407.2 📚 國考版醫垫國考 / PGY OSCE

407.2.0.1 📌 Cram Sheet

407.2.0.1.1 🔥 高 yield 10
  1. PCOS = #1 cause (~70-80%)
  2. Ferriman-Gallwey ≥ 8 (white women)
  3. Idiopathic hirsutism: normal hormones + family + ethnicity
  4. Non-classic CAH 21-OH: 17-OH-prog elevated (basal or post-ACTH)
  5. Tumor red flags: T > 200, DHEA-S > 700, sudden onset, virilization
  6. Hirsutism vs hypertrichosis vs virilization distinction
  7. Treatment: COC + spironolactone (most)
  8. Spironolactone teratogenic (avoid pregnancy planning)
  9. Eflornithine cream slow hair growth
  10. Laser/electrolysis permanent hair removal
407.2.0.1.2 🔢 必背
項目 æ•žå­—
Ferriman-Gallwey cutoff ≥ 8 (white), ~5 (Asian)
Tumor T cutoff > 200 ng/dL
Adrenal DHEA-S > 700 ÎŒg/dL
17-OH-prog basal > 200 (CAH)
Post-ACTH 17-OH-prog > 1000 (CAH)
Spironolactone dose 50-200 mg/d
COC drospirenone preferred Anti-androgen

407.2.0.2 ⭐ 高 yield

407.2.0.2.1 Causes Hierarchy
  1. PCOS 70-80%
  2. Idiopathic 10-15%
  3. Non-classic CAH 5%
  4. Cushing’s
  5. Tumor (急性, severe)
  6. Drug-induced
  7. Hyperprolactinemia (mild)
  8. Hyperthyroid (rare)
  9. Acromegaly (rare)
  10. HAIR-AN syndrome
407.2.0.2.2 Drug Causes
  • Anabolic steroid
  • Danazol
  • Valproate
  • Cyclosporine
  • Minoxidil
  • Phenytoin
  • Glucocorticoid (mild)
407.2.0.2.3 Treatment Algorithm
Confirm hirsutism + workup
  ↓
PCOS → COC + spironolactone + lifestyle
Idiopathic → COC + spironolactone
Non-classic CAH → low-dose HC/dexamethasone + COC
Tumor → surgery
Cushing's → treat underlying
Drug → stop
407.2.0.2.4 Anti-androgen Drugs
Drug Mechanism
Spironolactone AR antagonist + ↑ aromatase
Cyproterone acetate AR antagonist + progestin
Flutamide AR antagonist (hepatotoxic)
Bicalutamide AR antagonist
Finasteride 5α-reductase inhibitor
Drospirenone (in COC) AR antagonist + diuretic

407.2.0.3 🎯 自我檢枬

  1. Hirsutism #1 cause? → PCOS
  2. Ferriman-Gallwey cutoff? → ≥ 8 (white)
  3. Tumor T threshold? → > 200 ng/dL
  4. Adrenal DHEA-S threshold? → > 700 ÎŒg/dL
  5. CAH 17-OH-prog basal? → > 200 ng/dL
  6. Idiopathic hirsutism workup? → Normal hormones, family Hx, ethnicity
  7. Spironolactone teratogenic? → Yes (avoid in pregnancy)
  8. Eflornithine? → Slows hair growth (topical)
  9. Laser hair removal? → Permanent reduction
  10. Drug-induced examples? → Anabolic, danazol, valproate, cyclosporine, minoxidil

⚠ AI 草皿。