u**6
发帖数: 8 | 1 1.) An asymptomatic 57-year-old man with a 3-year history of type 2 diabetes
mellitus comes for a routine follow-up visit. Examination shows no
abnormalities. Serum studies show: Aspartate aminotransferase (AST, GOT) 76
U/L Alanine aminotransferase (ALT, GPT) 86 U/L Iron 260 µg/dL Total
iron-binding capacity 300 µg/dL (N=250–450) Ferritin 1200 ng/mL
Antinuclear antibody negative Serologic testing for hepatitis is negative.
Which of the following is the most appropriate next step in m |
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p*******w
发帖数: 311 | 2 本人6岁不到就被诊断为甲亢。一直是吃Tapazol/PTU 和甲状腺片治疗的。6岁以后到10
岁一直是吃维持剂量。
10岁的时候很严重的发作了一次，在学校里走走路会突然摔倒，整个人无力，修学半年
。严重的全身性皮肤过敏，据说那是因为从Tapazol转吃了PTU。但我自己也搞不清楚当
时到底吃了什么药没吃什么药，只知道很痛苦就是了。后来吃中药，脖子上贴药膏，就
治好了。并且一切恢复正常，突出的眼睛也正常了。
14岁时轻微的复发了一次，稍微吃点药就好了。
22岁时又轻微的复发了一次，没吃药自己就好了。
现在27岁，又复发了。
4月29号验血的时候还一切正常。
7月6号下午突然心跳达95/min，就去校医那儿再验了一次血。
T3是300多。
T4超出不明显。
TSH < 0.01。
但是肝功能异常
AST 112
ALT 232
无肝炎病史
另外有缺铁性贫血
Ferritin 才 4。
骨密度偏低。
这两项都是在最近甲亢复发前就发现了。贫血4年前就发现了，一直没采取措施。
因为肝功能异常医生拒绝给我开 Tapazol 或 PTU。说这两种药都有肝损害。说我这种
情况可能会造成 liver f |
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s**********1
发帖数: 68 | 3 I'm a little confused with the following question. Different forums have
different answers. Anybo
the following vignette applies to the next 2 items.
You have been treating a 5-month-old child in the neonatal intensive care
unit (NICU). He was delivered at 26 weeks' gestation by cesarean delivery
because of premature rupture of membranes. The mother is 18 years old and is
unemployed. There are two other children in the home. The father is not
living with them, and he has not been in contact with... 阅读全帖 |
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e****0
发帖数: 678 | 4 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 |
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r*****1
发帖数: 805 | 5 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 |
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z******8
发帖数: 844 | 6 ☆─────────────────────────────────────☆
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 |
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A****t
发帖数: 61 | 7 也许这里发帖不是特别合适，但这几天一直在想自己的问题，挺想听听大家的意见。
26男性，没有非常specific的症状，但是从四个月前开始出现疲惫，难以集中精力，
decreased libido, 也可能伴随一些erection困难问题，但现在单身没有固定的
partner所以很难确定。libido也是上上下下波动，忽好忽坏。但是绝对从夏天开始我
注意到有些奇怪了。但是一直觉得自己症状不够特异，也有些不好意思跟医生说。
这两周因为偶然原因去看PCC，问我有什么concern的时候我说了这些，给了一些检查,
检查都是Quest的
体格检查好像都阴性，唯一是血压偏高（129/75），不过我一直在医生办公室比较高，
自测一般在115/70.
CBC正常，Hb 162g/L, hematocrit 48.4%, RBC4.97
STIs全阴性，hepatitis A/B/C 全阴，有A／B的抗体
TSH 0.57 (ref: 0.4-4.5)
metabolism panel(glucose, electrolytes, kidney, and liver functions) all neg... 阅读全帖 |
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r***l
发帖数: 163 | 8 有国内朋友想做进口体外诊断试剂盒，特别对下列免疫比浊项目有兴趣。不知道版上有
没有做这块可以合作的朋友？或许能指点下去哪里找这样的合作伙伴比较靠谱，不胜感
激！
如果供应商在中国没有代理，可以帮他们在中国跑审批做代理。如果已经有代理，是不
是还能帮他们在不同地区销售或者代理？还请有经验的高手指点一二。另外，请教下怎
么查这些试剂盒的价格，多谢！
免疫比浊项目
1． PGⅠ 胃蛋白酶原Ⅰ
2． PGⅡ 胃蛋白酶原Ⅱ
3． HP 胃幽门螺旋杆菌
4． RbP 视黄醇结合蛋白
5． NGAL 人类中性粒细胞明胶酶相关载脂蛋白
6． CystatinC 胱氨酸蛋白酶抑制剂 C
7． Myo 肌红蛋白Myoglobin
8． TnI / TnT 肌钙蛋白Ultra Troponin
9． HFABP 心肌型脂肪酸结合蛋白
10． Hcy 同型半胱氨酸
11． NT-proBNP 脑钠肽
12．... 阅读全帖 |
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a*******n
发帖数: 82 | 9 Mannual diff only significant for Monocyte percentage 25-30%. She had low
iron saturation, but elevated ferritin (this is after 2 units she got from
the other hospital). Normal hapto and slight elevated LDH. normal reti index
. Normal RBC folate and B12.
FT3 |
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a*******n
发帖数: 82 | 10 Mannual diff only significant for Monocyte percentage 25-30%. She had low
iron saturation, but elevated ferritin (this is after 2 units she got from
the other hospital). Normal hapto and slight elevated LDH. normal reti index
. Normal RBC folate and B12.
FT3 |
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y***d
发帖数: 33 | 11 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 | 12 agree to see a hepatologist, need liver biopsy. |
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r*******n
发帖数: 51 | 13 Thanks for the suggestions and I do appreciate them!
A++: Is there any alternatives other than liver biopsy to confirm the
disease?
Icetea: My TIBC is actually low. I am a guy. My family doctor said my
weight is just below the upper bound of the normal range and need to control
weight from now on.
I talked to my family doctor and she said it would be possiblely related to
AIN or RA. But she would let liver specialist to do further investiagtion.
Are there any further tests to confirm that?
Many... 阅读全帖 |
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r*******n
发帖数: 51 | 14 Flonaw：家庭医生没说过我贫血，献血的时候说我的血红蛋白正常。
DIFFERENTIAL WBC'S:
NORMAL: Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils,
Immunoglobulin A Serum, Immunoglobulin M Serum, Ceruloplasmin, Alpha 1
Antitrypsin TL
ABNOMAL: Immunoglobulin G Serum (High, 17.7, normal range:7.2-16.9) |
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y******a
发帖数: 590 | 15 how about other inflammatory markers, e.g. CRP, ESR, albumin, platelet, LDH?
are they also elevated? |
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r*******n
发帖数: 51 | 16 I am not sure whether CRP, ESR and LDH were ordered or not. Below are all
tests that were ordered and normal.
Albumin and platelet are normal.
Besides, Creatinine, Creatinine(Crcl), Estimated Glomerular Filteration Rate
- MDRD, Bilirubin Total, Alkaline Phosphatase, and Gama Glutamyl
Transferase are normal.
Iron, Iron saturation, B12, TSH, A1C, eGFR, Cholesterol, Triglycerides, HDL,
LDL, TC/HDL-C Ratio, and Potassium are normal.
Hemoglobin, Hematocrit, RBC, RBC indeces: MCV, MCH, MCHC, RDW, WBC,... 阅读全帖 |
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I****a
发帖数: 407 | 17 For the benefit of doubt, he was plasma exchanged to treat presumptive TTP.
The ADAMTS13 level was 42% before the first exchange. He also got a 1-2
doses of IVIG prior to plasma exchange.
The ADAMTS13 level of the classic and severe TTP causing this much damage
usually is very low, so 42% is not that impressive.
Finally he was exubated but he remained dialysis dependent. He is
pancytopenic, he is neutropenic with ANC of 0.2. He has more bloody diarrhea
, his platelet dropped to low teens and he ... 阅读全帖 |
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I****a
发帖数: 407 | 18 Good job! That is the most likely diagnosis. Blow is the direct copy of
blood paper, How I treat hemophagocytic lymphohistiocytosis
1. Michael B. Jordan1,2,*,
2. Carl E. Allen3,*,
3. Sheila Weitzman4,
4. Alexandra H. Filipovich2, and
5. Kenneth L. McClain3
The diagnosis of HLH† may be established:
A. Molecular diagnosis consistent with HLH: pathologic mutations of PRF1,
UNC13D, Munc18-2, Rab27a, STX11, SH2D1A, or BIRC4
or
B. Five of the 8 criteria listed below are fulfilled:... 阅读全帖 |
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k**o
发帖数: 18 | 19 it sounds like hemophagocytic syndrome with high ferritin and triglyceride.
It usually does not cause marrow necrosis. I've been thinking transfusion
associated graft versus host disease with marrow involvement. Mortality with
the latter is nearly 100%.
great case. |
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k**o
发帖数: 18 | 20 hemophagocytic syndrome with high ferritin and triglyceride. It does not
usually cause marrow necrosis. I've been thinking of transfusion associated
graft vs host disease, but these pts ususally have extremely high mortality
rate
great case. |
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I****a
发帖数: 407 | 21 Ferritin was obtained initially however it was not quite high as what was
later on. |
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m****g
发帖数: 42 | 22 我觉得应该认真考虑一下是否HLH,免疫分析如何?有没有CD8扩增,NK功能如何?ferritin
level 是不是过千?如果是HLH,要化疗的,否则,没治. |
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l*****9
发帖数: 9501 | 23 骨髓确实有嗜血现象，不过血液内科考虑嗜血是续发的，现在外周血常规，没有全血细
胞减少
如果是嗜血确实要化疗
ferritin |
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l*****9
发帖数: 9501 | 24 哪位大夫可以帮助看看化验单？文件太大，可以email
ferritin |
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l*****9
发帖数: 9501 | 25 腹泻发热前一天出现，一过性，当时没做stool test,来我们医院后的stool test正常
-: 另外,每天输丙球?他的抗体水平低? IgG 半衰期是21天,要天天输吗?还有保肝,有这说
法么?除了给点vitK,怎么保肝?
ferritin |
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b******a
发帖数: 704 | 26 谢谢。学习了。根据前面医生的发言，马后炮的想想，从现有病史来看，这个年轻的病
人的主诉是
什么？咽喉剧痛伴发热及上腹部疼痛。发病之前有大量饮酒，腹泻+腹痛病史。 体检和
初步实验室检查明确表明：假膜化脓性扁桃体炎+颈部淋巴结肿大（颈前？颈后淋巴结
？）和急性肝功能损害（非胆道阻塞）表现。
首先考虑是否是单一病变导致。然后考虑是否是由分别的病因导致。就如同你所说，从
常见病到少见病，有简单便宜的实验室检查到复杂，昂贵的或侵入性的检查。
如果是单一病变，有什么病和病原体能够导致如此的临床表现？印象中，能够导致假膜
坏事性化脓性扁桃体&咽炎的70%是病毒 （大都是EBV, CMV，HSV 等），20% 左右是GAS
链球菌感染。以及其他细菌感染。
首先要排除最常见的GAS链球菌感染，化脓性咽炎，因为只有像GAS类细菌感染，抗生素
才有效或有价值。链球菌感染也容易导致咽喉旁，后脓肿以及其他后期并发症，好像不
包括咳嗽，肺炎。链球菌快速检测能够帮助诊断或排除。血培养，咽喉拭子培养可以做
，可以指导抗生素选择，但没有那么快。也不一定阳性。在国内，好像不上抗生素都不
敢啊。
好像能够同时导致化脓性扁... 阅读全帖 |
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l*****9
发帖数: 9501 | 27 ferritin的结果一开始就给了，肝脾有肿大 （具体的B超磁共振结果文件太大，可以
email)。
颈前淋巴结肿大最大也就1.5cm左右。骨髓穿刺是由血液科会诊后认为要排除血液疾病
后进行的，因为这些检查差不多都要等3-5天才出结果，所以就同时进行了。患者来自
疫区，有蚊虫叮咬，有焦痂，所以会考虑恙虫，HSV肝炎有史以来在我们科还是第一次
碰到，确实不太熟悉。
GAS |
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p******3
发帖数: 318 | 28 怀疑 AOSD 为啥不查 Ferritin. eosinophil 这莫高可能跟药物有关。对激素有
反应,状况似乎到了MAS/HLH. 激素冲击加cyclosporin.
参考Yamaguchi criteria. |
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x*******i
发帖数: 819 | 29 你，你，你，也太专业了点儿吧。看懂你的帖子我还查了几次字典和wiki ：（ 有时间
给俺们文化低的
展开讲讲？拉一把落后同学呗？：）比如这个ferritin是从哪里来的?蒲林是什么？它
的英文是什么？ |
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