l****t
发帖数: 1 | 1 hi,
who can help me to find a paper? There is no such a journal in the lib.
The paper is * the determination of creatinine in human urine by capillary
zone electrophoresis with photodiode array detection*, written by Jia li, Chen
Xi, Wang Yiru, Wang Xiaoru etc.. The journal is J. Liq, Chromatogr. Relat.
Technol.(1998), 21(7), 965-977
Thanks a lot!
if you find the paper, please scan it for me. or just show me the information
on pH and buffer conditions. My email address is l****[email protected] |
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z8
发帖数: 350 | 2 Annals of Internal Medicine. 1999;130:461-470.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D, et al. A More
Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine |
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W****i
发帖数: 325 | 3 看网上资料，中医调养对早期肾衰有作用，请诸位神医给个方子，我应该怎么调呢？&
nbsp;不胜感激
女性
CREATININE：0.8 （Standard 0.6-1.1 mg/dL） （肌酐酸，肌肉中肌酸的分解产
物，属于代谢废物)
GLOMERULAR FILTRATION RATE：88-NB （肾小球滤过率，应该》90 ） |
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l********z
发帖数: 810 | 4 An elderly woman has generalized bone pain and loss of height over the last
5 years. Complete blood count is normal Serum calcium , phosphate, and
creatinine concentrations and serum alkaline phosphatase activity are within
reference range . serum protein electrophoresis shows no abnormalities . X
ray films of the spine show generalized bone density and compression
fracture of T8 . Which of the following is most likely to be seen in the
tissue obtained on biopsy of the iliac crest
?
1] cysts fil |
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u***e
发帖数: 611 | 5 不佩服风mm不行，又学了不少。
没有人想到PE吗？半夜里把attending叫起来后，她第一个反应是病人又来了一次PE。
病人在做CT前就被上了heparin drip，转到了ICU。PT INR回来后是1.2. SaO2很好，没
有chest pain, SOB.
至于fluid，a-fib八成是和这个有关，病人的确如风mm分析的以前的echo有右心扩大，
LV的EF是正常的，我和senior谈了他还是认为要bolus病人。肺没有crackle，CXR没有
congestion. 脚也不肿，不太像是fluid overload. 现在病人还在run着fluid..... 我
不知道well compensated的右心衰是不是需要fluid restriction.
BMP回来后钾只有2.1，低钾会导致afib吗，不太确定。
BUN 55,Creatinine 1.2, 看上去像dehydration. 这个肾功能你们会让病人去做
contrast CT吗？
下回分解。 |
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d****2
发帖数: 118 | 6 2-17. A 42-year-old woman comes for a follow-up examination. Two weeks ago,
her blood pressure was 152/94 mm Hg during a routine visit. Her blood
pressure today is 150/94 mm Hg, pulse is 76/min, and respirations are 14/min
. Examination shows no other abnormalities. Serum studies show:
Na+ 142 mEq/L
Cl– 105 mEq/L
K+ 4 mEq/L
HCO3– 26 mEq/L
Urea nitrogen (BUN) 12 mg/dL
Glucose 101 mg/dL
Creatinine 0.8 mg/dL
An ECG shows no abnormalities. Which of the following is the most
appropriate next step in |
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a****9
发帖数: 773 | 7 A 42-year-old woman comes for a follow-up examination. Two weeks ago, her
blood pressure was 152/94 mm Hg during a routine visit. Her blood pressure
today is 150/94 mm Hg, pulse is 76/min, and respirations are 14/min.
Examination shows no other abnormalities. Serum studies show:
Na+ 142 mEq/L
Cl– 105 mEq/L
K+ 4 mEq/L
HCO3– 26 mEq/L
Urea nitrogen (BUN) 12 mg/dL
Glucose 101 mg/dL
Creatinine 0.8 mg/dL
An ECG shows no abnormalities. Which of the following is the most
appropriate next step in managem |
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o**h
发帖数: 55 | 8 A MAOi taker presents in ER with hypertensive crisis after drinking.
Alert patient, Nifedipine.
Unconscious patient,Labetalol.
preventive therapy of cluster headache,: Cab
Viral agents are factors contributing to the development of RA
To confirm urine in a urine leak: measuring the creatinine level.
In winter, intermittent headache, joint pain, nausea
next step in mx: checking arterial blood gas.
renal tubular acidosis
type I: low potassiun
type II: maybe hypophosphatemia
type IV: high potassium |
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l**********e
发帖数: 382 | 9 USMLE Step 1 Clinical Question of the Day
The clearance of several substances was measured at a constant glomerular
filtration rate and constant urine flow rate, but at increasing plasma
concentrations of the substance. Under these conditions, clearance will
increase at high plasma concentrations for which of the following substances
?
A. Creatinine
B. Mannitol
C. Penicillin
D. Phosphate
E. Urea |
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l*********0
发帖数: 85 | 10 Thanks for this great question.
I would go for DDDDD. Reabsorption (85%) via sodium/phosphate cotransporter[
2]. Inhibited by parathyroid hormone, especially at high concentration.
C=U*V/P; where U = concentration, V =urine volume / time, U*V = urinary
excretion, and P = plasma concentration.
A creatinine clearance aproach to GFR (higher than real 10-20%)
B mannitol diuretic
C penicillin clearance decrease based on above formula
E urea; reabsorption (50%) via passive transport, transporter would |
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a***u
发帖数: 318 | 11 小妹正在攻读NP，前不久完成导师给的case study，等批下来发现分数不理想，原因似
乎是我理解错误（因果不分），读了导师给我的“完美答案”，我心里依然固执地认为
我没错。知道这里的高手如云，所以想来讨个公道，当然输也要输的心服口服。
CASE STUDY
A young woman was admitted with 28 weeks of intermittent abdominal pain and
leg spasms. She had also noted increasing left leg pain for a few weeks
before admission. The leg pain had in-creased resulted in 14 days bedrest
before admission. The leg spasms were related to the movement of the lower
extremities. Review of systems was remarkable for in-creased irritabilit... 阅读全帖 |
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l********y
发帖数: 2295 | 12 【 以下文字转载自 Pre_Resident_Club 俱乐部 】
发信人: lovelypony (pony), 信区: Pre_Resident_Club
标 题: case presentation 学习笔记
发信站: BBS 未名空间站 (Tue Feb 22 20:03:05 2011, 美东)
昨天第一次参加了由现任斑竹chipmunk和元老knockingdown主持的case presentation
，觉得收获很大，后面慢慢的把自己的学习笔记贴出来，后面的同学看了可以少犯些我
们犯过的低级错误，这样前辈们也可以省些力气。前辈们牺牲自己宝贵的私人时间，聆听我们支离破碎，毫无章法的presentation ，耐心细致的指出错误，提出建议，pony真的觉得没有更好的语言来表达自己的感激之情。就希望能抛砖引玉，大家能互帮互助，提高我们CMG的整体水平，这样前辈们的心思也算没有白花，希望大家都能来补充和指出错误，多谢了！
要present一个case，结构一定要完整。
1. CC: 第一句话永远是chief complaint，怎么样用一句话简明扼要的把CC说好了，还是要花大... 阅读全帖 |
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r*********s
发帖数: 1027 | 13 不是,血浆渗透压和钠相关，urine取决于尿素、肌酐和其它代谢产物。
In general, urine consists of urea and other organic and inorganic chemicals
dissolved in water. Considerable variations in the concentrations of these
substances can occur as a result of the influence of factors such as dietary
intake, physical activity, body metabolism, endocrine function, and even
body position. Urea, a metabolic waste product produced in the liver from
the breakdown of protein and amino acids, accounts for almost half of the
total dissolved... 阅读全帖 |
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f****i
发帖数: 129 | 14 17. A 42-year-old woman comes for a follow-up examination.
Two weeks ago,
her blood pressure was 152/94 mm Hg during a routine
visit. Her blood
pressure today is 150/94 mm Hg, pulse is 76/min, and
respirations are
14/min. Examination shows no other abnormalities.
Serum studies show:
Na+ 142 mEq/L
Cl– 105 mEq/L
K+ 4 mEq/L
HCO3– 26 mEq/L
Urea nitrogen (BUN) 12 mg/dL
Glucose 101 mg/dL
Creatinine 0.8 mg/dL
An ECG shows no abnormalities. Which of the following
is the most
appropriate next step in man... 阅读全帖 |
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d****y
发帖数: 2180 | 15 选B， J， I的都有，到底哪个是正确的？
For each patient with cognitive impairment, select the most likely
diagnosis.
A ) Acute stress disorder
B ) Dementia, Alzheimer's type
C ) Dissociative amnesia
D ) General paresis
E ) Head trauma
F ) Hepatolenticular degeneration (Wilson's disease)
G ) HIV encephalitis
H ) Huntington's disease
I ) Major depressive disorder
J ) Multi-infarct (vascular) dementia
K ) Niacin deficiency
L ) Normal-pressure hydrocephalus
M ) Parkinson's disease
N ) Pick's disease
O ) Schizophreni... 阅读全帖 |
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l******g
发帖数: 278 | 16 Six hours after undergoing surgical excision of the distal colon for
cancer, a 77-year-old man has decreased urine output. His urine output has
been 10 mL/h during the past 3 hours. During the 4-hour operation, he lost
500 mL of blood and underwent transfusion of 1 unit of packed red blood
cells. His initial postoperative course was uncomplicated. Two years ago, he
had a myocardial infarction and underwent coronary artery bypass grafting.
He has a 10-year history of hypertension well contro... 阅读全帖 |
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l******g
发帖数: 278 | 17 NBME form 4
1. A 22-year-old woman with asthma comes to the physician for a follow-up
examination. She feels well. She has been treated for six acute episodes of
wheezing and nonproductive cough during the past year; her last episode was
1 month ago. Her symptoms are exacerbated when she is outside during the
spring and fall. Current medications include an albuterol inhaler and
echinacea. She has smoked one-half pack of cigarettes daily for 5 years and
does not drink alcohol. She is employed in ... 阅读全帖 |
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h*******y
发帖数: 1220 | 18 8. Elderly female with body aches, joint pains and now throbbing headache
.
BP 160/90, HR irregularly irregular. While all of the following tests may be
helpful, the one most likely to confirm the source of her headache is
A. CBC
B. Troponin
C. ESR
D. Calcium
E. BUN/Creatinine
this one too easy |
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J*********4
发帖数: 1274 | 19 一家之言, just for discussion
1. C, 2. C, 3.don't know 4. E, 5.C, 6.C, 7.B, 8.E
1. The old lady has dehydration, which causes pre-renal azotemia and
eventrually leads to renal tubule necrosis. The low creatinine is due to the
lack of muscle mass in old people, which underestimates the actual renal
insufficiency.
8. RBC cast indicates damage in GBM. Here is a paragraph from wiki
Hyaline casts
The most common type of cast, hyaline casts are solidified Tamm-Horsfall
mucoprotein secreted from the tubula... 阅读全帖 |
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p******d
发帖数: 374 | 20 A four-year-old asian boy has fever ranging from 102 F to 104 F for more
than five days. Fever can be reduced by taking acetaminophen and ibuprophen
. Bilateral eyes are slightly pinkish. Lips are erythematous but no
fissure. Tongue and oropharynx are normal. No lymphadenopathy, extremity
swelling, and rash. Pediatric Transthoracic endocardiogram report shows no
abnormal findings except patent foramen ovale and physiological tricuspid
and pulmonary valve regurgitation. Blood culture negat... 阅读全帖 |
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u*******8
发帖数: 497 | 24 介绍一下网购吧。正规网站出售药品，凡是涉及处方药品，都是需要Rx，每个处方有一
个Number，以及开具处方的医生信息，你在网购的时候，这些信息都是必不可少，否则
你不可能完成交易，另外这个处方还必须是有效期内的，失效了，也不行完成交易。 |
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j*********g
发帖数: 324 | 27 谢谢你的解释，那个老人在国内专家门诊看了不少了。也吃了不少药，也没什么效果。 |
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d******u
发帖数: 10 | 28 Thanks!!!! Your explaination is so clear. His Bicarb is normal 25mmol/L,
Creatinine 1mg/dL, eGFR>60. But he had a history of MI, and got stent placed
. |
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j*****o
发帖数: 137 | 29 A 76-year-old man has had fatigue and loss of interest in daily activities
over the past 4 months. He sleeps poorly and has had a 4.5-kg (10-lb) weight
loss during this period. He states that he has probably lived long enough.
His blood pressure is 110/78 mm Hg, and pulse is 68/min. Examination shows a
slow return of deep tendon reflexes. Measurement of which of the following
serum levels is the most appropriate next step in management?
A ) Calcium
B ) Creatinine
C ) Glucose
D ) Testosterone
E )... 阅读全帖 |
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J*********4
发帖数: 1274 | 30 1. Slowed DTR is typical of hypothyroidism. All diseases at its very severe
stage can cause weight loss.
2. A? The most common cause of secondary hypertension is renal parenchymal
diseases. However, not entirely sure about 1.1 creatinine, it is not a
entirely accurate indicator for renal function |
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j*****o
发帖数: 137 | 31 20. A 57-year-old woman comes for a follow-up examination. She has a 15-year
history of type 2 diabetes mellitus and hypertension well controlled with
an angiotensin-converting enzyme (ACE) inhibitor. Examination shows no flank
tenderness. The kidneys are not palpable. Laboratory studies show:
Serum creatinine
1.9 mg/dL
Urine
Protein
1+
WBC
5–7/hpf
Which of the following is the most appropriate next step in management to
minimize progression of her renal disease?
A
) High-phosphate diet
B
)... 阅读全帖 |
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A**********9
发帖数: 151 | 32 请版上同学帮忙看看这两道题。
1. A 16-year-old boy is brought to the physician for a routine examination.
He has a lifelong history of developmental delays and unusual movements such
as hand flapping. He has a meager vocabulary. Two maternal uncles have
mental retardation. Physical examination shows coarse facial features and
macro-orchidism. DNA testing shows an expansion of a trinucleotide repeat.
The patient comes from a family of four daughters. If the parents appear
healthy, on
average how many of their d... 阅读全帖 |
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E***a
发帖数: 60 | 33 Fragile X is X dominant, but have variable penetrance, it depend on the
number of the triple repeats, in female, usually the repeat is less than 200
, they may not show metal retardation or only mild MR.
Q2: you need to link to the X-ray, it clearly shows a lesion in lung, why do
you think about renal? if renal, should have hematouria or increase
creatinin.... |
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A**********9
发帖数: 151 | 34 谢谢大家！Elora, 可能是我想太多了，第二道题中creatinin 1.4mg/dL,所以就往
renal 想了。 |
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j*****o
发帖数: 137 | 35 65yo woman comes to the office for a follow-up examination. She has an 18y
history of Dm and 2y history of diabetic nephropathy. She had laser
treatments 1 y ago for proliferative retinitis with some loss of vision. She
currently takes intermediate and short-acting insulin before breakfast and
dinner. She also takes enalapril for HTN. She does home glucose monitoring
three times daily. her blood glucose concentrations usally range bw 70-130
mg/dl, but several readings every week are < 60m/dl at ... 阅读全帖 |
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t*******i
发帖数: 315 | 36 不要紧张，我背的数据也就是做题遇到的那几个，k, Na, BUN, Creatinine, 血气数据
，而且我觉得背一个书上的数据就可以，就像NCLEX上讲的，出题的时候给出的数据不
会是模棱两可的那种。药物我也背的一般，我就看了几遍书上的药物部分，又听了两遍
online course, 最后也只记住了一半，因为有的药实在是不常见。如果你有online
course,可以多听两边帮助记忆。 |
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y**m
发帖数: 1049 | 37 Bun and Creatinine 是和renal有关的lab. |
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M******C
发帖数: 623 | 38 ☆─────────────────────────────────────☆
oxhorn (^_^) 于 (Mon Mar 21 20:55:02 2011, 美东) 提到:
type 2 病人急诊到ED，诊断了HHNS，hyperglycemia hyperosmolar Nonketotic state
,两天后Head to toe assessment:
IBW 150%
I/O 3600/1600
+2 edema L ankle
pedal pulses +0/3 bilateral
lung crackles
last BM 4 days ago
FSBS 200
ate 100% of lunch，complain of still hungry
HHNS的症状不是dehydration吗？什么情况下会I/O +？priority nursing diagnosis可
以是Excess fluid volume吗？
Excess fluid volume r/t decrease fluid volume output AMB I/O(+ 2000 ml)... 阅读全帖 |
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r********r
发帖数: 352 | 39 我觉得好些都不对，或者是不常见side effects.
For ACEI,
serious side effect: angioedema
common side effect: dry cough
effects on lab values: increase serum potassium and serum creatinine. |
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l******k
发帖数: 27533 | 40 在医院里实习是件sad的事情
不可避免的要接触到束手无策，等待死亡的病例
一个女的癌症晚期，医生给出剩下的时间，不推荐任何chemo,丈夫女儿们的流下无奈的眼泪
31岁的hepatorenal syndrome, 整个人又黄又虚弱，全身浮肿，被死神判了死刑，医生
却不愿意放弃
每天dialysis,不知道他能坚持到哪一天
creatinine level在5-8之间徘徊
实习比上课累，每天学习paper,要写7，8页的SOAP
又回到2周前的每天4，5个小时的睡眠
今天回家早，想补觉，却睡不着
我觉得，我又快要depress了：（（（（ |
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P*A
发帖数: 7996 | 41 Serum creatinine
很意外吧哈哈 |
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r********r
发帖数: 352 | 42 1. AST/ALT 只是 mildly elevated, 不足以说明是肝功能异常。单纯CK elevation 也
和心衰没有关系。CK其实也不算很高了，我觉得这三个lab偏高主要是 rosuvastatin的
副作用 － LFT elevation, muscle break down. 其实CK也没有高太多，病人有没有肌
肉疼痛的症状呢？我觉得应该再查一下scr, 以及lipid panel。不过既然你有AST/ALT
了，说明做了CMET, 那creatinin 你没有列出来说明不高对吗？那说明还没有发展到
rhabdomyolysis。这个时候如果LDL不太高，可以暂停 rosuvastatin. 针对lipid
profile 选择合适的降脂药。
2. calcium channel blockers may decrease the metabolism of statins. but the
dosage for rosuvastatin is not high. 如果一定要用其他statin可以试试
pravastatin or atorvastatin，这样可以s... 阅读全帖 |
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u*******s
发帖数: 688 | 43 来总结一下常见的(不完全的）需要renal dosing的药物吧~
allopurinol, colchicine
aminoglycosides, beta-lactams, fluoroquinolone, bactrim, vanco, macrolide,
azoles, some antivirals
digoxin, dabigatran, lovenox
tramadol, gabapentin, pregabalin, morphine
venlafaxine
metoclopramide
以下是肾功能较严重不足就要注意避免的一些药物：
metformin
duloxetine
nitrofurantoin
NSAIDs
K-sparing diuretics
lithium
xarelto
bisphosphonate
CKD的病人如果有高血压或者糖尿病，应该使用ACEI/ARB，不过医生好像常常忽略~ 药
剂师在做chart review的时候不要忘记检查哦。同时还要记得monitor serum
creatinine and K+. |
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n****d
发帖数: 100 | 44 creatinine肌酐和BUN尿素都在正常范围内，表明肾功能还在正常范围内，只是有蛋白
尿。 |
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b**o
发帖数: 5769 | 45 师姐考我那。ADA < 7, AACE < 6.5
他们诊所按ADA的标准。老年人或者身体很弱的可以提高到<8.
现实中经常有病人12左右的，能有下降就可以夸奖了。
BP and lipid和JNC 8一样。现实中有好多医生还是不喜欢新的JNC8,还是用旧标准。推
荐上Statin，除非病人不耐受，诊所里不少病人拒绝的。
metformin is the first line, 他的creatinine 也在正常范围内，可以用，500mg
BID然后titrate up。每天测血糖可以2-4次，记录下来,记录carb intake, exercise.
一个月复查，三个月复查A1C，每年做eye exam, foot exam, MA, 监控 lipid panel,
chem 7, 流感疫苗，乙肝疫苗和肺结核疫苗up to date.教育如何认识低血糖症状，如
何自己处理。
如果metformin用到高剂量也不行可以加别的。我们老师最近很推荐Victoza，因为会让
人有饱足感，顺便减肥。:) |
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I****a
发帖数: 407 | 46 What issue is primary? What issues are secondary?
It is hard to pinpoint at this moment for me w/o knowing any lab values.
This is likely a systemic process with multiple organ system involvement: GI
, vascular and possible renal and heme. I would guess diagnosis is
eventually made by a pivotal biopsy.
How would you work her up?
I would focus on elucidating the cause of anasarca and hypokalemia,
specifically UA, urine protein/creatinin ratio, urine lytes to calculate
transtubular potassium gradi... 阅读全帖 |
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A*******s
发帖数: 9638 | 47 Many physcians out there abuse the system.
-Every time I see a patient on the floor, they have been consulted by almost
every service in the hospital. Creatinine up call nephro, stomach pain
call GI, has a rash call Derm. What exactly do hospitalists do other than
call consults? A lot of times the consults have nothing to do with the
chief complaint.
-CT surgeons will operate on corpses if they have insurace.
-Lord knows how many negative upper/ lower endoscopies I've seen.
-The hospital I tr... 阅读全帖 |
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