R******7
发帖数: 53 | 1 好不容易找到一份工，因为TB test在2004年就positive，叫去做CXR，又有right
apical infiltrate，不让开工啊！我没有TB的syptoms， 连咳嗽一声都没，但医院一
定要我去做sputum smear 和 culture。是不是3次sputum smear都没事就行了？听说
sputum smear 结果2天就知道，culture要6个星期啊。有没有相同经历的？咋办啊？真
是烦死人！ |
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R******7
发帖数: 53 | 2 I am taking : Rifamate, EMB and PZA. They just came check the family. The
kids seem OK, negative result but they still want a CXR. |
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z******8
发帖数: 844 | 3 ☆─────────────────────────────────────☆
rhcrc11 (Rebel) 于 (Thu May 15 00:13:42 2014, 美东) 提到:
Step3考场壮烈回来。第一天挺累人，最后一个block甚至做到有心无力状，看着题反应
不过来，导致来不及做完。非常没有信心能否通过。所以match之前先考Step3的童鞋，
需要考前调整生物钟，坚持锻炼，提高耐力。
MCQ没有资格说，CCS有一点小感受，拿出来分享下。大家请轻拍砖。
复习资料：
UW 52 online cases : 基础。最好复习早起找高手一起过一遍，尽快摸熟软件，进入
状态。第二遍找一位水平相近童鞋过一遍，不断总结protocol. 考前迅速做一遍，熟练
运用protocol.
UW 41 offline cases: 我当时和partner每个case仔细做一遍，虽然不像online有反馈
，但对练临床思维，补充protocol非常有帮助。最后考试与41 case有异曲同工之处，
遇到复杂case也不慌神。
CD 6 cases： 最后再熟悉下考试软件。与UW相近，但... 阅读全帖 |
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r*****1
发帖数: 805 | 4 My CCS protocol:
P.S.：多有重复，谨防遗漏，仅供参考。
Screening test: General—Lipid profile/ multi-vitamin; Elderly—DEXA scan&
Calcium& VitD/ Colonscopy or FOBT/ vaccination; F-- >18yo Pap smear; >50yo
Mammogram; reproductive age- folate; menopause- Lipid/DEXA/FOBT; M-- >50yo
PSA; sickle cell dz child-prophylaxis w penicillin till 5yo, CF-prophylaxis
w Abx
Prophylaxis: Pantoprazole, pneumatic compression stocking;
Acute abd w perforation: triple Abx- Gentamycin/ Ampicillin/
Metronidazole (口诀：阿扁举旗庆国庆)
E... 阅读全帖 |
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w***b
发帖数: 86 | 5 谢谢！！！
问题2 我明白了。
对问题1，你是说PPD+CXR（ChestX-Ray吗)可以确诊结核病吗？可是老年性结核病的CXR
不是和肺癌的CXR很像吗？
老太太现在被怀疑有肺癌，专家的意思高度怀疑是肺癌，没有肺结核。
我想确认的是：如果影像+病理结果确认是肺癌，之前的PPD阳性是否说明完整的病情应
该是肺结核并发肺癌？而不只是肺癌？恳请你的建议，万分感谢。
1.PPD皮试（有鸡蛋大的包）阳性，可以说明有active的结核菌，这个结论对吗？难道
PPD也可能有假阳性？
PPD is just a screening test, a screening test means higher sensitivity,
with an acceptable specificity, which means there are many false positive
cases. That's why CXR is warranted to check the presence of active TB.
2.PET可以确诊有没有癌细胞，但不能确认小细胞癌或非小细胞癌，这个结论对吗？
t |
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w*******4
发帖数: 17 | 6 Pearls:
1. Fiberoptic bronchoscopy is part of the evaluation of a patient with
hemoptysis, but it is typically performed after a chest x-ray (CXR). It is
the next step if a CXR shows a mass, if the CXR is normal and there are
major risk factors for cancer, or if the CXR is normal and there are no risk
factors for cancer, but there is a recurrence of hemoptysis after weeks to
months of observation. Then remember, if you have a patient with hemoptysis
with past history of smoking ,your first step |
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l********y
发帖数: 2295 | 7 ID:
- PNA: determine type (CAP, HCAP, or HAP) and start appropriate abx regimen;
r/o COPD exac
- DM with chronic infections: r/o bone infection, check for osteo (imaging,
XR); start vanco; inherently immunosuppressed; think of fungal infxn's too
- Back pain + fever: r/o epidural abscess with MRI; call neurosurgery
- Low threshold to do LP in anyone with AMS, h/a, nuchal rigidity, concern
for meningitis; consider septic emboli and checking TTE; image head
- TB: if suspect, admit to neg airflow is... 阅读全帖 |
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S******1
发帖数: 44 | 8 今天得知了step3的成绩，210+，心里的石头终于落下。终于轮到我给USMLE说再见了。
回顾从step1自己闭门造车考了只带一个9的分数， step2开始参加小组学习，做了所有
能做的题只为拿个99，虽胸有成竹且考试感觉很好，最终但又得到一个9的分数。虽然
这次成绩不高，依然很高兴，毕竟不用发愁如果没过的话住院医开始后没有时间复习该
咋办。过去的3年中得到太多人的帮助 (此处略去人名20个)，绝大多数甚至从未谋面。
今天发贴也是为了回报我们这个社区吧。
自我介绍：毕业>15年，220+/220+/1st/210+；
复习时间：6月，头4个月每天约2-3小时，周末由于陪孩子们玩（前两年欠的太多，你
懂得）及做点家务（再不做但心被老婆炒掉），反而复习不了多少；最后2个月每天4小
时，鼓励自己考了这个2年内再不用受这个罪。
复习资料：随大流，MTB 3, UW CCS, UW step3 Qbank, UW step2 Qbank;
模拟：考前2月，NBME 1 190+, 考前1周，NBME 2 220+;
体会：难，考过不容易，考高分更难。主要是因为没有合适的复习资料。UW的1300... 阅读全帖 |
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b*****o
发帖数: 6080 | 9 我给大家看看我当初的经历和想法，看过即忘便可以。
01/31.昨夜是一个irritated病人，只能睡着，一醒着就瞎折腾，要离开医院，VS就非
常不正常。我想给他short bedbath,他就醒了，这下爆炸了，弄的我很没底气。我
preceptor开始就告诉我别她弄醒了，我不小心就。。。反正后来一剂Ativan又让他睡
过去了，我才感觉好一些。3点多钟来一个new admission,因为不熟悉Medtech，又使自
己焦头烂额。非常非常懊丧。
赶紧去睡，呼呼大睡，眼皮撑不开了。突然想起来3K说“在改”，我也每天都“在改”。
02/05. Had a boring night. One patient is passing away, and the other is
actually passing away as well. The only exciting point is to know one needs
to do urine culture, blood culture & sputum culture (intubated) if in high
fever e... 阅读全帖 |
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b*****o
发帖数: 6080 | 10 我给大家看看我当初的经历和想法，看过即忘便可以。
01/31.昨夜是一个irritated病人，只能睡着，一醒着就瞎折腾，要离开医院，VS就非
常不正常。我想给他short bedbath,他就醒了，这下爆炸了，弄的我很没底气。我
preceptor开始就告诉我别她弄醒了，我不小心就。。。反正后来一剂Ativan又让他睡
过去了，我才感觉好一些。3点多钟来一个new admission,因为不熟悉Medtech，又使自
己焦头烂额。非常非常懊丧。
赶紧去睡，呼呼大睡，眼皮撑不开了。突然想起来3K说“在改”，我也每天都“在改”。
02/05. Had a boring night. One patient is passing away, and the other is
actually passing away as well. The only exciting point is to know one needs
to do urine culture, blood culture & sputum culture (intubated) if in high
fever e... 阅读全帖 |
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c********e
发帖数: 496 | 11 once single pulmonary nodule is found on CXR, first thing is always to
compare with previous CXRs, if any. |
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j*****1
发帖数: 105 | 12 I have to say first that I am not neuroradiologist. My training in
neuroradiology is limited to my residency experience.
From the non-contrast enhanced CT head, which is not modality of choice for
brain space occupying lesion, and based on pt's hx, it does look a lot like
a abscess in the left frontal lobe. The lesion is ring-shaped with lots of
edema surrounding it and evidence of mass effect. In pt who developed the
symptoms in such a short period of time, abscess has to be considered first
un... 阅读全帖 |
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j*****1
发帖数: 105 | 13 I have to say first that I am not neuroradiologist. My training in
neuroradiology is limited to my residency experience.
From the non-contrast enhanced CT head, which is not modality of choice for
brain space occupying lesion, and based on pt's hx, it does look a lot like
a abscess in the left frontal lobe. The lesion is ring-shaped with lots of
edema surrounding it and evidence of mass effect. In pt who developed the
symptoms in such a short period of time, abscess has to be considered first
un... 阅读全帖 |
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c*******r
发帖数: 54 | 14
四五个月还是咳嗽，（X光片，拍了4次)
This is reasonable.------你有孩子吗？你会给他一个月照一次X光片么？I do have
kids, and CXR f/u for undiagnosed chronic cough is reasonable. Having kids
does not mean you know what you are doing.
家庭医生（不是个人诊所，是正规医院的大夫）居然不会看片子，
getting consultants does not mean he/she is not capable of reading CXR
-------对不起，这是大夫在我反复追问下，自己说的。No comment. But I doubt it.
可恨的是他大概知道自己是二把刀，找了一个他认为是专门看片子的人给确认，结果那
个人也看错。
How did you know the consultant was "wrong"?----这也是他打电话来自己告诉我们
的 No comment. Looks like all of the doc... 阅读全帖 |
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c*******r
发帖数: 54 | 15 四五个月还是咳嗽，（X光片，拍了4次)
This is reasonable.------你有孩子吗？你会给他一个月照一次X光片么？I do have
kids. Serial CXR f/u for undiagnosed chronic cough is reasonable. Having
kids does not mean you know what you are doing.
家庭医生（不是个人诊所，是正规医院的大夫）居然不会看片子，
getting consultants does not mean he/she is not capable of reading CXR
-------对不起，这是大夫在我反复追问下，自己说的。No comment. But I doubt it.
Looks like you don't know much about the differences between solo practice
and group/hospitalist practice.
可恨的是他大概知道自己是二把刀，找了一个他认为是专门看片子的人给确认，结果那
... 阅读全帖 |
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l*******8
发帖数: 1745 | 16 来自主题: MedicalCareer版 - 请教啊！ 大家为病人担心吗？下班后，我总是不放心重病人。虽然都已经交班过了。今天上午一
个CT引导下肾活检的病
人在我下午交班前突然FLANK pain, sob, pain with deep breath. I did physical
exam, breath sound is present, flank
pain is localized. Bp increased, HR increased, paged my senior, but senior
is in clinic, cannot and did not return my
call. I ordered oxygen, morphin, portable cxr, CBC, but forgot that I should
do a blood type and cross match along
with that CBC:-( told nurse vital signs q2h. Told on call team follow up on
my patient with CBC and cxr result. Or |
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t*****s
发帖数: 139 | 17 PPD positive + CXR negative: lifetime active TB risk 概率 10%
PPD positive + CXR negative + INH 9 Mon: lifetime active TB risk 概率 down
to 1%
PPD test should not be repeated once it's positive. |
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L*****r
发帖数: 722 | 18 1. 胸痛的几个误区：
（1）ACS，这个本来看起来不会有什么问题，因为胸痛待查不可能不做系列心电图和肌
酶谱，但是也存在很致命的暗礁：
a.是开出心电图Q6hour, 但是病人收到病房，你却在急诊室忙着收病人，于是就忘记了
跑到病房 follow up 心电图Q6hour！这一段时间病情有可能急剧变化，譬如由NSTEMI
变成STEMI，需要立刻上心导管，如果你漏掉了，那就是很严重的事故。所以，新
INTERN的 duty check list 很重要，一定要按时follow up病人，不能够认为收入病房
就万事大吉。
b. 糖尿病患者或老年人，痛阈很高，心梗或PE可能没有胸痛，但是会表现为呼吸困难
。所以，这些患者的呼吸困难，等同于胸痛对待。
c. 常看到“order EKG, cardiac enzyme to R/O ACS” 的医嘱，其实这反映了一个概
念性错误。因为 即使EKG变化不明显,、cardiac enzyme正常，也可能从临床上诊断
unstable angina。关键是UA也是ACS的一个亚型，要按 NSTEMI 处理，给 full dose
anticoagu... 阅读全帖 |
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e****0
发帖数: 678 | 19 • 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 |
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e****0
发帖数: 678 | 20 • 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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t********o
发帖数: 228 | 21 Just found out i passed it. Well, not a big surprise and finally, I can say
good by to USMLE
Material: MTB3 and UptoDate. Step 1/Step2: 250/249 but those were 3 years
ago. Step 3: 227. Time: on/off for 3 months.
Good luck to everybody.
Not a whole lot of thoughts about this test. if you can memorize MTB3 and UW
, then there should be NO problem to pass it.
here are some thoughts about this CCS (combined mine and others)
Step I: patients: VASCULAR
Vitals/Age/Sex/Chief complaint/Urgent sympt... 阅读全帖 |
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m*****h
发帖数: 2638 | 22 dressing change: 每7天一次 and prn if dislodged， also change the lock。
那个biopatch， blue to the sky，（不过这个东西有新产品出来了，不在有单独的
biopatch，而是在那个dressing 上面自带的一种jelly样的东西）stat lock，然后
transparent dressing。严格无菌操作，护士带口罩，病人头偏向另一边或者带口罩。
flush： 10ml NS every 8hrs，有的地方用heparin 10units lock，也是every 8hrs
blood draw： 先flush10ml NS，然后回抽，扔掉10ml血，再收集标本，最后再flush
20ml。
每次要用picc时，那个hub要用酒精patch 用力的rub 20 seconds。
remove picc：每个picc 放进去的时候都有个记载，放了几个cm进去了，外面留了几个
cm，总长度几个cm，tip是不是trim 过。这个在病人的chart里头有，或者有的floor有
一个单独的folder... 阅读全帖 |
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A*******s
发帖数: 9638 | 23 我觉得没必要吃INH， 我现在就只做CXR， 我告诉他们我打过BCG。
对美国人来说，如果皮试阳性， 即使CXR没事， 他们还是认为你有感染的可能， 所以
让你吃药没什么错。 |
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n*******c
发帖数: 501 | 24 声明：本文纯属虚构，亦非本人真实经历，甚至有可能为代笔（按方某人的逻辑），各
位切勿对号入座，以假当真。
“嘟嘟…嘟嘟”page响了，该死，又是夺魂追命call，一看号码，糟糕，是妇产科病房。
值班最怕妇产科病人call了，产后的也就算了，产前的个个症状都不简单，有点什么内
科问题检查不敢随便做，药也不好随便用，得非常小心才行。
果然，33周孕妇，突发尖锐剧烈胸痛10/10，已经用了很多止痛药，疼痛还是没有缓解
，所以才内科急会诊。
看了病人，果不其然，又是那种似是而非的情况，年轻健康女性，初孕33周，产前一切
检查都没什么问题，这次入院是有些RUQ痛，大概妇产科不放心怕有急腹症的情况留院
观察的。现在腹痛缓解了很多，入院血液检查也都一切正常，本来病人已经准备明天办
出院的，不曾想今天出现了胸痛。
检查病人，气促，双肺呼吸音略弱但无罗音或哮鸣音，心脏和腹部都大致正常。监控显
示血压正常和SaO299% on ambient air.心电图显示sinus tachycardia，其他正常。
“what are you gonna do?”妇产科的医生催促着…“CTG is fine at... 阅读全帖 |
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T*R
发帖数: 36302 | 25 PE很危险，但是确诊比较难。需要做CT angiogram或VQ scan。
普通的CXR和CT诊断不出。
查血D Dimer可以排除，但是不能确诊。
如果每个short of breath的人都做ct angio／d dimer，医院就吃不消。毕竟绝大部分
sob的人不是pe。
这个看医生了。
要我是医生，我会给她做screen。 |
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z****g
发帖数: 7 | 26 Hello all,
I'm astonished to see Guangyao Li is still a student in your department
after so many frauds he has committed.
Your dear student or classmate or officemate or any mate else has cheated
more than $100,000(confirmed, may be more than that) through the biggest
Chinese forum in North America: www.mitbbs.com.
As I know, his main fraud trick is to pretend selling stuff(all kinds of
stuff, like flight ticket, rmb, dollars, or other goods) and vanishes after
he got the money.
He registered mu... 阅读全帖 |
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c********e
发帖数: 496 | 27 one possibility is obstructive pneumonia, but the sign of it is recurrent
inflammation of same lobe and same section.
but it has nothing to do with interstitial pneumonia, that's totally two
different diseases.
For the mass in the lung, first thing to do is to check and compare with
previous film, either CXR or CT. any calcification, duration of the disease,
History of smoking, family history. |
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n******s
发帖数: 210 | 28 busy with something else, just got time to come back.
OK, now the differentials in my mind:
1. Upper respiratory tract infection (RUI), runny nose, cough, yellow sputum
, but we can roughly rule out pneumonia, since the CXR is normal.
2. GERD: nocturnal cough, and relieved by losec, right? but typically, the
patient with GERD will tell that they can feel heartburn or chest pain, and
most of them can feel the reflux of the acid.
3. Gastritis: LUQ abdominal pain, not sure, sometimes, the pain as y |
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n******s
发帖数: 210 | 29 之前，先是感冒了一个星期，发烧，
Should be kind of infection, like URI, flu, pneumonia.
一个星期以后，不发烧了，但是一直咳嗽，但是没有什么痰。
should be post infectious cough.
几天以后看医生，怀疑是肺部感染，给了一种药，每天一片，总共七天，感
觉药的药力很强，七天以后，不再咳嗽了。 然后大概又过了一个星期，又感觉有点感
冒，几天以后，感冒症状没有了，但是就开始吐痰，频率非常高，
either this is just a caused by your previous infection.
or another around of infection.
you need to know the signs of infection:
1. yellow or green sputum,fever, WBC goes up.
2. rales on auscultation,
3, CXR positive
4. culture.
非常麻烦。又看医生，医生也没有结论。请问，这究竟是什么原因哪？谢谢。 |
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c********e
发帖数: 496 | 30 whenever single nodule is found in the lungs, first thing the doc needs to
do is to compare it with other CXRs. Duration is very important.
Other points:
if the border is clear, if not, invasive.
if calcification around nodule, if yes, malignancy.
if lymphadenopathy, if yes, cancer.
if smoking history +, if family history +.
if there is any endocrinolgoical changes recently, if yes, pancoast tumor.
Many others.
If malignancy is more likely (80-90%), go for thoracotomy.
If not clear cut. do VA |
|
c********e
发帖数: 496 | 31 1.PPD皮试（有鸡蛋大的包）阳性，可以说明有active的结核菌，这个结论对吗？难道
PPD也可能有假阳性？
PPD is just a screening test, a screening test means higher sensitivity,
with an acceptable specificity, which means there are many false positive
cases. That's why CXR is warranted to check the presence of active TB.
2.PET可以确诊有没有癌细胞，但不能确认小细胞癌或非小细胞癌，这个结论对吗？
there are two options,
either do bronchoscopy, biopsy or lavage, and get pathology report.
or PET first and then surgery, send the sample for a quick pathology report
during the operat |
|
y*****g
发帖数: 193 | 32 No matter whereever she goes, she need CXR and induced sputum smear and
culture for acid-fast bacilli. TB is highly contagious, and she will be
admitted to hospital and put into isolation room before ruling out acitve TB.
She does not need a specialist to rule out TB. TB diagnosis and treatment is
pretty standard. TB can be dormant, but it can turn into active.
There is other serious reasons to have hemopytosis. They all need to be
worked out in hospital. Even you go to see a specialist or go to |
|
c********e
发帖数: 496 | 33 if it is clearly a nodule, next step, there are two things that you need to
do.
1. compare with the previous CXR or CT, if there is any.
2. biopsy, video-assisted thoracoscopy (VAT), also known as video-assisted
thoracic surgery may be able to reach the apex. |
|
f****o
发帖数: 2770 | 34 我也就是照着washington manual of oncology给你啊查查。
宫颈癌几期根据physical examination, CXR, intravenous pyelography,
cyystocoscopy, proctosigmoidoscopy,基本上就是医生检测来判断的。。。
CT, MRI, PET是用来guide treatment and cannot be used to change the stage.
5年存活率
stage IA, curable; IB, 85-90%; IIA, 73%; IIB, 65-68%; III, 35-44%; IV, 15%.
医生不给staging咱也没法子。既然没转移，起码是III以前了。 |
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s********8
发帖数: 264 | 35 老爸肺癌晚期，每天疼痛难忍，同时吃四种止痛药也没用。 刚刚拿到了基因检
测结果。 医生说没有合适的靶向治疗match上。 两种基因突变都是最common的。
但我不甘心呀。 把基因结果post在这里。 跪求板上大拿review，给我们一些建议！
！ 谢谢
简单治疗过程：
1. 11/17: 发现肺癌肿瘤，一厘米大小，一期。 手术切掉了。 术后说非常圆满，
我们十分lucky发现的早，痊愈了。
Underwent R VATS, wedge resection with mini R thoracotomy, R upper lobectomy
and mediastinal LN dissection. Path demonstrated a 1.3 cm adenosquamous
carcinoma, moderately differentiated with visceral pleural invasion,
negative vascular and bronchial margins, and 0/16 LNs, pT2aN0M0.
Immunoh... 阅读全帖 |
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s********8
发帖数: 264 | 36 老爸肺癌晚期，每天疼痛难忍，同时吃四种止痛药也没用。 刚刚拿到了基因检
测结果。 医生说没有合适的靶向治疗match上。 两种基因突变都是最common的。
但我不甘心呀。 把基因结果post在这里。 跪求板上大拿review，给我们一些建议！
！ 谢谢
简单治疗过程：
1. 11/17: 发现肺癌肿瘤，一厘米大小，一期。 手术切掉了。 术后说非常圆满，
我们十分lucky发现的早，痊愈了。
Underwent R VATS, wedge resection with mini R thoracotomy, R upper lobectomy
and mediastinal LN dissection. Path demonstrated a 1.3 cm adenosquamous
carcinoma, moderately differentiated with visceral pleural invasion,
negative vascular and bronchial margins, and 0/16 LNs, pT2aN0M0.
Immunoh... 阅读全帖 |
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T*R
发帖数: 36302 | 37 No way, all women before menopausal will be tested for urine HCG in ER if
they get tretments such as CXR or Antibiotics.
This is policy. |
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e********e
发帖数: 435 | 38 我的理解是，你的医生没有给你bronch，而是做CXR and Chest CT是因为他们不觉得你
的症状符合aspiration, 而是想确定不是其他的。 |
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w******y
发帖数: 4871 | 39 Flovent属于inhaled corticosteroid (ICS).
俺记得Flovent 不能加在nebulizer machine里的。
Pulmicort是可以加在neb machine里的。
俺怎么记得flovent一般是不给小小孩用的。
Albuterol 用起来有时候心跳270/min,没有先天心脏病的话小孩子还是在一定时间范围
内能tolerate的。
严重性和是否住院不是看你wheezing有多严重而决定的，好多其它因素都要考虑。
首先你家娃vital sign. Intake, activity level都不错，can speak in sentences,
pulse oxygen saturation也不错，CBC and CXR也没异常，给几次albuterol
treatment,口服激素，follow up with ur doctor 门诊，这样的处理很正常。
你娃娃的ICS用量真的该调一调了，你看过Peds A/I and peds pulm,一般general Peds
会让你看他们调整剂量，general peds一般不敢违反subspec... 阅读全帖 |
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w******y
发帖数: 4871 | 40 Normal cxr, usually means no consolidation, infiltrate or 胸膜积液。
If no rales or ronchi can be heard by stethoscope, then in general,
pneumonia is less likely.
But sometimes chest X-ray is lagging behind,所以如果clinical situation is
deteriorating, then need to go to ER right away.
Infection and inflammation r two different things.
In general asthma is considered to be a chronic inflammatory disease which
can be triggered by viral or bacterial infection in the airway. |
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w******y
发帖数: 4871 | 41 几个医生都听到肺里有wheezing,那就是肺里有wheezing了啊。一般来说俺们听到时候
会非常小心的。
喉咙咕噜咕噜是另一回事。你家娃没准有鼻炎导致postnatal drip, or sometimes
vocal cord dysfunction can produce wheezing too.
ur baby一般状况良好，血氧含量好，CXR正常，如果CBC 正常，又没有其他部位比如耳
朵喉咙sinus 感染的迹象，根本没有必要上抗生素。就是咳的要死到acute bronchitis
大部分情况是病毒引起的，如果没有细菌感染的迹象或患者本身也不是immune-
compromised ,还是不给抗生素的。
俺不管楼上的还有国内的是如何如何处理，这里的treatment guideline就这样。也没
有必要去把rhino, RSV, flu那一堆病毒检查给做一遍，一点都不cost-treatment
effective.
研究表明好多小孩一岁内上呼吸道病毒感染后，以后几年内就是反复wheeze.
有一定比例最后就是成了哮喘。
孩子太小，一些diagnostic test比如... 阅读全帖 |
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B****r
发帖数: 1737 | 42 看了三次医生，没有任何进展。可能下周要收入院了。小地方没有儿童医院，也不知道
该不该换个别的医生。恳请大家帮着瞧瞧 。万分感谢。
高烧１０天，咳嗽１４天。抗生素吃了４天后，症状没有好转。４天前开始腹泻。没有
皮疹／关节红肿疼痛／眼症。炎性指标增高，但白细胞正常。胸片显示支气管增粗，提
示病毒性肺炎可能。腹部B超正常。病人具体情况如下。
5 yo female with persistent cough x 14 days and fever x 10 days. Fever runs
102-104 F, but does normalize when given motrin or tylenol. Symptom no
improvement after 4 days of Azithromycin. Began to have loose stool /watery
diarrhea for past 3-4 days. She had complained of abdominal pain (mostly
peri-umbilical) intermittently for... 阅读全帖 |
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w******y
发帖数: 4871 | 43 一般情况下出生两周后才有第一次自己儿医的门诊visit.
估计楼主的娃娃这时候还没有自己的PCP.
而且newborn,在怀疑感染的情况下,即使血,尿,痰培养还有CXR阴性,即使体温不高,脑脊
液没有抽出来,照常规,要用抗生素两周.(希望俺记忆还正确). |
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c*******r
发帖数: 54 | 44 四五个月还是咳嗽，（X光片，拍了4次)
This is reasonable.
家庭医生（不是个人诊所，是正规医院的大夫）居然不会看片子，
getting consultants does not mean he/she is not capable of reading CXR
可恨的是他大概知道自己是二把刀，找了一个他认为是专门看片子的人给确认，结果那
个人也看错。
How did you know the consultant was "wrong"?
更可恨的是，那个人就‘纠正’了自己的错误，和肺科专家看的还是不一样。
最可恨的是儿童肺科专家，胡说八道，要真是肺萎馅，我儿子夏天怎么就没事了？肺粘
膜粘连难道还和季节有关？
Atelectasis could be secondary to foreign object in the airway (most common
in children), how do you know the pediatric pulmonologist is a jerk? |
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b*****1
发帖数: 3331 | 45
四五个月还是咳嗽，（X光片，拍了4次)
This is reasonable.------你有孩子吗？你会给他一个月照一次X光片么？
家庭医生（不是个人诊所，是正规医院的大夫）居然不会看片子，
getting consultants does not mean he/she is not capable of reading CXR
-------对不起，这是大夫在我反复追问下，自己说的。
可恨的是他大概知道自己是二把刀，找了一个他认为是专门看片子的人给确认，结果那
个人也看错。
How did you know the consultant was "wrong"?----这也是他打电话来自己告诉我们的
更可恨的是，那个人就‘纠正’了自己的错误，和肺科专家看的还是不一样。
最可恨的是儿童肺科专家，胡说八道，要真是肺萎馅，我儿子夏天怎么就没事了？肺粘
膜粘连难道还和季节有关？
Atelectasis could be secondary to foreign object in the airway (most
common
in children), how do you know... 阅读全帖 |
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B****r
发帖数: 1737 | 46 看了三次医生，没有任何进展。可能下周要收入院了。小地方没有儿童医院，也不知道
该不该换个别的医生。恳请大家帮着瞧瞧 。万分感谢。
高烧１０天，咳嗽１４天。抗生素吃了４天后，症状没有好转。４天前开始腹泻。没有
皮疹／关节红肿疼痛／眼症。炎性指标增高，但白细胞正常。胸片显示支气管增粗，提
示病毒性肺炎可能。腹部B超正常。病人具体情况如下。
5 yo female with persistent cough x 14 days and fever x 10 days. Fever runs
102-104 F, but does normalize when given motrin or tylenol. Symptom no
improvement after 4 days of Azithromycin. Began to have loose stool /watery
diarrhea for past 3-4 days. She had complained of abdominal pain (mostly
peri-umbilical) intermittently for... 阅读全帖 |
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s******t
发帖数: 1672 | 47 有听说要写 treatment plan的。但是大多数都没有。
你先给你医生说 你在国内做过 卡介苗（ＢＣＧ）， have BCG induced positive
TB test， and do not have any symptoms and your CXR is normal. So do not
need to take any medication。 不让他写。
如果非要写，你也不想写，你最好多找个医生问问，就说你刚做的,皮试阳性，x-ray阴
性，不想写treatment plan，他们可以签字么。 你什么东西都有，就是再多找个医生
，多交１００多块钱。 |
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c*******2
发帖数: 346 | 48 医生建议吃6个月的药。。。
是不是485体检只能等吃完药才能去找移民医生出报告？？
求建议，谢谢 |
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a**e
发帖数: 5094 | 49 yeah, I told the physician that I have strong reaction to PPD test, so they
waive the test. Then I got my CXR at county hospital for free. No meds taken
. The physician is an American doc. |
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e******u
发帖数: 6296 | 50 健康查体不行么，血尿便三大常规，血生化，CXR，腹部B超，ECG，国内做一套500来块钱
要是非要有症状才给看，就说头晕心悸，怎么也得给你查血和ECG吧 |
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