88.2 📚 國考版醫垫國考 / PGY OSCE

88.2.0.1 📌 Cram Sheet

88.2.0.1.1 🔥 高 yield 12
  1. PDAC ~90%, head 70%
  2. Painless jaundice + Courvoisier
  3. Trousseau syndrome = migratory thrombophlebitis
  4. New-onset DM > 50 + 體重 ↓ → 疑 pancreas
  5. Risk genes: BRCA1/2, PALB2, ATM, Lynch, STK11, CDKN2A, PRSS1
  6. Pancreas protocol CT triphasic + EUS-FNA
  7. CA 19-9 marker (Lewis neg → false neg ~10%)
  8. Resectability by vessel involvement
  9. FOLFIRINOX good PS 1st line
  10. Adjuvant m-FOLFIRINOX > gem (PRODIGE 24)
  11. BRCA mutation maintenance → olaparib (POLO)
  12. MSI-H → pembrolizumab
88.2.0.1.2 🔢 必背
項目 æ•žå­—
5-yr survival overall ~12%
5-yr resectable ~30%
5-yr metastatic < 5%
Head % 70%
Resectable at dx ~15-20%
BRCA in pancreatic ~5-10%
Lewis-neg CA 19-9 false neg ~10%

88.2.0.2 ⭐ 高 yield

88.2.0.2.1 Drugs Quick
Setting Drug
1st line good PS FOLFIRINOX
1st line standard Gem + nab-paclitaxel (MPACT)
1st line newer NALIRIFOX (NAPOLI-3)
Adjuvant m-FOLFIRINOX (PRODIGE 24); gem + cape alt
BRCA maintenance Olaparib (POLO)
MSI-H Pembrolizumab
KRAS G12C Sotorasib / adagrasib (22E)
NTRK Larotrectinib
2nd line Nano-liposomal irinotecan + 5-FU (NAPOLI)
88.2.0.2.2 Trial Quick
  • ACCORD 11 / PRODIGE 4: FOLFIRINOX 1st line
  • MPACT: gem + nab-paclitaxel
  • NAPOLI-3: NALIRIFOX 1st line
  • PRODIGE 24: adjuvant m-FOLFIRINOX
  • POLO: olaparib BRCA maintenance
  • BILCAP: capecitabine adjuvant biliary
88.2.0.2.3 Genetic Syndromes (Pancreatic Risk)
  • BRCA1, BRCA2 (Ashkenazi)
  • PALB2, ATM
  • Lynch (MLH1/MSH2/MSH6/PMS2)
  • Peutz-Jeghers (STK11)
  • FAMMM (CDKN2A)
  • Hereditary pancreatitis (PRSS1, SPINK1)

88.2.0.3 🎯 自我檢枬

  1. PDAC %? → ~90%
  2. Head %? → 70%
  3. Courvoisier sign? → Palpable non-tender GB + jaundice
  4. Trousseau? → Migratory thrombophlebitis
  5. New-onset DM age? → > 50 + 體重 ↓ → 疑
  6. CT type for pancreas? → Pancreas protocol triphasic
  7. CA 19-9 limitation? → Lewis-neg ~10% don’t produce
  8. FOLFIRINOX 4 drugs? → Oxaliplatin + irinotecan + 5-FU + leucovorin
  9. MPACT regimen? → Gem + nab-paclitaxel
  10. POLO trial? → Olaparib BRCA maintenance
  11. Adjuvant standard? → m-FOLFIRINOX (PRODIGE 24)
  12. 5-yr survival overall? → ~12%

⚠ AI 草皿。