L*****r
发帖数: 722 | 1
Uptodate 专门提到了stroke 和MI 的血糖控制问题：
Hyperglycemia — Hyperglycemia, generally defined as a blood glucose level >
126 mg/dL (>7.0 mmol/L), is common in patients with acute ischemic stroke
and is associated with poor functional outcome.
Hyperglycemia may augment brain injury by several mechanisms including
increased tissue acidosis from anaerobic metabolism, free radical generation
, and increased blood brain barrier permeability:
· Hyperglycemia worsens ischemic damage in animal models of stroke |
|
m*****5
发帖数: 438 | 2 In my opinion, this is not just DKA for the following reasons. A simple rule
in pH and pCO2 is that last two digits of pH are roughly equal to the pCO2
level. So per the question the pCO2 is 19, then the pH should be around 7.19,
but it is 6.9 which means this is a mixed acidosis (could be anion and non
anion gap). Secondly the pco2 is 19 (lower than it is supposed to), which
could mean that this patient has some respiratory alkalosis too. This makes
it a mixed acid base disorder. This kind of d |
|
u***e
发帖数: 611 | 3 老刘，如果你在ER值班，EMS送来这么个unresponsive的病人，你难道会连血糖都不知
道是多少的情况下先给人家胰岛素？50yo diabetic male presents with
unresponsiveness and severe acidosis，如果不是已知1型糖尿病以前有过多次DKA入
院史的，DKA的嫌疑不是太高，DKA的病人也比较少一进来就unresponsive,大部分是年
轻人，肚子痛啥的，又忘了注射胰岛素了，有时候都不用问，一闻就知道是DKA。这个
题目给的信息太少，大家现实中肯定都会先拿到vitals，basic labs在做决定，在不知
道钾的情况下给insulin和glucose那病人要是低钾直接室颤给你看。bicarb我知道不是
严重的酸中毒一般不给，我就记7，低于7就可以考虑给。bicarb相对是比较安全的，虽
然不是很好的答案。这个题目本来就出的不好。但给insulin+glucose实在是太危险了
。 |
|
l********y
发帖数: 2295 | 4 I like this one too:
indications of dialysis:
you need EAD to perform dialysis in KFC.我为绿卡狂阿～～～～
E: Encephalopathy
A: acidosis
D: Drugs which are dialysable.
K: hyperKalemia
F: Fluid overload
C: periCarditis
其实口诀什么的是个辅助，题海战术才是王道。。 |
|
p******9
发帖数: 114 | 5 1. A 5-year-old boy is brought to the physician 1 hour after urinating
bright red blood. He has been taking ibuprofen since injuring his right
flank while wrestling with friends yesterday; he also has been taking
penicillin for 3 days for streptococcal pharyngitis. His temperature is 36.7
C (98 F), blood pressure is 90/48mm Hg, pulse is 108/min, and respirations
are 18/min. Examination shows purple ecchymoses over the shins and right
flank; there is tenderness of the right costovertebral area. T... 阅读全帖 |
|
h***a
发帖数: 312 | 6 Is aspirin related with metablic acidosis or respiratory alkalosis? |
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a********e
发帖数: 3771 | 7 overdose of aspirin results in metabolic acidosis. |
|
y******a
发帖数: 590 | 8 interesting case. I thought EtOH intoxication can suppress the resp. center
, cause hypoxia, then bradycardia. metabolic acidosis can cause bradycardia
and hypotension too. Never thought about vitamin deficiency. Thanks.
But
giving |
|
e****0
发帖数: 678 | 9 My 2 cents:
should be resp. acidosis with renal compensation by secreting ammonia to
buffer the H+.
Her
respirations
Arterial |
|
h***y
发帖数: 834 | 10 ☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的目的就达到了。
希望所有ID， 包括考生， resident， fellow， attending，PA/NP, nurse 和中国来
的医生不再从事医疗工作的， 都能奉献你的pearl. 英文中文都行。
我先来：
CC: Left leg pain for 5 days.
35 y... 阅读全帖 |
|
h***y
发帖数: 834 | 11 ☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的目的就达到了。
希望所有ID， 包括考生， resident， fellow， attending，PA/NP, nurse 和中国来
的医生不再从事医疗工作的， 都能奉献你的pearl. 英文中文都行。
我先来：
CC: Left leg pain for 5 days.
35 y... 阅读全帖 |
|
e****0
发帖数: 678 | 12 • Exaggerated deep tendon reflexes can be seen in lock in syndrome.
• Non bleeding varices are managed with nonselective beta-
adrenergic antagonists, such as propranolol.
• Sclerotherapy, endoscopic band ligation, and surgery are
indicated after a patient has a first episode of variceal bleeding.
• TIPS is a last resort in variceal bleeding unresponsive to
medical and endoscopic intervention.
• Ischemic colitis
CT—thickening of eth bowel ... 阅读全帖 |
|
e****0
发帖数: 678 | 13 • leukemia
ALL AML CLL
child adult elderly
BM lymphoblasts 25%myeloblasts
lab Lymphocyte 5000, mature-appearing cells
• Osgood-schlatters disease
Adolescent male athletes
Traction apophysitis—quadriceps tendon put the traction on the
apophysis of the tibial tubercle where patellar tendon inserts.
A firm mass =heterotopic bone formation
Pain can be reproduced by extending the kne... 阅读全帖 |
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h*******y
发帖数: 1220 | 14 Sorry for hacking your thread. Those who have not taken CK may learn a point
or two:
From wiki
VIPoma：A VIPoma (also known as Verner Morrison syndrome, after the
physicians who first described it)[1] is a rare (1 per 10,000,000 per year)
endocrine tumor,[2] usually (about 90%) originating from non-β islet cell
of the pancreas, that produce vasoactive intestinal peptide (VIP). It may be
associated with multiple endocrine neoplasia type 1.
The massive amounts of VIP in turn cause profound and chro... 阅读全帖 |
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d******u
发帖数: 10 | 15 上课的一个糖尿病例：
Blood glucose 378, A1c: 14 ( current )
Blood Glucose 140, A1C: 10 ( 2 years ago)
Weight 218lb (99kg)
Medications:
Metformin 1000mg, 1TAB BID Levemir (long acting insulin), 35units QD
怀疑noncompliance 导致血糖失控. 我是应该:
１。 告诉病人坚持吃药，打INSULIN, do nothing else
２。 增加INSULIN的剂量， 4 units every 3 days until FBG<180, then 2 units
every 3 days until in target range
３。 增加其他糖尿病口服药
４。１+２， １+２+３
Also Anion Gap 15mmol/dL, should I order lab for Ketone and pH to check if
he develops acidosis? By the way,... 阅读全帖 |
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J*********4
发帖数: 1274 | 16 恩，这题我也不太懂哦。
勉强选2吧。病人血糖控制不好，有AG acidosis, 是不是要停metformin，只用胰岛素?
专家们请~~ |
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a*********d
发帖数: 2763 | 17 is this a real case or an exam case? answer can vary depending on the
situation. there is absolutely no uniform way to treat a DM patient, lots of
factors should be considered, therapy should be tailored individually.
in this case, if it is a real case, nothing should be done until you look at
the patient's daily glucose data. you SHOULD NOT adjust regimen just base
upon A1c.
it is important to know where the problem is, fasting hyperglycemia?
postprandial hyperglycemia? does he/she have hypogly... 阅读全帖 |
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b*****g
发帖数: 53 | 18 特别特别感谢热心的victor和jenny！受益匪浅！
很抱歉以下notes,中英文混杂。
HOW TO SURVIVE IN YOUR INTERN YEAR (BY VICTOR)
1. Familiar with EMR
• Intern’s responsibility and daily work
1. inpt floor: when you enter, check your pts, follow up with lab results
(trend), VS, medication, overnight changes, progress notes(overnight and
morning symptom, PE, lab trend, meds list, assessment and plan, 会诊意见计划
)。During round, report it to senior and attending. Assessment &Plan will be
for yours. 45min for 1pt, intern can... 阅读全帖 |
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m*******y
发帖数: 1233 | 19 A 23-year old woman comes to physician because of severe abdominal cramping,
menorrhagia, and low back pain correlating with her menstrual cycle. On
pelvic examination, the physician palpates a nodular, enlarged ovary.
Exploratory abdominal laparoscopy reveals multiple lesions on the exterior
of ovaries bilaterayy.
Which of the following is an adverse effect of drug most commonly used to
treat this patient's condition?
A. Hyperkalemic metabolic acidosis
B. Increased breast cancer rish
C. Pseudot... 阅读全帖 |
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t*****0
发帖数: 264 | 20 book gave 1 and 3, but I have some arguement on the 3 for 48.
I remember that type 1 is the insulin dependent which means pt don't secret
insulin at all. Since the question was talking about not enough insulin
secretion. I think it should be Type 2 and it won't cause ketone acidosis.
How you guy/gals think about the ans to 48? |
|
J******f
发帖数: 355 | 21 我觉得答案是3
non-compensatory respiratory acidosis， 通常是ACUTE的HYPOVENTILATION造成的。
124都是INTERVENTION， 我觉得要先ASSESSMENT确定原因。 |
|
m*******e
发帖数: 1886 | 22 This is a really sick question... I think the key points here are "acidosis"
& "post op". PO2 will be low anyway.->Deep breathing is more likely an
answer if there is a CO2 retention.
But, if there is a PH @ 7.28, pt's LOC will be altered?->so how to make pt
breathing deeply, unless pt is on vent?
That's why I think Kaplan/Nclex suck! |
|
l**********t
发帖数: 1212 | 23 I did a research and found that HG can induce acidosis due to starvation. |
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a********n
发帖数: 438 | 24 SOB
病人申诉“I CANN'T BREATH”第一步，还是要ASSESSMENT，VS 包括RR，SAT O2，有没
有nostril flare/using accessory muscle ，结合病史找原因，Pulmonary: PNA,
Pneumothorax, PE, Aspiration, bronchspasm, airway obstruction.
Cardiac: MI, CHF, arrhythmia, , 还有acidosis, sepsis, anemia, anxiety. 有没
有给新药？（allergic reaction), 肺音（fluid overload/asthma?). 先给氧气，酌情
处理，从simple face mask 到non- rebreather, 再打电话给医生，通常，会order
CXR, EKG, ABG.lasix, breathing treatment(beta agonist).这个时候RT 就是好伙伴
了，要找CHARGE帮忙，必要的时候CALL RAPID RESPOND TEAM, 最好ABG PO2〉 |
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Q*****3
发帖数: 218 | 25 ARDS 死亡率很高。你的病人有 sepsis,还合并afib估计是resp distress triger, 如
果没有afib history, 这样的心率loss the atrial kick, 血压更难搞。这样的病人,
我们这边都是用低的tidal volume 450-500ml, high peep, hyperventilation, rr 16
或者更快。他的pH 7.21, overventilation 可以帮助稍稍纠正一下acidosis.
不过,看你们的医生会不会激进一些,用到bivent. 这个病人基本要上肌松剂才行。我见
过活下来的病人, 是那种上了autoprone床加bivent的病人。 |
|
Q*****3
发帖数: 218 | 26 ARDS 死亡率很高。你的病人有 sepsis,还合并afib估计是resp distress triger, 如
果没有afib history, 这样的心率loss the atrial kick, 血压更难搞。这样的病人,
我们这边都是用低的tidal volume 450-500ml, high peep, hyperventilation, rr 16
或者更快。他的pH 7.21, overventilation 可以帮助稍稍纠正一下acidosis.
不过,看你们的医生会不会激进一些,用到bivent. 这个病人基本要上肌松剂才行。我见
过活下来的病人, 是那种上了autoprone床加bivent的病人。 |
|
Y***Y
发帖数: 232 | 27 我在MICU/CCU刚刚满一年，最近把CCRN考了，一次高空飞过，来分享一下考经吧。
最近科室里面掀起了一阵CCRN潮，科室还给大家一套AACN的复习材料给大家轮流使用。
AACN 有一盘CD 和三套模拟训练题， 我只看了CD，觉得非常有用的，每个系统把考点
总结了一下，很好的加强了理论知识。
我还用了pass CCRN CD 的题库，没有全部做完，cardio 和 pulm 实在太多了，大概各
做了70题，
其他category题目少的基本都做完了，每次无论对的错的都看解释加做笔记，虽然笔记
后来一遍都没看过 ：（
总共复习了两个星期，其中全职上班,不上班的日子每天复习8小时，上班的日子完全不
看书。
实战感觉和 pass ccrn 接近或者更简单一些，基本一分钟一题，题干也不长，磨棱两
可的做bookmark，做完全部150题 然后回头琢磨那些磨棱两可的，根本不需要三小时。
以下理论知识基本在考题中都有用到：
CVP, PAOP, PAP, CO, CI 这些正常范围一定要知道，怎么区分LVHF 和 RVHF，fluid
status,
preload, afterload,
IC... 阅读全帖 |
|
c********y
发帖数: 33 | 28 准备第一步evaluation exam总结的，都是参考别的书的，也不是很全面，所以如果有
错误请多包
涵，如下：
Methyldopa —— galatorrhea, SLE
Levodopa - taste disturbance
Procainamide - SLE, agranulocytosis,torsade de points
Captopril - agranulocytosis
ACEI - taste disturbance, dark stool
Cyclosporin - acute gout, gingival overgrowth
Phenytoin - SLE, gingival overgrowth
Thiazide - SLE, pulmonary edema, gout
Sulfasalazine - Pulmonary fibrosis, SLE
Chlopramazine - SLE, seizure, dry mouth
Verapamil - galactorrhea, bradycardia
PTU - agranulocytosis, S... 阅读全帖 |
|
r********r
发帖数: 352 | 29 Different from Type 1 DM, patients with type 2 DM do produces insulin,
especially during the first several years of their disease onset. Their
problem is insulin sensitivity. Therefore oral agents improves their insulin
sensitivity such as Metformin is beneficial. In later stage of the disease
when then eventually lost their pancreatic beta-cell function, they will
need high dose insulin to control their blood sugar.
Moreover, think about if you have the option of taking a pill once or twice
a d... 阅读全帖 |
|
s********o
发帖数: 3319 | 30 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
s********o
发帖数: 3319 | 31 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
N*G
发帖数: 217 | 32 metabolic acidosis, uncompensated;
Since he has positive orthostatic BP, IV fluid is most important for
correcting dehydration. I would just give normal saline, maybe 10-15% of
body weight, if he does not have cardiac problem. But always guided by pt's symptoms. Kidney injury looks like pre-renal, and should be improved after correcting dehydration. Also, potassium supplement, Vit B1, folate acid should be given simultaneously; For an alcoholic, we should watch for withdrawal. So ativan protoco... 阅读全帖 |
|
N*G
发帖数: 217 | 33 metabolic acidosis, uncompensated;
Since he has positive orthostatic BP, IV fluid is most important for
correcting dehydration. I would just give normal saline, maybe 10-15% of
body weight, if he does not have cardiac problem. But always guided by pt's symptoms. Kidney injury looks like pre-renal, and should be improved after correcting dehydration. Also, potassium supplement, Vit B1, folate acid should be given simultaneously; For an alcoholic, we should watch for withdrawal. So ativan protoco... 阅读全帖 |
|
g*2
发帖数: 658 | 34 主要是我以前没有做过临床，做过的应该会适应得快些。感觉我们这里做完2年的住院
已经很驾轻就熟，看得真是羡慕啊。
对，的确路很长。 住院还说护士会对新生很不客气，有些担心，因为的确看到有护士
冲进来质问为什么要q4hr 不是q6hr。他们解释说因为病人DKA, acidosis，，blah
blah...挺烦的。。还有有的family也很难做工作。 这条路真是有长又艰难啊，但愿能
在前3个月survive先。 |
|
g*2
发帖数: 658 | 35 主要是我以前没有做过临床，做过的应该会适应得快些。感觉我们这里做完2年的住院
已经很驾轻就熟，看得真是羡慕啊。
对，的确路很长。 住院还说护士会对新生很不客气，有些担心，因为的确看到有护士
冲进来质问为什么要q4hr 不是q6hr。他们解释说因为病人DKA, acidosis，，blah
blah...挺烦的。。还有有的family也很难做工作。 这条路真是有长又艰难啊，但愿能
在前3个月survive先。 |
|
A*******s
发帖数: 9638 | 36 On the next day when she was having CT, the patient was found confused so she was admitted to hospital. Her glucose was 500 with mild acidosis. Apparently, she could not take her DM pills due to the chorea.
What is the diagnosis?
说对的有BZ. |
|
