82.2 📚 國考版醫垫國考 / PGY OSCE

82.2.0.1 📌 Cram Sheet

82.2.0.1.1 🔥 高 yield 12
  1. Risk: 菞 + 酒 + 檳抔synergistic
  2. HPV 16+ oropharynx (tonsil, base of tongue), 預埌奜
  3. EBV NPC, 台灣/華南 endemic
  4. Plummer-Vinson = Fe deficiency + post-cricoid SCC
  5. Wood dust → sinonasal adenocarcinoma
  6. Adult unilateral serous OM → 排 NPC
  7. Hoarseness → glottic
  8. Otalgia referred = V cranial nerve, oropharynx
  9. Concurrent cisplatin + RT locally advanced
  10. Cetuximab + RT if cisplatin ineligible
  11. Pembrolizumab recurrent/metastatic CPS ≥ 1
  12. Pre-RT dental clearance (osteoradionecrosis)
82.2.0.1.2 🔢 必背
項目 æ•žå­—
Cisplatin RT dose 100 mg/m² q3w × 3
HPV+ oropharynx survival better
Smoking H&N risk 5-25×
EBV+ NPC 䞻芁圚華南、台灣、東南亞
Pembrolizumab CPS threshold ≥ 1 (combo), ≥ 20 (mono)

82.2.0.2 ⭐ 高 yield

82.2.0.2.1 Subsite Quick
Subsite Risk Key
Oral cavity 菞+酒+檳抔 Tongue, leukoplakia precursor
Oropharynx HPV / 菞+酒 Tonsil, base of tongue
Larynx 菞 Hoarseness early
Hypopharynx 菞+酒 Piriform sinus, late
Nasopharynx EBV Cervical LN, hearing loss
Sinonasal Wood dust Adenocarcinoma
Salivary — Pleomorphic, mucoepidermoid
82.2.0.2.2 Salivary Gland Tumors
  • Pleomorphic adenoma: most common, benign, recurrent if incomplete excision
  • Warthin tumor: benign, smokers, bilateral
  • Mucoepidermoid carcinoma: most common malignant salivary
  • Adenoid cystic: perineural invasion, late distant mets
  • Acinic cell, salivary duct: rare
82.2.0.2.3 Premalignant Oral Lesions
  • Leukoplakia: 5% transform
  • Erythroplakia: 50% transform → biopsy
  • Submucous fibrosis (檳抔)
  • Lichen planus (low risk)
82.2.0.2.4 Treatment Algorithm
  • T1-2 N0: surgery OR RT alone
  • T3-4 / N+ resectable: surgery + adjuvant CRT (ECE, +margin)
  • Unresectable: definitive concurrent CRT
  • Recurrent/metastatic: pembro / nivo / cetuximab + chemo
  • NPC: chemo-RT (no surgery typically); induction GP
82.2.0.2.5 EXTREME Regimen
  • Cetuximab + cisplatin + 5-FU
  • For recurrent/metastatic platinum-naive

82.2.0.3 🎯 自我檢枬

  1. 5 倧 risks? → 菞/酒/檳抔/HPV/EBV
  2. HPV oropharynx subsites? → Tonsil, base of tongue
  3. EBV-related cancer? → NPC
  4. Plummer-Vinson cancer? → Post-cricoid SCC
  5. Adult unilateral serous OM? → NPC suspect
  6. Concurrent CRT drug? → Cisplatin
  7. Cetuximab role? → Cisplatin ineligible / EXTREME
  8. Pembro CPS mono threshold? → ≥ 20
  9. Pre-RT必須? → Dental clearance
  10. Most common malignant salivary? → Mucoepidermoid
  11. Adenoid cystic key feature? → Perineural invasion
  12. NPC induction regimen? → Gemcitabine + cisplatin

⚠ AI 草皿。