T****g
发帖数: 705 | 1 “临床思维，解题思路”
举个例子：
An 82 year-old man has been mechanically ventilated in the hospital for the
past 48 hours because of an exacerbation of chronic obstructive pulmonary
disease. He has passed no urine since removal of a urinary catheter 12 hours
ago. Current medications include intravenous methylprednisolone and
albuterol, ipratropium. And fluticasone by inhalation. Which of the
following is the most likely diagnosis?
A) Acute interstitial nephritis
B) Acute urethral obstruction
C) Contr... 阅读全帖 |
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T****g
发帖数: 705 | 2 谈谈做住院医
1. 现在回过头看，建议大家在开始住院医之前做好两件准备，这里是针对内科住院医
1） 考了Step 3。当然从知道Match结果到进科，有很多事情，要找房子，要搬家等
等，但要考个像样的成绩，是要至少2个月Full time study 才好。这对于要申请热门
Fellowship的同学，很重要，不是说过线就行。
2） 把Pocket Medicine过一遍，知道常见病的基本知识。在之后的三年里，把这本
书翻的滚瓜烂熟。
3） 如果还有时间和精力，建议好好练练Presentation，尤其是几个大病：Chest
pain; pneumonia; stroke; heart failure; syncope; COPD exacerbation; 要知道如
何带着鉴别诊断来问诊，如何体检，workup, differential diagnosis, assessment
and plan.
2. 进入住院医，不要掉以轻心，你会面对很多障碍，而这些障碍就是你的机会。
The brick walls are there for a reason.... 阅读全帖 |
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y******7
发帖数: 17 | 3 The following is what I collected when I was a student doing capstone in a
local hospital. Not sure if it is useful.
Lidocaine topical is a amide-type local anesthetic. for production of
topical anesthesia, relief of pain associated with postherpetic neuralgia,
reduction of gagging during dental procedures, prevention and control of
urethral pain, anesthetic lubricant for endotracheal intubation, and relief
of hemorrhoidal pain.
Polyethylene glycol(Miralax) is a nonabsorbed solution used to trea... 阅读全帖 |
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f****o
发帖数: 2770 | 4 我讲话难听由于家庭遗传，真不好意思。
我吧书本上的东西全部贴出来，你能看懂多少算多少吧。
Heart Failure
DEFINITION
Heart failure (HF) is a clinical syndrome caused by the inability of the
heart to pump sufficient blood to meet the metabolic needs of the body.
Heart failure can result from any disorder that reduces ventricular filling
(diastolic dysfunction) and/or myocardial contractility (systolic
dysfunction).
PATHOPHYSIOLOGY
Causes of systolic dysfunction (decreased contractility) are reduction in
muscle mass (e.g., myocardial infarctio... 阅读全帖 |
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f****o
发帖数: 2770 | 5 GENERAL PRINCIPLES
The first step in managing chronic HF is to determine the etiology or
precipitating factors. Treatment of underlying disorders (e.g., anemia,
hyperthyroidism) may obviate the need for treatment of HF.
Nonpharmacologic interventions include cardiac rehabilitation and
restriction of fluid intake (maximum 2 L/day from all sources) and dietary
sodium (approximately 1.5 to 2 g of sodium per day).
Stage A: The emphasis is on identifying and modifying risk factors to
prevent developm... 阅读全帖 |
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R*Q
发帖数: 179 | 6 去年的考题, 大家体会一下感觉吧.
时限 30分钟: 20分钟准备, 10分钟口试答题.
Patient is a 68 year old female, very nice and pleasant, obese Caucasian
female with a past medical history of multiple medical problems. She was
unable to sleep last night because she could not catch her breath. Her son
brought her to the emergency room. Patient is still feeling short of breath
. She denies any acute chest pain at this point. She denies any recent
fever, chills, cough, or purulent sputum. All her prior records were
reviewed. Sh... 阅读全帖 |
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f****o
发帖数: 2770 | 7 CHF:
metoprolol tartrate is NOT apporved for CHF.
Change to Toprol XL (metoprolol succinate) 100mg QD or 50mg BID. or Coreg
If she can't tolerate ACEI, she needs to be on ARB for CHF. ARB approved for
CHF: Diovan, Atacand.
metoformin contraindicated in her SCr level不能用的
DM, Lipid全部refer to PCP
hospital只负责acute heart failure exacerbation |
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P*******D
发帖数: 523 | 8 补充一点。
Pioglitazone can cause CHF exacerbation. Might consider discontinuing it and
start another oral med since her A1C is not that bad. I also wonder if she
has AF with a HR of 98. But we don't have the number after she was treated.
Hopefully metoprolol can take care of some of that. I would follow up with
an EKG, if she does have, she might need an anticoagulant due to her CHADS2
score being high.
I would also recommend getting flu vaccine and pneumococcal vaccine for her. |
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P*******D
发帖数: 523 | 9 Please read the question more carefully.
4 days later: Patient was treated adequately for an acute exacerbation of
congestive heart failure. Her edema has resolved. Before discharge an ECHO
reveals an EF of 34%. All labs have remained the same except BNP has
dropped to 42. Please complete a discharge assessment and plan for this
patient.
About the HR, at first I thought the question means there was also no change
in HR after the treatment. After I read it over again, I found it could
mean tha... 阅读全帖 |
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a*****8
发帖数: 2115 | 10 BNP: brain naturiuretic peptide. It is released when atrium wall is streched
which mean patient is volume over load. If right atrium is over streched,
that mean BP or volume status through vena cava is high. In that case,
patient is peripheral volume overloaded. If left atrium is over streched,
that mean BP or volume status through pulmonary vein. In that case,lung is
congested. Either way, patient is volume overloaded and is in acute HF
exacerbation. |
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r********r
发帖数: 352 | 11 I agree with ann2008 on this topic. Dig is not a first-line medication for
patient with heart failure. It doesn't have mortality benefit, has dangerous
side effects, and requires careful therapeutic monitoring. If the dig level
is above 0.8, it could produce worse outcome, and increase mortality. Not
that dig should bot be used in patient with heart failure. But I wouldn't
recommend it until all the standard therapy (BB/ACEI or ARB) are being
optimized. If a patient is already on target dose bb ... 阅读全帖 |
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l******k
发帖数: 27533 | 12 胸闷，踹不过气是HF exacerbation symptoms
case没有病人有asthma的病历
看看HF的pathophysiology就知道为什么BB是首选必须用药了 |
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a*****8
发帖数: 2115 | 13 Beta-blocker is not a contraindication in asthma or COPD patient. When
patient experienced acute asthma attack, do not initiate BBs or may hold BBs
during asthma attach. However, asthma or COPD are not a reason to withhold
BBs. Like Lilybank said 胸闷，喘不过气来 is due to pt is having an acute
heart failre exacerbation and probably very volume overloaded. It like he is
drowning and will cause 胸闷，喘不过气来. So diruetics especially loop
diuretics is very potent.
Also BB can mask hypoglycemia, however, again... 阅读全帖 |
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D********n
发帖数: 978 | 14 By JACOB BUNGE
For once, it isn't the high-frequency traders taking the blame for a wild
market ride.
Germany's main exchange operator has found that a miniature "flash crash" in
late August—in which stock-index futures dived 4% before recovering in a
matter of minutes—was simply the result of a barrage of selling by
financial institutions, and not the handiwork of superfast computerized
traders.
So-called high-frequency trading firms drew suspicions following the
gyration, but an internal repor... 阅读全帖 |
|
a**i
发帖数: 608 | 15 【 以下文字转载自 Stock 讨论区 】
发信人: audi (yiybf), 信区: Stock
标 题: WallStreet Equities Traders Worst Year since 2006
发信站: BBS 未名空间站 (Tue Oct 2 15:53:57 2012, 美东)
市场急需 CRASH 一把来提高点人气，
否则很多机构和短线 trader 包括 day trader 都要死掉了。
Wall Street Equities Traders Face Worst Year Since 2006
By Michael J. Moore | Bloomberg
Wall Street banks' equities-trading units aren't getting much relief from
the strongest stock rally since 2009, as sinking volume and already thin
margins threaten to make their annual performance the... 阅读全帖 |
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s********o
发帖数: 3319 | 16 【 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 | 17 今天下午看到一个case， 与大家分享：
67 yrs old WF with a history of A-fib, presented to ER with diaphoresis and
fatigue for 2 days. She has been on Pradaxa for a-fib. Cardiology suspected CHF exacerbation.
PMH: CAD, CHF and a-fib. No DM.
Social/FMH/ROS: Not remarkable.
On exam, Vital was stable. HR was only 76.
She was noticed to have an anisocoria. She blamed her cataract surgery 10 years ago for the cause of unequal sized pupils. But her family believed it was new onet.
Pupil OS 7 mm, Sluggish to light. OD ... 阅读全帖 |
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V*****G
发帖数: 337 | 18 Adie Pupil? Or medication effect?
and
suspected CHF exacerbation.
years ago for the cause of unequal sized pupils. But her family believed it
was new onet. |
|
s********o
发帖数: 3319 | 19 【 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 | 20 今天下午看到一个case， 与大家分享：
67 yrs old WF with a history of A-fib, presented to ER with diaphoresis and
fatigue for 2 days. She has been on Pradaxa for a-fib. Cardiology suspected CHF exacerbation.
PMH: CAD, CHF and a-fib. No DM.
Social/FMH/ROS: Not remarkable.
On exam, Vital was stable. HR was only 76.
She was noticed to have an anisocoria. She blamed her cataract surgery 10 years ago for the cause of unequal sized pupils. But her family believed it was new onet.
Pupil OS 7 mm, Sluggish to light. OD ... 阅读全帖 |
|
V*****G
发帖数: 337 | 21 Adie Pupil? Or medication effect?
and
suspected CHF exacerbation.
years ago for the cause of unequal sized pupils. But her family believed it
was new onet. |
|
m********4
发帖数: 607 | 22 Winning Their Trust-----by Anand K. Parekh, M.D., M.P.H.
The ranks of the U.S. medical profession will soon grow by 16,000 physicians
, as the class of 2011 graduates from medical schools throughout the country
. These new physicians will go on to receive graduate medical training that
is superb by global standards. Once in practice, they will be encouraged to
uphold high quality standards through licensing and certification,
activities of specialty societies, and participation in a growing arra... 阅读全帖 |
|
m********4
发帖数: 607 | 23 Winning Their Trust-----by Anand K. Parekh, M.D., M.P.H.
The ranks of the U.S. medical profession will soon grow by 16,000 physicians
, as the class of 2011 graduates from medical schools throughout the country
. These new physicians will go on to receive graduate medical training that
is superb by global standards. Once in practice, they will be encouraged to
uphold high quality standards through licensing and certification,
activities of specialty societies, and participation in a growing arra... 阅读全帖 |
|
d**o
发帖数: 618 | 24 非处方药: hydrocortisone 1% cream
非处方润肤霜: vaseline, eucerin, aquaphor, cerave
Also, find out the underlying reason for eczema. Half eczema cases are
linked to food allergy.
A guideline of 润肤霜 use is as follows:
"It is important to emphasize the use of ointments
or thick creams containing high lipid content
rather than watery lotions.
Emollients should be applied once or twice daily to
xerotic skin, and especially within 3 minutes of bathing
for optimal occlusion of a hydrated stratum corneum.
Bathin... 阅读全帖 |
|
d**o
发帖数: 618 | 25 非处方药: hydrocortisone 1% cream
非处方润肤霜: vaseline, eucerin, aquaphor, cerave
Also, find out the underlying reason for eczema. Half eczema cases are
linked to food allergy.
A guideline of 润肤霜 use is as follows:
"It is important to emphasize the use of ointments
or thick creams containing high lipid content
rather than watery lotions.
Emollients should be applied once or twice daily to
xerotic skin, and especially within 3 minutes of bathing
for optimal occlusion of a hydrated stratum corneum.
Bathin... 阅读全帖 |
|
A*******s
发帖数: 9638 | 26 Edema.
But Chronic condition also can have acute exacerbation.
all. |
|
n****a
发帖数: 2525 | 27 Thanks everyone for replying.
It's been 12 days into her hospital stay, she is still in pain. Her IgG4 to
look for autoimmune pancreatitis was negative, lab ordered for possible
Celiac (which leads to poor absorption of Levothyroxine and pancreatitis
link) also negative. GI still thinks pancreatitis, might have been
exacerbated by cold meds she was taking that has some ETOH content. EGD was
done by GI only showing gastritis. CT ab showed nothing but cysts, no
pancreatic cyst or pseudocyst or oth... 阅读全帖 |
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n*******c
发帖数: 501 | 28 （这个题目很知音，真烂，对不起）
是好久以前急诊夜班上发生的事。交班医生收了一个气促的病人，初步诊断是
exacerbation of pulmonary fibrosis，“这个病人很straightforward，老病号了，这次又是气促发作，收进来吸吸氧，你和呼吸科联系一下收入院吧。”交班医生简单的说道。
我看了一眼病历，果然老年女性病人，pulmonary fibrosis诊断好些年了，其间也住过几次院，好几封呼吸科医生有关治疗的信。
然后去看病人，非常可爱的老太太，可以看出很明显的气促，辅助肌呼吸，在2L的吸氧浓度下血氧勉强维持在90%，旁边陪着的是病人的女儿。
一问病史，才知道病人虽有P病多年，不过过去两三年都控制的不错，不需要吸氧，在家日常起居都很独立，今天据女儿说坐着好好的，突然一站起来就觉得呼吸困难，脸色都变了，没有明显的胸痛，觉得可能是老病发作，就赶快来医院了。
我看了一眼心电图，RBBB，一翻以前的病历，oh no…, 再一问病史，原来…
这时候上级医生来了，一看，赶快order一个Troponin, 果不其然，positive!
这个病人是要心内科急会诊吗？
不！... 阅读全帖 |
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s******v
发帖数: 477 | 29 Masqueraders in dermatology:
Onychomycosis vs nail psoriasis
Dermatitis or mycosis fungoides ( T cell lymphoma)
Rocacea vs Lupus
Steroid dermatitis/Acne
Furuncle vs carbuncle
Carbuncle vs Hidradenitis suppuritiva ( Myth for hidradenitis, it is not due
to poor hygiene, excess androgens, deodorants, antiperspirants, shaving,
bacterial infection. It can have 2nd bacterial infection. Obesity and
smoking are not causative but exacerbate)
Solar lentigo vs Lentigo Maligna
Asteatotic dermatitis vs scabi... 阅读全帖 |
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z******1
发帖数: 666 | 30 http://www.medicaldaily.com/news/20120813/11465/dairy-milk-calc
Research Indicates That Too Much Calcium Can Lead to Kidney and Heart Issues
Taking more calcium than needed can lead to kidney stones, heart attacks and
can cause hardened coronary arteries.
By Makini Brice | August 13, 2012
Calcium has been seen as a cure-all for physicians, parents, and consumers
alike. Have osteoporosis? There's calcium for that. Have PMS? There's
calcium for that. Trying to lose weight? Some research has indica... 阅读全帖 |
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M***D
发帖数: 249 | 31 Liza Long is an author, musician, and erstwhile classicist. She is also a
single mother of four bright, loved children, one of whom has special needs.
On 12/15/2012, Liza Long wrote following article.
Three days before Adam Lanza killed his mother, then opened fire on a
classroom full of Connecticut kindergartners, my 13-year old son Michael (
name changed) missed his bus because he was wearing the wrong color pants.
“I can wear these pants,” he said, his tone increasingly belligerent, the
black... 阅读全帖 |
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g*****d
发帖数: 991 | 32 来自主题: Medicalpractice版 - 食管裂孔疝 The common symptom of hiatal hernia, like you had, is acid reflux. You need
to be treated with antiacid meds, such as proton pump inhibitors and H2
receptor blockers. Follow your doctor's recommendation.
Surgery correction would be considered if the symptoms get severe and
chronic acid reflux.
The external force as you had for stretch could exacerbate your symptoms. |
|
b******a
发帖数: 704 | 33 Urine drug test?
exacerbation of his hallucination during holiday because of the three
younger siblings at home? |
|
s*********e
发帖数: 884 | 34 1. Introduction
China’s transition to a market-based economy has created new problems, one
of which is the growing inequality in per capita income between urban and
rural areas. Especially in China's western areas, challenges for rural
poverty alleviation and development are daunting. Despite significant and
long lasting efforts by the central and local governments to alleviate
poverty, inequality in income and asset distribution between rural settings
and urban centers, as well as between We... 阅读全帖 |
|
s*********e
发帖数: 884 | 35 2.2 Quality of Primary Education
The quality of primary education in rural China has been a major concern. A
recent study by Wang and Li (2009) compares the quality of primary education
of rural schools with urban schools in western China. They find that there
is a big gap between the quality of rural and urban primary education (Table
2). They argue that the main reason for such discrepancy lies in the
difference in teachers, as teachers in rural schools are poorly trained with
little access to... 阅读全帖 |
|
i*********5
发帖数: 19210 | 36 在过去两年的自由泳学习过程中，我听到的建议都是头要低，收下巴，眼睛看正下方，
“swim downhill”，头低了，腿就浮起来了，减少阻力。
直到上周跟高阳游泳时，他给我指出我的头太低了，造成头一上（换气）一下，反而增
大了阻力。建议我头可以高一些，水面刚好高过眉毛就行了，这样游开水时也更容易换
气。我说那腿会不会沉得更厉害？他说等你打水练出来了下身自然就浮起来了。
于是我试了试把头抬高些，看pool的斜前方，好像的确游得更流畅些。
回来上网搜索相关资料，找到这篇Swim Smooth的文章是支持他的观点的。
Choosing The Right Head Position For You
http://www.feelforthewater.com/2012/04/choosing-right-head-posi
Many swimmers (and some coaches) believe that every swimmer should look
straight down at the bottom of the pool when they swim, so as to... 阅读全帖 |
|
|
m******r
发帖数: 9604 | 38 The following is a suggested guideline for reducing the likelihood of an in-
race stomach "shutdown" while eating prior to, during, and immediately
following an Ironman-distance race for experienced athletes who are focused
on fast times or race placement. If your goal is to finish the race then the
pacing instructions here will be too aggressive, but the refueling
suggestions may still be effective.
You may need to modify this plan to fit your body size, previous race-
nutrition experience, and... 阅读全帖 |
|
u*****n
发帖数: 778 | 39 Sam Stovall, Chief Investment Strategist: Much to the surprise of many,
operating earnings for the large-, mid- and small-cap components of the S&P
Composite 1500 came in better than expected last quarter. The S&P 500
recorded a 51% increase in year-over-year results, while the S&P MidCap 400
saw a 45% rise. But the S&P SmallCap 600 wowed everybody by recording a 134%
surge in year-over-year results. This quarter, S&P is forecasting operating
results for the S&P 500, MidCap 400 and SmallCap 600 ... 阅读全帖 |
|
p**8
发帖数: 3883 | 40 Barron's Cover | SATURDAY, SEPTEMBER 3, 2011
Which Way Up?
By VITO J. RACANELLI | MORE ARTICLES BY AUTHOR
Stocks were pounded in August, but most market strategists expect them to
rally this fall as the economy expands.
Few expected Hurricane Uncertainty to wallop financial markets last month,
after U.S. stocks had risen 23% from Labor Day 2010 to July. Yet, as worries
intensified in August over the possibility of a second U.S. recession and
worsening debt problems both here and in Europe, the S... 阅读全帖 |
|
y*****l
发帖数: 5997 | 41 1月有个会议，这个最近有什么炒点吗？
Exelixis reports encouraging data from Phase II MBC trial
4 days 2 hours 36 minutes ago - Datamonitor via Comtex
Exelixis, Inc., a biotechnology company, has reported positive preliminary
data from a cohort of 45 patients with metastatic breast cancer, or MBC,
participating in the ongoing cabozantinib Phase II randomized
discontinuation trial, or RDT.
As of the October 15, 2011 data cut-off, 45 patients with previously treated
estrogen receptor-positive, triple negative, or in... 阅读全帖 |
|
k*****e
发帖数: 22013 | 42 【 以下文字转载自 ChinaNews 讨论区 】
发信人: pipigou123 (鼠姐虎弟), 信区: ChinaNews
标 题: Re: 在美国，学中医的比这里大部分人赚得多
发信站: BBS 未名空间站 (Sun Aug 14 19:55:23 2011, 美东)
INTRODUCTION — The word "acupuncture" is derived from the Latin words "acus
" (needle) and "punctura" (penetration). Acupuncture originated in China
approximately 2000 years ago and is one of the oldest medical procedures in
the world.
Over its long history and dissemination, acupuncture has diversified and
encompasses a large array of styles and techniques. ... 阅读全帖 |
|
w*******e
发帖数: 53 | 43 这是San Francisco Chronicle 上关于湾区房市走势的最新分析文章，应该算比
较中立、中肯。
全国光房市就Wipe Out了 6 个Trillion的财富，Obama的1个Trillion的救市计划能够
带来通货膨胀？看来是庸人自忧了。
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/26/MNR
--------------------
Signs of more trouble ahead for housing market
Carolyn Said, Chronicle Staff Writer
Tuesday, May 26, 2009
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g********n
发帖数: 2314 | 44 【 以下文字转载自 SanFrancisco 讨论区 】
发信人: dadabear (bless you), 信区: SanFrancisco
标 题: [合集] goldenrain的观点未免偏颇
发信站: BBS 未名空间站 (Thu Feb 8 16:24:51 2007), 站内
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MSJ (Mission San Jose) 于 (Tue Feb 6 00:42:38 2007) 提到:
看完他blog的《现在在哪里买房风险小》，我只能笑着摇摇头。在我眼里，这个列表与
其说是“风险小”列表，不如说是“房子难涨地区列表”。试论证一二：
1. 常言道“强者恒强，弱者恒弱”。NYC, SF地区房价高企不是一年两年了，支撑房价
的不是那个affordability的percentage，而是能afford的人口数和房子总数的比例。
这里看百分比是没有多大意义的。只要还有人能买得起还愿意买，即使affordability
只有15%又如何呢？
2. 正如high tech公司的P/E要远大于... 阅读全帖 |
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h********n
发帖数: 25 | 45 The founder of Microsoft, Bill Gates, testified at a Congressional Hearing
today (March 12, 2008) before
the House Science & Technology Committee. The following is the portion of
his testimony concerning
the urgently needed changes to US Immigration Law and how current
immigration policies are harming
the United States.
Prior to practicing Immigration Law, Attorney Harrington served as a counsel
to the House Science
Committee for more than three years (1997-2000). He hopes you find the
inform... 阅读全帖 |
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