98.3 🩺 內科專科考前版

98.3.0.1 📌 䞀頁重點

  • 22E: tolvaptan / hypertonic saline for severe SIADH; osilodrostat for ectopic Cushing’s; LMWH > warfarin Trousseau (CLOT, CATCH); DOAC evolving (CARAVAGGIO, HOKUSAI VTE)
  • Taiwan: 健保 NS, calcitonin, zoledronic, denosumab; 健保 fluid restriction + tolvaptan 條件; 健保 LMWH (enoxaparin); 健保 DOAC for cancer-associated thrombosis 條件; 健保 ATRA + arsenic for APL

98.3.0.2 🌟 Pearls (8)

  1. Paraneoplastic syndromes can predate cancer detection by months
  2. CLOT trial (2003): LMWH (dalteparin) > warfarin for cancer-associated VTE
  3. CARAVAGGIO + HOKUSAI VTE Cancer: DOAC (apixaban, edoxaban) non-inferior to LMWH (with caveats — GI/GU cancer + DOAC = bleeding)
  4. Pancreatic CA + Trousseau: classic; LMWH or apixaban
  5. HIT in cancer patient: separate consideration
  6. APL DIC management: ATRA early (suspicion alone) + supportive (cryo, FFP, platelets)
  7. Differentiation syndrome with ATRA: corticosteroid prophylaxis
  8. EPO ↑ in RCC paraneoplastic: VHL-related; specific endocrine consideration

98.3.0.3 📍 Taiwan + 健保

  • 健保 IV NS, calcitonin, zoledronic acid, denosumab (selected)
  • 健保 fluid restriction protocol + tolvaptan 條件
  • 健保 LMWH (enoxaparin, dalteparin)
  • 健保 DOAC (apixaban, rivaroxaban, edoxaban) for cancer-VTE 條件
  • 健保 ATRA + arsenic (APL standard)
  • 健保 osilodrostat / ketoconazole for ectopic Cushing’s 條件
  • 健保 steroid (dexamethasone, methylprednisolone)
  • 健保 rituximab for AIHA + thymoma 條件

98.3.0.4 🎓 內專必懂 (8)

  1. Paraneoplastic endocrine spectrum
  2. Hypercalcemia mechanism + treatment specific
  3. SIADH workup + treatment cascade
  4. NICTH IGF-2 testing + management
  5. Trousseau syndrome anticoagulation (LMWH/DOAC)
  6. APL + DIC ATRA emergency
  7. AIHA + PRCA tumor association
  8. Tumor agnostic recognition + workup

⚠ AI 草皿。