57.2 📚 國考版醫垫國考 / PGY OSCE

57.2.0.1 📌 Cram Sheet

57.2.0.1.1 🔥 高 yield 10
  1. Albumin correct: + 0.8 × (4 - albumin)
  2. HyperCa 90% = 1° HPT (outpatient) + malignancy (inpatient)
  3. PTH-dependent vs PTH-suppressed workflow
  4. PTHrP = humoral hypercalcemia of malignancy (squamous, breast, renal)
  5. Granulomatous / lymphoma = 1,25-vit D mediated → steroid responsive
  6. HyperCa Mx: NS → calcitonin → bisphosphonate → denosumab
  7. Calcitonin tachyphylaxis 48 hr
  8. Chvostek + Trousseau = hypoCa
  9. Replace Mg first if hypoCa + hypoMg
  10. FHH = familial, low urine Ca, normal/high PTH, don’t operate
57.2.0.1.2 🔢 必背
項目 æ•žå­—
Normal Ca 8.5-10.5
Severe hyperCa > 14
Severe hypoCa < 7
Albumin correction + 0.8 × (4 - alb)
IV NS hyperCa 200-300 mL/h
Calcitonin dose 4 IU/kg q12h
Zoledronic acid 4 mg IV
Denosumab 60-120 mg SC
57.2.0.1.3 易錯
  • 未 albumin correct
  • Loop diuretic before hydration
  • 䞍查 Mg in hypoCa
  • IV Ca push 倪快
  • Calcitonin tachyphylaxis 挏

57.2.0.2 ⭐ 高 yield

57.2.0.2.1 Hypercalcemia DDx

PTH high/normal: - Primary HPT - Tertiary HPT (CKD) - FHH (CASR mutation, low UCa) - Lithium

PTH suppressed: - Malignancy (osteolytic, PTHrP, 1,25-D, MM) - Granulomatous (sarcoid, TB) - Vit D / A intoxication - Hyperthyroid - Adrenal insufficiency - Immobilization - Milk-alkali

57.2.0.2.2 Treatment Algorithm
Severity Tx
Mild < 12 hydration + treat cause
12-14 IV NS + bisphosphonate + treat
> 14 / sx IV NS + calcitonin + bisphosphonate + (steroid for granulomatous) ± dialysis
57.2.0.2.3 Bisphosphonate
  • Zoledronic acid 4 mg IV (preferred for malignancy)
  • Pamidronate 60-90 mg IV
  • Onset 24-48 hr, duration weeks
  • Renal dose adjust
  • Risk: ONJ, hypoCa, atypical fracture
57.2.0.2.4 Denosumab
  • For CKD severe (BP contraindicated)
  • 60-120 mg SC
  • Severe hypoCa risk (replete first)
57.2.0.2.5 Calcitonin
  • 4 IU/kg SC/IM q12h
  • Onset 4-6 hr
  • Tachyphylaxis 48 hr
57.2.0.2.6 Hypocalcemia Causes

Mnemonic 7P: - Post-thyroid surgery / Pseudohypoparathyroid - PTH (low) - hypoparathyroidism - Pancreatitis - Phosphate (hyperPO4 in CKD/TLS) - Plasma alkalosis - Mg low (functional) - Vit D Phototoxicity / def

57.2.0.2.7 Hypocalcemia Tx
  • Severe / sx: Ca gluconate 1-2 g IV over 10 min (peripheral)
  • IV calcium chloride central only
  • Replace Mg first if hypoMag
  • Chronic: oral Ca + calcitriol
57.2.0.2.8 Specific Conditions
  • DiGeorge: CATCH-22 (Cardiac, Abnormal facies, Thymic, Cleft palate, Hypocalcemia)
  • Hungry bone syndrome: post-parathyroidectomy massive Ca uptake
  • Pseudohypoparathyroidism: PTH high, end-organ resistance, Albright phenotype

57.2.0.3 🎯 自我檢枬

  1. HyperCa outpatient most common? → 1° HPT
  2. HyperCa inpatient most common? → Malignancy
  3. PTHrP source? → Squamous, breast, renal
  4. FHH urine Ca? → Low
  5. Calcitonin tachyphylaxis? → 48 hr
  6. Granulomatous hyperCa Tx? → Steroid
  7. HypoCa + hypoMg? → Replace Mg first
  8. Chvostek + Trousseau? → HypoCa
  9. Albumin correct formula? → + 0.8 × (4 - alb)
  10. Denosumab side effect? → Severe hypoCa, ONJ

⚠ AI 草皿。