414.2 📚 國考版醫垫國考 / PGY OSCE

414.2.0.1 📌 Cram Sheet

414.2.0.1.1 🔥 高 yield 10
  1. Obesity = chronic disease (not lifestyle)
  2. BMI ≥ 30 (Asian ≥ 27), WC > 102/88 (US) or > 90/80 (Asian)
  3. Hunger: ghrelin (stomach), AgRP/NPY (hypothalamic), cortisol
  4. Satiety: leptin, insulin, GLP-1, GIP, PYY, CCK, MC4R signaling
  5. Visceral > subcutaneous in pathogenicity
  6. Adipokine imbalance: ↓ adiponectin, ↑ TNF/IL-6/leptin (resistance)
  7. MC4R mutation = most common monogenic (5% severe early-onset)
  8. Prader-Willi: 15q11.2 deletion, hyperphagia, hypogonadism
  9. Drug-induced: steroid, atypical antipsychotic, insulin
  10. Setmelanotide for MC4R/POMC/LEPR rare monogenic
414.2.0.1.2 🔢 必背
項目 æ•žå­—
BMI overweight Asian ≥ 23
BMI obese Asian ≥ 27 (囜健眲 ≥ 27.5)
BMI Class 1 30-34.9
Class 2 35-39.9
Class 3 ≥ 40
WC US 男 > 102 cm
WC Asian 男 > 90 cm
WC Asian 女 > 80 cm
MC4R % monogenic ~5%
RMR % total expenditure 60-70%

414.2.0.2 ⭐ 高 yield

414.2.0.2.1 Hormones Quick
Hunger Satiety
Ghrelin Leptin
AgRP/NPY Insulin
Cortisol GLP-1
CB1 GIP
PYY
CCK
Amylin
α-MSH (POMC → MC4R)
414.2.0.2.2 Genetic Obesity
Gene Feature
MC4R Most common monogenic (5%)
POMC Severe early-onset
LEPR Severe early-onset
LEP Leptin def (very rare)
PCSK1 Rare
FTO Polygenic risk
414.2.0.2.3 Syndromic Obesity
Syndrome Features
Prader-Willi (15q11.2) Hyperphagia, hypogonadism, intellectual
Bardet-Biedl Obesity + retinitis pigmentosa + polydactyly + renal
Alström Obesity + multi-organ + retinal
WAGR (11p13) Obesity + tumor risk + intellectual
414.2.0.2.4 Drug-Induced
  • Steroid
  • Atypical antipsychotic (olanzapine > clozapine > risperidone)
  • Insulin (with poor lifestyle)
  • SU/glinide
  • TZD (pioglitazone)
  • β-blocker (older)
  • Valproate, mirtazapine, paroxetine
  • GnRH agonist, anti-androgen
414.2.0.2.5 Adipose Biology
Type Function
WAT Storage
BAT Thermogenesis (UCP-1)
Beige / Brite Browning of WAT
Visceral Pathogenic (TNF, IL-6, FFA → liver)
Subcutaneous Storage primarily

414.2.0.3 🎯 自我檢枬

  1. BMI Asian obese? → ≥ 27 (台灣 ≥ 27.5)
  2. WC Asian 男 / 女? → > 90 / > 80
  3. Hunger hormone main? → Ghrelin
  4. Satiety hormones 5? → Leptin, insulin, GLP-1, PYY, CCK
  5. MC4R signaling? → α-MSH → MC4R = satiety
  6. Most common monogenic obesity? → MC4R (~5% severe)
  7. Setmelanotide for? → MC4R/POMC/LEPR
  8. Prader-Willi region? → 15q11.2
  9. Bardet-Biedl features? → Obesity + RP + polydactyly + renal
  10. Drug-induced top 3? → Steroid, atypical antipsychotic, insulin
  11. Visceral vs subcutaneous? → Visceral pathogenic
  12. BAT activation? → Cold exposure, exercise; UCP-1
  13. Leptin in obesity? → Resistance (high level, not work)
  14. Adiponectin in obesity? → ↓ (anti-inflammatory loss)
  15. Microbiome obesity? → Firmicutes:Bacteroidetes ratio ↑

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