58.2 📚 國考版醫垫國考 / PGY OSCE

58.2.0.1 📌 Cram Sheet

58.2.0.1.1 🔥 高 yield 12
  1. 6 步驟 ABG analysis
  2. AG = Na - (Cl + HCO3), normal 8-12
  3. HAGMA = MUDPILES
  4. NAGMA = HARDUP (or diarrhea)
  5. Winter’s formula for compensation
  6. Acute vs chronic resp acidosis compensation
  7. Saline-responsive (urine Cl < 20) vs resistant
  8. Toxic alcohol = high AG + high OG → fomepizole
  9. Salicylate = mixed RA + HAGMA
  10. DKA: insulin + IV fluid + K monitor
  11. RTA: type 1 (distal hypoK), type 2 (proximal hypoK), type 4 (hyperK)
  12. Delta-delta for mixed metabolic disorders
58.2.0.1.2 🔢 必背
項目 æ•žå­—
pH normal 7.35-7.45
PaCO2 35-45
HCO3 22-26
AG normal 8-12
Albumin AG correct + 2.5 per 1 g/dL < 4
Winter’s 1.5 × HCO3 + 8 ± 2
Acute resp ΔHCO3 = 1 per 10 PaCO2
Chronic resp ΔHCO3 = 4 per 10 PaCO2
OG normal < 10
58.2.0.1.3 易錯
  • 䞍算 AG
  • 䞍算 expected compensation
  • COPD high O2
  • DKA 䞍 K monitor

58.2.0.2 ⭐ 高 yield

58.2.0.2.1 Stepwise Analysis
  1. pH (acidosis vs alkalosis)
  2. Identify primary disturbance
  3. Calculate expected compensation
  4. AG if 酾
  5. Delta-delta if HAGMA
  6. OG if toxic alcohol suspected
58.2.0.2.2 MUDPILES (HAGMA)
  • M: methanol
  • U: uremia
  • D: DKA
  • P: propylene glycol
  • I: iron / INH
  • L: lactic
  • E: ethylene glycol
  • S: salicylate
58.2.0.2.3 HARDUP (NAGMA)
  • H: hyperalimentation
  • A: Addison’s
  • R: RTA
  • D: diarrhea
  • U: ureterosigmoidostomy
  • P: pancreatic fistula
58.2.0.2.4 RTA Comparison
Type Site UpH K Stones
1 (distal) distal H+ secretion fails > 5.5 low calcium phosphate
2 (proximal) HCO3 wasting variable low rare
4 (hypoaldosterone) DM/CKD low high rare
58.2.0.2.5 Toxic Alcohol Treatment
  • Fomepizole: alcohol dehydrogenase inhibitor
  • Dialysis if severe
  • Methanol: + folate
  • Ethylene glycol: + thiamine + B6
58.2.0.2.6 Salicylate Poisoning
  • Tinnitus + AG acidosis + resp alkalosis (mixed)
  • NaHCO3 alkalinize urine
  • Dialysis if severe
58.2.0.2.7 Lactic Acidosis Types
  • A: tissue hypoperfusion (sepsis, shock)
  • B: 䞍 hypoperfusion related (toxin: metformin, Linezolid, propofol; drug: salicylate; thiamine def)
  • D-lactic: short bowel syndrome, fermenting bacteria
58.2.0.2.8 Metabolic Alkalosis
  • Saline-responsive: vomit, diuretic resolved (UCl < 20)
  • Saline-resistant: hyperaldosterone, hypoK, current diuretic (UCl > 20)

58.2.0.3 🎯 自我檢枬

  1. AG normal? → 8-12
  2. Albumin correct AG? → + 2.5 per 1 g < 4
  3. Winter’s formula? → 1.5 × HCO3 + 8 ± 2
  4. MUDPILES? → Methanol/Uremia/DKA/Propylene glycol/Iron-INH/Lactic/Ethylene glycol/Salicylate
  5. RTA type 4 K? → High
  6. Methanol / EG treatment? → Fomepizole
  7. Salicylate ABG? → Mixed RA + HAGMA
  8. Saline-responsive metabolic alkalosis UCl? → < 20
  9. Acute respiratory acidosis HCO3 change? → ↑ 1 per 10 PaCO2
  10. Chronic respiratory acidosis HCO3 change? → ↑ 4 per 10 PaCO2

⚠ AI 草皿。