406.2 📚 國考版醫垫國考 / PGY OSCE

406.2.0.1 📌 Cram Sheet

406.2.0.1.1 🔥 高 yield 12
  1. Cycle: 28d (24-38), bleed 4-8d, < 80 mL
  2. PALM-COEIN AUB: PALM structural, COEIN non-structural
  3. Amenorrhea workup 1st: pregnancy test
  4. Primary amenorrhea: no menarche 15 (with sec) / 13 (without)
  5. Secondary amenorrhea: ≥ 3 mo (regular) / 6 mo (irregular)
  6. Dysmenorrhea primary: PG; NSAID 1st line
  7. Endometriosis 3D: dysmenorrhea + dyspareunia + difficulty pregnancy
  8. Endometriosis gold dx: laparoscopy + biopsy
  9. Endometriosis treatment ladder: NSAID → COC → progestin → GnRH agonist/antagonist → surgery
  10. Fibroid PALM “L”: heavy menses + bulk + infertility
  11. GnRH agonist 6 mo limit + add-back HRT (bone)
  12. Levonorgestrel IUD multi-purpose: AUB, fibroid, adenomyosis, endometriosis
406.2.0.1.2 🔢 必背
項目 æ•žå­—
Heavy bleed cutoff > 80 mL
Cycle range 24-38 d
Endometriosis prevalence 10% repro
Fibroid prevalence 30-70% repro
Endometriosis dx delay avg 7-10 yr
GnRH agonist limit 6 mo (no add-back)

406.2.0.2 ⭐ 高 yield

406.2.0.2.1 PALM-COEIN
Letter Cause
P Polyp
A Adenomyosis
L Leiomyoma (fibroid)
M Malignancy + hyperplasia
C Coagulopathy
O Ovulatory dysfunction
E Endometrial
I Iatrogenic
N Not classified
406.2.0.2.2 Endometriosis Stage (rASRM)
  • I: minimal
  • II: mild
  • III: moderate
  • IV: severe (frozen pelvis)
406.2.0.2.3 Fibroid Treatment Quick
Goal Option
AUB NSAID, tranexamic acid, COC, levonorgestrel IUD
Pre-op shrinkage GnRH agonist (3-6 mo)
Bulk + AUB Myomectomy / hysterectomy / UAE / MRgFUS
Definitive Hysterectomy
Newer Elagolix + relugolix (GnRH antagonist) — 22E
Off-label Ulipristal acetate (SPRM)
406.2.0.2.4 Amenorrhea Workup Algorithm
1. Pregnancy test (always)
2. TSH + prolactin
3. FSH/LH + estradiol
   - High FSH → POI
   - Low FSH/LH → central (Kallmann, FHA, prolactinoma)
   - Normal/low FSH → PCOS
4. Pelvic US
5. Karyotype if primary
6. MRI sella if PRL ↑ or central
7. Progestin challenge → bleed = estrogen present
406.2.0.2.5 Drug Effects on Cycle
Drug Effect
COC Suppress (intentional)
GnRH agonist Initial flare → suppress
Antipsychotic ↑ PRL → amenorrhea
Tamoxifen Variable + endometrial CA risk
Aromatase inhibitor Variable
Anabolic steroid Suppress
Antithyroid Restore
Spironolactone Anti-androgen + irregular

406.2.0.3 🎯 自我檢枬

  1. PALM-COEIN? → P-Polyp / A-Adenomyosis / L-Leiomyoma / M-Malig + hyperplasia / C-Coag / O-Ovulatory / E-Endometrial / I-Iatrogenic / N-Not class
  2. Heavy bleed? → > 80 mL
  3. Primary amenorrhea? → No menarche 15 (with sec sex) / 13 (without)
  4. Endometriosis 3D? → Dysmenorrhea + dyspareunia + difficulty pregnancy
  5. Endometriosis gold? → Laparoscopy + biopsy
  6. Endometriosis treatment ladder? → NSAID → COC → progestin → GnRH agonist/antagonist → surgery
  7. GnRH agonist add-back? → After 6 mo
  8. Fibroid medical pre-op? → GnRH agonist 3-6 mo
  9. Levonorgestrel IUD use 4? → AUB, fibroid, adenomyosis, endometriosis
  10. UAE? → Uterine artery embolization (fibroid)
  11. Adenomyosis dx? → MRI / TVS / hysterectomy
  12. Acute pelvic pain ddx? → Ovarian torsion, ectopic, ruptured cyst, PID, appendicitis
  13. Tranexamic acid? → Heavy menses
  14. Adolescent heavy menses 䞍查? → vWD (common)
  15. Asherman? → Intrauterine adhesion post D&C

⚠ AI 草皿。