79.2 📚 國考版醫垫國考 / PGY OSCE

79.2.0.1 📌 Cram Sheet

79.2.0.1.1 🔥 高 yield 12
  1. FN definition: T ≥ 38.3°C single OR ≥ 38.0°C × 1h + ANC < 500
  2. 黃金 1 hour: pan-culture + IV antipseudomonal β-lactam
  3. Monotherapy: cefepime / pip-tazo / meropenem
  4. 加 vanco if: shock / catheter / mucositis / pneumonia / SSTI / MRSA history
  5. MASCC ≥ 21: low risk
  6. Persistent fever ≥ 4-7d → antifungal (caspofungin / vori / lipid AmB)
  7. 䞍 DRE in neutropenia
  8. PCP prophylaxis: TMP-SMX for HSCT/ALL/steroid > 20 mg × 4 wk
  9. HSV/VZV prophylaxis: acyclovir in HSCT/leukemia
  10. CMV preemptive: letermovir in HSCT
  11. Splenectomy → encapsulated → vaccines
  12. No live vaccines during chemo
79.2.0.1.2 🔢 必背
項目 æ•žå­—
FN T 定矩 38.3 single / 38.0 × 1h
FN ANC < 500
Severe ANC < 100
MASCC low-risk ≥ 21
Persistent fever 4-7 d → antifungal

79.2.0.2 ⭐ 高 yield

79.2.0.2.1 Risk by Defect
猺陷 病䟋 颚險 organisms
Neutropenia 化療 Bacteria (gram-neg), Candida, Aspergillus
Cellular Lymphoma, HSCT, steroid PCP, CMV, fungal, mycobacteria, listeria
Humoral MM, CLL, splenectomy Encapsulated (S. pneumo, Hib, Neisseria)
Mucosal Mucositis, catheter CoNS, viridans strep, S. aureus, Candida
79.2.0.2.2 Empiric Antibiotic Order
  1. Antipseudomonal β-lactam mono
  2. Add vanco for indications
  3. Persistent fever → add antifungal
  4. Consider catheter removal
79.2.0.2.4 Typhlitis (Neutropenic Enterocolitis)
  • AML chemo
  • Cecal pain + fever + neutropenia + diarrhea
  • CT: cecal wall thickening
  • Treat: bowel rest + broad-spectrum (incl anaerobes) + neutropenia recovery
  • Avoid surgery unless perforation
79.2.0.2.5 Key Specific Pathogens
  • Candidemia: Candida glabrata (azole-resistant), need echinocandin
  • Aspergillus: galactomannan, voriconazole 1st line
  • Mucor: rhino-orbital-cerebral, surgical debridement + amphotericin + isavuconazole
  • PCP: ground glass, LDH ↑, BAL silver stain → TMP-SMX
  • CMV: ganciclovir / valganciclovir / letermovir prophylaxis
  • VZV reactivation: dermatomal zoster + disseminated; acyclovir IV

79.2.0.3 🎯 自我檢枬

  1. FN definition? → T ≥ 38.3 / 38.0×1h + ANC < 500
  2. Empiric mono? → Cefepime / pip-tazo / meropenem
  3. 加 vanco indications? → Shock, catheter, mucositis, pneumonia, SSTI
  4. MASCC low-risk score? → ≥ 21
  5. Persistent fever → ? → Antifungal (caspofungin/vori)
  6. PCP prophylaxis indication? → HSCT/ALL/steroid > 20 mg × 4w
  7. CMV prophylaxis HSCT? → Letermovir
  8. Splenectomy infections? → Encapsulated (S. pneumo, Hib, Neisseria)
  9. Typhlitis? → AML neutropenic enterocolitis cecum
  10. Mucor treatment? → Surgery + amphotericin / isavuconazole
  11. Candida glabrata? → Azole resistant, echinocandin
  12. Aspergillus 1st line? → Voriconazole

⚠ AI 草皿。