k**e
发帖数: 2728 | 1 In the case of CO poisoning, CO affinity to hemoglobin is 220 times higher t
han O2, so O2 cannot compete with hemoglobin for binding (or, CO can cause t
igher binding of oxygen in hemoglobin) and the net result is, with normal O2
pressure, the O2 bound to hemoglobin is just difficult to be release / or n
o O2 to be released at all and result in tissue hypoxia...
For anemia, you have normal O2 partial pressure but not enough hemoglobin to
bring the required amount of O2 to peripheral tissue...
y |
|
o******u
发帖数: 60 | 2 in the case of CO poisoning and
anemia, you have O2 out but you only carry enough to maintain the O2
pressure and not as enough to supply the targeted tissue...
???!!!好像有一点明白了...
恩...所以说正常人体的话...
组织吸收氧气然后RBC平衡压力
然后贫血的病人....组织吸收氧气然后RBC仅仅平衡压力
.............
....................
唉...问题点就是在于不管是CO中毒还是贫血...组织里面的氧气分压必是低于外面血管的氧气分压的...(因为组织缺氧)
如果血管氧气分压不变...那表示血管的氧气可以一直进来...也就不会缺氧...了
......= ="" |
|
m****n
发帖数: 322 | 3 maybe there is a left mass too, but not palpated:)
20 years history with hypertension with possible anemia, I would go
polycystic kidney disease instead of cancer. |
|
s******t
发帖数: 579 | 4 来自主题: MedicalCareer版 - 急问这道题 This pt may be suffering from DT, hypoglycemia and megalocytic anemia...this
question seems focus on hematology. I don't think he got cirrhosis, so I won't choose B. I would choose E because of alcohol's suppressive effects on bone marrow.
Waiting for a better answer. |
|
d********9
发帖数: 16 | 5 来自主题: MedicalCareer版 - 急问这道题 could be B or E, but more likely E, because of his drinking binge which
could be directly toxic to bone marrow and all his 3 cell lines are low.
However low Hb could be due to macrocytic anemia. |
|
l**********e
发帖数: 382 | 6 来自主题: MedicalCareer版 - 急问这道题 DT usually happen 2-3 days after restricting from alcohol whcih explains his
neurological symptoms. His hemotological test shows macrocytic anemia and
follic acid deficiency is very common among alcoholics. |
|
e*********r
发帖数: 221 | 7 这点是比较奇怪,我也上了一个辅导班,不是kaplan, 老师没有说只问一种病,而是说在
associated symptoms里把可能的differential都问到.我印象很深的是当时老师还举了
个例子,说fatigue可能有那些情况,让大家发言,有人说sleep,有人说anemia,还有
thyroid 和depression,然后老师就说把这些都问到就可以了,这样才叫focus.所以不知
道是不是kaplan的老师没有说清楚还是怎么回事.anyway,希望楼主认真复习总结,下次
考出好成绩. |
|
N******9
发帖数: 70 | 8 From Golian RRP P191,
stimuli for EPO release including: hypoxemia, severe anemia, left-shift O2-
binding curve, high altitude. So I think both hypoxemia and hypoxia can
stimulate EPO release, but not ischemia, which is decreased arterial blood
flow or venouse out flow of blood, unless it is renal ischemia, where it
will be considered as hypoxia and stimulate EPO release.
Hope this would help. |
|
R****0
发帖数: 138 | 9 PK deficiency mainly affects RBC, it is caused by gene mutation, no cure for
it yet. However, supporting therapy (transfusion) or splenectomy can
alleviate the symptoms of anemia, bone marrow transplantation is also an
option with high risk. |
|
a****9
发帖数: 773 | 10 ON: overnight
SNF: skilled nursing facility
DNR:do not resuscitate
AMA: against medical advice
HHA: home health aid
HPI: history of present illness
SOB: short of breath (or son of bitch)
MS: mental status
OSA: obstructive sleep apnea
AOCD: anemia of chronic disease
HLD: hyperlipidemia
NSR: normal sinus rate
DNR: deny resussitation
NPO: nothing per os
N/V/D: nausea, vomiting, diarhhea
TBI: traumatic brain injury
NAD: No Abnormality Detected (used in System review)
ALOC: acute loss of consciousnes... 阅读全帖 |
|
R****0
发帖数: 138 | 11 The USMLE step1 mainly tests the underlying mechanisms of medical conditions
. Most of the questions are formulated as patient history, medical exam and
lab tests, et al, implying either a clear diagnosis or most likely a type of
disease. The questions usually touch the mechanisms or basic medical
knowledge.
Does anyone like to summarize different types of questions they met in the
new format of Step1? For example, a patient with TTP/HUS, let you think of
schistocyte in blood smear due to micro-... 阅读全帖 |
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l********y
发帖数: 2295 | 12 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 |
|
c*******s
发帖数: 399 | 13 能不能这样理解， 这个病人有sickle cell trait， 但是anemia 的原因是 iron
difficiency
hbs 的比例很高 |
|
R****0
发帖数: 138 | 14 β-Thalassemia has both ineffective erythropoiesis (IE) and hemolysis, IE
is due to accelerated apoptosis of erythroid precursors, and hemolysis is
because of the accelerated peripheral destruction of erythrocytes. The bone
marrow significantly increases the erythroid precursors due to anemia, cause
bone marrow expansion, but frequent transfusion is still needed for
thalassemia major due to above reasons.
The normal red cell life span is 120 days and that the duration of a
reticulocyte in the p... 阅读全帖 |
|
g*******n
发帖数: 319 | 15 A 69-year-old woman comes to the physician because of worsening dyspnea on
exertion and easy fatigubility. Her symptoms began several years ago but
have been progressively affecting her daily acitivities. Her other medical
problems include hypertension. Her past surgical history includes meningioma
removal and a total abdominal hysterectomy. She eats a balanced diet. Test
of the stool for occult blood is negative. Laboratory evaluation reveals a
hemoglobin level of 9.6mg/dl. Which of the followi... 阅读全帖 |
|
b****e
发帖数: 227 | 16 for pernicious anemia,
use vitB12 IM deep subQ. |
|
L****n
发帖数: 12932 | 17 The key to this question is the prominence of symptom inconsistant with
degree of anemia (9.x).
★ Sent from iPhone App: iReader Mitbbs 6.81 - iPhone Lite |
|
b****e
发帖数: 227 | 18 病人没有pernicious anemia的risk factor阿?
查了查药典,vitbB12 deficiency的话,B12可以nasal,oral or IM补,
那给药途径也不是解题的关键了.
several years的病程,应该比急性失血耐受更低的Hb
9.x的Hb症状应该是什么样呢?
没有临床经验,敬请蒙古大夫进一步解答.
多谢阿~~ |
|
g*******n
发帖数: 319 | 19 不好意思，忘记说是UW pharmacology的题目。不知道把UW解释copy在这里是否
appropriate，就不贴了吧。不过解释里面没有提及pernicious anemia，倒是把每个答
案的给药途径都提了一遍。其他选项都是口服给药，B12主要是肠外给药，B12口服给药
主要针对dietary deficiency, 而题干里这个病人是balanced dietary.
觉的Aplusplus前辈讲得挺对！我开始看UW解释的时候不得要领，看了楼
上各位的回帖再回去看，才豁然开朗。而且UW也提到绝大部分B12 deficiency是吸收障碍
造成，特别是老人由于胃酸少 （achlorhydria) 导致B12吸收障碍很常见。
恩，这样子理解应该是对了，多谢大家发言！！ |
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y********9
发帖数: 237 | 20 Iron deficiency anemia could cause your symptom. |
|
R****0
发帖数: 138 | 21 My first research project during graduate study was to find the markers to
evaluate the erythropoiesis in different types of anemia, so red blood cell
(life time, about 120 days, RBC120) became the first research target,
followed by leukemia research in PhD and lymphoma studies in postdoc. To my
surprise, the initial work on RBC has led me to the long research journey in
this field. |
|
t***o
发帖数: 160 | 22 老是分不清，选项中有这两个就晕了，有什么区别，显微镜下都是骨髓fat多，细胞少
吗？临床有什么关键词可以区分这两个？谢谢！ |
|
w*l
发帖数: 43 | 23 aplastic - hypocellular marrow, often only fat cells/ 'dry tap' when do
marrow aspirate/ most likely no splenomegaly/reticulocytopenia/mucocutaneous
bact. infect./abnormal bleeding;
primary myelofibrosis - hallmark is oblitertive marrow fibrosis //
extramedullary hematopoisis eg spllen or liver - but disordered/immature RBC
&WBC in circulation/ 'teardrop' RBC/ hyperuricemia/ may transform to AML. |
|
t***o
发帖数: 160 | 24 老是分不清，选项中有这两个就晕了，有什么区别，显微镜下都是骨髓fat多，细胞少
吗？临床有什么关键词可以区分这两个？谢谢！ |
|
w*l
发帖数: 43 | 25 aplastic - hypocellular marrow, often only fat cells/ 'dry tap' when do
marrow aspirate/ most likely no splenomegaly/reticulocytopenia/mucocutaneous
bact. infect./abnormal bleeding;
primary myelofibrosis - hallmark is oblitertive marrow fibrosis //
extramedullary hematopoisis eg spllen or liver - but disordered/immature RBC
&WBC in circulation/ 'teardrop' RBC/ hyperuricemia/ may transform to AML. |
|
|
f****i
发帖数: 129 | 27 20. A 47-year-old woman comes to the emergency department because of severe
abdominal pain for 3 hours. The pain began after a 2-week drinking binge.
She has a 15-year history of alcoholism. She has no history of jaundice or
hepatitis. Current medications include multivitamins and iron. Her
temperature is 38°C (100.4°F), blood pressure is 110/80 mm Hg, and pulse
is 110/min. Examination shows mild jaundice and diffuse spider angiomata
over the trunk and abdomen. The liver is tender to palpation. ... 阅读全帖 |
|
l********y
发帖数: 2295 | 28 NEPH: ESRD pts
- watch lytes closely; careful with things like laxatives (fleets enemas),
etc. Hi phos load, Na load; same with kayexalate
- if hyperkalemic: check EKG and see pt; if no peaked T's, likely can wait
to get HD; but give insulin, Ca gluconate, etc. If worried, give kayexalate
- if septic and oliguric: carefulw ith IVF; small boluses, ~500cc at a time
(like CHF pts); avoid fluid overload and causing pulm edema
- Phos: danger is elevated Ca x Phos product (serum Ca x serum Phos); > 55... 阅读全帖 |
|
e****0
发帖数: 678 | 29 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 |
|
s******h
发帖数: 103 | 30 因为时间短，纽约学习班的重点是查体，问病史教的很简略，而SP是随机抽取case，老
师即兴讲。问题就是不一定能完全覆盖，而且笔记也不一定记完整。所以自己回来总结
口诀反复练习是很重要的。比如我总结的Fatigue的鉴别诊断：
Fatigue and weight loss (DAMN SHiT)
Diabetes mellitus
1. Do you have any change of urination?
2. Are you more thirsty? Increased snacking?
3. How about your appetite? Do you have any change of your body weight?
Diet?
Depression:
1. How is your mood?
2. Did you thought to hurt yourself? Do you have any plan?
3. Do you have family to support you? Do you have any friend... 阅读全帖 |
|
B****r
发帖数: 1737 | 31 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 |
|
h*******y
发帖数: 1220 | 32 A glucagonoma is a rare tumor of the alpha cells of the pancreas that
results in up to a 1000-fold overproduction of the hormone glucagon. Alpha
cell tumors are commonly associated with glucagonoma syndrome, though
similar symptoms are present in cases of pseudoglucagonoma syndrome in the
absence of a glucagon-secreting tumor.
he primary physiological effect of glucagonoma is an overproduction of the
peptide hormone glucagon, which enhances blood glucose levels through the
activation of anabolic... 阅读全帖 |
|
s********o
发帖数: 3319 | 33 我记得folate不足（比如说影响它的吸收或者代谢）才会引起巨幼贫。
anemia |
|
e***5
发帖数: 106 | 34 但现在的问题是叶酸引起MEGALOBLASTIC ANEMIA的机制是什么？若是由于DNA合成缺陷
，那别的引起DNA缺陷的因素（如5-FU）为啥不能引起MEGALOBLASTIC?
谢谢楼主提的好问题 |
|
x******a
发帖数: 195 | 35 Megaloblast的细胞核（成熟受阻）、细胞浆（持续合成）都大，形成的RBC体积大，很
好理解。RBC本身没有细胞核没有DNA。LZ列的那些药物是通过影响DNA合成（形成
megaloblast）而导致Megaloblastic macrocytic anemia的。
正常RBC是双凹的，膜缺陷时是圆的，体积也大了。另一种情况是reticulocytosis。
Reticulocyte体积大于RBC，而计算MCV时包含了reticulocyte，所以reticulocytosis
的情况下MCV也是大的。 |
|
U*******4
发帖数: 4 | 36 你说的这两处，FA 2012版都有错误，你去找找FA 2012版的纠错，或者去看看2013版是
怎么写的吧。
anemia |
|
S******1
发帖数: 44 | 37 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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W********r
发帖数: 158 | 38 The first line of treatment for Aplastic anemia is stem cell transplant. If
no suitable donor, first line is ATG and cyclosporin. Shanghai Children's
Hospital is one of the best center to deal with this kind of disease in
China. I will definitely continue treatment there. |
|
j*******k
发帖数: 209 | 39 A 40-year-old woman comes to the physician because of "too much stress in my
life now." She describes feeling depressed and tense because of a recent
marital separation, a job change, the need to relocate to another city, and
the worsening of her 8-year-old son's asthma. Physical examination shows no
abnormalities. Laboratory studies are most likely to show which of the
following abnormalities?
A)Decreased lymphocyte reactivity to antigens
B)Decreased serum prolactin concentration
C)Increased se... 阅读全帖 |
|
i**********d
发帖数: 853 | 40 Todd‘s paralysis
Diamond-Blackfan anemia |
|
i**********d
发帖数: 853 | 41 Todd‘s paralysis
Diamond-Blackfan anemia |
|
r*****1
发帖数: 805 | 42 My CCS protocol:
P.S.：多有重复，谨防遗漏，仅供参考。
Screening test: General—Lipid profile/ multi-vitamin; Elderly—DEXA scan&
Calcium& VitD/ Colonscopy or FOBT/ vaccination; F-- >18yo Pap smear; >50yo
Mammogram; reproductive age- folate; menopause- Lipid/DEXA/FOBT; M-- >50yo
PSA; sickle cell dz child-prophylaxis w penicillin till 5yo, CF-prophylaxis
w Abx
Prophylaxis: Pantoprazole, pneumatic compression stocking;
Acute abd w perforation: triple Abx- Gentamycin/ Ampicillin/
Metronidazole (口诀：阿扁举旗庆国庆)
E... 阅读全帖 |
|
z******8
发帖数: 844 | 43 ☆─────────────────────────────────────☆
rhcrc11 (Rebel) 于 (Thu May 15 00:13:42 2014, 美东) 提到:
Step3考场壮烈回来。第一天挺累人，最后一个block甚至做到有心无力状，看着题反应
不过来，导致来不及做完。非常没有信心能否通过。所以match之前先考Step3的童鞋，
需要考前调整生物钟，坚持锻炼，提高耐力。
MCQ没有资格说，CCS有一点小感受，拿出来分享下。大家请轻拍砖。
复习资料：
UW 52 online cases : 基础。最好复习早起找高手一起过一遍，尽快摸熟软件，进入
状态。第二遍找一位水平相近童鞋过一遍，不断总结protocol. 考前迅速做一遍，熟练
运用protocol.
UW 41 offline cases: 我当时和partner每个case仔细做一遍，虽然不像online有反馈
，但对练临床思维，补充protocol非常有帮助。最后考试与41 case有异曲同工之处，
遇到复杂case也不慌神。
CD 6 cases： 最后再熟悉下考试软件。与UW相近，但... 阅读全帖 |
|
e*****c
发帖数: 69 | 44 【 以下文字转载自 Medicine 讨论区 】
发信人: eestoic (ic stone), 信区: Medicine
标 题: 紧急求助：骨髓增生异常综合症MDS-RAEB-II
发信站: BBS 未名空间站 (Thu Jan 15 01:35:49 2015, 美东)
我朋友的父亲在国内突染重病：Myelodysplastic syndrome Refractory anemias with
excess blasts II (MDS-RAEB-II)，中文名叫：骨髓增生异常综合症，现在造血细胞
功能基本丧失，仅能通过定期输血维持，免疫力抵抗力都很弱。医生表示目前唯一能彻
底治愈的方法就是骨髓移植，但是他的骨髓型号跟他父亲并不十分匹配，现在只能暂时
开始化疗以缓解病情，正在寻求其他方法救治。
我在这里帮忙请问诸位是否遇见过此类病例？有无良方？朋友正在考虑把他父亲转移到
美国的医院来救治（朋友本人在加州湾区工作，有公司保险），请问美国有哪些治疗这
类疾病比较有名的医院？转移到美国如何操作比较好？保险上怎么处理？朋友在国内心
急如焚，诸多问题，望各位多给建议，万分感谢！ |
|
J*********4
发帖数: 1274 | 45 It seems that your mother's disease is indolent
Assume your mother was asymptomatic before the treatment, no weight loss,
low fever, no loss of appetite, no enlargement of lymphonodes, no enlarged
spleen
If her lymphocyte count <30,000/microL, blood lymphocyte doubling time >12
months, hemoglobin ≥13 g/dL, her survival statistics could be similar to
those of an age and sex-matched group.
For 慢淋, even extreme increased lymphocytosis, without symptoms or impaired
bone marrow function such as anemi... 阅读全帖 |
|
t*****0
发帖数: 264 | 46 thx cczhang for the work, hope this benifit you as well.
Just some recall from my poor memory, I think the first choice should be '
have pt drink a lot of water' or something like that. IF that's the case,
1st choice would not be a good one, since it may contraindicate the upcoming
surgery.
FYI, Cczhang, The sickle Cell anemia is a autosomal recessive disease. Most
A.A. female get it.
is
of |
|
j**y
发帖数: 417 | 47 以前是，现在少了。 Anemia 基本上是dialysis病人的通病。ESAs（Epogen & Aranesp
etc)以及iron的使用可以让大多数病人的hgb保持在10 - 12之间。但hgb太低的话，还
是要的。取决于医生了和病人的情况了。 |
|
a********n
发帖数: 438 | 48 SOB
病人申诉“I CANN'T BREATH”第一步，还是要ASSESSMENT，VS 包括RR，SAT O2，有没
有nostril flare/using accessory muscle ，结合病史找原因，Pulmonary: PNA,
Pneumothorax, PE, Aspiration, bronchspasm, airway obstruction.
Cardiac: MI, CHF, arrhythmia, , 还有acidosis, sepsis, anemia, anxiety. 有没
有给新药？（allergic reaction), 肺音（fluid overload/asthma?). 先给氧气，酌情
处理，从simple face mask 到non- rebreather, 再打电话给医生，通常，会order
CXR, EKG, ABG.lasix, breathing treatment(beta agonist).这个时候RT 就是好伙伴
了，要找CHARGE帮忙，必要的时候CALL RAPID RESPOND TEAM, 最好ABG PO2〉 |
|
y******7
发帖数: 17 | 49 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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o******h
发帖数: 198 | 50 即日起 大家有空发一些匿名的病历讨论吧 熟悉一下病历书写和缩写吧
有不懂的可以提问 有工作经验的同学路过可以帮助回答
回帖的同学 第一部分请写你的问题， 第二部分请写你知道的答案 谢谢!
不会念医学单词的可以查这个 没有声音的 按允许pop up插件即可
http://www.merckmanuals.com/home/resources/pronunciations/index
xxx year old F with a pmh significant for dementia,asthma, dvt, pe in 2011,
htn, osteoporosis, rectal bleeding, new dvt rt. Leg 03/31 restarted on
Coumadin and lovenox, non verbal sent from NHF on 4/3 for drop in H/H 7/23.
On arrival V/S: 153/51, 74, 20, 99.4 and o2 100% on ra. Awake and non verbal
, neuro... 阅读全帖 |
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