47.2 📚 國考版醫垫國考 / PGY OSCE

47.2.0.1 📌 Cram Sheet

47.2.0.1.1 🔥 高 yield 8
  1. Oropharyngeal vs esophageal
  2. 固體 only = mechanical固體 + 液體 = motility
  3. 玅旗 → EGDage > 50 + new + 體重 ↓ + bleeding
  4. Achalasia: bird’s beak + manometry aperistalsis + 䞍攟鬆 LES
  5. POEM (22E) for achalasia
  6. EoE: young + atopy + food impaction; topical steroid + dupilumab (22E)
  7. Zenker: halitosis + regurg undigested food
  8. Stroke swallow eval before feeding (aspiration prevention)
47.2.0.1.2 🔢 必背
項目 æ•žå­—
Achalasia LES pressure > 35 mmHg
EoE eos count ≥ 15 / hpf
Cancer dysphagia 進行性 + 體重 ↓
47.2.0.1.3 易錯
  • 老人 dysphagia 䞍 EGD
  • Stroke 䞍 swallow eval
  • Achalasia 挏

47.2.0.2 ⭐ 高 yield

47.2.0.2.1 Diagnostic Approach
  1. EGD first if mechanical concerned
  2. Barium swallow if subtle / large bolus / Zenker
  3. Manometry for motility (achalasia, DES, scleroderma)
  4. VFSS / FEES for oropharyngeal
47.2.0.2.2 Achalasia Subtypes (Chicago classification)
  • Type I: minimal contractility
  • Type II: pan-esophageal pressurization (best response to therapy)
  • Type III: spastic + premature contraction
47.2.0.2.3 EoE
  • Diagnosis: ≥ 15 eos/hpf on biopsy
  • Treatment: topical steroid (swallow budesonide), dietary elimination, dupilumab
  • Esophageal stricture → dilation
47.2.0.2.4 Esophageal Cancer
  • SCC: alcohol, smoking, achalasia, lye burn
  • Adenocarcinoma: Barrett’s (GERD)

47.2.0.3 🎯 自我檢枬

  1. Achalasia barium? → Bird’s beak
  2. EoE biopsy? → ≥ 15 eos/hpf
  3. Zenker symptom? → Halitosis + regurg undigested food
  4. POEM 適應? → Achalasia
  5. 固體 + 液體 dysphagia 想? → Motility (achalasia)

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