405.2 📚 國考版醫垫國考 / PGY OSCE

405.2.0.1 📌 Cram Sheet

405.2.0.1.1 🔥 高 yield 12
  1. HPG (女): GnRH → LH/FSH → ovary (theca androgen + granulosa estradiol)
  2. Cycle 28d: follicular → ovulation (LH surge) → luteal (progesterone)
  3. PCOS Rotterdam: ≥ 2 of (oligo/anov + hyperandrogen + PCO US), exclude others
  4. PCOS associated: insulin resistance, T2DM, MetS, NAFLD, OSA, endometrial CA
  5. PCOS treatment: lifestyle + COC + metformin + spironolactone
  6. PCOS fertility: clomiphene or letrozole 1st line; metformin adjunct
  7. POI: < 40 yr + FSH > 25-40 ↑ + low estradiol; HRT until natural menopause age (~ 51)
  8. POI causes: genetic (Turner, fragile X), autoimmune (APS-2), iatrogenic, idiopathic
  9. FHA: low FSH/LH + low estradiol; eating disorder/exercise/stress
  10. Prolactinoma → cabergoline
  11. Sudden virilization → 排 tumor (not gradual PCOS)
  12. PCOS endometrial CA risk → COC or cyclic progestin protective
405.2.0.1.2 🔢 必背
項目 æ•žå­—
Cycle 平均 28 d
Menarche 平均 12-13 yr
Natural menopause 平均 51 yr
POI age cutoff < 40
FSH POI threshold > 25-40 IU/L
PCO US criteria ≥ 12 follicles 2-9 mm or > 10 mL
LH:FSH PCOS > 2:1 typical
PCOS T2DM RR 4x
Cycle progesterone peak Day 21
Total T tumor cutoff > 200 ng/dL
DHEA-S adrenal source > 700
Prolactin → 排 prolactinoma > 200

405.2.0.2 ⭐ 高 yield

405.2.0.2.1 Hyperandrogenism Causes
Cause Source Markers
PCOS Ovary T mild ↑, DHEA-S mild ↑, 17-OH-prog normal
Idiopathic hirsutism None All normal (hair follicle sensitive)
Non-classic CAH Adrenal 17-OH-prog ↑↑ post-ACTH
Cushing’s Adrenal 24-h urine cortisol ↑, 1mg dex+
Androgen-secreting tumor Ovary or adrenal T very high (> 200) or DHEA-S high (> 700)
Drug-induced — Hx (anabolic, danazol)
405.2.0.2.2 PCOS Comorbidity Surveillance
  • Annual: lipid, glucose (or HbA1c), BP
  • Q3-5 yr: OGTT (some recommend)
  • NAFLD: LFT + US
  • OSA: screen if obese
  • Endometrial: TVS / biopsy if abnormal bleeding
  • Mental health: depression/anxiety
405.2.0.2.3 Distinguishing Amenorrhea Causes
Type FSH LH Estradiol Prolactin
PCOS normal/low high normal normal
POI high high low normal
FHA low low low normal
Prolactinoma low low low high
Hypothyroidism varies varies normal mildly high
Pregnancy low low high high
405.2.0.2.4 Drugs Affecting Cycle
Drug Effect
OCP Suppresses HPG (intentional)
GnRH agonist Initial flare → suppress
GnRH antagonist Immediate suppress
Antipsychotic / metoclopramide ↑ PRL → amenorrhea
Anabolic steroid Hirsutism + suppress cycle
Spironolactone Anti-androgen (helpful for hirsutism); irregular menses
405.2.0.2.5 Fertility Drugs Quick
Drug Mechanism Use
Clomiphene SERM (estrogen antagonist at hypothalamus) PCOS ovulation
Letrozole Aromatase inhibitor PCOS ovulation (preferred)
Metformin ↓ IR PCOS adjunct
GnRH agonist + gonadotropin Controlled ovarian stim IVF
hCG LH surge mimic Ovulation trigger

405.2.0.3 🎯 自我檢枬

  1. PCOS Rotterdam? → ≥ 2 of (oligo/anov + hyperandrogen + PCO US)
  2. PCOS first-line treatment? → Lifestyle + COC + metformin + spironolactone
  3. POI cutoff age? → < 40
  4. POI FSH threshold? → > 25-40 IU/L
  5. POI HRT until? → ~ 51 yr (natural menopause age)
  6. FHA cause? → Eating disorder, exercise, stress, weight loss
  7. PCOS LH:FSH ratio? → > 2:1
  8. PCOS T2DM RR? → 4x
  9. Sudden virilization → ? → Tumor (not PCOS)
  10. Prolactinoma 1st line? → Cabergoline
  11. PCOS fertility 1st? → Letrozole > clomiphene
  12. Endometrial CA in PCOS? → Chronic unopposed estrogen
  13. POI causes? → Genetic, autoimmune, iatrogenic, idiopathic
  14. FHA labs? → Low FSH/LH + low estradiol
  15. Pregnancy + cycle? → Low FSH/LH + high estradiol + high hCG

⚠ AI 草皿。