x***y
发帖数: 45 | 1 I have several questions when using UW CCS software:
1. I want to monitor ESR in 1 wk but the software ends the case and ignored
my request.
2. After finishing several cases, nothing show up under "Treatment records"
category. What does that category for? Is it for treatment history or is
it for the treatment that you ordered?
3. One case ends abruptly and says that the pt hope that she will get
better. Does not mean that I did not finish the case correctly?
Any input? Thanks in advance. |
|
h******u
发帖数: 602 | 2 刚开始看CCS，问题可能比较幼稚，大家别笑话哈.
CASE 5： 27 YO female, 3 months of alternating diarrhea and constipation，
irritable bowel syndrome。 UW的解释是先order一堆检查，CBC,BMP, TSH, ESR,
stool for WBC, stool culture，没有给治疗直接约一周后的appointment， 一周后
给治疗。我的疑问是为啥不当天做完stool for WBC 后直接给治疗呢，反正就是常
规的，比如high fiber diet, laxtose free diet, patient counsel...是担心有
别的病？等排除以后再治疗？
CASE 6：depression的case，这个正相反，没有等TSH/B12等结果出来就给药治疗了。
我感觉可以先suicide counsel，如果病人没自杀倾向，那就等两天排除了别的问题
再给药。
是不是我的思路有问题？ |
|
x********n
发帖数: 214 | 3 arthritides rheumatoid factor ANA ESR sacroiliitis |
|
P*******l
发帖数: 105 | 4 Arthritis: 关节炎
Rheumatoid factor: 内风湿因子
ANA: 抗核抗体
ESR: 血沉
Sacroilitis:骶髂关节炎 |
|
R**********n
发帖数: 473 | 5 昨天和今天考了step3，但愿pass, 跟usmle说88了。从考完CK到现在，都一年了。当中
经历了跨州搬家，CS, OB, 第二个宝宝出生，申请，面试。
去年6月就买了uw ， 但只做了mcq, 后来肚子太大懒得去考，就搁下了。直到差不多面
完，12-1月才pickup。这次又买了3个月的uw mcq+ccs, 重新做题。MTB是上次看的，这
次没看，但是看了一遍CK first aid, 因为很多基本的东西都忘了。Family practice
看了一半。从考试内容来看，如果说什么东西还占上点边，那就是uw了。还有CK基础很
重要。我可以这么说，pony要是明天就去考step3, 假设她ccs已经练好了，肯定是99，
因为实在没有什么额外的东西。我考的不好是因为基础就不扎实，再让我看上一年也就
这样了，因为脑容量有限，记不住就是记不住。
第一天7个block, 5个office觉得还能handle。那2个 ER, 题目又臭又长，很多看了2遍
也不知所云，勉强做完。前一晚又没睡，考时觉得恶心，然后跳出来的图又增加了恶心
感。昨晚吃了安眠药，今天总算survive了。（我们这里天天... 阅读全帖 |
|
A*******s
发帖数: 9638 | 6 Today I got a phone call from a collegue. His previous nurse who is 54
years old female, presented with right foot pain for 4 days. The pain was
so severe that she could not walk. He did a MRI of L-spine and vascular u/s
which were all normal. ESR is 30. He wanted me take a 2nd look if he missed
something.
PMH. Lung Ca for 2 yrs. DM. HTN. Depression.
SH/FH/ROS: not remarkable.
What are you going to do at Exam if you suspect something? |
|
A*******s
发帖数: 9638 | 7 昨天有同仁对我的一个case感兴趣， 我今天查了下病历， 给大家写个完整的。
53 yrs old WM, previously healthy, presented with intractable fatigue and
weight loss for 3 months. A comprehensive workup by his PCP including a CT
of chest was reported as unremarkable.
PMH: Asthma, seeing a pulmonologist who reviewed CT and agreed with
radiologist's report.
Soical. Smoker 1 ppd. No ETOH/Drug.
FMH: neg for CA.
ROS: Not remarkable, no diplopia, dysphagia, no fever, no joint pain, no
muscle ache.
PE: Vital normal.
No positive findings on P... 阅读全帖 |
|
s********n
发帖数: 342 | 8 【 以下文字转载自 Medicine 讨论区 】
发信人: seesnowman (wachdog), 信区: Medicine
标 题: 恳请诊断意见：新产妇结节性甲状腺肿！
发信站: BBS 未名空间站 (Mon Mar 12 12:25:53 2012, 美东)
以下是一个朋友的病情描叙：
病情描述（发病时间、主要症状、就诊医院等）：
我在2011年11月21日在公司体检的时候发现甲状腺结节， ３个月后（２０１２年２月
２２日），发现左边的结节明显增大；但在当时无任何不适症状，吞咽也无任何不适；
触检此结节可以移动；
自2月24日开始各种检查； ３月１日下午觉得咽喉吞咽时不舒服（异物感），不知是否
传染感冒；目前这种不舒服不是痛的感受，到现在这个症状未消除；
补充说明：我9月23日生了小孩，现在小孩5个多月了，因为这个病断奶了；
做的各类检查结果
检查结果：
一、2011年11月21日体检发现时B超结果：
超甲状腺左右侧叶分别为5.1*2*1.8mm，5.0*1.5*1.3mm; 双侧叶内可见大小分别为左边
0.3mm*0.3mm；右边0.6*0.8mm的稍低回身光团，边界清，... 阅读全帖 |
|
h*******y
发帖数: 1220 | 9 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 |
|
e****0
发帖数: 678 | 10 翻翻我的箱子底， 找到我自己临考前的单子。
•Pregnancy
CBC/BMP
Blood type and Rh
Atypical antibodies/rubella AB
UAUCX
HIV/RPR/HBSag
Chlamydia/pap smear
•All disease
Diet
Exercise
Consult/counseling/consent/vaccine/screening/monitoring
PT/OT
•Acute R distress
Oxygen
ABG
Chest X ray
Pulse oximetry q 1hour
•COPD/asthma PEFR+Elevated head of bed
•All arthritis
Synovial fluid
•All office cases
CBC/BMP, PT/PTT, UA/UCX, FOBT, LIPD/LFT, ESR/TSH, EKG/Glucometer/CXR
•Surgery
NPO/bedres... 阅读全帖 |
|
B****r
发帖数: 1737 | 11 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 （病人情况如下）。万分感谢。
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 the past 2-3 weeks. Has a history of
problems with constipation. Slightly decreased PO intake, ... 阅读全帖 |
|
p******d
发帖数: 374 | 12 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 |
|
e****0
发帖数: 678 | 13 • 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 | 14 • 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 |
|
W********r
发帖数: 158 | 15 CBC has 3 cell line down, elevated ESR. The CBC needs to be repeated. if is
true, the patient need to have Bone marrow aspiration and/or biopsy to rule
out malignancy.
Wing |
|
m*******1
发帖数: 328 | 16 你儿子多大了？ 查没查ESR或者是CRP？ 粪常规，血常规？ 看上去不像感染导致！ 如
果还有低热或者关节痛， 建议去看GI的专家， 排除一下炎症性肠病（IBD) |
|
m*******1
发帖数: 328 | 17 你儿子多大了？ 查没查ESR或者是CRP？ 粪常规，血常规？ 看上去不像感染导致！ 如
果还有低热或者关节痛， 建议去看GI的专家， 排除一下炎症性肠病（IBD) |
|
t********o
发帖数: 228 | 18 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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q*d
发帖数: 22178 | 19 【 以下文字转载自 Military 讨论区 】
发信人: Regina (猫宝宝), 信区: Military
标 题: 中国脉冲强磁场实验装置通过评估 跻身世界四强
发信站: BBS 未名空间站 (Thu Oct 10 20:33:13 2013, 美东)
中国脉冲强磁场实验装置通过评估 跻身世界四强
字号:小中大2013-10-10 14:53:28
更多
100
关键字 >> 基础研究磁场脉冲磁场中国脉冲强磁场中国脉冲强磁场实验中国脉冲强磁场
实验装置自主开发中国基础研究
《中国质量报》10日报道，建于华中科技大学的中国脉冲强磁场实验装置，于10月8日
顺利通过了包含美、德、日、法、荷等国行业权威的专家评估组的相关评估，成为继美
国、法国、德国之后，世界四大脉冲强磁场科学中心之一。而实现90特斯拉以上的磁场
强度，美国用20年，德国10年，而我国仅用了5年时间，且全套装置均为自主开发。
10月8日，国内外30余位强磁场领域的权威专家齐聚武汉。专家们此行目的，是实地考
察脉冲强磁场实验装置，给出国际评估意见。评估组由德国德累斯顿强磁场实验室主任
约亨·沃斯尼察教授担任组长，成员... 阅读全帖 |
|
|
n*****n
发帖数: 3123 | 21 （本文来自2005年的白云黄鹤BBS，未经排版，四年来，文末一直保留有英文原文出处
并注明链接）
这个版上太多的问题，不能让我以很愉快的心情来解答，于是，我放弃了强忍着指责别
人的心情找到了这篇《提问的艺术》（两年前我在HomePage版张贴过），真诚的希望那
些又困难又期望得到帮助的新手朋友们抽时间看看，问“好的问题”，收获“好的答案
”，这对改善答题人的心情和形成版面氛围都有好处。
提问之前
在通过电邮、新闻组或者聊天室提出技术问题前，检查你有没有做到：
1. 通读手册，试着自己找答案。
2. 在FAQ里找答案（一份维护得好的FAQ可以包罗万象:）。
3. 在网上搜索（个人推荐google~~~）。
4. 向你身边精于此道的朋友打听。
当你提出问题的时候，首先要说明在此之前你干了些什么；这将有助于树立你的形象：
你不是一个妄图不劳而获的乞讨者，不愿浪费别人的时间。如果提问者能从答案中学到
东西，我们更乐于回答他的问题。
周全的思考，准备好你的问题，草率的发问只能得到草率的回答，或者根本得不到任何
答案。越表现出在寻求帮助前为解决问题付出的努力，你越能得到实质性的帮助。
小心别问错了... 阅读全帖 |
|
x**********i
发帖数: 280 | 22 本科，ms学化学的，觉得这个program门槛不高，学费也不贵，附近一个公立大学。
但是毕竟没有学位，不知道这个好找工作么？工作多少钱要求不高，只要面比较广就行
。
这个是哪个program提供的课程
Course Number
Course title
CE 566
EC 570
Environmental Data Analysis
Econometrics
EC 571 Advanced Econometrics
EC 595
Applied Advanced Econometrics
ECE 565
Signals and Noise
ESR 549
Applied Environmental Statistics
ME 588
Design of Industrial Experiments
PA 551, 552
Analytical Methods in Public Admin. I, II
PSY 523
Factor Analysis and Covariance Structure Modeling
PSY 524
Research Design in Appli... 阅读全帖 |
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A*******s
发帖数: 9638 | 23 The reasons i believe she has conversion are:
1. Inconsistency on physical exam. For example, she was paraplegic but at the
exam, she was able to stand up with assistance.
2. Normal MRI of brain and whole spine.
3. Normal LP.
4. Normal NCV/EMG.
5. Normal ESR, CRP, and CPK.
6. After the reassurance, she had a dramatic improvement.
Why she used a cane? I think she was still seeking medical attention or
reassurance. Maybe the psychiatrists can provide a better explanation.
查体，问：“这痛吗”， 答：痛。教授又查... 阅读全帖 |
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s********o
发帖数: 3319 | 24 【 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 |
|
A*******s
发帖数: 9638 | 25 昨天有同仁对我的一个case感兴趣， 我今天查了下病历， 给大家写个完整的。
53 yrs old WM, previously healthy, presented with intractable fatigue and
weight loss for 3 months. A comprehensive workup by his PCP including a CT
of chest was reported as unremarkable.
PMH: Asthma, seeing a pulmonologist who reviewed chest CT and agreed with
radiologist's report.
Soical. Smoker 1 ppd. No ETOH/Drug.
FMH: neg for CA.
ROS: Not remarkable, no diplopia, dysphagia, no fever, no joint pain, no
muscle ache.
PE: Vital normal.
No positive finding... 阅读全帖 |
|
s********o
发帖数: 3319 | 26 【 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 |
|
A*******s
发帖数: 9638 | 27 昨天有同仁对我的一个case感兴趣， 我今天查了下病历， 给大家写个完整的。
53 yrs old WM, previously healthy, presented with intractable fatigue and
weight loss for 3 months. A comprehensive workup by his PCP including a CT
of chest was reported as unremarkable.
PMH: Asthma, seeing a pulmonologist who reviewed chest CT and agreed with
radiologist's report.
Soical. Smoker 1 ppd. No ETOH/Drug.
FMH: neg for CA.
ROS: Not remarkable, no diplopia, dysphagia, no fever, no joint pain, no
muscle ache.
PE: Vital normal.
No positive finding... 阅读全帖 |
|
y***d
发帖数: 33 | 28 OK, labs:
I was hoping that people would ask for more stool studies, but maybe people
just assume that since she's had extensive work up, all the stool data would
be available. Anyway, here are the labs from this hospitalization and from
before. If a lab is not listed, then it wasn't done. The stool studies were
mostly done on a low residue, lactose free diet.
Several people asked for LE dopper and echo. We didn't do them bacause based
on her H&P along with labs, the patient's anasarca is more c... 阅读全帖 |
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A*******s
发帖数: 9638 | 29 84 yrs old WF, presented with right eye vision loss for the past 10 days.
Her left eye went blind 1 year ago. She was seen by an optometrist who
diagnosed her as GCA. Her daughter brought her to me for a 2nd opinion.
PMH: Left eye blindness for 1 year. DM. HTN and CRF.
On exam: Temporal tenderness bilaterally. VA: 20/70 OD, 20/400 OS. (+)APD.
fundoscopy suggests ischemic changes, no papillary edema.
Lab: ESR 20; CRP: 0.6.
What are you going to tell the daughter? |
|
V*****G
发帖数: 337 | 30 Most likely optometrist is right. Just that ESR is normal.
But need to rule out:
Macular degeneration
Central artery embolization
DM opthalmopathy
HTN opthalmopathy
MS
Is there anything more in fundoscopy?
. |
|
A*******s
发帖数: 9638 | 31 You are right about ESR/CRP.
She was seen by an ophthalmologist who suggested GCA as well.
Neither of them suggested macular degeneration or DM retinalopathy.
MS is less likely due to her age.
So do you think she needs a biopsy? |
|
A*******s
发帖数: 9638 | 32 What if she has no GCA since ESR/CRP are normal? |
|
S******9
发帖数: 2837 | 33 only 90% of pts have increased ESR in GCA. What did doctor treat him one
year before when he was blindness?
Doing biopsy after starting steroid. |
|
A*******s
发帖数: 9638 | 34 http://www.eyeassociates.com/understanding_a_stroke_of_the_op.h
Since ESR/CRP is normal, she likely has Non-Arteritic” Anterior Ischemic
Optic Neuropathy (NAAION). The risk factor is DM.
Final diagnosis depends on temporal artery biopsy.
Two possibilties:
1.Patient has GCA(less likely), she needs long term steroids which is no
good for her DM.
2.AION not related to GCA (more likely), no treatment except ASA.
After a long discussion, the patient and the family decided to leave it
alone and take ... 阅读全帖 |
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y***d
发帖数: 33 | 35 Came too late. I'll toss in my 2 cents anyways. Like a good Monday morning
quarterback, I would put some question marks on GCA after seeing the normal
ESR/CRP, especially if the patient has no other inflammatory symptoms such
as fatigue, stiffnedd, weakness, headache, etc.
Never heard of NAAION before. If I were to see this patient in clinic,
probably would have sent him straight to ophtho's office or ER and let the
experts figure it out.
Learned one more thing today. Thanks. |
|
s******t
发帖数: 579 | 36 (The patient was admitted because of MDD secondary to her debilitating LLE weakness, numbness and tightness. I'd like to focus on her neurological symptoms.)
CC:
A 72 y/o white F complains of LLE weakness, numbness and tightness.
HPI:
Pt was diagnosed lumbar spondylosis, lumbar spinal stenosis, low back pain and lumbar radiculopathy 2 yrs ago. Had a lumbar fusion 1 yr ago. Started to recover at the beginning, but had worsening of weakness and eventually required a hardware removal 6 months ago. ... 阅读全帖 |
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s******t
发帖数: 579 | 37 多谢A＋＋的详细耐心的回答！
在psych unit，他们倾向于将病人的躯体症状归罪于精神因素，我提了CK，和再测一次
BMP或CMP，但是他们不想测。更别提会测cervical MRI了。他们一直想push病人多做PT。
不过你是对的，第一次测glucose的时候病人不是fasting的，病人也没有DM 的病史。
不过，再测一次也不过分的不是？
病人的ESR是正常的，一直afebrile，有4/10 back pain,没有其它地方的pain。她下肢
的力气还是很大的，力量上基本上很对称。没见过PMR case，但感觉应该是有比较
general的疼痛的吧?
上次测gait时忘了做heel to toe。几天特意看了看，她做起来有时不稳，但有时很好
，感觉她的左下肢有些僵直的样子，但muscle tone没问题。
她反复说感觉下肢的tightness，也不是muscle spasm，也不是pain，我真搞不明白这
个tightness是指什么。她说这个tightness在运动之后会加重，所以她都不出去和老公
散步了。谁有经验的给咱解解迷？ |
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y******a
发帖数: 590 | 38 how about other inflammatory markers, e.g. CRP, ESR, albumin, platelet, LDH?
are they also elevated? |
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y******a
发帖数: 590 | 39 No I don't think you need to check those. As fionaww mentioned earlier,
ferritin is also a marker for chronic inflammation. But with chronic
inflammation, you will see other abnormalities, like anemia, low albumin, high
platelet count, high ESR, CRP, and LDH. With a normal albumin and PLT, it's
unlikely you have chronic inflammation going on. |
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s********n
发帖数: 342 | 40 【 以下文字转载自 Medicine 讨论区 】
发信人: seesnowman (wachdog), 信区: Medicine
标 题: 恳请诊断意见：新产妇结节性甲状腺肿！
发信站: BBS 未名空间站 (Mon Mar 12 12:25:53 2012, 美东)
以下是一个朋友的病情描叙：
病情描述（发病时间、主要症状、就诊医院等）：
我在2011年11月21日在公司体检的时候发现甲状腺结节， ３个月后（２０１２年２月
２２日），发现左边的结节明显增大；但在当时无任何不适症状，吞咽也无任何不适；
触检此结节可以移动；
自2月24日开始各种检查； ３月１日下午觉得咽喉吞咽时不舒服（异物感），不知是否
传染感冒；目前这种不舒服不是痛的感受，到现在这个症状未消除；
补充说明：我9月23日生了小孩，现在小孩5个多月了，因为这个病断奶了；
做的各类检查结果
检查结果：
一、2011年11月21日体检发现时B超结果：
超甲状腺左右侧叶分别为5.1*2*1.8mm，5.0*1.5*1.3mm; 双侧叶内可见大小分别为左边
0.3mm*0.3mm；右边0.6*0.8mm的稍低回身光团，边界清，... 阅读全帖 |
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I****a
发帖数: 407 | 41 Good thoughts so far. I remember he was taking ASA prior to admission.
I will fast forward a little bit.
All the cultures you can think of are all negative.
His coags were cold normal at the time of presentation and several days
later. His smear showed some spherocytes which is consistent with hemolysis.
There was no schistocytosis.
His white cell were slightly elevated with slight neutrophilia.
His platelet count was normal but by day 3-5 into the admission, it dropped
to 40-50K.
His liver fun... 阅读全帖 |
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y******a
发帖数: 590 | 43 I am not convinced that he has immune deficiency. Based on all your posts,
he has not had any positive cultures anywhere. Hypogammaglobulinemia can be
caused by reduced hepatic synthesis, like in patients with cirrhosis. I am
not impressed by hypocomplementia either, for the same reason.
Go back to his history, he has had recurrent fevers for years. Has he ever
had any episode that he did use antibiotics and fever resolved by itself in
a few days? Do his fever episodes follow any patterns? ... 阅读全帖 |
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B****r
发帖数: 1737 | 44 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 （病人情况如下）。万分感谢。
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 the past 2-3 weeks. Has a history of
problems with constipation. Slightly decreased PO intake, ... 阅读全帖 |
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m******r
发帖数: 1904 | 45 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: Blazer (--), 信区: MedicalCareer
标 题: 求助：５岁小孩高烧１０天
发信站: BBS 未名空间站 (Sat Feb 2 23:01:40 2013, 美东)
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 （病人情况如下）。万分感谢。
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... 阅读全帖 |
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M****a
发帖数: 577 | 46 ESR,CRP,ANA,RF
tagged RBC scan
Bowel sound auscultation
Step 2CS,Step 3 |
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l*********o
发帖数: 21 | 47 来自主题: Medicalpractice版 - 病情咨询 Dr. Garland,
Thank you very much.
ANA 抗体： 1:640
ESR: 1:90
ANTI-DSDNA: POSITIVE
RIBONUCLEOPROTEIN AB : POSITIVE
ANTI-CENTROMERE AB: POSITIVE
MRI- BRAIN: NEGATIVE
诊断： MIXED CONNECTIVE TISSUE DISEASE ？
风湿科医生 开了强的松
现在主要是头晕
请问下一步还要做什么检查？
如何治疗？
多谢！ |
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M***D
发帖数: 249 | 48 Agree, but CT is a quick and easy test to start a stoke work up. If cannot
get precert from the patient's insurance for a MRI, I will check lipid
profiles, UDS, ESR, ANA, and will the patient's insurance approve a carotid
echo? |
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M***D
发帖数: 249 | 49 Agree, but CT is a quick and easy test to start a stoke work up. If cannot
get precert from the patient's insurance for a MRI, I will check lipid
profiles, UDS, ESR, ANA, and will the patient's insurance approve a carotid
echo? |
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A*******s
发帖数: 9638 | 50 俗话说无图无真相，你一没有MRI，二没有病理，没有人能给你一个靠谱的答案，相反
你把大家七嘴八舌的意见反馈回去，反而给你的医生造成困扰。
如果ESR那么高而且有granuloma，结核应该考虑。 我觉得你还是应该听你医生的，他
们掌握第一手资料。 |
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