94.2 📚 國考版醫垫國考 / PGY OSCE

94.2.0.1 📌 Cram Sheet

94.2.0.1.1 🔥 高 yield 12
  1. Endometrial = #1 gyne in developed
  2. Postmenopausal bleeding workup mandatory (TVS + biopsy)
  3. Endometrial Type 1 (estrogen) vs Type 2 (aggressive)
  4. Lynch + Cowden + family Hx for endometrial
  5. Cervical HPV 16/18 (70%); vaccine + Pap
  6. Cervical chemo-RT cisplatin locally advanced
  7. Tisotumab vedotin (Tivdak) TF-DM1 cervical (FDA 2021)
  8. Ovarian “silent killer”; BRCA testing all
  9. Ovarian: debulking + carbo/paclitaxel + PARP maintenance
  10. Mirvetuximab soravtansine (FRα ADC) ovarian (22E)
  11. Pembro + lenvatinib advanced endometrial (KEYNOTE-775)
  12. Trophoblastic > 90% cure with methotrexate / EMA-CO
94.2.0.1.2 🔢 必背
項目 æ•žå­—
Endometrial PMB TVS > 4 mm postmen → biopsy
Cervical HPV 16/18 70%
Ovarian BRCA1 lifetime 40-50%
Ovarian BRCA2 15-20%
HPV vaccine age cap 45 yr
Pap age 21-65
CA-125 cutoff > 35 (postmenopausal)
HE4 + ROMA risk score
Optimal debulking < 1 cm residual

94.2.0.2 ⭐ 高 yield

94.2.0.2.1 Drug Quick
Cancer Drug
Endometrial advanced Pembrolizumab + lenvatinib (KEYNOTE-775)
MSI-H endometrial Pembrolizumab mono
Cervical chemo-RT Cisplatin
Cervical metastatic Paclitaxel + cisplatin + bevacizumab; pembrolizumab CPS+; tisotumab vedotin
Ovarian standard Carbo + paclitaxel
Ovarian maintenance Bevacizumab; olaparib/niraparib/rucaparib
Ovarian + BRCA/HRD PARP inhibitor maintenance
Ovarian platinum-resistant FRα+ Mirvetuximab soravtansine
Hydatidiform mole D&C + methotrexate
Choriocarcinoma EMA-CO
94.2.0.2.2 Trials
  • KEYNOTE-775: pembro + lenvatinib endometrial
  • NRG-GY018: chemo + pembro/dostarlimab endometrial
  • GOG 240: cervical chemo + bevacizumab
  • GOG-218: bevacizumab ovarian
  • SOLO-1: olaparib BRCA ovarian maintenance
  • PAOLA-1: olaparib + bevacizumab maintenance
  • PRIMA: niraparib regardless BRCA
  • MIRASOL: mirvetuximab soravtansine ovarian
94.2.0.2.3 Genetic Syndromes
  • BRCA1/2: ovarian (40-50%, 15-20%); breast
  • Lynch (MMR): endometrial 60% lifetime; CRC
  • Cowden (PTEN): endometrial + breast + thyroid
  • Peutz-Jeghers (STK11): granulosa cell + sex cord
  • DICER1: ovarian Sertoli-Leydig

94.2.0.3 🎯 自我檢枬

  1. #1 gyne CA developed? → Endometrial
  2. Endometrial PMB workup? → TVS + biopsy
  3. Cervical HPV 16/18 %? → 70%
  4. HPV vaccine age? → ≀ 45 yr
  5. Cervical locally advanced treatment? → Chemo-RT (cisplatin)
  6. Tisotumab vedotin? → TF-DM1 cervical (22E)
  7. Ovarian BRCA1 lifetime? → 40-50%
  8. Ovarian standard chemo? → Carbo + paclitaxel
  9. PARP maintenance? → Olaparib (SOLO-1), niraparib (PRIMA), rucaparib
  10. Mirvetuximab soravtansine? → FRα ADC ovarian platinum-resistant (22E)
  11. Pembro + lenvatinib? → KEYNOTE-775 endometrial
  12. Hydatidiform mole treatment? → D&C + methotrexate
  13. Choriocarcinoma? → EMA-CO
  14. Optimal ovarian debulking? → < 1 cm residual
  15. Lynch endometrial lifetime? → 60%

⚠ AI 草皿。