41.2 📚 國考版醫垫國考 / PGY OSCE

41.2.0.1 📌 Cram Sheet

41.2.0.1.1 🔥 高 yield 8
  1. Massive > 600 mL/24h
  2. Death by asphyxiation > 倱血
  3. 5 倧病因bronchitis / lung cancer / bronchiectasis / TB / PE
  4. Smoker hemoptysis = cancer rule out
  5. Cavitary TB classic
  6. Lateral decubitus bleeding side down
  7. Bronchial artery embolization first-line definitive
  8. Goodpasture / GPA for pulmonary-renal
41.2.0.1.2 🔢 必背
項目 æ•žå­—
Massive cutoff > 600 mL/24h or 100-200 mL/episode
Bronchial artery embolization success > 90%
Sputum AFB sensitivity smear ~50%
41.2.0.1.3 易錯
  • 䞍分 hemoptysis vs hematemesis
  • Smoker 䞍查 cancer
  • TB 䞍 AFB
  • Massive 䞍 lateral position

41.2.0.2 ⭐ 高 yield

41.2.0.2.1 Hemoptysis vs Hematemesis
Hemoptysis Hematemesis
顏色 Bright red Brown / coffee
pH Alkaline Acidic
Frothy + −
Clots Less +
Symptoms Cough, dyspnea N/V, melena
41.2.0.2.2 Vasculitis Workup
  • GPA (Wegener’s): cANCA, sinus + lung + kidney
  • MPA: pANCA
  • EGPA (Churg-Strauss): pANCA, asthma + eos
  • Anti-GBM (Goodpasture): lung + kidney
41.2.0.2.3 Massive Hemoptysis Mx
  1. Airway (intubate selectively)
  2. Position lateral bleeding-side-down
  3. Reverse coagulopathy
  4. Bronchoscopy + balloon
  5. Bronchial artery embolization (IR)
  6. Surgery (refractory)

41.2.0.3 🎯 自我檢枬

  1. Massive cutoff? → > 600 mL/24h
  2. 死因? → Asphyxiation > 倱血
  3. Smoker hemoptysis 必查? → Lung cancer (CT chest + bronchoscopy)
  4. TB cavitary? → 經兞 hemoptysis
  5. Pulmonary-renal? → Goodpasture, GPA, MPA, SLE
  6. Massive position? → Lateral decubitus bleeding-side-down
  7. First-line definitive? → Bronchial artery embolization

⚠ AI 草皿。