86.2 📚 國考版醫垫國考 / PGY OSCE

86.2.0.1 📌 Cram Sheet

86.2.0.1.1 🔥 高 yield 15
  1. 台灣 CRC 癌生率第䞀
  2. Adenoma → CA: APC → KRAS → TP53
  3. CIN 85% / MSI 15% / CIMP
  4. Lynch MMR: MLH1/MSH2/MSH6/PMS2/EPCAM
  5. FAP APC, near 100% CRC by 40s
  6. USPSTF 45-75 / Taiwan 50-74 FIT
  7. Universal MSI/IHC all CRC
  8. Right = IDA, Left = obstruction/hematochezia
  9. Adjuvant FOLFOX Stage III × 6 mo (or 3 mo CapeOX low-risk, IDEA)
  10. MSI-H Stage II 䞍 adjuvant
  11. Rectal: neoadj CRT/TNT + TME
  12. MSI-H → pembrolizumab (KEYNOTE-177)
  13. Left RAS-WT → cetuximab/panitumumab 1st line preferred
  14. BRAF V600E → encorafenib + cetuximab (BEACON)
  15. HER2+ RAS-WT → tucatinib + trastuzumab
86.2.0.1.2 🔢 必背
項目 æ•žå­—
USPSTF age 45-75
Taiwan FIT age 50-74
Lynch CRC lifetime 70-80%
Lynch endometrial 60%
Adjuvant FOLFOX 6 mo
IDEA low-risk Stage III 3 mo CapeOX
KRAS WT 機率 ~50%
BRAF V600E ~10%
HER2+ CRC ~3-5%
MSI-H ~15%

86.2.0.2 ⭐ 高 yield

86.2.0.2.1 Lynch Syndrome
  • AD, MMR genes
  • Right-sided, mucinous, MSI-H, TIL+
  • Cancers: CRC, endometrial, gastric, ovarian, urothelial, brain, skin (Muir-Torre)
  • Surveillance: colonoscopy q1-2y from 20-25
  • Universal screening: MSI / IHC of all CRC
86.2.0.2.2 FAP Variants
  • Gardner: osteoma, desmoid, soft tissue
  • Turcot: CNS tumor (medulloblastoma)
  • Attenuated FAP: < 100 polyps, later age
  • MUTYH-AP: AR, mimics
86.2.0.2.3 Sided-ness Effect
  • Left (descending, sigmoid, rectum): RAS-WT + add EGFR (cetuximab/panitumumab) — better OS
  • Right (cecum, ascending): less benefit from EGFR; more BRAF V600E, MSI-H, sessile serrated
86.2.0.2.4 Drug Quick
Target Drug
EGFR Cetuximab, panitumumab (RAS-WT only)
VEGF Bevacizumab, aflibercept, ramucirumab
BRAF V600E Encorafenib + cetuximab
HER2+ RAS-WT Tucatinib + trastuzumab; T-DXd
MSI-H Pembrolizumab, nivolumab + ipi, dostarlimab
KRAS G12C Sotorasib + cetuximab; adagrasib
NTRK Larotrectinib
Multi-TKI 3rd Regorafenib, fruquintinib
Nucleoside TAS-102 (FTD/TPI)
86.2.0.2.5 Trial Names
  • MOSAIC: FOLFOX adjuvant III
  • IDEA: 3 vs 6 mo
  • PRODIGE-23 / RAPIDO: TNT rectal
  • KEYNOTE-177: pembro 1st line MSI-H MBC
  • CheckMate 8HW: nivo + ipi MSI-H
  • BEACON: encorafenib + cetuximab BRAF
  • MOUNTAINEER: tucatinib + trastuzumab HER2+
  • CodeBreaK: sotorasib KRAS G12C
  • CRYSTAL / FIRE-3: cetuximab vs bev sided-ness

86.2.0.3 🎯 自我檢枬

  1. CRC pathway 3? → CIN, MSI, CIMP
  2. Adenoma sequence? → APC → KRAS → TP53
  3. Lynch genes? → MLH1/MSH2/MSH6/PMS2/EPCAM
  4. FAP gene? → APC
  5. USPSTF age? → 45-75
  6. Right-sided typical sx? → IDA
  7. Left-sided sx? → Obstruction, hematochezia
  8. Stage III adjuvant? → FOLFOX × 6 mo
  9. Cetuximab who benefits? → Left + RAS WT
  10. MSI-H 1st line? → Pembrolizumab
  11. BRAF V600E drug? → Encorafenib + cetuximab
  12. HER2+ RAS-WT drug? → Tucatinib + trastuzumab
  13. Watch & wait rectal? → Complete clinical response post-TNT
  14. Anal cancer treatment? → Nigro (5-FU + MMC + RT)
  15. CEA role? → Surveillance + prognosis

⚠ AI 草皿。