83.2 📚 國考版醫垫國考 / PGY OSCE

83.2.0.1 📌 Cram Sheet

83.2.0.1.1 🔥 高 yield 15
  1. NSCLC 85% / SCLC 15%
  2. Adeno 50% — driver mutation 倚
  3. Squamous 䞭倮型 + cavitation + hyperCa (PTHrP)
  4. SCLC 䞭倮型 + paraneoplastic (SIADH/Cushing/LEMS)
  5. LDCT screening: 50-80 + 20PY + quit < 15 yr (USPSTF)
  6. NGS panel mandatory for adeno: EGFR/ALK/ROS1/KRAS/BRAF/MET/RET/HER2/NTRK
  7. EGFR → osimertinib 1st line
  8. ALK → alectinib / lorlatinib 1st line
  9. KRAS G12C → sotorasib / adagrasib
  10. PD-L1 ≥ 50% → pembro mono
  11. PD-L1 < 50% → pembro + chemo
  12. Stage III unresectable: CRT + durvalumab (PACIFIC)
  13. SCLC ED: platinum + etoposide + atezo/durva
  14. Brain MRI for adeno + SCLC staging
  15. Pancoast → Horner’s
83.2.0.1.2 🔢 必背
項目 æ•žå­—
LDCT age 50-80
Pack-year ≥ 20
Quit < 15 yr
Adeno % ~50% NSCLC
Squamous % ~25% NSCLC
SCLC % ~15% all
Smoking SCLC % 99%
EGFR mutation Asian women 高頻

83.2.0.2 ⭐ 高 yield

83.2.0.2.1 Driver Mutation Drug Quick
Mutation Drug
EGFR (L858R, ex19 del) Osimertinib
EGFR T790M Osimertinib
ALK Alectinib, lorlatinib
ROS1 Crizotinib, entrectinib
KRAS G12C Sotorasib, adagrasib
BRAF V600E Dabrafenib + trametinib
MET ex14 skip Capmatinib, tepotinib
RET fusion Selpercatinib
NTRK Larotrectinib
HER2 ex20 T-DXd
83.2.0.2.2 Paraneoplastic by Histology
Syndrome Histology
SIADH SCLC
Cushing’s (ACTH) SCLC, carcinoid
HyperCa (PTHrP) Squamous
LEMS SCLC
Hypertrophic osteoarthropathy NSCLC adeno
Anti-Hu encephalitis SCLC
DVT/Trousseau Any
83.2.0.2.3 Special Locations
  • Pancoast (superior sulcus): shoulder/arm + Horner’s + hand atrophy
  • Hilar mass: squamous, SCLC
  • Peripheral nodule: adeno
  • Cavitating mass: squamous
83.2.0.2.4 NSCLC Stages Treatment Quick
  • I-II: surgery + adjuvant chemo (T2b+/N+)
  • IIIA resectable: surgery + adjuvant CRT (or neoadj chemo-immuno + surgery)
  • III unresectable / IIIB: CRT + durvalumab consolidation
  • IV driver mutation: TKI
  • IV no driver, PD-L1 ≥ 50%: pembro mono
  • IV no driver, PD-L1 < 50%: pembro + chemo
83.2.0.2.5 Resistance to EGFR TKI
  • T790M (gatekeeper) → osimertinib
  • C797S (after osimertinib) → trials
  • MET amplification → MET inhibitor combos
  • HER2 amplification
83.2.0.2.6 SCLC Treatment Highlights
  • LD: cisplatin + etoposide + concurrent thoracic RT + PCI for responders
  • ED: platinum + etoposide + atezolizumab/durvalumab
  • Refractory: lurbinectedin, topotecan

83.2.0.3 🎯 自我檢枬

  1. NSCLC vs SCLC %? → 85 vs 15
  2. Most common NSCLC histology? → Adeno
  3. Squamous paraneoplastic? → HyperCa (PTHrP)
  4. SCLC paraneoplastic 4? → SIADH/Cushing/LEMS/anti-Hu
  5. LDCT criteria? → 50-80 + 20 PY + quit < 15 yr
  6. EGFR 1st line? → Osimertinib
  7. ALK 1st line? → Alectinib / lorlatinib
  8. KRAS G12C drug? → Sotorasib
  9. PD-L1 ≥ 50% mono? → Pembrolizumab
  10. Stage III unresectable consolidation? → Durvalumab (PACIFIC)
  11. SCLC ED 1st line? → Platinum + etoposide + atezo/durva
  12. PCI indicated when? → SCLC responders (mainly LD)
  13. Pancoast Horner triad? → Ptosis, miosis, anhidrosis
  14. Adeno screening for? → EGFR/ALK/PD-L1 + full NGS
  15. ADAURA trial? → Adjuvant osimertinib EGFR Stage IB-IIIA

⚠ AI 草皿。