85.2 📚 國考版醫垫國考 / PGY OSCE

85.2.0.1 📌 Cram Sheet

85.2.0.1.1 🔥 高 yield 12
  1. 食道 SCC 侊 2/3 + 菞+酒+檳抔食道 adeno 例 1/3 + Barrett’s
  2. Plummer-Vinson = post-cricoid SCC
  3. CROSS = carbo + paclitaxel + RT preop
  4. CheckMate 577: adjuvant nivolumab × 1 yr if no pCR
  5. HER2+ esoph adeno: trastuzumab + chemo (ToGA)
  6. Gastric: H. pylori biggest risk
  7. Lauren intestinal vs diffuse (signet, linitis plastica, CDH1)
  8. Virchow / Sister Mary Joseph / Krukenberg / Blumer = mets clues
  9. FLOT perioperative for resectable gastric
  10. Pembro + chemo for PD-L1 CPS ≥ 5 gastric
  11. Claudin 18.2 → zolbetuximab
  12. GIST KIT+ → imatinib
85.2.0.1.2 🔢 必背
項目 æ•žå­—
Esoph SCC location 侊 2/3
Esoph adeno location 例 1/3
HER2+ ToGA threshold IHC 3+ or IHC 2+ + FISH
PD-L1 CPS gastric ≥ 5
FLOT cycles 4 pre + 4 post
CROSS RT dose 41.4 Gy
HDGC CDH1 Prophylactic gastrectomy 20s

85.2.0.2 ⭐ 高 yield

85.2.0.2.1 Esophageal
  • SCC: 菞+酒+檳抔, hot beverages, achalasia, Plummer-Vinson, lye
  • Adeno: Barrett’s + GERD + obesity
  • Treatment: CROSS preop → surgery → adjuvant nivolumab if no pCR
85.2.0.2.2 Gastric
  • H. pylori CagA, EBV (~10%)
  • Lauren intestinal (better) vs diffuse (CDH1, worse)
  • Linitis plastica = diffuse type
  • Krukenberg = ovarian mets from signet-ring
  • Virchow = L supraclav LN
85.2.0.2.3 Drugs Quick
Target Drug
HER2 Trastuzumab → T-DXd
PD-1 Pembro, nivo
VEGFR2 Ramucirumab
Claudin 18.2 Zolbetuximab
MSI-H Pembro
KIT/PDGFRA Imatinib (GIST)
PDGFRA D842V Avapritinib (GIST)
85.2.0.2.4 Trial Names
  • ToGA: trastuzumab gastric
  • CROSS: chemo-RT esoph
  • CheckMate 577: nivo adjuvant esoph
  • CheckMate 648 / KEYNOTE-590: pembro/nivo 1st line esoph
  • KEYNOTE-859 / 062: pembro gastric
  • DESTINY-Gastric 01/02: T-DXd
  • SPOTLIGHT: zolbetuximab Claudin 18.2
  • B-MAGIC / FLOT4: perioperative regimens

85.2.0.3 🎯 自我檢枬

  1. Esoph SCC location? → 侊 2/3
  2. Esoph adeno risk? → Barrett’s, GERD, obesity
  3. CROSS regimen? → Carbo + paclitaxel + RT
  4. Adjuvant if no pCR? → Nivolumab (CheckMate 577)
  5. Gastric biggest risk? → H. pylori
  6. Lauren diffuse → CDH1? → Yes (HDGC, prophylactic gastrectomy)
  7. Krukenberg tumor? → Ovarian mets from signet-ring gastric
  8. Virchow node? → L supraclavicular
  9. FLOT regimen? → 5-FU + leuc + oxaliplatin + docetaxel perioperative
  10. HER2+ gastric 1st line? → Trastuzumab + chemo
  11. Claudin 18.2 drug? → Zolbetuximab
  12. GIST 1st line? → Imatinib

⚠ AI 草皿。