408.2 📚 國考版醫垫國考 / PGY OSCE

408.2.0.1 📌 Cram Sheet

408.2.0.1.1 🔥 高 yield 12
  1. Menopause = 12 mo amenorrhea, 平均 51 yr
  2. FSH > 25 + low estradiol confirms (clinical 倚)
  3. Premature menopause = < 40 yr (= POI)
  4. Vasomotor symptoms 80% + persist 7-10 yr
  5. GSM = vaginal atrophy + urinary; vaginal estrogen 1st
  6. HRT timing: < 10 yr post-menopause + < 60 yr safe
  7. HRT > 60 yr or > 10 yr → ↑ CV risk
  8. Combined HRT (E + P) if uterus; E alone if no uterus
  9. WHI 2002: combined HRT older women → ↑ CV/breast/stroke
  10. Transdermal + micronized progesterone preferred
  11. Non-hormonal: SSRI/SNRI, gabapentin, fezolinetant (22E NK3)
  12. Bone protection: bisphosphonate, denosumab, teriparatide, romosozumab
408.2.0.1.2 🔢 必背
項目 æ•žå­—
Menopause age 51 yr (avg)
Premature menopause < 40 yr
Amenorrhea cutoff 12 mo
FSH cutoff > 25
HRT timing safe < 10 yr post / < 60 yr
Bone loss early 5%/yr
Paroxetine for hot flash 7.5 mg
Fezolinetant 45 mg/d
DXA screening age 65 (or earlier risk)
T-score osteoporosis ≀ -2.5

408.2.0.2 ⭐ 高 yield

408.2.0.2.1 HRT Contraindications
  • Breast CA / ER+ cancer history
  • DVT/PE history
  • Active liver disease
  • Undiagnosed vaginal bleeding
  • Pregnancy
  • Stroke / TIA / MI history
  • Severe HTN
  • Severe migraine with aura
408.2.0.2.2 HRT Formulations
  • Oral estradiol (1-2 mg)
  • Transdermal patch / gel / spray
  • Vaginal cream / ring / tablet
  • Combined oral CEE/MPA (older)
  • Bioidentical (controversial compounded)
408.2.0.2.3 Non-Hormonal for Vasomotor
Drug Mechanism
Paroxetine 7.5 mg (Brisdelle) SSRI
Venlafaxine 37.5-75 mg SNRI
Escitalopram SSRI
Gabapentin 300-900 mg/d Anticonvulsant
Clonidine 0.1-0.2 mg α2 agonist
Fezolinetant (Veozah) NK3 antagonist (22E)
Elinzanetant NK1+NK3 antagonist (phase 3)
408.2.0.2.4 GSM Treatment
  • Lubricant + moisturizer (1st)
  • Vaginal estrogen (cream/ring/tablet)
  • Ospemifene (SERM, oral)
  • Vaginal DHEA (prasterone)
408.2.0.2.5 Bone Protection Quick
Drug Class
Alendronate Bisphosphonate (PO weekly)
Risedronate Bisphosphonate
Zoledronic acid Bisphosphonate (IV q1y)
Denosumab Anti-RANKL (q6mo)
Teriparatide PTH analog (anabolic, q1d × 2y)
Abaloparatide PTHrP analog
Romosozumab Anti-sclerostin (12 monthly doses)
Raloxifene SERM (also breast protection)

408.2.0.3 🎯 自我檢枬

  1. Menopause definition? → 12 mo amenorrhea
  2. Average age? → 51
  3. Premature menopause? → < 40 (POI)
  4. Vasomotor prevalence + duration? → 80%, 7-10 yr
  5. HRT timing safe? → < 10 yr / < 60 yr
  6. With uterus + HRT? → Combined E + P
  7. WHI 2002 finding? → Combined HRT older → ↑ CV/breast/stroke
  8. Transdermal vs oral E? → Less DVT
  9. Vaginal E for GSM? → Yes, low systemic
  10. Fezolinetant? → NK3 antagonist (22E)
  11. Romosozumab? → Anti-sclerostin (newer bone)
  12. Paroxetine dose for hot flash? → 7.5 mg (Brisdelle)
  13. T-score osteoporosis? → ≀ -2.5
  14. DXA screening age? → 65 (earlier risk)
  15. HRT CI? → Breast CA, DVT, liver, undiagnosed bleed, stroke, MI

⚠ AI 草皿。