m******7
发帖数: 58 | 1 If a patient has repeated epigastric pain, and this time it has been on for
a certain time, should the chief complaint be" repeated epigastric pain for
3 years, recure 90 min" or "epigastric pain 90 min", then put the previous
experiences into past medical history?
Thanks! |
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h*******r
发帖数: 182 | 2 CC: Epigastric intermittent pain for 15 days, nausea and vomiting for 1 week.
PE: Patient is awake and alert, not in acute distress. There is tenderness
in epigastric area upon deep palpation. An epigastric mass is noted,
hepatomegaly, supraclavicular lymphadenopathy (#, size, left side?).
FOBT (+), Abd U/S: ascites is noted, hepatomegaly
EGD: 3x2.5 cm irregular lesion found on anterior wall of antrum.
Dx: Gastric cancer, stage IV.
有错请纠正.
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s*******1
发帖数: 428 | 3 My guess is :D
The question is asking for the causes of this patient's current symptoms.
For my understanding, the current symptoms are 1. epigastric pain; 2. foul-
smelling stool.
So, 1. Epigastric pain is caused by chronic pancreatitis.
2. Foul-smelling stool is caused by lack of pancreatic enzyme.
Fecal elastase from wiki:
Chymotrypsin-like elastase family member 3B also known as elastase-3B,
protease E, or fecal elastase is an enzyme that in humans is encoded by the
CELA3B gene.[1][2]... 阅读全帖 |
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d******0
发帖数: 296 | 4 Case 1
Opening scenario:
Sharon Smith, a 48-year-old female,comes to the clinic complaining of
abdominal pain. Married with four children.
Vital signs:
BP:135/70 mmHg
Temp:98.5 F
RR:16/minute
HR:76/minute, regular
Protocol:
Knock three times with confidence, a smile, walk in and say:
Good morning, Ms Smith. I am Dr. Dora, and I am here to see you today as
your physician. Nice to meet you .Shake hands. Is everything in the room
alright for you? Let me cover you with this to make you a little m... 阅读全帖 |
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m******r
发帖数: 1904 | 5 ☆─────────────────────────────────────☆
dora2010 (dora) 于 (Wed Feb 29 16:55:46 2012, 美东) 提到:
Case 1
Opening scenario:
Sharon Smith, a 48-year-old female,comes to the clinic complaining of
abdominal pain. Married with four children.
Vital signs:
BP:135/70 mmHg
Temp:98.5 F
RR:16/minute
HR:76/minute, regular
Protocol:
Knock three times with confidence, a smile, walk in and say:
Good morning, Ms Smith. I am Dr. Dora, and I am here to see you today as
your physician. Nice to meet you .Shake ha... 阅读全帖 |
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d**z
发帖数: 3577 | 6
Gallstones
In addition to the prevention of kidney stones there is evidence that
magnesium can prevent gallstones. Our medical dictionary says that the
gallstone is a concretion formed in the bladder or the biliary ducts,
composed, in varying amounts, of cholesterol, bilirubin, and other elements
found in bile. The biliary ducts are in the liver. In this case also,
magnesium is a specific preventive factor in the formation of gall- or liver
stones. For one thing, in a previous chapter, we showe... 阅读全帖 |
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r*******g
发帖数: 5495 | 7 Selected Differential Diagnosis of Abdominal Pain
Pain location Possible diagnoses
Right upper quadrant Biliary: cholecystitis, cholelithiasis, cholangitis
Colonic: colitis, diverticulitis
Hepatic: abscess, hepatitis, mass
Pulmonary: pneumonia, embolus
Renal: nephrolithiasis, pyelonephritis
... 阅读全帖 |
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g***r
发帖数: 285 | 8
appendicitis mostly present with right lower quadrant pain, with significant
rebound and guarding, associated with fever often,
gallbladder is in right upper quadrant,
diverticulitis is often in left lower quadrant,
pancreatitis is often epigastric with radiation to the back,
but in general abdominal pain is quite difficult to diagnose, |
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c****y
发帖数: 59 | 9 It's not as hard as you might think, but only 5% of the people managed to
get the right answer.
A 43-year-old man is evaluated for a one-year history of chronic abdominal
pain. He describes episodes of epigastric and left upper quadrant pain that
last for hours and are not relieved by antacids. Certain foods can
precipitate the pain. He also complains of occasional diarrhea. The patient has lost
10 pounds over the last 6 months. Four years ago he was hospitalized for
three clays with acute abdom |
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a****9
发帖数: 773 | 10 谢谢大家关心和建议，还有诊断，呵呵 :)
就是觉得奇怪，因为记忆中还从来没咳嗽这么厉害呢，现在多出来新症状就是
epigastric pain，感觉是咳嗽太多造成的。昨天开始有running nose,phlegm,low
fever了,咳嗽改善不大，现在只能祈祷，希望到考试前能恢复。 |
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a****9
发帖数: 773 | 11 A 28-year-old white woman returns to the office for follow-up of
hypertension. She says, "My blood pressure keeps getting
worse, no matter what I do." Her hypertension had been controlled with a
diuretic and a β-blocking medication for 4 years,
but her blood pressure has steadily increased in the past 8 months despite
taking maximum doses of the medications. She
insists she takes her medications as directed. Family history is negative
for hypertension. She does not smoke cigarettes.
Height is 16... 阅读全帖 |
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d******t
发帖数: 28 | 12 It seems a young female pt with renal artery fibromuscular dysplasia (
epigastric bruit), so for the Q: Which of the following is the most
appropriate diagnostic study to order next?
(D)Serum thyroid-stimulating hormone (TSH), cortisol, and aldosterone
concentrations - seems the best answer to me |
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x****n
发帖数: 893 | 13 2. A 56-year-old man with alcoholism comes to the physician because of a 2-
month history of increasingly severe stomach pain and increased volumes
offoul-smelling
stool; he also has had a 9-kg (20..Jb) weight loss during this period. He
has a history of multiple visits to the emergency department because of
severe abdominal pain.
He has consumed one bottle of red wine daily for 5 years. His temperature is
37"C (98.6"F). Physical examination shows epigastric tendemess. His fasting
serum
glucose ... 阅读全帖 |
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n***j
发帖数: 184 | 14 考试的时候，enter是占格的。但是全一起写又太难看了，我是分成下面的几个块写的
，下面有空行的地方考试的我没有空行。最后PN是*，希望能有帮助。 good luck
CC: A 45 yo M c/o bloody vomiting.
HPI: 2 episodes, 2 hours ago and 30 mins ago, w/o known causes. Feels dizzy.
A cupful each time, bright red, no clots, smelly. Epigastric pain at the
same time,dull, buring, 6-8/10, radiating to the back, intermittent,
aggravated with drinking fluids, no alleviating factors. Heartburn for a
long time. No previous episode of bloody vomiting/ nausea/ fever/ chest pain
/ cough/ bla... 阅读全帖 |
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d****y
发帖数: 2180 | 15 ☆─────────────────────────────────────☆
Jane27 (小简) 于 (Sun Nov 25 23:53:22 2012, 美东) 提到:
在USMLE官方网站上面练习PN的链接， 如果每次点enter的话就会take up 很多的space
,结果是我的PN上面的history taking 部分总是不够space。听人说在真正的考试的时
候，这个问题是不存在的，只要你字数不超就可以，你可以按enter来分行。
因为我写PN用的是bulletin的格式，需要分行很多，所以这个问题大大困扰了我。 有
考过的同学可以进来说说吗？
谢谢！
☆─────────────────────────────────────☆
largebird (largebird) 于 (Mon Nov 26 00:04:46 2012, 美东) 提到:
不能分行，要不写不下。一气呵成吧。没办法
☆─────────────────────────────────────☆
Jane27 (小简) 于 (Mon Nov 26 10:51:23 2... 阅读全帖 |
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S******1
发帖数: 44 | 16 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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y***d
发帖数: 33 | 17 Looks like people enjoyed last week's case. Here's the second one. This one
is shorter and more straightforward.
CC: fever, abdominal pain and arthralgias
HPI: 31 yo merchant ship worker p/w 3 days of acute febrile illness. 16 days
PTA, he flew from India to Long beach, where he had a negative pre-ship
exam including labs. Then patient boarded an oil tanker and sailed up west
coast. 3 days PTA, he developed mild mid-epigastric and LUQ pain. Over the
first day, pain worsened and was associated wi... 阅读全帖 |
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y***d
发帖数: 33 | 18 Patient didn't report a rash but there was one on exam. No stiff neck.
Exam:
T 39.3 P 104 BP 111/55 RR 18 O2sat 98%RA
Gen – mild discomfort, vary faint macular rash on abdomen, no petichae
HEENT – bilateral conjunctival injection, EOMI, no proptosis. No sinus
tenderness. OP clear. Neck soft, supple, no LAD.
CV – tachy, regular, 2/6 systolic mumur at LSB (flow murmur)
Resp – CTAB, no w/c/r
Abd – soft, obese, ND, mild epigastric and LUQ TTP, negative Murphy's sign,
HSM not felt
Ext –... 阅读全帖 |
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n****a
发帖数: 2525 | 19 Thyroidectomy for Hashimoto's, because the Hashimoto caused multinodular
goiter.
Her PE findings are rather benign actually. Soft, tender in most quadrants,
but mostly in epigastric region, bowel sounds present, no masses, no rebound
. Basically a rather benign abdominal exam.
Somebody suggested porphyuria, but I can't see the link between the 2 though
...
are
thyroidectomy |
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