l********y
发帖数: 2295 | 1 B1Q14. An 80-year-old man has had poor balance for 6 months. He has a
history of hypertension treated with hydrochlorothiazide. His blood pressure
is 136/86 mm Hg. Neurologic examination shows mild tremor of the hands when
his arms are outstretched and decreased vibratory sensation at the knees.
Deep tendon reflexes of the quadriceps and gastrocnemius-soleus muscles are
hyperactive. Babinski's sign is present bilaterally. He is unable to stand
with his eyes closed. Which of the following is most... 阅读全帖 |
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n***j
发帖数: 184 | 2 这个问题确实是很有意思啊
在first aid step 2CK里，写的beta blocker和CCB。同时提到了dehydration和
vasodilator会加重症状
first aid step3里，写到DOC是beta blocker和CCB。而digoxin，vasodilator以及
excessive diuresis应该避免
MTB step3上写到用beta blocker和diueesis。但是ACEI的作用不明确
所以整体看来的话，还是beta blocker和CCB，diuresis不是首选吧，但是如果有心衰
什么的估计就是另一说了
都是书上看来的，没有实际的经验，希望能有帮助！
谢谢！ |
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J*********4
发帖数: 1274 | 3 最近解剖被大家提及的越
来越多。除了Kaplan 和HY neuroanatomy，题库以外，请教还有别的书可以看吗？HY
anatomy cover 的如何？
=======================
答：我买了Netter's clinical anatomy, they have a lot of review Q&A for
anatomy
questions relevant for clinical scenario, which I think, is very good and
the type of questions USMLE will ask. 但是考试的时候还是觉得不太hold 住,哈
哈。HY anatomy cover 不了解，不敢评价。
请问,考前两周,看什么收益最大?
======================
答： GOJAN's HighYield， your previous wronged questions, Diagrams in FA,
especially those in pharmacology.
解剖十分差,看到解剖体就害... 阅读全帖 |
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b*****l
发帖数: 8603 | 4 2007年的，不知道你们说的是不是这个。祝好。
medical ethics more than hundred cases
Sep 24th, 2007, 12:17pm
1. A 25- year old mother refused immunization for her 2-month old son. The
social worker spoke to the mother. (Important for Board examination)
Next step in management: immunization should be given for the benefit of the
child.
2. A 30-year old mother refused surgery for suspected appendicitis for her 6
-year old daughter. The social worker spoke to the mother. (Important for
Board examination)
Next step in ma... 阅读全帖 |
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e****0
发帖数: 678 | 5 • 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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y**s
发帖数: 563 | 6 digoxin toxicity ----best therapy is Fab Fargments
what is Fab Fargments? |
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h*******g
发帖数: 19 | 7 对药很混淆，emergency的情况下，应该下哪个药？
谢谢 |
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x****i
发帖数: 169 | 8 什么emergency情况？这两种都不是常见的急救药物。 |
|
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d**********y
发帖数: 1506 | 10 It depends. give an example. |
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y**m
发帖数: 1049 | 11 我在非TELE, 一般给digoxin之前会按个脉搏,也就15秒钟,再长就没时间了. |
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a********n
发帖数: 438 | 12 Atrial Fibrillation
这个是最常见的arrhthymia 啦。如果SYMPTOMATIC/UNSTABLE，那么需要Electrical
CARDIOVERT
如果病人血压正常，没有心悸，relatively asymptomatic, 那么有3点注意：
1>Control ventricular responsive rate , 常用药有calcium channel blocker: IV
diltiazem BOLUS followed by continous IV 5-10mg/hr. 超过15mg/hr 需要转送ICU
。注意血压。beta-blocker:IV metoprolol 5-10mg IV then q6hrly. 我这儿有个医
生特喜欢用SOTALOL。 IV DIGOXIN : 0.5mg IV x1, then in 6hrs 0.25mg IV q6hrx2
then standing dose 0.125mg -0.25mg in am.
2>ANTICOAGULATE，会上HEPARIN DRIP（check PTT q6hr |
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n******e
发帖数: 40 | 13 A fib/ SVT
treatment:
cardizem
digoxin
amiodarone
per protocol |
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a****a
发帖数: 154 | 14 我只在med-surg实习过，现在记的仅限于书本有限记忆知识，列错了请更正我啊。
1. cardiac meds
digoxin，inocor,nitrate，nipride，tridil，beta blocker such as metoprolol，
ACEI such as captopril， enalapril， benzapril， calcium channel blocker
such as verapamil， nifedipine, ditiazem.
2 diuretics
lasix, ....不好意思，我得出门了，回来再尽量补充啊 |
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o****n
发帖数: 9475 | 15 Digoxin toxicity病人看起来什么样子？有个同学说脸色是yellow？
what |
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l***g
发帖数: 77 | 16 Just learnt digoxin in pharm class.
side effects include: n/v,weakness, altered mental status, visual change
like green halos.
For lasix, make sure pt's bp is ok. Also low potassium level.
For lopressor, it's a beta-blocker, make sure the pt is not hypotension or
bradycardia. |
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j****u
发帖数: 73 | 17 75道题， 近一半是multiple multiple, 恨死了。。
考试时有的是时间，不象做Kplan Qbank有时间限制，所以呢，慢慢读题，千万别急。
- 2道Alzheimer's 的药 -cept, 我重来没见过。。
- TB药，和Qbank里一模一样
- alcohol withdrawal symptom: multiple-multiple
- cocaine overdose的症状: multiple-multiple. 我当时竟然不知它是不是opiod,汗
死。。没选hypotension , urinary retention
- 一道排序：intermittent tube feeding
- 一道心电图 Tachy sinus,问该怎么处理
- chicken pox isolation
- newly admitted DKA pt, what should you do first: insulin IV or bolus 1000
ml NS
- Seasonal Affected Disorder, multiple-multiple: 这个Saund... 阅读全帖 |
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c*******n
发帖数: 1214 | 18 At the moment, use furosemide to reduce the edema and work load of heart may
be OK. For a 86 year old heart failure patient, use digoxin may help the
quality of life. |
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f****o
发帖数: 2770 | 19 heart failure的药美国有的国内基本上也都有，其实没有必要从美国弄的。
现在已经住院了就让医院处理吧。maintenance med和emergency treatment都是不一样
的。
现在这个阶段你可以看看你外婆有什么未完成的愿望，可以让她生前实现，如果突然去
了不会有遗憾。heart failure prognosis是很难断定的，很多临终的病人都会死的很
突然。
如果这次能救过来，每天都要吃diuretic+ACE inhibitor+beta blocker+digoxin
药量这些都是要医生根据你外婆的情况来做出决定的。这些药都不是什么新药，国内都
会有的。
每天都要吃，可以缓解symptom, slow disease progress,但是根治是不可能的。 |
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c*******n
发帖数: 1214 | 20 At the moment, use furosemide to reduce the edema and work load of heart may
be OK. For a 86 year old heart failure patient, use digoxin may help the
quality of life. |
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f****o
发帖数: 2770 | 21 heart failure的药美国有的国内基本上也都有，其实没有必要从美国弄的。
现在已经住院了就让医院处理吧。maintenance med和emergency treatment都是不一样
的。
现在这个阶段你可以看看你外婆有什么未完成的愿望，可以让她生前实现，如果突然去
了不会有遗憾。heart failure prognosis是很难断定的，很多临终的病人都会死的很
突然。
如果这次能救过来，每天都要吃diuretic+ACE inhibitor+beta blocker+digoxin
药量这些都是要医生根据你外婆的情况来做出决定的。这些药都不是什么新药，国内都
会有的。
每天都要吃，可以缓解symptom, slow disease progress,但是根治是不可能的。 |
|
M***e
发帖数: 40 | 22 Bless！
美国这边有的治心衰的药国内都有，都是非常成熟的药物，我想你外婆的医生现在应该
focus on 控制症状。像digoxin （地高辛）如果你外婆这样的情况要用药，应该要做
血药浓度监控的，所以我们能帮忙的也有限，相信医生，他们会尽力的。
LZ也不要太着急，我的一位亲人也是心衰，10年内数次报病危，但每次都平安挺过来，
祝你外婆平安。 |
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w**r
发帖数: 479 | 23 我就考了一个dosing，所以我觉得dose不是重点，但是有很多关于formulation的题目
。drug interaction我记得考了几个，不多，我遇到到都是最基本的，记熟常见的
inhibitor和inducer，几个重点的药，像digoxin, warfarin, lithium, theophyllin
，triptan 类单独看一下也就差不多了。 |
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l******k
发帖数: 27533 | 24 今天是最后一天在医院做medicine的rotation
最后跟的这个医生很酷，既会讲笑话又高效，雷厉风行的，看起来不年轻了，但一直没
结婚的一个女医生。
她今天问我的两个问题算是对我的第一个rotation很好的总结了
病例一：老太太A.fib，现在肠道complete obstruction, 需要尽量把PO的药改成IV
drips. 她问我，她如果把现在病人用的口服的digoxin 和 CCB, 再加上beta blocker
全部改成IV drips for 5 doses，我作为pharmacist，该怎么办？ IV作用快，三种
rate control的药同时IV对心率作用太强，如果pharmacist不打电话给她提醒她，要求
先试2个dose,而不是惯性的一次性开5个dose,病人要是死了，pharmacist就跟她一起坐
牢去了。我没忍住笑到跟她一起坐牢肯定很好玩，后来觉得这是件十分严肃的事情，需
要好好反省！
病例二：昨天她把病人的furosemide停了，spironolactone 一直在用，lab显示钾离子
三天前就恢复了正常，而且level越来越高，今天的钾跟... 阅读全帖 |
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f****o
发帖数: 2770 | 25 病例1：HR monitoring是医生护士的事情。病人难道digoxin+cardizem+BB三个都吃？
哪一个BB?
HR<50难道护士不马上报告？
病例2：d/c spironolactone也是她本分的事情。你们有药剂师participate in rounds
么？没有的话，basement的Order verification药剂师不会每天check K level的。。。 |
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w******e
发帖数: 42 | 26 Agree. Bcs EF<40, digoxin could be added.
快。 |
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l******k
发帖数: 27533 | 27 spironolactone 对stage III/IV HF证据挺明确的。It's very commonly used as
adjunctive therapy for HF
排在BB和ACEI之后
digoxin是last choice, and no evidence to improve mortality or morbidity
in |
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w******e
发帖数: 42 | 28 In the discharge assessment, if you can give some suggestion in case of
worse of symptoms in the future, this will set you apart from other
candidates during the interview. That's why I mention digi.
I do not understand why both of you disagreed with me...I did not say: Digi
MUST be added...I never say digi is the primary therapy for the
stabilization of patients with acutely decompensated HF either...and both of
you agreed that Digi could be added if pt still has symptoms after standard
treatm... 阅读全帖 |
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w******e
发帖数: 42 | 29 Now I am upset...I already reviewed the EMPHASIS-HF trial and specifically
pointed out that "only 96 of 2737 patients were enrolled with LVEF >30". The
result of EMPHASIS-HF can not be applied to our pt in this case whose EF is
34.
Also I never say digoxin is superior over other treatment. Please do not
over-interpret my post.
I believe all the discussion should be based on clinical trials or
guidelines rather than personal opinion. This is evidence-based practice,
and this is how I make argumen... 阅读全帖 |
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u***e
发帖数: 611 | 30 How's ur mom' heart rate? If not controlled well, can try digoxin.
Amiodarone has bad side effect, better to avoid if your mom is still young. |
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u*******s
发帖数: 688 | 31 常常跟保险打交道的童鞋们大概都很熟悉high-risk medications，有哪些，为什么
high-risk。
自从CMS对所有的Medicare part D 和 Medicare Advantage的保险计划进行星级评定，
保险公司对于quality measurements异常重视，因为一旦一个计划里有超过一定百分比
的病人达不到quality measurement，计划的星级就会收到影响。星级和利润直接挂钩。
有哪些quality measurements? 比如：
-high risk medications （本篇就讨论讨论这个话题):一个保险计划里使用高危药物
的病人的百分比要控制在一定范围，否则星星会掉哦~
-糖尿病的药物使用：糖尿病人中有多少人没有使用ACE-I/ARB？这个百分比在全国范围
内都不是很高，有药剂师称 -this is the bread and butter in quality
measurement.
-高血压控制百分比
-等等等等
保险公司开始意识到药剂师的作用。我所实习的公司也在不久的将来打算要hire更多（
大概6个）的药剂师来提高... 阅读全帖 |
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u*******s
发帖数: 688 | 32 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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m********4
发帖数: 607 | 33 We currently have these 2 patients. As a Doctor, how do you feel if they are
your patients?
Life is unfair, isn't it?
---------------------------------------------------
A: 46 yo patient multiple times hospital admissions.
-PAST MEDICAL HISTORY INCLUDES:
1. Hypertension.
2. Hyperlipidemia.
3. Diabetes type 2.
4. Hypothyroidism.
5. Obesity.
6. Congestive heart failure secondary to mitral stenosis status
post mitral and tricuspid annuloplasty in 2003 with known
physiology compl... 阅读全帖 |
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g*****d
发帖数: 991 | 34 Try this one.
3. A 75-year-old man presents with pain in both legs for the past six
months. He says that the pain has limited markedly his ability to walk. He
must sit down after walking a block. Stopping is not sufficient to decrease
the pain. At times, just standing causes his calves to ache, and he notices
tingling in both feet.
He has a 10-year history of systolic hypertension for which he has been
taking chlorthalidone. He has also been on warfarin and digoxin for a known
atrial fibrilla... 阅读全帖 |
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s*******w
发帖数: 1879 | 36 AVNRT is normally faster than JT.
AVNRT's p wave is either hidden in QRS or <=0.07s after QRS; JT's p wave is
either absent or looks inverted or even "weird".
One thing to add:
JT can be caused by digoxin or MV repair/replacement. AVNRT is more
idiopathic. |
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g*****d
发帖数: 991 | 37 最近，在4月15日，美国FDA刚刚批准了一款治疗心衰的药物，Ivabradine，商品名，
Corlandor。它是心脏窦房结If 离子通道阻滞剂，从而实现减缓心率的作用。虽然此药
已经在欧洲使用多年，但是在美国是第一次被批准用于心衰治疗。它的适应症是，慢性
稳定型心衰，射血分数小于35%，静态窦性心率大于70次每分钟，并且病人使用最高剂
量beta受体阻滞剂或者不能耐受Beta受体阻滞剂者。
这个药物在美国的通过是基于大规模临床试验SHIFT (Systolic Heart Failure
Treatment With the If Inhibitor Ivabradine Trial)。这个临床随机试验包含
了6505名心衰病人，所有病人都有常规心衰药物治疗，病人随机分配到治疗组和安慰剂
组，随访30个月。试验结果发现Ivabradine可以有效的降低26%的心衰住院率，但是，
没有减低病人的总体死亡率。在试验中，新药Ivabradine的通常副作用是心动过缓（10
% Vs. 2.2% 安慰组），血压升高（8.9% Vs. 7.8 ），房颤（8.3% Vs. 6... 阅读全帖 |
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