415.2 📚 國考版醫垫國考 / PGY OSCE

415.2.0.1 📌 Cram Sheet

415.2.0.1.1 🔥 高 yield 12
  1. Treatment goal: 5-10% lifestyle, 15-20% drug, 25-30% bariatric
  2. Lifestyle foundation: 500-750 kcal deficit + 150-300 min/wk + behavior + sleep
  3. Drug indication: BMI ≥ 30 OR ≥ 27 + comorbidity
  4. Tirzepatide (Zepbound): best class, ~ 20% weight; SC weekly
  5. Semaglutide (Wegovy): ~ 15% weight; SC weekly
  6. Liraglutide (Saxenda): ~ 8%; daily SC
  7. Phentermine-topiramate (Qsymia): ~ 9%; teratogenic
  8. Naltrexone-bupropion (Contrave): ~ 5%
  9. Orlistat: ~ 3%; GI SE
  10. Setmelanotide: MC4R/POMC/LEPR/BBS monogenic
  11. Retatrutide (phase 3): triple agonist, ~ 24%
  12. Bariatric AACE 2024: BMI ≥ 35 OR 32-35 + comorbidity (Asian lower)
415.2.0.1.2 🔢 必背
項目 æ•žå­—
Lifestyle weight loss 5-10%
Drug weight loss range 5-20%
Bariatric weight loss 25-30%
Caloric deficit 500-750 kcal/d
Exercise 150-300 min/wk
Semaglutide max 2.4 mg/wk
Tirzepatide max 15 mg/wk
Bariatric BMI threshold ≥ 35 (AACE 2024)
Bariatric + comorbidity 32-35
Pediatric GLP-1 age ≥ 12 yr
Pediatric bariatric ≥ 13 yr selected

415.2.0.2 ⭐ 高 yield

415.2.0.2.1 Drug Comparison
Drug Weight Loss Mechanism SE
Semaglutide 2.4 mg ~ 15% GLP-1 RA GI
Tirzepatide 15 mg ~ 20% GIP+GLP-1 GI
Liraglutide 3 mg ~ 8% GLP-1 RA GI
Phentermine-topiramate ~ 9% Sympathomimetic + anti-seizure Teratogenic, tachy
Naltrexone-bupropion ~ 5% Opioid antagonist + DA/NE Nausea, BP
Orlistat ~ 3% Lipase inhibitor GI oily stool
Setmelanotide varies MC4R agonist Monogenic
Retatrutide (phase 3) ~ 24% GLP-1+GIP+glucagon TBD
Cagrilintide+semaglutide ~ 22% Amylin + GLP-1 TBD
415.2.0.2.2 Bariatric Procedures
Procedure Weight Loss T2DM Remission Risks
Sleeve gastrectomy 20-25% 50-60% GERD, leak
RYGB 25-30% 60-80% Dumping, hypoglycemia, malabsorption
Adjustable band < 20% < 50% Less common now
BPD > 30% > 80% Severe malabsorption
Endoscopic balloon 10-15% minor Temporary
ESG 15-20% minor Endoscopic
415.2.0.2.3 Bariatric Indications (AACE 2024)
  • BMI ≥ 35 (regardless comorbidity)
  • BMI 32-35 + comorbidity (T2DM, HTN, NASH, OSA)
  • Asian-specific lower thresholds (BMI 30 + comorbidity in some guidelines)
  • Pediatric ≥ 13 yr severe + comorbidity (ASMBS)
415.2.0.2.4 Lifestyle Components
  • Caloric deficit 500-750 kcal/d
  • Mediterranean / DASH / low-carb / various — adherence > specific
  • Exercise: 150-300 min moderate-vigorous + 2x resistance
  • Behavioral therapy
  • Sleep optimization (7-9 hr)
  • Stress management
  • Alcohol moderation
  • Smoking cessation
415.2.0.2.5 Drug-Induced Weight Gain Recognition
  • Steroid
  • Atypical antipsychotic
  • Insulin / SU / TZD
  • β-blocker
  • Antiepileptic (valproate)
  • Mirtazapine, paroxetine
  • GnRH agonist, anti-androgen
  • Switch when possible

415.2.0.3 🎯 自我檢枬

  1. Lifestyle weight loss target? → 5-10%
  2. Drug indication BMI? → ≥ 30 OR ≥ 27 + comorbidity
  3. Tirzepatide weight loss? → ~ 20%
  4. Semaglutide weight loss? → ~ 15%
  5. Liraglutide dose obesity? → 3 mg/d
  6. Bariatric AACE 2024 BMI? → ≥ 35 OR 32-35 + comorbidity
  7. Sleeve vs RYGB DM remission? → RYGB higher
  8. Setmelanotide for? → MC4R/POMC/LEPR/BBS
  9. Retatrutide phase? → 3 (triple agonist ~ 24%)
  10. Pediatric GLP-1 age? → ≥ 12 yr
  11. Pediatric bariatric? → ≥ 13 selected
  12. Phentermine-topiramate teratogenic? → Yes (topiramate)
  13. Naltrexone-bupropion CI? → Uncontrolled HTN, opioid
  14. Orlistat SE? → GI oily stool, ADEK
  15. Post-bariatric supplementation? → Lifelong B12, iron, Ca/D, multi
  16. Post-RYGB hypoglycemia? → Dumping; dietary modification + acarbose

⚠ AI 草皿。