77.2 📚 國考版醫垫國考 / PGY OSCE

77.2.0.1 📌 Cram Sheet

77.2.0.1.1 🔥 高 yield 12
  1. Cell cycle phases: G1 → S → G2 → M (+ G0)
  2. Cyclin D + CDK4/6 → RB phosphorylation → S
  3. CDK4/6 inhibitor: palbociclib for HR+/HER2- breast
  4. TP53 = guardian, 50%+ cancers mutate
  5. BCL-2 follicular t(14;18), venetoclax CLL/AML
  6. Apoptosis: intrinsic (mito) + extrinsic (death receptor)
  7. MAPK: RAS-RAF-MEK-ERK; BRAF V600E + dabrafenib + trametinib
  8. PI3K/AKT/mTOR: PTEN loss-of-function; everolimus mTOR
  9. JAK2 V617F = PV, ET, MF; ruxolitinib
  10. Wnt/β-catenin: APC loss in CRC
  11. VEGF angiogenesis: bevacizumab
  12. EMT + E-cadherin loss = metastasis
77.2.0.1.2 🔢 必背
Cyclin CDK Phase
D 4, 6 G1/S
E 2 G1/S
A 2 S
B 1 M
77.2.0.1.3 Drug targets
Target Drug
CDK4/6 Palbociclib
BCL-2 Venetoclax
BRAF V600E Dabrafenib
MEK Trametinib
mTOR Everolimus
JAK Ruxolitinib
VEGF Bevacizumab
HER2 Trastuzumab
EGFR Osimertinib
ALK Alectinib
BCR-ABL Imatinib
Hedgehog Vismodegib
PARP Olaparib

77.2.0.2 ⭐ 高 yield

77.2.0.2.1 Hallmarks 6+4+
  1. Sustained proliferation
  2. Evading growth suppressors
  3. Resisting apoptosis
  4. Replicative immortality (telomerase)
  5. Angiogenesis
  6. Invasion + metastasis
    1. Reprogrammed metabolism (Warburg)
    1. Avoiding immune destruction
    1. Genome instability
    1. Tumor-promoting inflammation
  • (新增 2022): plasticity, epigenetic, microbiome, senescent cells
77.2.0.2.2 Translocations Quick
  • BCR-ABL t(9;22) — CML, ALL
  • PML-RARA t(15;17) — APL
  • MYC t(8;14) — Burkitt
  • BCL2 t(14;18) — Follicular
  • CCND1 t(11;14) — Mantle cell
  • EWS-FLI1 t(11;22) — Ewing
  • NPM-ALK t(2;5) — ALCL
  • EML4-ALK — NSCLC
77.2.0.2.3 Apoptosis
  • Intrinsic: mitochondrial, BCL-2/BAX/BAK, cytochrome c, caspase-9
  • Extrinsic: Fas/TNF, caspase-8
77.2.0.2.4 Immune Evasion
  • PD-L1 on tumor → exhausts T cell
  • CTLA-4 inhibits T cell priming
  • Pembrolizumab, nivolumab = anti-PD-1
  • Atezolizumab = anti-PD-L1
  • Ipilimumab = anti-CTLA-4

77.2.0.3 🎯 自我檢枬

  1. Cyclin D partner CDK? → 4, 6
  2. CDK4/6 inhibitor? → Palbociclib (HR+/HER2- breast)
  3. TP53 function? → DNA damage → arrest/apoptosis
  4. BCL-2 t(14;18)? → Follicular lymphoma
  5. Venetoclax target? → BCL-2 (CLL, AML)
  6. BRAF V600E drug? → Dabrafenib + trametinib
  7. JAK2 V617F MPN? → PV, ET, MF
  8. JAK inhibitor? → Ruxolitinib
  9. VEGF inhibitor? → Bevacizumab
  10. PD-L1 cancer drug? → Atezolizumab
  11. PARP inhibitor target? → BRCA mutant
  12. EMT marker loss? → E-cadherin

⚠ AI 草皿。