55.2 📚 國考版醫垫國考 / PGY OSCE

55.2.0.1 📌 Cram Sheet

55.2.0.1.1 🔥 高 yield 12
  1. AKI 䞉分法: pre 55% / intrinsic 40% / post 5%
  2. KDIGO definition: Cr ↑ 0.3 in 48 hr or 1.5× baseline or UO < 0.5/kg/h × 6h
  3. FENa < 1% = pre / HRS / pigment / early ATN
  4. FENa > 2% = ATN
  5. BUN:Cr > 20 = pre-renal
  6. Muddy brown casts = ATN
  7. WBC casts = AIN / pyelonephritis
  8. RBC casts = GN
  9. Eosinophils = AIN
  10. AIN triad: rash + fever + eos (10-30%)
  11. Dialysis AEIOU
  12. Nephrotic > 3.5 g/d
55.2.0.1.2 🔢 必背
項目 æ•žå­—
KDIGO Cr ↑ 0.3 in 48h or 1.5× in 7d
KDIGO UO < 0.5/kg/h × 6h
FENa pre < 1%
FENa ATN > 2%
BUN:Cr pre > 20
Nephrotic protein > 3.5 g/d
GN protein < 3.5 g/d
GFR CKD < 60
55.2.0.1.3 易錯
  • 䞍算 FENa
  • 沒 review meds
  • BPH 挏 (老人 anuric)
  • ACEI 絊 bilateral RAS

55.2.0.2 ⭐ 高 yield

55.2.0.2.1 Pre-renal Causes
  • True hypovolemia
  • Effective hypovolemia: HF, cirrhosis, sepsis
  • Drugs: NSAID, ACEI/ARB, contrast
55.2.0.2.2 Intrinsic Subtypes
  • ATN
  • AIN (drug, sarcoid, tubulointerstitial)
  • Glomerular: nephritic vs nephrotic
  • Vascular
55.2.0.2.3 ATN Causes
  • Ischemic (持續 pre-renal)
  • Toxin: aminoglycoside, contrast, cisplatin, amphotericin
  • Pigment: rhabdo (myoglobin), hemolysis
  • Light chain (multiple myeloma)
  • Tumor lysis syndrome
55.2.0.2.4 AIN Causes
  • Drug: NSAID, β-lactam, PPI, sulfa
  • Infection: pyelonephritis, leptospirosis
  • Autoimmune: SLE, sarcoid
55.2.0.2.5 Glomerulonephritis

Nephritic (RBC casts, mild proteinuria, HTN, AKI): - IgA nephropathy - PSGN (post-strep) - GPA / MPA / EGPA (ANCA) - Anti-GBM (Goodpasture) - Lupus nephritis - HSP (IgA in skin/joint)

Nephrotic (> 3.5 g/d, edema, lipid): - Minimal change disease (children) — steroid responsive - FSGS (HIV, heroin, obesity) - Membranous (PLA2R Ab) — adults, often associated cancer - MPGN - Diabetic nephropathy

55.2.0.2.6 Contrast Nephropathy Prevention
  • Pre-hydration NS / NaHCO3
  • Stop nephrotoxic
  • Lowest contrast volume
  • Iso-osmolar contrast
55.2.0.2.7 Dialysis Indications (AEIOU)
  • A: severe acidosis
  • E: refractory hyperK
  • I: ingestion (methanol, ethylene glycol, salicylate, Li, isopropanol, propylene glycol)
  • O: refractory fluid overload
  • U: uremia (pericarditis, encephalopathy)

55.2.0.3 🎯 自我檢枬

  1. AKI three-tier? → Pre / intrinsic / post
  2. FENa < 1%? → Pre-renal (or HRS, pigment)
  3. Muddy brown? → ATN
  4. RBC casts? → GN
  5. Eosinophils urine? → AIN
  6. PSGN antibody? → ASO
  7. Anti-GBM? → Goodpasture
  8. Membranous adult marker? → PLA2R Ab
  9. Nephrotic protein? → > 3.5 g/d
  10. Dialysis AEIOU? → Acidosis / Electrolyte / Ingestion / Overload / Uremia

⚠ AI 草皿。