418.2 📚 國考版醫垫國考 / PGY OSCE

418.2.0.1 📌 Cram Sheet

418.2.0.1.1 🔥 高 yield 18
  1. 急性: DKA, HHS, hypoglycemia, lactic acidosis
  2. 慢性: micro (retin/neph/neuro) + macro (CAD/stroke/PAD/HF)
  3. DKA: T1 倚, glucose > 250 (eu-DKA exception), pH < 7.30, HCO3 < 18, AG > 10, ketone+
  4. HHS: T2 倚, glucose > 600, eff osm > 320, pH > 7.30, mortality 10-20%
  5. DKA Tx: fluid + insulin (0.1 U/kg/hr) + K + bicarb (only pH < 6.9)
  6. DKA resolution: AG closes (not glucose alone)
  7. SGLT2 → eu-DKA possible (hold pre-op)
  8. Retinopathy screen: T2 at dx, T1 5 yr after; annual
  9. DKD: ACE-i + SGLT2 + GLP-1 + finerenone
  10. DSPN: stocking-glove, sensory > motor, foot ulcer risk
  11. Pain neuropathy 1st line: pregabalin/gabapentin/duloxetine/amitriptyline
  12. Tapentadol = only approved opioid for DPN
  13. Annual foot exam + monofilament
  14. CV benefit drugs: SGLT2 + GLP-1
  15. HF in DM: SGLT2 mandatory regardless of HbA1c
  16. CKD eGFR > 20 + albuminuria: SGLT2 mandatory
  17. Anti-VEGF for DME
  18. Charcot foot: neuroarthropathy
418.2.0.1.2 🔢 必背
項目 æ•žå­—
DKA glucose > 250
DKA pH < 7.30
DKA HCO3 < 18
DKA AG > 10
HHS glucose > 600
HHS eff osm > 320
HHS pH > 7.30
Insulin DKA bolus 0.1 U/kg or 0.14 U/kg/hr no bolus
Insulin DKA infusion 0.1 U/kg/hr
K hold insulin < 3.3
DKA fluid 1st hour 1 L NS
Glucose drop target 50-75 mg/dL/hr
HHS fluid deficit 9-10 L
HHS mortality 10-20%
Retinopathy screen T2 At dx, annual
Retinopathy screen T1 5 yr post, annual
BP DM < 130/80

418.2.0.2 ⭐ 高 yield

418.2.0.2.1 DKA vs HHS Quick
DKA HHS
Type T1 mostly T2 mostly
Age younger older
Glucose 250-800 > 600 (often > 1000)
Eff osm normal-high > 320
pH < 7.30 > 7.30
HCO3 < 18 > 18
AG > 10 normal
Ketone + trace/−
Mental varies obtunded
Mortality 1-5% 10-20%
Onset days weeks
418.2.0.2.2 DKA Treatment (5 支柱)
  1. Fluid: NS 1L/hr → 0.45% based on Na
  2. Insulin: 0.1 U/kg IV bolus + 0.1 U/kg/hr infusion (or skip bolus, 0.14 U/kg/hr)
  3. K: < 3.3 hold insulin; 3.3-5.3 add 20-30 in fluid; > 5.3 hold
  4. Bicarb: only if pH < 6.9
  5. Phosphate: only if < 1.0 + sx
418.2.0.2.3 Retinopathy
  • NPDR: mild → moderate → severe
  • PDR: neovascularization
  • DME: center vs non-center
  • Anti-VEGF: ranibizumab, aflibercept, bevacizumab, faricimab (22E)
  • PRP for PDR
  • Vitrectomy for vit hem / TRD
  • Rapid HbA1c drop → transient worsening
418.2.0.2.4 DKD Drugs (蚘順序)
  1. ACE-i / ARB (1st line for proteinuria, even normotensive)
  2. SGLT2 inhibitor (eGFR > 20 + albuminuria — mandatory)
  3. GLP-1 RA (semaglutide CKD benefit, FLOW)
  4. Finerenone (FIDELIO, FIGARO; non-steroidal MRA)
  5. Other: HbA1c control, BP < 130/80, Na restriction, weight management
418.2.0.2.5 Neuropathy Drugs
Class Drug
Anticonvulsant Pregabalin, gabapentin
SNRI Duloxetine, venlafaxine
TCA Amitriptyline, nortriptyline
Opioid (only approved) Tapentadol
Topical Capsaicin, lidocaine patch
418.2.0.2.6 Macro CV Drugs by Indication
  • ASCVD secondary prevention: aspirin + statin + ACE-i + GLP-1/SGLT2
  • HFrEF: GDMT (ACE-i/ARNI + β-blocker + MRA + SGLT2)
  • HFpEF: SGLT2 + diuretic; tirzepatide if obesity (SUMMIT)
  • CKD: ACE-i/ARB + SGLT2 + finerenone + GLP-1

418.2.0.3 🎯 自我檢枬

  1. DKA glucose threshold? → > 250 (or eu-DKA SGLT2 exception)
  2. DKA pH? → < 7.30
  3. DKA insulin? → 0.1 U/kg/hr
  4. DKA K hold insulin? → < 3.3
  5. DKA bicarb indication? → pH < 6.9
  6. DKA resolution criteria? → AG closes
  7. HHS eff osm? → > 320
  8. HHS mortality? → 10-20%
  9. eu-DKA cause? → SGLT2
  10. Retinopathy screen T2? → At dx
  11. Retinopathy screen T1? → 5 yr post
  12. PDR treatment? → PRP / anti-VEGF
  13. DME treatment? → Anti-VEGF
  14. DKD ACE-i indication? → Albuminuria (even normotensive)
  15. SGLT2 in CKD eGFR? → > 20 + albuminuria
  16. Finerenone trial? → FIDELIO + FIGARO
  17. DPN pain 1st line? → Pregabalin/duloxetine
  18. Charcot foot? → Neuroarthropathy of foot

⚠ AI 草皿。