f***e
发帖数: 140 | 1 Chief complain: chest pain
Medical history: hypertension, peptic ulcer disease two years ago.
family history: MI, DM, hypertension and hiyperlipidemia, depression.
SH: drinks two or three vodka martinis/day, smokes a pack of cigarettes/day
Assessment:
Vital signs stable.
Lungs: diffuse wheezing bilaterally
cardiovascular: no lower leg edema, regular rate and rhythm, no murmurs,
normal s2, no s3, no s4
abdominal and neuro are normal.
Medications:
zestril 10 mg po q AM
HCT... 阅读全帖 |
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t******a
发帖数: 408 | 2 非常感谢Peter, Jenny, Coffee, 和 Pathodream 大牛前辈
给我们分享发自肺腑的宝贵经验和精彩的演讲指导！
感谢版主Newman迅速组织这么精彩的演讲！
下面是笔记(对不起有些地方没有记下来，不全)，仅抛砖引玉
期望其他同学能够补充，指正！造福大家。
********************************************
Forget your USMLE score; ask and learn from your co-intern
Form a Tx plan by yourself and then, compare and learn from other people’s
critique, and why the new plan is better.
头三个月决定别人对整个residency的评价。
重要的实验室结果，不要等, 自己去查
Fever --- pan culture, CBC, C/S, Electrolyte ---
凡事多和resident商量。
Must follow THROUGH your or... 阅读全帖 |
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U******u
发帖数: 5829 | 3 发信人: USMedEdu (US_CMGs), 信区: Pre_Resident_Club
标 题: Summary for externship with Dr. He's program
发信站: BBS 未名空间站 (Thu Sep 10 01:07:41 2015, 美东)
Summary for externship with Dr. He's program
CHZ
It was a difficult decision for me to have an externship in New York
this summer. I had to leave work without payment, and I am also the
only person earning money for my family. However, I believe it was
very important for me, a truly old CMG, to have the special training
from Dr. He, a medical education s... 阅读全帖 |
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U******u
发帖数: 5829 | 4 发信人: USMedEdu (US_CMGs), 信区: Pre_Resident_Club
标 题: Summary for externship with Dr. He's program
发信站: BBS 未名空间站 (Thu Sep 10 01:07:41 2015, 美东)
Summary for externship with Dr. He's program
CHZ
It was a difficult decision for me to have an externship in New York
this summer. I had to leave work without payment, and I am also the
only person earning money for my family. However, I believe it was
very important for me, a truly old CMG, to have the special training
from Dr. He, a medical education s... 阅读全帖 |
|
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d*****a
发帖数: 3983 | 6 哈。我上学期看同学给一个老太太换药就哭了。其
实是我俩共同的病人，老师让我们一起干，我明智的选择了打下手
（当年去医院找老爸没少见他给学生示范怎么往病人腿里打钉子），
也就是说可以不必全神贯注的盯着伤口，
不过尽管如此，听见老太太哼哼出来我还是忍不住掉眼泪了。
结果被老师给轰出了病房，第二天还专门为此谈话了。：（
这学期换了个厉害的实习老师，TNND，我都不记得哭几回了，
同学看见我早上打招呼都改“带纸巾了吗？” |
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d*****a
发帖数: 3983 | 7 这边的大环境，怎样才能教育孩子孝顺你？
我就没见过周围有成年子女跟父母住在一起便于照顾的。
少是夫妻老是伴，到老了，也就那个人是你的伴了，
我觉得指不上孩子。
我是跟老公说等咱老了一起住老人院吧，
要不咱回国养老？。。。
我是想多要孩子，只要能养的起，
老公不合作，说培养孩子责任太大，怕教育不好。
?在 THR (HIP) 的大作中提到: 】
401K多几十万块都管用. |
|
|
b*****o
发帖数: 6080 | 9 NH早就臭名昭著了看来.去年有一在本地轰动的新闻,老头发现自己患晚期癌症,就开枪
把自己照顾了几年的瘫痪在床的老太太打死,打自己时因为枪太老不工作,没死成.他就
是不想自己死后老太太进NH.子女行孝很难,美国是什么都讲求实用和效率的国家,这种
观念一时半会不会改的,老人会一直被当成无用的负担抗着.还有就是人人都那么忙,有
时连小孩都没时间照顾,更别提老人了.
及时行乐很重要.我们中国人这方面差些,容易攒一大笔钱留着养老,其实老了之后能享
受的东西太少了,哪怕有点钱.
在 THR (HIP) 的大作中提到: 】 |
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b*****o
发帖数: 6080 | 10 我们老师特和气特鼓励人,象我这种动手能力很差的在她面前都不慌张.但一考scenario
就慌.明天考physical assessment. |
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b*****o
发帖数: 6080 | 11 同感.而且我特别害怕成为子女的负担.估计老了得回国. |
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w**o
发帖数: 645 | 12 ☆─────────────────────────────────────☆
toddf70 (foxy) 于 (Thu Dec 7 22:52:37 2006) 提到:
There's a conflict between the floor nurse and our instructor this morning.
It's in the hospital, thursday, conflict occured between clinical instructor
and floor nurse, time ~1100. One of the patient was sitting in bed all
morning. She has decubetus ulcer on her buttocks and sever COPD, emphysema,
CAD, lung CA, matastasis, etc you name it. DNR and palliative care. Lung
sound crackles and wheezes probabl |
|
s*******o
发帖数: 284 | 13 我看录像都觉得发毛，尤其是pressure ulcer IV, 的时候，要把皮掀开收集drainage.
.. |
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v*******7
发帖数: 883 | 14 http://meded.ucsd.edu/clinicalmed/introduction.htm
I was upset by my classmate at last week clinical cause I am afraid to
assess the back pressure ulcer dressing on a palliative care pt. She looks
so fragile.
BTW, I have to admit that I have no confidence with my skills on head to toe
assessment.
Afraid to fail clinicals, so got to do more homework.
Here is the link, I think it is very helpful. |
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n********a
发帖数: 53 | 15 A case study, Pt. female, 52yrs. DM history, HTN history, Pneumonia & foot
ulcer history. Her DM has been managed well since the past 5 yrs AEB A1c 7.5
-8.0. But one night after heavy birthday party dinner, she began to feel
pressure in the middle chest and was sent to ER.
Questions are:
1. List 5-10 questions you would like to ask the pt.
2. What things with your physical exam you are looking for or at? List why
they are pertinent.eg. JVD>2cm
XDJM, help please. Millions of thanks!!! |
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f*****y
发帖数: 847 | 16
wet to dry dressing for pressure ulcers. |
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y*****n
发帖数: 367 | 17 生词也是我当初的最怕，记得有次考判断Stage of Pressure ulcer时，选项中有一个
单词：petechiae，我是怎么也想不起它的意思是什么，随身带了电子辞典却不能用，
可要放弃又心里不甘，于是硬着头皮试着去问那个印度老师。结果她回答说：This is
a medical term --哈，这不是说了也等于没说嘛。
因为知道自己的弱项在单词，所以课后总是抓紧时间尽量多看书。令人高兴的是，凡是
看过的，考试时基本上都能认出来。所以，真正考试时遇到生词的机会其实也屈指可数
。另外，我当初读书时也是经常查词典，不过随着单词量的增加，越往后的阅读就越轻
松。我想，大多数的外国学生都要经历这样的一个学习过程吧，只不过不同学生的主客
观情况不同，所采取的方法及措施也有所不同而已。 |
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Y***Y
发帖数: 232 | 18 我是NH的supervisor，我一般主要看是general nursing note 还是skilled nursing
notes， 主要看病人的保险。如果是medicaid的话是skilled nursing notes， look
at admitting diagnosis， 看是哪个系统就针对这个系统，如果是呼吸道，就主要
lung sounds， RR， SatO2 level. 如果是普通medicare的病人呢， 看看有没有
treatment order，有没有氧气管， risk of pressure ulcer， Turing reposition
q2hr?? 就是这些拉。 还有发生了啥事儿，白天有新order的时候，最好在notes里面提
一下， PO intake， 是不是在bowel list上？ tube feeding？ 主要就是highlight一
下你的nursing care 着重的地方。 |
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Y***Y
发帖数: 232 | 19 我是NH的supervisor，我一般主要看是general nursing note 还是skilled nursing
notes， 主要看病人的保险。如果是medicaid的话是skilled nursing notes， look
at admitting diagnosis， 看是哪个系统就针对这个系统，如果是呼吸道，就主要
lung sounds， RR， SatO2 level. 如果是普通medicare的病人呢， 看看有没有
treatment order，有没有氧气管， risk of pressure ulcer， Turing reposition
q2hr?? 就是这些拉。 还有发生了啥事儿，白天有新order的时候，最好在notes里面提
一下， PO intake， 是不是在bowel list上？ tube feeding？ 主要就是highlight一
下你的nursing care 着重的地方。 |
|
l******k
发帖数: 27533 | 20 师姐有空来教教呀～
1. UTI: 如果culture sensitive to cefazolin, 决定给keflex，是 500 mg BID 还是
TID OR QID for 7 days or 5 days？今天一个PA说她学的是QID. 但uptodate 和
micromedex都是BID,快速看了idsa uti guideline，没提到keflex dosing，只有
提到证据不充分，也不知道是resistance problem 还是 lack of efficacy...
2. 今天进来那个巨臭的人，在床上躺了半年没人管，背上ulcer流得稀里哗啦，一想到
就噁心。。。anyway，admitted for hyperkalemia, renal failure, sepsis,
hyponatremia. 然后呢，allergic to penicillin, cipro. 病人无法说话，不知道具
体是啥allergic reactions. 在ED就得上ABX了，preceptor就问我啦，该用啥呢，我觉
得vanco加aztreonam不错呀，但prec... 阅读全帖 |
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a*****8
发帖数: 2115 | 21 for your second questions:
Lets put aside the fast kill or slow kill issue.
1. we are treating potential sepsis right, but where is the source, is it
skin-soft tissue or osteo, or bacteremia or pneumonia, cause the organisms
you want to cover may be different.
2. I am assuming pt has been in the hospital or LTCF for a long time, in
that case we do want to cover broadly
3. If we are treating skin and soft tissue infection due to his ulcer, it
usually gram positive directed, but if he is at a hig... 阅读全帖 |
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f***e
发帖数: 140 | 22 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: fayee (BSH), 信区: MedicalCareer
标 题: case study
发信站: BBS 未名空间站 (Mon Jun 23 09:03:29 2014, 美东)
Chief complain: chest pain
Medical history: hypertension, peptic ulcer disease two years ago.
family history: MI, DM, hypertension and hiyperlipidemia, depression.
SH: drinks two or three vodka martinis/day, smokes a pack of cigarettes/day
Assessment:
Vital signs stable.
Lungs: diffuse wheezing bilaterally
cardiovascular: no lower leg edema, regular rate and rhythm, no... 阅读全帖 |
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l******k
发帖数: 27533 | 23 More information is needed: patient's age,sex, weight and height....for the
new cholesterol guideline, any complaint of SOB? CXR? How long has the
patient been on current meds?
I don't think any anti-hypertensive med the patient on causes significant
chest pain. The lipid panel alone doesn't support statin use per new
guideline.
Uncontrolled peptic ulcer and alcohol intake may cause chest pain if the
patient doesn't have any other undiagnosed disease.
day |
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z**********i
发帖数: 12276 | 24 我都做了快一年了,也谈不上什么经验.
数据很多是nursing home,也有hospital的.真对的人群是medicare/medicaid.主要是>
65岁的.
medicaid没有年龄的要求,但要求疾病是不治之症.
主要的方向:
patient safety:
measures in nursing home: pressure ulcers, physical restraints, chronical
pain, acute pain
drug safty:
drug drug interaction
core prevention:
breast cancer and colorectal cancer screening; influenza and pneumonia
immunization
这些是9th scope basic contract
另外,我们还有一些national 的项目
care transition, advancing excellence, reporting hospital data for payment
主要是做report为主.对 |
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s**********8
发帖数: 25265 | 25 Sterilization (microbiology)
http://en.wikipedia.org/wiki/Sterilization_(microbiology)
From Wikipedia, the free encyclopediaJump to: navigation, search This
article has multiple issues. Please help improve it or discuss these issues
on the talk page.
It may need reorganization to meet Wikipedia's quality standards. Tagged
since March 2008.
It is in need of attention from an expert on the subject. WikiProject
Microbiology may be able to help recruit one. Tagged since December 2010.
Contents [hide... 阅读全帖 |
|
g*2
发帖数: 658 | 26 刚开始的第一天，带我的第一和第二年住院搭档正好on call. 在急诊室里，第一年住
院让我去打听一下谁cover那个病人？我当时的第一反应是，哪个是床位医生？问了一
个护士，告诉了我名字。结果，第一年住院说“我让你打听的是哪个护士？“
还是在急诊室，让我给护士传个信， 我当时听到的是“去做cardiac cath” 。 结果
发现我听错了，是去做cat scan.
一次查房，我看到病人的几个手指有些异样，很象硬皮病的手指，血管炎引起的ulcer,
然后骨质吸收。不知道怎么搞得，嘴里居然蹦出一个“degenerative”. 住院赶紧问
病人，结果说是她以前遇到了accident, 把手指切了。住院回头说“this is not
degenerative”. 恨不得找个洞钻进去。
在急诊室，去给一个critical care里的病人抽血，抽了几次，终于有血出现在
butterfly的管子里，边上的医学生说，“you got it” ， 但我想怎么只有这么一点
血呢，是不是把血管穿破了， 就把针头拔了出来。 回去汇报说没抽到。 直到看到住
院抽血的整个过程，才发现自己居然犯了一个非常低级... 阅读全帖 |
|
A*******s
发帖数: 9638 | 27 让我想起当年我做intern时的艰难岁月。
钢铁其实就是这样炼成的， 不是吗？
ulcer, |
|
D****r
发帖数: 162 | 28 tell me about it. it happens to me all the time. something is at the tip
of my tongue. but I just draw a blank.
ulcer, |
|
z******1
发帖数: 666 | 29 我觉的我的问题也不少.
中国医学院毕业生即使match了，也有很长的路要走。
我的想法是培养下一代比较现实。当然年轻人还有拼博的资本(<35)。
ulcer, |
|
g*2
发帖数: 658 | 30 刚开始的第一天，带我的第一和第二年住院搭档正好on call. 在急诊室里，第一年住
院让我去打听一下谁cover那个病人？我当时的第一反应是，哪个是床位医生？问了一
个护士，告诉了我名字。结果，第一年住院说“我让你打听的是哪个护士？“
还是在急诊室，让我给护士传个信， 我当时听到的是“去做cardiac cath” 。 结果
发现我听错了，是去做cat scan.
一次查房，我看到病人的几个手指有些异样，很象硬皮病的手指，血管炎引起的ulcer,
然后骨质吸收。不知道怎么搞得，嘴里居然蹦出一个“degenerative”. 住院赶紧问
病人，结果说是她以前遇到了accident, 把手指切了。住院回头说“this is not
degenerative”. 恨不得找个洞钻进去。
在急诊室，去给一个critical care里的病人抽血，抽了几次，终于有血出现在
butterfly的管子里，边上的医学生说，“you got it” ， 但我想怎么只有这么一点
血呢，是不是把血管穿破了， 就把针头拔了出来。 回去汇报说没抽到。 直到看到住
院抽血的整个过程，才发现自己居然犯了一个非常低级... 阅读全帖 |
|
A*******s
发帖数: 9638 | 31 让我想起当年我做intern时的艰难岁月。
钢铁其实就是这样炼成的， 不是吗？
ulcer, |
|
D****r
发帖数: 162 | 32 tell me about it. it happens to me all the time. something is at the tip
of my tongue. but I just draw a blank.
ulcer, |
|
z******1
发帖数: 666 | 33 我觉的我的问题也不少.
中国医学院毕业生即使match了，也有很长的路要走。
我的想法是培养下一代比较现实。当然年轻人还有拼博的资本(<35)。
ulcer, |
|
|
d**o
发帖数: 618 | 35 Per HIPPA, some details are modified.
CC: MX is a 43yo female visiting a PCP for diabetes mellitus diagnosis.
HPI: Pt was checked at the PCP office annually. Last year she requested a test of HbA1c; result was 5.5. Pt has been measuring glucose by herself at home using OTC glucose meter, and reports orally that her glucose has been all over the range (60 to 400). Per her request, she had HbA1c and glucose tolerance tests before today's visit. Pt complains of debilitating fatigue and hand numbnes... 阅读全帖 |
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A*******s
发帖数: 9638 | 36 Are these your attending's questions?
The answers are yes. Rare but yes.
ASA frequently causes skin bruises and sometimes GI ulcers/bleeding.
Heparin causes more internal bleeding. |
|
L****n
发帖数: 12932 | 37 1: years, stay in your body for life. Can't be cured yet.
2. No
3. One of you is lying. Or both. Most of oral ulceration is not related to
virus.
herpes
years. |
|
s*******g
发帖数: 7 | 38 Hi,
After learning the sad fact from a guy who dies young and someone suggests
to take a test on Helicobacter pylori.
I went to the health center and not got the blood test result back.
H. PYLORI IgG POSITIVE
This result shows that I do have bacterial presented. But I did not show
any evident symptoms so far. I have abdomen pain one time, but disappears
soon.
If I decide to take antibiotic medicines, will a follow-up blood test
determine that the cure?
The doctor told me that the blood test... 阅读全帖 |
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b*****l
发帖数: 8603 | 39 Surgery~~
2. A 17 year old female with a history of ulcerative colitis for 2 years had
two recent hospital admissions for massive GI bleeding in the past 3 months
. In her most recent admission, her hemoglobin was 4.1. She received 6 units
of pRBC. Her current hemoglobin is 10.7. Her medical history is otherwise
unremarkable. She has been treated with infliximab and adalimumab 6 months
ago, but continues to have flare-ups with symptoms including fever,
abdominal pain, and hematochezia. Her curre... 阅读全帖 |
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A*******s
发帖数: 9638 | 40 Interesting, but I still believe it is from upper GI. I would do capsule
endoscopy to rule out small bowel bleeding although it is odd to have both
ulcer and small bowel problem. Let us know if you have an answer. |
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s********e
发帖数: 1596 | 41 呵呵，好多人还认为医学是算术呢，黑白分明，多简单啊，所以才有人认为电脑医生将
来会取代咱们这些人。
对了，不知道ls说的是什么ulcer？ |
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m**z
发帖数: 787 | 42 2个月前为了诊断H.pylori,做了EGD. 最近收到账单发现其实做了upper GI and small
bowel endoscopy.两个procedure,于是账单也就比预期高了不少。不知道这种情况正常
吗？医生现在说当时觉得有必要，我们当然也没有足够专业知识加以判断，所以来这里
请教。当时也没发现ulcer,只是有点redness，虽然后来h pylori是阳性的。谢谢 |
|
A*******s
发帖数: 9638 | 43 ulcerative keratitis and conjunctivitis |
|
y**********u
发帖数: 6366 | 44 本来打算5月5号去跑50mile
不过目前mileage还是0，n多个月没跑过15mile+了
原来打算这周一个30mile,下周一个30mile，然后5/5号去死磨
上周跑完5k之后就胃不舒服，半夜去急症。医生怀疑是Ulcer。没当回事，周日晚上还
加班干活到早上7点
这周开始上吐下泻，连发2天烧，睡在家里歇工，每天都睡1天，下周的travel也取消了。
看来我的50mile梦想是完不成了。打算写信去延迟了。 |
|
|
R*****s
发帖数: 41236 | 46 patpat, 啥是Ulcer?
我以前得过一次急性肠胃炎， 也是疼得我死去活来， 终生难忘....
了。 |
|
B*****e
发帖数: 2220 | 47 zz
林中药，INTP不擅交际.不要跟厦门人讲睡懒觉好吗.
收起
芮芮芮、王克宇、梅文韬 等人赞同
-------- 2015.07.29更新 --------
我顾着开脑洞被折叠了..so sad.
脑洞放在后面.
----
先补充正确答案:
章鱼的触手具有很强的再生能力.
在危机时刻,章鱼也会像壁虎一般,舍弃触手以此摆脱猎手的追击.
舍弃的触手在几天后就会重新长出来.
而章鱼的自食行为可能是因为饥饿与疾病.
再生本身需要消耗能量,不可能无限循环.
或许最终这一行为导致了自身的死亡.
具体参照此问题: 章鱼为什么会自体吞噬？
以下是国外文献,感谢 @邓巧玲
This paper describes an automutilation syndrome (OAS) in three species of
captive octopuses, Octopus dolfleini, O. bimaculoides, and O.maya,
characterized by external arm and mantle lesions. Three clinical patterns in... 阅读全帖 |
|
