409.2 📚 國考版醫垫國考 / PGY OSCE

409.2.0.1 📌 Cram Sheet

409.2.0.1.1 🔥 高 yield 12
  1. Infertility: 1 yr (< 35) / 6 mo (≥ 35)
  2. 40% female / 30% male / 20% both / 10% unexplained
  3. Female workup: TSH, prolactin, AMH, HSG, ovulation tracking
  4. Male workup: semen analysis (WHO 2010)
  5. Letrozole > clomiphene for PCOS ovulation
  6. Treatment ladder: lifestyle → induction → IUI → IVF → ICSI → donor
  7. OHSS = IVF complication
  8. Klinefelter / Y microdeletion for severe oligo
  9. CBAVD + CFTR for obstructive azoospermia
  10. COC CI: smoker 35+, DVT, migraine aura, breast CA, liver
  11. Contraception efficacy: implant > IUD > sterilization > injection > pill > barrier > rhythm
  12. Emergency: levonorgestrel < 72h, ulipristal < 120h, copper IUD < 5d
409.2.0.1.2 🔢 必背
項目 æ•žå­—
Infertility threshold 1 yr (<35) / 6 mo (≥35)
AMH diminished < 1 ng/mL
Day 21 progesterone (ovulation) > 3 ng/mL
Semen volume ≥ 1.5 mL
Sperm concentration ≥ 15 M/mL
Sperm motility ≥ 40%
Sperm morphology ≥ 4%
IVF success per cycle 30-50% (age)
Levonorgestrel emergency within 72 h
Ulipristal emergency within 120 h
Copper IUD emergency within 5 d

409.2.0.2 ⭐ 高 yield

409.2.0.2.1 Female Infertility Causes
Cause %
Ovulatory dysfunction 25%
Tubal factor (PID, endo) 25%
Endometriosis 15%
Uterine factor (fibroid, polyp, Asherman) 10%
Cervical < 5%
Age Major modifier
Unexplained 10-15%
409.2.0.2.2 Male Infertility Causes
  • Pre-testicular: hypogonadism, drug
  • Testicular: Klinefelter, varicocele, chemo, RT, mumps, autoimmune
  • Post-testicular: CBAVD (CFTR), retrograde ejac, post-vasectomy
  • Genetic: Klinefelter, Y microdeletion, CFTR
409.2.0.2.3 Ovulation Induction Drugs
Drug Mechanism
Clomiphene SERM (estrogen blocker)
Letrozole Aromatase inhibitor (preferred PCOS)
Gonadotropin (hMG, FSH) Direct ovarian stim
Metformin PCOS adjunct
409.2.0.2.4 Contraception Efficacy (Typical Use)
  1. Implant (Nexplanon) > 99%
  2. IUD (levonorgestrel or copper) > 99%
  3. Sterilization > 99%
  4. DMPA injection 99%
  5. COC / patch / ring 91%
  6. Diaphragm 88%
  7. Condom 87%
  8. Withdrawal 78%
  9. Spermicide 72%
  10. Fertility awareness 76%
409.2.0.2.5 COC Contraindications (CDC 4 = avoid)
  • Smoker ≥ 35 yr
  • Migraine with aura
  • DVT / PE history
  • Hypertension uncontrolled (≥ 160/100)
  • CAD / stroke
  • Breast cancer
  • Active liver disease
  • Diabetes with vascular complications
  • < 21 d postpartum

409.2.0.3 🎯 自我檢枬

  1. Infertility threshold? → 1 yr (<35) / 6 mo (≥35)
  2. Female causes top 2? → Ovulatory + tubal (each 25%)
  3. AMH diminished? → < 1 ng/mL
  4. Sperm normal volume? → ≥ 1.5 mL
  5. Sperm normal motility? → ≥ 40%
  6. PCOS ovulation 1st? → Letrozole
  7. Severe male factor (azoo)? → ICSI + TESE
  8. CBAVD gene? → CFTR
  9. COC contraindications? → Smoker 35+, DVT, migraine aura, breast CA, liver
  10. Emergency contraception 72h? → Levonorgestrel
  11. Emergency 120h? → Ulipristal
  12. Emergency 5d? → Copper IUD
  13. Levonorgestrel IUD duration? → 5-7 yr
  14. Copper IUD duration? → 10 yr
  15. OHSS? → IVF ovarian hyperstimulation

⚠ AI 草皿。