89.2 📚 國考版醫垫國考 / PGY OSCE

89.2.0.1 📌 Cram Sheet

89.2.0.1.1 🔥 高 yield 12
  1. WHO grading by Ki-67: G1 < 3% / G2 3-20% / G3 > 20%
  2. NET well-diff vs NEC poorly-diff
  3. Carcinoid syndrome (with liver mets): flushing + diarrhea + RHD (TR/PR) + bronchospasm + pellagra
  4. 5-HIAA + CgA markers
  5. DOTATATE PET = gold standard
  6. PNET 5 functional: insulinoma/gastrinoma/glucagonoma/VIPoma/somatostatinoma
  7. MEN1 3P: pit + parathyroid + pancreas
  8. Insulinoma Whipple’s triad + 72-h fast
  9. Gastrinoma ZES: ulcer + diarrhea, gastrin off PPI
  10. Glucagonoma 4D: dermatitis + DM + DVT + depression
  11. VIPoma WDHA
  12. Somatostatin analog 1st line metastatic well-diff
89.2.0.1.2 🔢 必背
項目 æ•žå­—
G1 Ki-67 < 3%
G2 Ki-67 3-20%
G3 Ki-67 > 20%
Insulinoma 良性 % ~90%
Gastrinoma 惡性 % ~60%
Gastrinoma + MEN1 % ~25%
Glucagon syndrome 4D’s

89.2.0.2 ⭐ 高 yield

89.2.0.2.1 Drugs Quick
Setting Drug
Functional symptom Octreotide / lanreotide
Carcinoid diarrhea refractory Telotristat
Metastatic 1st line SSA (octreotide LAR / lanreotide)
PNET 2nd Everolimus, sunitinib
PNET CAPTEM Capecitabine + temozolomide
SSTR+ progressive 177Lu-DOTATATE (PRRT)
Liver mets TACE, RFA, surgical debulking, Y-90
MSI-H Pembrolizumab
NEC Platinum + etoposide
89.2.0.2.2 Trial Names
  • PROMID: octreotide LAR midgut NET
  • CLARINET: lanreotide depot intestinal/pancreatic
  • NETTER-1: 177Lu-DOTATATE midgut
  • NETTER-2: 177Lu-DOTATATE 1st line G2/G3
  • RADIANT-3 / 4: everolimus
  • A6181111: sunitinib PNET
89.2.0.2.3 Stomach NET Subtypes
Type Mechanism Prognosis
1 Atrophic gastritis + hypergastrinemia 最奜
2 ZES + MEN1 äž­
3 Sporadic å·®
89.2.0.2.4 MEN1 Tumors
  • Pituitary: prolactinoma most common
  • Parathyroid: 4-gland hyperplasia (most common manifestation)
  • Pancreas: gastrinoma, insulinoma, NF-PNET

89.2.0.3 🎯 自我檢枬

  1. WHO G2 Ki-67? → 3-20%
  2. Carcinoid syndrome 4 features? → Flushing/diarrhea/RHD/bronchospasm
  3. 5-HIAA from? → Serotonin breakdown
  4. DOTATATE PET targets? → SSTR receptor
  5. Insulinoma test? → 72-h fast
  6. Gastrinoma test? → Fasting gastrin (off PPI) + secretin
  7. Glucagonoma 4D? → Dermatitis/DM/DVT/depression
  8. VIPoma syndrome? → WDHA
  9. MEN1 3 P? → Pit/parathyroid/pancreas
  10. SSA 1st line metastatic? → Octreotide / lanreotide
  11. PRRT? → 177Lu-DOTATATE for SSTR+
  12. CAPTEM? → Capecitabine + temozolomide PNET
  13. NEC treatment? → Platinum + etoposide
  14. NETTER-1 trial? → 177Lu-DOTATATE midgut NET
  15. Carcinoid crisis pre-treat? → Octreotide

⚠ AI 草皿。