90.2 📚 國考版醫垫國考 / PGY OSCE

90.2.0.1 📌 Cram Sheet

90.2.0.1.1 🔥 高 yield 10
  1. Clear cell 75% (VHL inactivation)
  2. Papillary Type 2 + FH (HLRCC): aggressive
  3. 70% incidentaloma (CT)
  4. Classical triad (flank pain + hematuria + mass) only 10%
  5. Paraneoplastic: PTHrP, EPO (erythrocytosis), renin (HTN), Stauffer
  6. T1 → partial nephrectomy preferred
  7. Adjuvant pembrolizumab high-risk post-nephrectomy (KEYNOTE-564)
  8. Metastatic 1st line IO+TKI: pembro+axi / nivo+cabo / pembro+len; IO+IO ipi+nivo
  9. Belzutifan (HIF-2α) for VHL (22E)
  10. Hereditary: VHL, MET (HRPC), FH (HLRCC), FLCN (BHD), TSC
90.2.0.1.2 🔢 必背
Subtype % Genetics
Clear cell 75% VHL
Papillary Type 1 5% MET activation
Papillary Type 2 5-10% FH
Chromophobe 5% Multiple chr loss
項目 æ•žå­—
T1 ≀ 7 cm
T1a ≀ 4 cm
T1b 4-7 cm
T2 > 7 cm
T3 Venous/perinephric
T4 Beyond Gerota
Adjuvant pembro duration 1 yr
IMDC risk groups Favorable / intermediate / poor

90.2.0.2 ⭐ 高 yield

90.2.0.2.1 Hereditary RCC Syndromes
Syndrome Gene Histology
VHL VHL Clear cell (multifocal, bilateral)
HRPC MET (activating) Papillary Type 1
HLRCC FH Papillary Type 2 (aggressive)
Birt-Hogg-Dubé FLCN Chromophobe + oncocytoma + skin + lung
TSC TSC1/2 Angiomyolipoma + RCC
BAP1 BAP1 Multiple cancers (mesothelioma, RCC)
SDHB SDHB RCC + paraganglioma
90.2.0.2.2 Drugs Quick
Class Drug
VEGFR TKI Sunitinib, pazopanib, cabozantinib, lenvatinib, axitinib, tivozanib
Anti-PD-1 Pembrolizumab, nivolumab
Anti-PD-L1 Avelumab
Anti-CTLA-4 Ipilimumab
mTOR Everolimus, temsirolimus
Anti-VEGF Bevacizumab
HIF-2α Belzutifan (VHL)
IL-2 Aldesleukin (high-dose; selected)
90.2.0.2.3 IMDC Risk Stratification (Metastatic)
  • 6 factors: KPS, time to therapy, Hb, Ca, neutrophils, platelets
  • Favorable: 0 factors
  • Intermediate: 1-2
  • Poor: ≥ 3
90.2.0.2.4 1st-line by Risk
  • Favorable: TKI alone (pazopanib, sunitinib) or IO+TKI
  • Intermediate/Poor: IO+IO (ipi+nivo) or IO+TKI

90.2.0.3 🎯 自我檢枬

  1. Clear cell %? → 75%
  2. Clear cell genetics? → VHL
  3. HLRCC gene? → FH (aggressive papillary 2)
  4. Classical triad %? → ~10%
  5. Paraneoplastic 4? → PTHrP, EPO, renin, Stauffer
  6. T1a vs T1b? → ≀ 4 cm vs 4-7 cm
  7. Localized T1 surgery? → Partial nephrectomy
  8. Adjuvant trial? → KEYNOTE-564 pembrolizumab × 1 yr
  9. Metastatic 1st line combos? → IO+TKI (pembro+axi/nivo+cabo/pembro+len) or IO+IO (ipi+nivo)
  10. Belzutifan target? → HIF-2α (VHL)
  11. VHL hereditary? → Hemangioblastoma + RCC + pheo + pancreatic NET
  12. Birt-Hogg-Dubé histology? → Chromophobe
  13. Stauffer syndrome? → Cholestasis without mets
  14. EPO from RCC? → Erythrocytosis paraneoplastic
  15. IMDC factors 6? → KPS, time, Hb, Ca, neutrophils, platelets

⚠ AI 草皿。