63.2 📚 國考版醫垫國考 / PGY OSCE

63.2.0.1 📌 Cram Sheet

63.2.0.1.1 🔥 高 yield 10
  1. 5 類: morbilliform / urticaria / fixed / DRESS / SJS-TEN
  2. **HLA-B*1502 + carbamazepine** = SJS 亞掲
  3. **HLA-B*5801 + allopurinol** = SJS/TEN/DRESS
  4. **HLA-B*5701 + abacavir** = HSR
  5. DRESS 2-8 wk + LAP + eos + multi-organ + HHV-6 reactivation
  6. SJS < 10%, TEN > 30% BSA
  7. SCORTEN for TEN mortality
  8. Cyclosporine emerging > IVIG/steroid for TEN
  9. AGEP β-lactam, terbinafine, CCB + 突癌 pustules
  10. DRESS sequelae: 自體免疫 (DM, thyroid)
63.2.0.1.2 🔢 必背
項目 æ•žå­—
Morbilliform onset 7-14 d
DRESS onset 2-8 wk
SJS BSA < 10%
SJS/TEN overlap 10-30%
TEN BSA > 30%
TEN mortality 30-50%
DRESS mortality ~10%

63.2.0.2 ⭐ 高 yield

63.2.0.2.1 SCORTEN (TEN mortality)
  • Age > 40
  • Malignancy
  • HR > 120
  • BSA > 10%
  • BUN > 28
  • Glucose > 252
  • Bicarb < 20
63.2.0.2.2 Drug Eruption Time
病 起始
Urticaria < 1 hr
AGEP 1-3 d
Morbilliform 7-14 d
SJS/TEN 1-3 wk
DRESS 2-8 wk
63.2.0.2.3 HLA Pharmacogenomics 對照
Drug HLA Reaction Population
Carbamazepine B*1502 SJS/TEN Asian
Carbamazepine A*3101 DRESS Asian + EU
Allopurinol B*5801 SJS/TEN/DRESS All
Abacavir B*5701 HSR All
Dapsone B*13:01 DRESS Asian
Phenytoin B*1502 SJS/TEN Asian
63.2.0.2.4 TEN Treatmentevidence shifting
  • 停藥 + 燒傷 ICU
  • Cyclosporine 3-5 mg/kg/d → 22E preferred
  • IVIG 2 g/kg total
  • Steroid: controversial郚分 increase mortality
  • TNF-α inhibitor (etanercept) — emerging

63.2.0.3 🎯 自我檢枬

  1. SJS BSA? → < 10%
  2. TEN BSA? → > 30%
  3. DRESS time? → 2-8 wk
  4. Carbamazepine HLA 亞掲? → B*1502
  5. Allopurinol HLA? → B*5801
  6. Abacavir HLA? → B*5701
  7. AGEP 機蜉? → 倚 β-lactam + neutrophilic
  8. TEN 治療 evidence shift to? → Cyclosporine
  9. DRESS sequelae å…©çš®? → DM, thyroiditis
  10. SCORTEN > 5 mortality? → > 90%

⚠ AI 草皿。