419.2 📚 國考版醫垫國考 / PGY OSCE

419.2.0.1 📌 Cram Sheet

419.2.0.1.1 🔥 高 yield 12
  1. Whipple’s triad: symptoms + low glucose + 緩解 with 補糖
  2. DM Levels: 1 (<70), 2 (<54), 3 (severe, 需他人助)
  3. Adrenergic (心悞/汗/抖) vs neuroglycopenic (confusion/coma)
  4. 15-15 rule: 15 g carb → 15 min → repeat if needed
  5. Severe at home: glucagon 1 mg IM/SC or nasal Baqsimi
  6. Severe hospital: D50 25-50 mL IV
  7. SU overdose: D5/D10 + octreotide 50-100 ÎŒg q6h + admit
  8. Hypoglycemia unawareness: avoid hypo 2-3 wk → 郚分 restore
  9. 72-h fast = insulinoma diagnostic
  10. Insulinoma profile: insulin ↑, C-peptide ↑, proinsulin ↑, β-OHB ↓
  11. Exogenous insulin: insulin ↑, C-peptide ↓ (factitious)
  12. NICTH (IGF-2 producing tumor): large mesenchymal/HCC; insulin ↓
419.2.0.1.2 🔢 必背
項目 æ•žå­—
Whipple’s plasma glucose < 55
DM Level 1 < 70
DM Level 2 < 54
15-15 carb 15 g
Glucagon kit 1 mg IM
Glucagon nasal 3 mg (Baqsimi)
D50 dose 25-50 mL IV
Octreotide for SU 50-100 ÎŒg SC q6h
72-h fast cutoff < 55 + symptoms
Counter-regulatory order insulin ↓ → glucagon ↑ → Epi ↑ → cortisol/GH ↑

419.2.0.2 ⭐ 高 yield

419.2.0.2.1 72-h Fast Interpretation
Source Insulin C-peptide Proinsulin β-OHB
Insulinoma ↑ ↑ ↑ ↓
Exogenous insulin (factitious) ↑ ↓ ↓ ↓
Sulfonylurea ↑ ↑ ↑ ↓ + SU+
NICTH (IGF-2) ↓ ↓ ↓ ↓
Cortisol def ↓ ↓ ↓ ↑
Glycogen def ↓ ↓ ↓ varies
419.2.0.2.2 Drug-induced Quick
Drug Mechanism
Insulin Direct
SU/glinide β-cell secretion
Alcohol ↓ gluconeogenesis
Quinolone (gati > moxi/levo) β-cell stim
Pentamidine Initial release then β-cell death
Quinine β-cell stim
Salicylate (high dose) ↓ gluconeogenesis
ACE-i (rare) Insulin sensitivity
419.2.0.2.3 Insulinoma Imaging
  • CT/MRI pancreas (often missed if small)
  • EUS highest yield
  • DOTATATE PET (SSTR+)
  • GLP-1 receptor PET (specific, 22E)
  • Selective intra-arterial calcium stimulation (rare)
419.2.0.2.4 Treatment Quick
Setting Treatment
Mild alert 15 g carb (15-15 rule)
Moderate (still alert) 15-30 g carb
Severe (unable swallow) Glucagon 1 mg IM / nasal 3 mg
Hospital severe D50 25-50 mL IV
Prolonged D5W/D10W infusion
SU overdose D5/D10 + octreotide
Insulinoma Surgery (enucleation); diazoxide bridge; octreotide
Post-bariatric Diet + acarbose + octreotide
NICTH Tumor resection + steroid
Hirata syndrome Stop offending drug + steroid + immunosuppressant

419.2.0.3 🎯 自我檢枬

  1. Whipple’s triad? → Symptoms + low glucose < 55 + 補糖緩解
  2. DM Level 1/2/3? → < 70 / < 54 / 需他人
  3. 15-15 rule? → 15 g carb, 15 min check
  4. Severe at home? → Glucagon 1 mg IM
  5. Severe hospital? → D50 25-50 mL IV
  6. SU overdose特殊? → Octreotide
  7. 72-h fast cutoff? → < 55 + symptoms
  8. Insulinoma profile? → Insulin ↑, C-peptide ↑, β-OHB ↓
  9. Exogenous insulin clue? → C-peptide ↓
  10. NICTH? → IGF-2 producing large tumor
  11. Hypoglycemia unawareness restore? → Avoid hypo 2-3 wk
  12. Wernicke prevention? → Thiamine before glucose in alcoholic
  13. Insulinoma + MEN1 %? → ~10%
  14. Hirata syndrome? → Insulin Ab; Asian; SH-drug
  15. Reactive hypoglycemia? → Post-prandial; idiopathic

⚠ AI 草皿。