39.3 🩺 內科專科考前版

39.3.0.1 📌 䞀頁重點

  • 22EHFmrEF / HFpEF management、SGLT2 inhibitor for HF、severe asthma biologic
  • NIV / HFNC evidence
  • TaiwanHF center、AECOPD admissions

39.3.0.2 💊 進階治療

39.3.0.2.1 HFrEF GDMT (4 pillars)
  • ACEI/ARB/ARNI
  • BB
  • MRA (spironolactone, eplerenone)
  • SGLT2i (dapagliflozin, empagliflozin)
    • ICD/CRT for selected
  • Diuretic for symptoms
39.3.0.2.2 HFpEF
  • SGLT2i evidence (DELIVER, EMPEROR-Preserved)
  • Diuretic
  • Treat comorbidity (HTN, AF, CAD)
39.3.0.2.3 COPD
  • LABA + LAMA + (ICS for ACO/eos)
  • Triple therapy for severe
  • Pulmonary rehab
  • Long-term O2 if PaO2 < 55
39.3.0.2.4 Severe Asthma
  • ICS + LABA + LAMA (triple inhaler)
  • Biologic: omalizumab (IgE), mepolizumab/benralizumab/reslizumab (IL-5/5R), dupilumab (IL-4Rα), tezepelumab (TSLP)
  • Bronchial thermoplasty
39.3.0.2.5 PE
  • DOAC first-line
  • Massive PE thrombolysis
  • Catheter-directed for submassive
  • IVC filter selected
39.3.0.2.6 NIV vs HFNC
  • AECOPD hypercapnia → NIV
  • Hypoxemic respiratory failure → HFNC vs NIV
  • COVID-19 era HFNC widely used

39.3.0.3 🌟 Pearls (10)

  1. HFrEF 4 pillars ASAP after diagnosis
  2. SGLT2i in HF even non-DM
  3. COPD O2 88-92 target
  4. PE thrombolysis only massive (hypotensive)
  5. Severe asthma biologic revolutionizing
  6. NIV reduces intubation in AECOPD
  7. HFNC in hypoxemic respiratory failure (FLORALI)
  8. D-dimer age-adjusted in elderly
  9. POCUS lung rapid bedside
  10. Pulmonary rehab evidence-based

39.3.0.4 📍 台灣 Context

  • HF GDMT 健保含 SGLT2i, sacubitril-valsartan
  • COPD GOLD-based treatment
  • Asthma biologic 健保條件
  • HFNC 普及

39.3.0.5 🎓 內專重點

  1. Cardiac vs pulmonary dyspnea
  2. HFrEF/HFpEF management (22E)
  3. COPD GOLD
  4. Asthma severe biologic
  5. PE management
  6. NIV / HFNC
39.3.0.5.1 跚章節
  • Ch 40 Cough
  • Ch 41 Hemoptysis
  • Ch 42 Hypoxia
  • Ch 261-262 HF
  • Ch 290 PE
  • Ch 297 COPD
  • Ch 298 Asthma

⚠ AI 草皿。