95.2 📚 國考版醫垫國考 / PGY OSCE

95.2.0.1 📌 Cram Sheet

95.2.0.1.1 🔥 高 yield 10
  1. Brain mets 10x > primary (lung > breast > melanoma > RCC > CRC)
  2. GBM: IDH-wt grade 4; median 12-15 mo
  3. WHO 2021 glioma: IDH status + 1p/19q codeletion
  4. Oligodendroglioma: IDH-mut + 1p/19q codeletion (best glioma)
  5. Stupp protocol: surgery + TMZ + 60 Gy + adjuvant TMZ × 6 + TTF
  6. MGMT methylation = better TMZ response
  7. Vorasidenib (IDH 1/2 inhibitor) FDA 2024 for IDH-mut grade 2 glioma
  8. PCNSL: high-dose MTX + rituximab
  9. Brain mets: SRS preferred (less cognitive than WBRT)
  10. HER2+ brain mets: tucatinib + trastuzumab + cape (HER2CLIMB)
95.2.0.1.2 🔢 必背
項目 æ•žå­—
GBM median survival 12-15 mo
Stupp RT 60 Gy / 30 fractions
TMZ during RT 75 mg/m²/d
TMZ adjuvant 150-200 mg/m² × 5 d/cycle × 6
Brain mets vs primary 10x more common
MGMT methylation rate ~ 40% GBM

95.2.0.2 ⭐ 高 yield

95.2.0.2.1 Glioma WHO 2021 Quick
Tumor IDH 1p/19q ATRX Other
GBM (grade 4) wt 䞍 codel retained EGFR amp, TERT
Astrocytoma (grade 2-4) mut 䞍 codel lost TP53 mut
Oligodendroglioma mut codel retained TERT
95.2.0.2.2 Brain Mets Source Quick
  • Lung 50%
  • Breast 20%
  • Melanoma 10%
  • RCC 5%
  • CRC 5%
  • GI other
95.2.0.2.3 Drug for Brain Mets by Primary
Cancer Drug
HER2+ breast Tucatinib + trastuzumab + cape (HER2CLIMB)
EGFR+ lung Osimertinib
ALK+ lung Alectinib, lorlatinib
BRAF V600E melanoma Dabrafenib + trametinib
Melanoma immunotherapy Pembro / nivo / ipi+nivo
RCC Cabozantinib + IO
95.2.0.2.4 CNS Lymphoma
  • DLBCL
  • HIV-associated: EBV-driven
  • High-dose MTX-based + rituximab
  • Consolidation: auto-HSCT (preferred) or WBRT
95.2.0.2.5 Increased ICP Treatment
  • Dexamethasone 10 mg IV → 4-6 q6h
  • Mannitol 0.5-1 g/kg IV
  • Hyperventilation (temporary)
  • Hypertonic saline
  • Surgery (decompress / EVD)

95.2.0.3 🎯 自我檢枬

  1. Brain mets vs primary? → 10x mets
  2. GBM IDH? → wt
  3. Best prognosis glioma? → Oligodendroglioma (IDH-mut + 1p/19q codel)
  4. Stupp protocol? → Surgery → TMZ + 60 Gy → adjuvant TMZ × 6 + TTF
  5. MGMT methylation effect? → Better TMZ response
  6. Vorasidenib indication? → IDH-mut grade 2 glioma (22E)
  7. PCNSL treatment? → High-dose MTX + rituximab
  8. Brain mets RT preferred? → SRS over WBRT
  9. HER2+ brain mets drug? → Tucatinib + trastuzumab + cape
  10. EGFR+ brain mets? → Osimertinib
  11. Top brain mets source? → Lung
  12. Steroid for edema? → Dexamethasone
  13. WHO grade 1 most common extra-axial? → Meningioma
  14. Medulloblastoma location? → Cerebellum (peds)
  15. Hippocampal-sparing WBRT? → Reduces cognitive decline

⚠ AI 草皿。