421.2 📚 國考版醫垫國考 / PGY OSCE

421.2.0.1 📌 Cram Sheet

421.2.0.1.1 🔥 高 yield 12
  1. MetS criteria ≥ 3 of 5: WC, TG, HDL, BP, glucose
  2. Asian WC: > 90 男 / > 80 女 (台灣國健眲同 IDF)
  3. TG ≥ 150, HDL < 40 男 / < 50 女
  4. BP ≥ 130/85, glucose ≥ 100
  5. 栞心: insulin resistance + visceral obesity
  6. 5x T2DM + 2-3x CV + NAFLD 50%
  7. Lifestyle 1st: weight 5-10% + Mediterranean + 150 min exercise
  8. HTN 1st line: ACE-i / ARB
  9. Dyslipidemia: statin (high-intensity if CV)
  10. DM/IR: metformin + GLP-1/SGLT2/tirzepatide
  11. NASH drug 22E: resmetirom (Rezdiffra, FDA 2024)
  12. Bariatric BMI ≥ 35 (or 32-35 + DM, AACE 2024)
421.2.0.1.2 🔢 必背
項目 æ•žå­—
WC US 男 > 102 cm
WC US 女 > 88 cm
WC Asian 男 > 90 cm
WC Asian 女 > 80 cm
TG ≥ 150 mg/dL
HDL 男 < 40
HDL 女 < 50
BP ≥ 130/85
Glucose ≥ 100
MetS ≥ X criteria 3 of 5
Bariatric BMI threshold ≥ 35 (or 32-35 + DM, AACE 2024)
Weight loss target 5-10%
Exercise 150 min/wk

421.2.0.2 ⭐ 高 yield

421.2.0.2.1 Pathophysiology Quick
  • Insulin resistance (core)
  • Visceral adipose (lipotoxicity)
  • Adipokine imbalance (↓ adiponectin, ↑ leptin)
  • Free fatty acids (lipotoxicity)
  • Inflammation (IL-6, TNF, MCP-1)
  • Mitochondrial dysfunction
421.2.0.2.2 Associated Conditions
  • T2DM (5x), CAD/MI/stroke (2-3x)
  • HF (HFpEF particular)
  • NAFLD/NASH 50%
  • PCOS
  • OSA
  • CKD
  • Gout
  • Cancer (CRC, breast, endometrial, pancreatic, HCC, kidney)
  • Dementia
421.2.0.2.3 Treatment by Component
Component Drug
HTN ACE-i / ARB 1st; CCB; avoid β-blocker first
Lipid Statin; ezetimibe; PCSK9; fenofibrate (TG); icosapent ethyl
DM/Pre-DM Metformin; GLP-1 RA; tirzepatide; SGLT2; pioglitazone
Obesity GLP-1 (semaglutide 2.4 mg/wk Wegovy); tirzepatide (Zepbound); phentermine-topiramate; naltrexone-bupropion; orlistat; setmelanotide; bariatric
NASH Resmetirom (FDA 2024); GLP-1 / tirzepatide off-label; Vit E (non-DM); pioglitazone (off-label)
Gout Allopurinol; febuxostat
CKD ACE-i; SGLT2; finerenone
421.2.0.2.4 Weight Loss Drugs Comparison
Drug Weight Loss SE
Semaglutide 2.4 mg ~ 15% GI
Tirzepatide 15 mg ~ 20% GI
Liraglutide 3 mg ~ 8% GI
Phentermine-topiramate ~ 9% Tachy, paresthesia
Naltrexone-bupropion ~ 5% Nausea, BP
Orlistat ~ 3% GI
Bariatric (RYGB, sleeve) ~ 25-30% Surgical
421.2.0.2.5 NAFLD / NASH Treatment 22E
  • Resmetirom (Rezdiffra): THRβ agonist, FDA 2024 (first NASH drug)
  • GLP-1 / tirzepatide: weight + steatohepatitis improvement
  • Vit E 800 IU/d: non-DM biopsy-proven NASH
  • Pioglitazone: off-label
  • Bariatric surgery: best for severe NAFLD with obesity

421.2.0.3 🎯 自我檢枬

  1. MetS criteria 5? → WC, TG, HDL, BP, glucose
  2. Asian WC threshold? → > 90 男 / > 80 女
  3. TG MetS? → ≥ 150
  4. HDL MetS 男? → < 40
  5. BP MetS? → ≥ 130/85
  6. Glucose MetS? → ≥ 100
  7. Core mechanism? → Insulin resistance + visceral obesity
  8. T2DM risk? → 5x
  9. NAFLD prevalence? → 50%+
  10. Lifestyle weight target? → 5-10%
  11. HTN 1st? → ACE-i / ARB
  12. NASH drug 22E? → Resmetirom (Rezdiffra)
  13. Bariatric BMI threshold (AACE 2024)? → ≥ 35 (or 32-35 + DM)
  14. Best weight-loss drug? → Tirzepatide (~ 20%)
  15. Hyperuricemia drug? → Allopurinol / febuxostat

⚠ AI 草皿。