推 wangea:辛苦聖維了 謝謝~ 04/15 17:17
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※ 編輯: Ck900406 來自: 59.126.45.209 (04/20 00:33)
老師說她很早就把題目出好了,前面胎盤功能的部分約出2題,後面GTN約6題
不過老師說他考古題只有參考,不是出一模一樣的,GTN會出成情境題
爐了醫師很久,他勉強擠出了一下的重點
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胎盤功能部分
1.胎盤所製造的hormone的功能是什麼要知道,以下替大家稍微整理
一.hCG維持黃體製造progesterone
二.hPL抗insulin使脂肪分解,增加glucose合成以供給母親及胎兒營養
三.CRH除了影響adrenal gland分泌glucocorticoid外,在足月時free CRH會讓孕婦
感受產痛及促使分娩開始
四.progesterone維持子宮不收縮及抗發炎,免疫抑制
2.hormone合成的原料來源
這個重點真是相當精美阿~就猜老師會考progesterone的原料90%來自母體的cholesterol吧
GTD部分
老師這裡講得相當含糊,只說會給一個婦女的情況,接著會讓大家判斷她是得哪種病
需要接受哪種程度的治療,如果remisssion還需要在加做幾次的chemo,以及要會complete
mole跟partial mole的區別,所以針對這樣模糊的重點我來幫大家勾勾共筆
的頁數(僅供參考)
1.共筆P.9 complete mole跟partial mole比較,這100%出題= =
2.共筆P.11中間slide 56 invasive GTN有15%會在complete mole刮除後發生
3.共筆p.12 slide 63 老師說 good and poor prognosis分辨要會
4.共筆P.12~13 who scoring system以及FIGO stage要會算,老師已經說會出情境
讓大家算分數了
5.當GTN類型為non-meta/low risk時治療方式採用 ACT-D或MTX-folonic acid
劑量不用背
6.我們必須連續監測3個禮拜的hCG下降才能判定GTN remission
7.當GTN種類為 poor prognosis的GTN時,一開始就要使用EMACO的複合chemo
EMACO:Etoposide、Methotrexate、Actinomycin-D (dactinomycin)、
Cyclophosphamide (cytoxan)、vincristine (Oncovin)
如果治療完成連續3次hCG皆正常後,還要多加2次化療的療程以避免復發
最後我們在前幾年的考題裡面很神奇的發現了跟上面重點很像的提示,大家可以直接翻
血腫-鄭義銅醫師的GTD共筆後面的考古題或是繼續往下看
A 24 year-old woman, gravida 1, para 1, complained of vaginal bleeding
recently.
She also felt nausea, vomiting and occasional palpitation. Her abdomen became
enlarged progressively. Her last menstrual period was about 2 months ago. She
visited our OPD for help. The doctor arranged urine pregnancy test for her
and the test revealed positive pregnancy finding. An ultrasound showed the
presence of a uterus 16-week in size and a snowstorm picture. Serum β- hCG
was checked and high to 430,000 mIU/ml.
15. Which diagnosis may be made most accurately in the following : (A) molar
pregnancy (B)complete mole (C)partial mole (D)placental trophoblastic tumor
(E)ovarian choriocarcinoma
ANS : (B) 這位女性正在懷孕狀態且超音波顯示了snowstorm picture以及Serum β- hCG
高達430000mIU/mL都指向了這是個complete mole,這裡有一個重點大家要記得
GTN的定義是指molar pregnancy / normal pregnancy/develop after
abortive outcomes(including ectopic pregnancy)之後所產生的
gestational trophoblastic disease,這題女生是正在懷孕的狀態所檢查到
各項數值,所以我們不選D
16. After the uterine contents of the patient are evacuated and sent for
pathologic, cytologic study and karyotyping, which characteristic about the
contents is correct in the following : (A)marked villous scalloping (B)focal
trophoblastic hyperplasia with or without atypia (c)prominent stromal
trophoblastic inclusions (D)a 46XX karyotype with a 90% of chance (E)none of
above statemente?
ANS: (D)其實由這題可以推上一題,A B C 3個選項都是partial mole的特徵,只有D
是complete mole
Thereafter, the patient received dilation and curettage. She had regular serum
β-hCG follow up at OPD in the first 2 months. The serumβ-hCG declined
smoothly. Then, she lost follow up. However, she visited our Emergency room
with the chief complaints of low abdomen pain and vaginal bleeding after 6
months passed.
17. The hazard of uterine local invasion, which the patient may have in the
future, is ? (A)5% (B)10% (C)15% (D)20% (E)30%
ANS : (C) complete mole刮除後有15%會產生invasive GTN
Tracing back her history, further complete examinations were done. Important
data were showed as follows:
serumβ-hCG 280,000 mIU/ml
CBC WBC: 9320 segment: 72%
Blood type Patient: O
Her husband : A
Body surface 1.25 m2
Theca lutein cyst 7 cm in diameter
Metastasis site liver
No prior chemotherapy non
18. Which score is correct according to WHO scoring system : (A) 4-6 (B) 6-8
(C) 8-10 (D) 11-12 (E) 13
ANS: (C) 8分
經過建議還是採用老師講義的表格加以計算
Prognostic factors Score*
0 1 2 4
Age (years) <40 40 - -
Antecedent HM Abortion Term -
Interval <4 4 but <7 7 but <13 13
Pretreatment <1000 1000-<10,000 10,000-<100,000 >= 100,000
serum hCG (IU/mL)
Largest tumor - 3-<5 cm >= 5 -
Site of Lung Spleen, kidney GI liver Brain
metastases
Number of - 1-4 5-8 >8
metastases identified
Prior failed - - Single drug 2 or more drugs
chemotherapy
所以分數是0+0+2+4+0+2+0=8分 這題歡迎能確定的答案的同學提出討論
19. According to the classification of GTN-spectrum, she was classified to
(A) a good prognosis non-metastatic dis. (B) poor prognosis non-metastatic
dis. (C) good prognosis metastasis dis. (D)poor prognosis metastatic dis. (E)
none of above
ANS : D 應該很容易吧^^
20. Which stage is the patient classified according to FIGO staging? (A)Ⅱa
(B)Ⅱc (C) Ⅲb (D)Ⅳb (E)Ⅳc
ANS : (E) 轉移到liver STAGE Ⅳ,且有以下2個risk factor
1. hCG>100,000mLU/mL
2. 距上次懷孕>6個月
所以是stage Ⅳc
看完以上的內容.......我覺得老師說他要改題目很像是在唬我的= =
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◆ From: 59.126.45.209
※ 編輯: Ck900406 來自: 59.126.45.209 (04/15 16:43)