78.2 📚 國考版醫垫國考 / PGY OSCE

78.2.0.1 📌 Cram Sheet

78.2.0.1.1 🔥 高 yield 12
  1. 4 倧支柱: surgery / RT / chemo / targeted-immuno
  2. 意圖: curative / adjuvant / neoadjuvant / palliative
  3. Chemo 5 類: alkylating, antimetabolite, antitumor abx, plant alkaloid, hormonal
  4. Cisplatin 3N: Nephro, Neuro, Oto + Mg waste
  5. Doxorubicin cardiotoxic (cumulative)
  6. Bleomycin pulmonary fibrosis
  7. Vincristine never IT (臎呜)
  8. Cyclophosphamide + mesna (hemorrhagic cystitis)
  9. Tamoxifen endometrial + DVT
  10. Trastuzumab cardiotoxic
  11. Bevacizumab HTN, proteinuria, GI perf
  12. CAR-T CRS + ICANS
78.2.0.1.2 🔢 必背
項目 æ•žå­—
Doxorubicin lifetime dose < 450 mg/m²
Bleomycin lifetime < 400 units
Tamoxifen duration 5-10 yr
AI duration breast 5-10 yr
Cisplatin emetogenic High (4-drug regimen)

78.2.0.2 ⭐ 高 yield

78.2.0.2.1 Drug Toxicities Quick
Toxicity Drug
Cardiotoxic Doxorubicin, trastuzumab, 5-FU (rare)
Pulmonary fibrosis Bleomycin, busulfan
Hemorrhagic cystitis Cyclophosphamide, ifosfamide
Neuropathy Cisplatin, vincristine, paclitaxel, oxaliplatin
Mucositis 5-FU, methotrexate
Hand-foot 5-FU, capecitabine, sorafenib
Hyperuricemia TLS post-chemo
HTN/proteinuria VEGF inhibitor (bevacizumab)
Thyroid dysfunction Checkpoint inhibitor, sunitinib
Pneumonitis Bleomycin, methotrexate, checkpoint inhibitor
78.2.0.2.2 Tumor Agnostic Therapies (22E)
  • Pembrolizumab for MSI-H any cancer
  • Larotrectinib, entrectinib for NTRK fusion
  • Dabrafenib + trametinib for BRAF V600E (incl. unusual primary)
  • Selpercatinib for RET fusion
78.2.0.2.3 Tumor Lysis Syndrome (TLS)
  • Lab: K ↑, P ↑, uric acid ↑, Ca ↓, AKI
  • Risk: high-grade lymphoma, ALL, large MM, CLL with venetoclax
  • Prevention: hydration + allopurinol + rasburicase
78.2.0.2.4 Cytokine Release Syndrome (CRS) post CAR-T
  • Fever, hypotension, hypoxia
  • Treatment: tocilizumab (anti-IL-6), steroid
  • ICANS: encephalopathy, seizure → steroid + supportive

78.2.0.3 🎯 自我檢枬

  1. Vincristine 絊 IT? → 臎呜 (must IV)
  2. Cyclophosphamide + 防 hemorrhagic cystitis? → Mesna
  3. Doxorubicin lifetime dose limit? → 450 mg/m²
  4. Bleomycin toxicity? → Pulmonary fibrosis
  5. Tamoxifen 2 副䜜甚? → Endometrial ca + DVT
  6. Trastuzumab toxicity? → Cardiotoxic
  7. Bevacizumab 3 副䜜甚? → HTN, proteinuria, GI perforation
  8. Cisplatin 3N? → Nephro, Neuro, Oto
  9. CAR-T 兩 toxicities? → CRS + ICANS
  10. Tumor agnostic for MSI-H? → Pembrolizumab
  11. NTRK fusion drug? → Larotrectinib
  12. CRS treat? → Tocilizumab + steroid

⚠ AI 草皿。