68.2 📚 國考版醫垫國考 / PGY OSCE

68.2.0.1 📌 Cram Sheet

68.2.0.1.1 🔥 高 yield 8
  1. HLH-2004 criteria 5/8
  2. Ferritin ≥ 500 clinical / > 10,000 highly specific
  3. Primary 兒童 genetic (PRF1, UNC13D, STX11)
  4. Secondary 成人 — infection / cancer / autoimmune (MAS)
  5. HLH-94: etoposide + dex + IT MTX
  6. MAS = Still’s, SLE, Kawasaki
  7. Ruxolitinib emerging
  8. Anakinra for MAS + rituximab for EBV-HLH
68.2.0.1.2 🔢 必背
項目 æ•žå­—
Ferritin clinical cutoff ≥ 500
Ferritin high specific > 10,000
Cytopenia ≥ 2 lineage
Hgb cutoff < 9
Plt cutoff < 100
ANC cutoff < 1

68.2.0.2 ⭐ 高 yield

68.2.0.2.1 HLH-2004 (5/8)
  1. Fever
  2. Splenomegaly
  3. Cytopenia ≥ 2 lineage
  4. Hypertriglyceridemia / hypofibrinogenemia
  5. Ferritin ≥ 500
  6. Hemophagocytosis BM
  7. Low NK
  8. High sCD25
68.2.0.2.2 Adult Secondary HLH Triggers
  • Infection: EBV (most), CMV, dengue, malaria, parvovirus, HIV, COVID
  • Cancer: T-cell lymphoma (most), B-NHL, AML
  • Autoimmune (MAS): Adult-onset Still’s, SLE, RA
  • Drug-induced (rare)
68.2.0.2.3 MAS Specific
  • 圚 autoimmune setting
  • Often Still’s disease (juvenile or adult-onset)
  • Treat: high-dose steroid + cyclosporine + anakinra (IL-1 antagonist)
68.2.0.2.4 EBV-Driven HLH
  • High EBV viral load
  • Rituximab + HLH-94

68.2.0.3 🎯 自我檢枬

  1. HLH-2004 criteria æ•ž? → 5/8
  2. Ferritin highly specific? → > 10,000
  3. Primary HLH genes 3? → PRF1, UNC13D, STX11
  4. Secondary 䞉類 trigger? → Infection / cancer / autoimmune
  5. HLH-94 䞉藥? → Etoposide + dex + IT MTX
  6. MAS first-line additional? → Anakinra
  7. EBV HLH 加? → Rituximab
  8. Ruxolitinib target? → JAK1/2 (22E emerging)

⚠ AI 草皿。