404.2 📚 國考版醫垫國考 / PGY OSCE

404.2.0.1 📌 Cram Sheet

404.2.0.1.1 🔥 高 yield 15
  1. HPG axis: GnRH → LH/FSH → testis (LH/Leydig/T; FSH/Sertoli/sperm)
  2. Primary hypogonadism: 高 LH/FSH + 䜎 T
  3. Secondary: 䜎 LH/FSH + 䜎 T
  4. Klinefelter 47,XXY: most common congenital primary
  5. Kallmann: GnRH deficiency + anosmia + KAL1/FGFR1
  6. Workup: AM total T × 2, LH/FSH, PRL, MRI sella if central
  7. TRT formulations: IM, gel, patch, oral undecanoate (Jatenzo), pellet, nasal
  8. TRT 抑 spermatogenesis → fertility 䞍可同時
  9. TRT monitor: T, Hct, PSA, BMD
  10. TRT erythrocytosis cutoff: Hct > 54% → phlebotomy or stop
  11. Gynecomastia drugs: spironolactone, ketoconazole, finasteride, cimetidine, anabolic
  12. Acute gynecomastia 老人 → 排 testicular tumor (β-hCG)
  13. ED 1st line: PDE5 inhibitor (sildenafil etc)
  14. Cryptorchidism orchiopexy by 1-2 yr (cancer + fertility risk)
  15. Opioid → 50% chronic 甹 hypogonadism
404.2.0.1.2 🔢 必背
項目 æ•žå­—
Total T cutoff ~ 300 ng/dL (lab variable)
AM testosterone 8-10 AM × 2 days
Hct cutoff TRT < 54%
Cryptorchidism orchiopexy by 1-2 yr
Cryptorchidism cancer risk 5x
Opioid → hypogonadism ~ 50% chronic
Klinefelter karyotype 47,XXY
Klinefelter incidence 1/500-1000 male

404.2.0.2 ⭐ 高 yield

404.2.0.2.1 Drug-induced Hypogonadism / Gynecomastia
Drug Mechanism
Spironolactone AR antagonist + ↑ aromatase
Ketoconazole ↓ T synthesis (steroidogenic blocker)
Finasteride 5α-reductase inhibitor
Cimetidine AR antagonist
Opioid ↓ GnRH
Anabolic steroid (chronic abuse) Suppress HPG
Glucocorticoid (high dose) Suppress HPG
Estrogen (rare exposure) Direct
Cyclophosphamide Direct testis toxic
Cisplatin Direct testis toxic
404.2.0.2.2 Hypogonadism Causes Quick
Type Cause
Primary congenital Klinefelter, anorchia, AR/SRY mutation
Primary acquired Mumps orchitis, trauma, chemo (alkylating), RT, autoimmune, hemochromatosis
Secondary congenital Kallmann, IHH, prader-Willi
Secondary acquired Pituitary tumor, opioid, anabolic, obesity, T2DM, glucocorticoid
404.2.0.2.3 TRT Formulations Comparison
Type Administration Pros Cons
IM enanthate/cypionate Q2 wk Cheap Peaks/troughs
IM undecanoate (Nebido) Q10-14 wk Stable Painful injection
Gel Daily Steady Transfer risk; women/kids
Patch Daily Convenient Skin irritation
Oral undecanoate (Jatenzo) BID Avoid injection Liver-bypassed; expensive
Pellet Q3-6 mo Long-acting Procedure
Nasal TID Avoid injection Frequent dosing
404.2.0.2.4 TRT Monitoring Schedule
  • Baseline: T, Hct, PSA, BMD, lipid, LFT
  • 3 mo + 6 mo: T, Hct
  • Annual: PSA, lipid, symptoms
  • Bone: q1-2 yr
404.2.0.2.5 Functional Testing for Fertility
  • Semen analysis: WHO 2010 cutoffs
    • Volume ≥ 1.5 mL
    • Concentration ≥ 15 M/mL
    • Total ≥ 39 M
    • Motility ≥ 40%
    • Progressive motility ≥ 32%
    • Morphology ≥ 4%

404.2.0.3 🎯 自我檢枬

  1. HPG axis male? → GnRH → LH/FSH → T + sperm
  2. Klinefelter karyotype? → 47,XXY
  3. Kallmann gene + sx? → KAL1, FGFR1; anosmia + GnRH def
  4. Primary vs secondary diff? → LH/FSH high (primary) vs low (secondary)
  5. Total T cutoff (rough)? → 300 ng/dL
  6. TRT first-line? → AM testosterone × 2 confirmed + symptoms
  7. TRT monitor 4? → T, Hct, PSA, BMD
  8. TRT spermatogenesis? → Suppressed
  9. Fertility goal + low T treatment? → Gonadotropin (hCG + FSH)
  10. Anosmia + hypogonadism? → Kallmann
  11. Gynecomastia drugs 5? → Spiron, ketocon, finast, cimetidine, anabolic
  12. Acute gynecomastia adult? → 排 testicular tumor (β-hCG)
  13. ED first line? → PDE5
  14. Cryptorchidism cancer risk? → 5x
  15. Opioid hypogonadism %? → ~ 50% chronic

⚠ AI 草皿。