87.2 📚 國考版醫垫國考 / PGY OSCE

87.2.0.1 📌 Cram Sheet

87.2.0.1.1 🔥 高 yield 12
  1. HCC risks: HBV/HCV/alcohol/NASH/aflatoxin
  2. Surveillance: cirrhosis/HBV → AFP + US q6 mo
  3. LI-RADS 5 = arterial + washout = HCC (no biopsy in cirrhotic)
  4. BCLC staging (0/A/B/C/D)
  5. Milan: 1 ≀ 5 cm OR 2-3 ≀ 3 cm each
  6. HCC 1st line: atezo + bev (IMbrave150)
  7. HCC 1st line alt: durva + treme (HIMALAYA)
  8. HCC 2nd line: cabozantinib, regorafenib, ramucirumab (AFP+)
  9. Cholangio: PSC, liver flukes, hepatolithiasis
  10. Klatskin = perihilar
  11. iCCA targets: FGFR2 (pemigatinib), IDH1 (ivosidenib)
  12. TOPAZ-1: gem-cis + durvalumab cholangio
87.2.0.1.2 🔢 必背
項目 æ•žå­—
AFP HCC threshold > 200 (specific)
Surveillance interval q6 mo
Milan 1 nodule ≀ 5 cm
Milan 2-3 nodules ≀ 3 cm each
Ramucirumab AFP threshold > 400
iCCA FGFR2 % ~10-15%
iCCA IDH1 % ~20%

87.2.0.2 ⭐ 高 yield

87.2.0.2.3 Drug Quick HCC
Line Drug
1st Atezo + bev (IMbrave150)
1st alt Durva + treme (HIMALAYA)
1st alt Lenvatinib (REFLECT, vs sorafenib non-inferior)
1st historical Sorafenib (SHARP)
2nd Cabozantinib (CELESTIAL), regorafenib (RESORCE), ramucirumab AFP+ (REACH-2), pembrolizumab (KEYNOTE-240)
87.2.0.2.4 Cholangiocarcinoma Targets
Mutation Drug
FGFR2 fusion Pemigatinib, infigratinib, futibatinib
IDH1 Ivosidenib
BRAF V600E Dabrafenib + trametinib
HER2+ Trastuzumab, T-DXd
MSI-H Pembrolizumab
NTRK Larotrectinib
87.2.0.2.5 Gallbladder Cancer
  • Porcelain GB
  • Salmonella typhi carrier
  • Adjuvant: capecitabine (BILCAP)

87.2.0.3 🎯 自我檢枬

  1. HCC #1 risk Taiwan? → HBV
  2. Surveillance interval? → q6 mo AFP + US
  3. LI-RADS 5 imaging features? → Arterial enhancement + washout
  4. Milan criteria 1 nodule? → ≀ 5 cm
  5. HCC 1st line 22E? → Atezo + bev
  6. HCC ramucirumab indication? → AFP > 400
  7. Klatskin location? → Perihilar
  8. PSC associated? → Cholangiocarcinoma + IBD
  9. FGFR2 fusion drug? → Pemigatinib
  10. IDH1 drug? → Ivosidenib
  11. Cholangio + durvalumab trial? → TOPAZ-1
  12. GB cancer adjuvant? → Capecitabine (BILCAP)

⚠ AI 草皿。