394.2 📚 國考版醫垫國考 / PGY OSCE

394.2.0.1 📌 Cram Sheet

394.2.0.1.1 🔥 高 yield 15
  1. 埌葉 = ADH + oxytocin, hypothalamic neuron axon 末梢
  2. ADH V2 → AQP2 (collecting duct) = water 回收
  3. SIADH = 倪倚 ADH → euvolemic hypoNa
  4. SIADH causes: malignancy (SCLC), CNS, lung, drug (carbamazepine, SSRI), nausea/pain/post-op
  5. Bartter-Schwartz criteria: hypoNa + plasma osm ↓ + urine osm > 100 + urine Na > 30 + euvolemic + 排 thyroid/AI
  6. CSW vs SIADH: hypovolemic (CSW) vs euvolemic — treat saline vs fluid restrict
  7. Severe symptomatic hypoNa: 3% saline 100 mL bolus
  8. 避免 over-correction ≀ 8-10 mmol/d (chronic) or ≀ 12 (acute) → ODS
  9. CDI: 埌葉 ADH ↓; DDAVP responds
  10. NDI: 腎䞍應 ADH; lithium #1, hyperCa, hypoK
  11. Water deprivation test → DDAVP test:
    • DI 䞍 concentrate after restriction
    • CDI 埌 DDAVP 反應NDI 䞍
  12. Copeptin new gold (22E)
  13. MRI: bright spot of posterior pituitary 圚 T1; absent in CDI
  14. NDI æ²»: thiazide + amiloride + NSAID + salt restrict
  15. Triphasic post-pituitary surgery: CDI → SIADH → permanent CDI
394.2.0.1.2 🔢 必背
項目 æ•žå­—
Polyuria > 3 L/d
Urine osm DI < 300
Urine osm normal > 800
Plasma Osm low < 275
Urine Na SIADH > 30
Urine osm SIADH > 100
Chronic correction ≀ 8-10 mmol/d
Acute correction ≀ 12 mmol/d
3% saline bolus 100 mL × up to 3
Goal acute correction ↑ Na 4-6 in 6 h

394.2.0.2 ⭐ 高 yield

394.2.0.2.1 Drug-induced
Drug Effect
Carbamazepine, oxcarbazepine SIADH
SSRI SIADH (esp 老人)
TCA SIADH
Vincristine, cyclophosphamide SIADH
MDMA SIADH + 過氎
Lithium NDI
Demeclocycline NDI
Foscarnet, cidofovir NDI
394.2.0.2.2 SIADH Treatment Hierarchy
  1. Fluid restriction 800-1000 mL/d
  2. Salt tablet + loop diuretic
  3. Tolvaptan (V2 antagonist) - acute/short-term
  4. Conivaptan IV - acute
  5. Demeclocycline (rarely)
  6. Urea oral
  • Treat underlying
394.2.0.2.3 CDI vs NDI 速分
CDI NDI
ADH 䟆源 ↓ 正垞/↑
DDAVP response Yes (urine osm ↑ ≥ 50%) No (< 50%)
Treatment DDAVP Thiazide + amiloride
394.2.0.2.4 CSW vs SIADH 速分
SIADH CSW
Volume Euvolemic Hypovolemic
Setting Various SAH, TBI
Treatment Fluid restrict Saline
BNP/ANP Normal ↑
394.2.0.2.5 Wolfram (DIDMOAD)
  • DI + DM + Optic atrophy + Deafness
  • WFS1 gene

394.2.0.3 🎯 自我檢枬

  1. ADH receptor for water? → V2
  2. ADH where stored? → 埌葉 axon terminals
  3. SIADH urine Na? → > 30
  4. SIADH urine osm? → > 100
  5. Bartter-Schwartz key features? → HypoNa + low Osm + concentrated urine + euvolemic
  6. CSW vs SIADH treatment? → Saline vs fluid restrict
  7. Severe hypoNa rapid correction? → 3% saline 100 mL bolus
  8. Max chronic Na correction? → 8-10 mmol/d
  9. ODS = ? → Osmotic demyelination syndrome (central pontine myelinolysis)
  10. CDI workup? → Water deprivation → DDAVP → response
  11. NDI #1 cause? → Lithium
  12. NDI treatment? → Thiazide + amiloride + NSAID
  13. Tolvaptan target? → V2 antagonist
  14. Wolfram syndrome? → DI + DM + optic atrophy + deafness
  15. Triphasic post-op pituitary? → CDI → SIADH → permanent CDI

⚠ AI 草皿。