69.2 📚 國考版醫垫國考 / PGY OSCE

69.2.0.1 📌 Cram Sheet

69.2.0.1.1 🔥 高 yield 12
  1. PT extrinsic (VII), aPTT intrinsic (VIII/IX)
  2. PT + aPTT both ↑: common, DIC, liver
  3. Hemophilia A (VIII), B (IX): X-linked, hemarthrosis
  4. vWD most common inherited: mucocutaneous + ristocetin cofactor
  5. DIC: PT/aPTT ↑, fibrinogen ↓, plt ↓, D-dimer ↑↑↑
  6. APL DIC → ATRA STAT
  7. APS: VTE + pregnancy loss + 3 Ab
  8. HIT 4T score → stop heparin, argatroban
  9. Factor V Leiden = most common inherited thrombophilia (5% Caucasian)
  10. Warfarin skin necrosis = Pro C def
  11. DOAC reverse: idarucizumab (dab), andexanet (Xa) / 4F-PCC
  12. Emicizumab = bispecific Ab for hemophilia A (22E)
69.2.0.1.2 🔢 必背
項目 æ•žå­—
INR target VTE 2-3
INR target mech valve 2.5-3.5
aPTT heparin 1.5-2.5×
4T HIT high ≥ 6
4T HIT intermediate 4-5
ITP transfuse threshold < 30k or bleed
APL Auer rod treat ATRA + ATO

69.2.0.2 ⭐ 高 yield

69.2.0.2.1 Coagulation Test 對應 Factor
Test Factor
PT/INR II, V, VII, X, fibrinogen
aPTT VIII, IX, XI, XII, V, X, II, fibrinogen
TT Fibrinogen, heparin
Mixing study Distinguish factor def vs inhibitor
69.2.0.2.2 Hemophilia
A B
Factor VIII IX
Inheritance X-linked X-linked
Severity < 1% severe / 1-5 mod / 5-30 mild Same
Treat rFVIII / DDAVP (mild) / emicizumab prophylaxis rFIX
69.2.0.2.3 vWD Types
Type Defect
1 Partial quantitative
2A/B/M/N Qualitative
3 Severe (homozygous)
69.2.0.2.4 DIC Causes (STOP Making Pathologic Thrombi)
  • Sepsis
  • Trauma / Toxin (snake)
  • Obstetric (abruption, AFE, retained POC, HELLP)
  • Pancreatitis
  • Malignancy (APL)
  • Pulmonary (ARDS)
  • Transfusion (massive)
69.2.0.2.5 APS Criteria
  • Lupus anticoagulant
  • Anti-cardiolipin
  • Anti-β2-glycoprotein 1
  • Clinical: VTE / arterial / pregnancy morbidity
  • 12 weeks confirm
69.2.0.2.6 HIT 4T Score
  • Thrombocytopenia magnitude
  • Timing (5-10 days post heparin)
  • Thrombosis (new)
  • OTher causes excluded
  • ≥ 6 high; 4-5 intermediate; ≀ 3 low
69.2.0.2.7 Inherited Thrombophilia Workup Order
  1. APC resistance (Factor V Leiden screen)
  2. Prothrombin G20210A
  3. Antithrombin
  4. Protein C / S
  5. Anticardiolipin / β2GP1 / Lupus AC

69.2.0.3 🎯 自我檢枬

  1. PT vs aPTT ç•°åžž cause? → PT extrinsic, aPTT intrinsic
  2. vWD test? → Ristocetin cofactor activity
  3. DIC labs? → ↑ PT/aPTT/D-dimer, ↓ fibrinogen/plt
  4. APL DIC treatment? → ATRA + ATO STAT
  5. APS 3 Ab? → Lupus AC, anti-CL, anti-β2GP1
  6. HIT 4T high? → ≥ 6
  7. HIT alternative AC? → Argatroban, bivalirudin, fondaparinux
  8. Factor V Leiden 機蜉? → APC resistance
  9. Warfarin skin necrosis? → Pro C def
  10. Dabigatran reverse? → Idarucizumab
  11. Emicizumab? → Bispecific Ab for hemophilia A prophylaxis (22E)
  12. ITP first-line? → Steroid + IVIG

⚠ AI 草皿。