44.2 📚 國考版醫垫國考 / PGY OSCE

44.2.0.1 📌 Cram Sheet

44.2.0.1.1 🔥 高 yield 10
  1. Diastolic = pathological無 innocent
  2. AS radiate to carotid + parvus tardus + 䞉聯
  3. MR radiate to axilla
  4. HCM Valsalva ↑ (與 AS 反)
  5. AR wide PP + water-hammer
  6. MS opening snap + loud S1
  7. Carvallo’s (Inspiration → R heart ↑)
  8. PDA = machinery murmur
  9. MVP = midsystolic click
  10. All diastolic + continuous + grade ≥ 3 + symptomatic → echo
44.2.0.1.2 🔢 必背
項目 æ•žå­—
AS severe AVA < 1.0 cm²
AS severe gradient mean > 40 mmHg
MS severe MVA < 1.5 cm²
MR severe regurg vol > 60 mL
AR severe PHT < 200 ms
Murmur grade thrill ≥ 4
44.2.0.1.3 易錯
  • Diastolic 當 functional
  • 䞍做 maneuvers
  • AS 絊 vasodilator
  • HCM 絊 nitrate

44.2.0.2 ⭐ 高 yield

44.2.0.2.1 Murmur 對照
病 Timing Location Radiation Maneuver
AS Mid-systolic crescendo-decrescendo RUSB Carotid Hand grip ↓
MR Holosystolic Apex Axilla Hand grip ↑
MVP Mid-systolic click + late Apex — Valsalva ↑
TR Holosystolic LLSB — Inspire ↑
HCM Mid-systolic LSB — Valsalva ↑
VSD Holosystolic harsh LSB — Hand grip ↑
AR Early diastolic decrescendo LSB 3rd — Hand grip ↑
MS Mid-late diastolic rumble Apex — Expire ↑
PDA Continuous machinery LSB upper — —
44.2.0.2.2 Maneuvers 速查
  • Valsalva ↓ preload → HCM ↑, MVP click 提前 + 雜音長, 其他 ↓
  • Hand grip ↑ afterload → MR, AR, VSD ↑; AS, HCM ↓
  • Inspiration → Carvallo’s (TR, TS, PR, PS ↑)
  • Expiration → 巊心 ↑
44.2.0.2.3 AR Severe Signs
  • Wide pulse pressure
  • Water-hammer (Corrigan) pulse
  • de Musset (head bobbing)
  • Quincke (nail capillary pulsation)
  • Mueller (uvula pulsation)
  • Traube (pistol shot femoral)
  • Duroziez (femoral to-and-fro)
  • Hill (BP leg > arm by 60+ mmHg)
44.2.0.2.4 MS Severe
  • OS to S2 distance ↓ (severer)
  • Loud S1
  • Diastolic rumble + presystolic accentuation (in NSR)
  • AF, LA enlargement, RVH, pulmonary HTN

44.2.0.3 🎯 自我檢枬

  1. AS radiate? → Carotid
  2. MR radiate? → Axilla
  3. HCM Valsalva? → ↑
  4. AS Valsalva? → ↓ (or unchanged)
  5. Carvallo’s sign? → R heart ↑ on inspire
  6. AR severe sign? → Water-hammer pulse, wide PP
  7. MS opening snap? → After S2
  8. PDA? → Continuous machinery murmur

⚠ AI 草皿。