40.2 📚 國考版醫垫國考 / PGY OSCE

40.2.0.1 📌 Cram Sheet

40.2.0.1.1 🔥 高 yield 8
  1. 䞉分類acute / subacute / chronic< 3 / 3-8 / > 8 週
  2. Chronic 3 巚頭UACS / asthma / GERD+ ACEI
  3. ACEI cough 10-20% → 換 ARB
  4. Pertussis 成人 = paroxysmal cough > 2 週 + posttussive emesis
  5. Red flagshemoptysis / weight loss / night sweats / smoker
  6. Empiric trial 順序1st antihistamine for UACS → ICS for asthma → PPI for GERD
  7. CXR for chronic cough first
  8. Cough-variant asthma: cough + methacholine challenge +
40.2.0.1.2 🔢 必背
項目 æ•žå­—
Acute < 3 週
Subacute 3-8 週
Chronic > 8 週
ACEI cough % 10-20%
ACEI 停藥 cough 消 2-4 週
Pertussis treatment window 早期 4 週
GERD trial PPI bid 8-12 週
40.2.0.1.3 易錯
  • ACEI cough 䞍停藥
  • Chronic cough 䞍 CXR
  • Pertussis 挏成人 atypical

40.2.0.2 ⭐ 高 yield

40.2.0.2.1 Chronic Cough Algorithm
  1. Stop ACEI if on it
  2. CXR
  3. Empiric:
    • UACS: 1st gen antihistamine + decongestant
    • Asthma: ICS + LABA
    • GERD: PPI bid 8-12 週 + lifestyle
  4. PFT + methacholine
  5. Sinus CT, ENT consult
  6. Bronchoscopy if persistent
40.2.0.2.2 Pertussis
  • Bordetella pertussis
  • Three stages: catarrhal → paroxysmal → convalescent
  • 成人 atypical
  • Azithromycin (or clarithromycin / TMP-SMX)
  • Tdap vaccine

40.2.0.3 🎯 自我檢枬

  1. Chronic cough 3 å·šé ­? → UACS / asthma / GERD
  2. ACEI cough 機蜉? → Bradykinin
  3. Pertussis 治療? → Azithromycin
  4. Cough variant asthma 蚺斷? → Methacholine challenge
  5. Subacute most common? → Post-infectious
  6. Red flags 5 個? → Hemoptysis / weight loss / night sweats / smoker / persistent

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