423.2 📚 國考版醫垫國考 / PGY OSCE

423.2.0.1 📌 Cram Sheet

423.2.0.1.1 🔥 高 yield 15
  1. Hypercalcemia algorithm: PTH high vs low
  2. PTH high: PHPT (#1), tertiary HPT, lithium, FHH
  3. PTH low: malignancy (PTHrP, osteolytic, 1,25-D), granulomatous, Vit D excess, thiazide
  4. PHPT triad: Ca ↑ + PTH ↑/inappropriately normal + P ↓
  5. PHPT vs FHH: 24h urine Ca/Cr ratio (> 0.02 PHPT, < 0.01 FHH)
  6. Surgery indications (NIH 2014): symptomatic, Ca > 1 above upper, 24h Ca > 400, eGFR < 60, T < -2.5 hip/spine/forearm or fracture, age < 50
  7. Hypercalcemia of malignancy: PTHrP > osteolytic > 1,25-D
  8. Acute hypercalcemia: IV NS + calcitonin + zoledronic acid + steroid (granulomatous)
  9. Calcitonin onset 4-6 hr; tachyphylaxis
  10. Zoledronic acid peak 4-7 d
  11. Hypocalcemia: post-surgery #1; tetany, Chvostek, Trousseau, QT prolong
  12. Severe hypocalcemia: IV calcium gluconate + ECG
  13. PHP Ia: GNAS + AHO + multi-hormone resistance
  14. rhPTH (palopegteriparatide, 22E) for refractory hypoPTH
  15. Mg deficiency suppresses PTH AND causes resistance
423.2.0.1.2 🔢 必背
項目 æ•žå­—
Ca normal 8.5-10.5
Ionized Ca 4.4-5.2
Mild hyperCa 10.5-12
Moderate 12-14
Severe > 14
Mild hypoCa 7.5-8.5
Severe hypoCa < 6.5
24h urine Ca PHPT > 400
Urine Ca/Cr clearance PHPT > 0.02
Urine Ca/Cr clearance FHH < 0.01
Surgery age cutoff PHPT < 50
eGFR cutoff PHPT surgery < 60
T-score cutoff ≀ -2.5
Calcitonin dose 4-8 IU/kg q6-12h
Zoledronic acid 4 mg IV

423.2.0.2 ⭐ 高 yield

423.2.0.2.1 Hypercalcemia Causes
Category Causes
PTH high PHPT (#1), tertiary HPT, lithium, FHH
Malignancy (PTH low) PTHrP (squamous lung/H&N/breast/RCC), osteolytic (MM, breast mets), 1,25-D (lymphoma)
Granulomatous Sarcoidosis, TB, lymphoma, fungal
Drug Thiazide, Vit A/D excess, lithium, Ca-antacid (milk-alkali)
Endocrine Hyperthyroidism, adrenal insufficiency, immobilization
423.2.0.2.2 PHPT Surgery Indications (NIH 2014)
  • Symptomatic (overt)
  • Ca > 1 mg/dL above upper normal
  • 24h urine Ca > 400 mg/d
  • Nephrolithiasis or nephrocalcinosis
  • eGFR < 60
  • T-score ≀ -2.5 (hip/spine/forearm)
  • Vertebral fracture (CT/X-ray)
  • Age < 50
  • Patient preference / 䞍胜 follow
423.2.0.2.3 Hypocalcemia Causes
PTH Cause
Low Hypoparathyroidism (post-surgery, autoimmune, DiGeorge, Mg-related, ADH)
High Vit D deficiency, CKD, hyperphosphatemia, PHP, hypomagnesemia, drug
423.2.0.2.4 Hypocalcemia Symptoms
  • Tetany, paresthesias (perioral, finger)
  • Chvostek sign (facial twitch)
  • Trousseau sign (carpal spasm with BP cuff)
  • Seizure, prolonged QT
  • Laryngospasm, bronchospasm
  • Cognitive (confusion, depression)
  • Cataract (chronic), basal ganglia calcification (Fahr)
423.2.0.2.5 Treatment Quick
Condition Treatment
Hypercalcemia mild Hydration, treat cause
Hypercalcemia moderate IV NS, treat cause, consider bisphos
Hypercalcemia severe IV NS + calcitonin + zoledronic acid + steroid (granulomatous)
Hypocalcemia acute IV calcium gluconate + ECG monitor
Hypocalcemia chronic Oral Ca + calcitriol
Hypoparathyroidism refractory rhPTH (palopegteriparatide, 22E)
Parathyroid CA Surgery + cinacalcet (long-term)
FHH No surgery, family screening

423.2.0.3 🎯 自我檢枬

  1. PHPT triad? → Ca ↑ + PTH ↑ + P ↓
  2. PHPT #1 cause? → Single adenoma (80-85%)
  3. PHPT vs FHH? → 24h urine Ca/Cr (> 0.02 vs < 0.01)
  4. Surgery NIH 2014 age cutoff? → < 50
  5. Surgery T-score cutoff? → ≀ -2.5
  6. Hypercalcemia malignancy mechanism 3? → PTHrP, osteolytic, 1,25-D
  7. Calcitonin onset? → 4-6 hr
  8. Zoledronic acid peak? → 4-7 d
  9. Hypocalcemia #1 cause? → Post-thyroid/parathyroid surgery
  10. Chvostek vs Trousseau? → Facial twitch vs carpal spasm
  11. PHP Ia? → GNAS + AHO + multi-hormone resistance
  12. AHO features? → Short, round face, brachydactyly (4th metacarpal)
  13. Mg deficiency Ca effect? → Both suppress PTH + cause resistance
  14. Granulomatous hyperCa mechanism? → Ectopic 1,25-D
  15. rhPTH 22E? → Palopegteriparatide for refractory hypoPTH

⚠ AI 草皿。