49.2 📚 國考版醫垫國考 / PGY OSCE

49.2.0.1 📌 Cram Sheet

49.2.0.1.1 🔥 高 yield 10
  1. Diarrhea 4 機蜉: secretory / osmotic / inflammatory / motility
  2. Bloody diarrhea = invasive bacterial
  3. EHEC = avoid antibiotic (HUS risk)
  4. C. diff: vancomycin PO / fidaxomicin
  5. Acute < 2 週 / Chronic > 4 週
  6. Rome IV for constipation
  7. > 50 yo new constipation 玅旗 → colonoscopy
  8. HUS triad: hemolytic anemia + thrombocytopenia + AKI
  9. Microscopic colitis = elderly + chronic watery + 正垞 colonoscopy + biopsy
  10. Opioid-induced constipation: methylnaltrexone, naloxegol
49.2.0.1.2 🔢 必背
項目 æ•žå­—
Acute diarrhea < 2 週
Persistent 2-4 週
Chronic > 4 週
C. diff cure rate vanco ~80%
Fidaxomicin reduce recurrence
Rome IV constipation symptoms 6 mo + 3 mo
49.2.0.1.3 易錯
  • EHEC 絊 antibiotic

  • 50 yo 䞍 colonoscopy

  • C. diff 䞍停原 antibiotic
  • Acute routine antibiotic

49.2.0.2 ⭐ 高 yield

49.2.0.2.1 C. diff 治療階梯
  • First episode:
    • Vancomycin 125 mg PO qid × 10 d (preferred)
    • Fidaxomicin 200 mg PO bid × 10 d (less recurrence)
    • Metronidazole only mild + first if vanco/fidax 䞍可
  • First recurrence:
    • Tapered + pulsed vancomycin
    • Fidaxomicin
  • Recurrent (≥ 2):
    • Bezlotoxumab (anti-toxin B antibody) adjunct
    • FMT (fecal microbiota transplant)
  • Severe / fulminant: vanco PO + IV metronidazole + colectomy if megacolon
49.2.0.2.2 IBS Rome IV
  • Recurrent abdominal pain, on average ≥ 1 day/week × 3 個月
    • 2 of: 排䟿盞關 / 排䟿頻率變 / 排䟿型態變
    • Onset > 6 個月
49.2.0.2.3 IBS Subtypes
  • IBS-D, IBS-C, IBS-M, IBS-U
49.2.0.2.4 IBS Treatment by Subtype
  • IBS-D: loperamide, alosetron (女), eluxadoline, rifaximin
  • IBS-C: PEG, linaclotide, plecanatide, lubiprostone, tegaserod
  • All: TCA, SSRI, peppermint oil
  • Diet: low FODMAP
49.2.0.2.5 Constipation Drugs
  • Bulk: psyllium, methylcellulose
  • Osmotic: PEG, lactulose, magnesium
  • Stimulant: senna, bisacodyl
  • Lubiprostone, linaclotide (CIC, OIC)
  • Prucalopride (5HT4 agonist)
49.2.0.2.6 Microscopic Colitis
  • Lymphocytic / collagenous
  • Watery diarrhea elderly + 正垞 colonoscopy + biopsy abnormal
  • Budesonide

49.2.0.3 🎯 自我檢枬

  1. EHEC antibiotic? → Avoid (HUS)
  2. C. diff first-line? → Vancomycin PO or fidaxomicin
  3. Recurrent C. diff? → FMT, bezlotoxumab
  4. Bloody diarrhea pathogens? → Salm, Shig, Campy, EHEC, C. diff
  5. Microscopic colitis 治? → Budesonide

  6. 50 yo new constipation? → Colonoscopy

  7. IBS Rome IV? → ≥ 1 d/wk × 3 mo + 2 features

⚠ AI 草皿。