prednisone PO or methylpred IV)
  • MgSO4 2 g IV
  • Heliox
  • Avoid sedation 過量
  • Intubate if 嚎重 acidosis / 意識差

39.2.0.3 🎯 自我檢枬

  1. COPD O2 target? → 88-92%
  2. PE Wells ≥ 4? → CTA
  3. Tension PTX 處眮? → Needle decompression
  4. HF NIV 適應? → Acute pulmonary edema
  5. Asthma MgSO4? → 2 g IV
  6. BNP < 100? → HF unlikely
  7. Status asthmaticus 譊瀺? → 沉默 chest, paradoxical, exhaustion
  8. Acute pulmonary edema 急救? → LMNOP + BiPAP

⚠ AI 草皿。