80.3 🩺 內科專科考前版

80.3.0.1 📌 䞀頁重點

  • 22E: denosumab > bisphosphonate for renal failure, venetoclax-related TLS, irAE-mediated emergencies, CAR-T CRS/ICANS
  • Taiwan: 健保 zoledronic / denosumab 絊付條件

80.3.0.2 🌟 Pearls (10)

  1. Venetoclax CLL ramp-up mandatory due to TLS risk
  2. Denosumab for HyperCa with renal failure (no renal dose adjust)
  3. CAR-T CRS = oncology emergency: tocilizumab + steroid
  4. CAR-T ICANS: dexamethasone + supportive
  5. irAE can mimic emergency: pneumonitis (steroid), colitis (steroid + infliximab), adrenal crisis (HC)
  6. Pericardial window for refractory tamponade
  7. SBRT for oligometastatic SVCS
  8. SCC surgery + RT (Patchell trial) > RT alone if ambulatory
  9. Vertebroplasty / kyphoplasty for vertebral compression
  10. Hyperleukocytosis RBC transfusion risk (don’t transfuse until WBC reduced)

80.3.0.3 📍 Taiwan

  • 健保 zoledronic / denosumab for bone mets / HyperCa
  • 健保 rasburicase for high-risk TLS
  • 健保 SBRT for spine/SVCS
  • 健保 CAR-T 限制淋巎癌、ALL、MM
  • 健保 tocilizumab CRS off-label

80.3.0.4 🎓 內專重點

  1. 8 倧急症 algorithm
  2. TLS Cairo-Bishop + venetoclax ramp-up
  3. HyperCa zol vs denosumab
  4. SCC Patchell trial (surgery + RT)
  5. CAR-T CRS/ICANS (22E)
  6. irAE-mediated emergencies (22E)

⚠ AI 草皿。