w******n
发帖数: 61 | 1 19. A 60-year-old woman is brought to the emergency department by her
husband because of chest pain that began 3 hours ago. She is dyspneic and
diaphoretic, and she appears anxious Her pulse is 110/rnin and regular,
respirations are 35'min, and blood pressure is 190/110 mm Hg An ECG shows an
acute myocardial infarction Winch of the following is the most likely cause
of this patient's pain?
A) Abnormalities of ion transport in myocytes
B) Accumulation of metabolic products in heart tissue
C) Incr... 阅读全帖 |
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h***a
发帖数: 312 | 2 答案没问题，是B， II-III-AVF ST elevation提示inferior infarction-RCA
occlustion, 不明白的是为什么同时I, avL ST depression? |
|
J****C
发帖数: 1465 | 3 It's very different. Inferior wall infarct usually involves right ventricle
failure, and its treatment requires volume loading |
|
z****a
发帖数: 150 | 4 Fellowship programs
Cardiovascular Disease (IM) Regions: Mid Atlantic 43, New England 20.
Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont;;
New Jersey, New York, Pennsylvania.
Connecticut
1. Bridgeport Hospital/Yale University Program
Bridgeport, Connecticut 141-08-11-211.. Yes we do sponsor H1b visas, and
starting date for Eras applications is at the end of November and the cut
off date end of March.
No further info on application.
Program Director: Craig A McPhers... 阅读全帖 |
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h***y
发帖数: 834 | 5 ☆─────────────────────────────────────☆
zhzhaa (麦地) 于 (Fri Jun 24 16:27:52 2011, 美东) 提到:
没有绿卡，怎么办？用H1。网站信息不全？自己努力！
每一个我都打电话或者 email确定过，
如果写的含糊，说明这个pregram电话没有接通，email也不回。
信可以写的很简单：
Dear Dr. Scorpion,
I am interested in the general cardiology fellowship in your institution
starting 2012. Could you please let me know if your institution sponsors H1B
visa?
记得 检查拼写正确就是了。
这个没有包括阿拉私家。
心脏科依然挣钱多，但是lifestyle不好。任何一个call 都是要命的。
但是，生活方式都是自己选的。祝愿 各位心想事成。
----
刚刚发现 没办法添加word附件，只好 后面慢慢贴上来：
☆─────────────... 阅读全帖 |
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x*******8
发帖数: 68 | 6 12 days after sustaining a cerebral infarction, a 72 year old man has fever
and cough initial sytoms included inability to move his right arm and leg,
swallow, speak, or respond to questions. He has been receiving a diet of
pureed food since he recovered his ability to swallow 3 days ago. He is
wearing false teeth. His temperature is 38.8, blood pressure is 135/85 mmHg.
Pulse is 94. And respirations are 28. Examination shows moderate weakness
of the facial muscles and right extremities. Gag refl... 阅读全帖 |
|
x*******8
发帖数: 68 | 7 another one. 2-8
A 50 year old man has a cardiac arrest during sexual intercourse. He is
promptly resuscitated and recovers uneventfully from an acute anterior wall
myocardial infarction. At discharge from the hospital, he and his wife
inquire about the safety of future sexual intercourse. Which of the
following is the most appropriate advice?
A psychiatric consultation
B sexual intercourse should be performed while wearing an ambulatory ECG
monitor
C will be safe when exercise tolenrance impr... 阅读全帖 |
|
d****y
发帖数: 2180 | 8 选B， J， I的都有，到底哪个是正确的？
For each patient with cognitive impairment, select the most likely
diagnosis.
A ) Acute stress disorder
B ) Dementia, Alzheimer's type
C ) Dissociative amnesia
D ) General paresis
E ) Head trauma
F ) Hepatolenticular degeneration (Wilson's disease)
G ) HIV encephalitis
H ) Huntington's disease
I ) Major depressive disorder
J ) Multi-infarct (vascular) dementia
K ) Niacin deficiency
L ) Normal-pressure hydrocephalus
M ) Parkinson's disease
N ) Pick's disease
O ) Schizophreni... 阅读全帖 |
|
S******9
发帖数: 2837 | 9 J ) Multi-infarct (vascular) dementia |
|
m******r
发帖数: 1904 | 10 1.没用过。不懂。
2.Common abbreviations for SP note
BP Blood pressure
P pulse
R respiatory rate
T temperature
yo year-old
m male
f female
b black
w white
L left
R right
hx history
h/o history of
c/o complaining of
NL normal limits
WNL within normal limits
Ø without or no
+ positive
- negative
Abd abdomen
AIDS acquired immune deficiency... 阅读全帖 |
|
l******g
发帖数: 278 | 11 Six hours after undergoing surgical excision of the distal colon for
cancer, a 77-year-old man has decreased urine output. His urine output has
been 10 mL/h during the past 3 hours. During the 4-hour operation, he lost
500 mL of blood and underwent transfusion of 1 unit of packed red blood
cells. His initial postoperative course was uncomplicated. Two years ago, he
had a myocardial infarction and underwent coronary artery bypass grafting.
He has a 10-year history of hypertension well contro... 阅读全帖 |
|
l******g
发帖数: 278 | 12 A 72-year-old man comes to the emergency department because he has
vomited blood three times during the past 12 hours. He has had dizziness
during this period. He has a 5-year history of arthritis treated with daily
ibuprofen. Over the past 4 weeks, he has increased his daily dose of
ibuprofen because of worsening joint pain but is not sure how many pills he
has been taking. He has been unable to take his daily walks because of the
joint pain. He has not had chest pain. He had an uncomplicat... 阅读全帖 |
|
e****0
发帖数: 678 | 13 Class One
NEJM-evidence for overturning the guidelines in cardiogenic shock
08/27/2012
##TRENDS
The results of the IABP-SHOCK II trial parallel those from many recent
outcome trials that have challenged our understanding of the management of
acute and chronic heart failure, including those regarding the use of
pulmonary artery catheters9 and the role of revascularization in ischemic
cardiomyopathy.
##FUTURE
Secondary analyses of data from the IABP-SHOCK II trial may help us
understand the mechan... 阅读全帖 |
|
b******a
发帖数: 704 | 14 不是神经科的，只是在实习学习中，看到一些脑梗病人。 是非常不幸，也是很常见的
疾病。 控制高血压，高血脂，吸烟这些危险因素重要啊。这里的医生/医学生并不知道
具体的病情，什么样的症状和遗留的功能损害，所以最多只是提供一些建议。
肺炎是中风病人的常见并发症之一。 60% 是由于中风导致的吞咽功能失调，包括咽喉
肌肉的运动和感觉功能，或其他原因等等而导致的吸入性肺炎。 可能是吸入口咽的细
菌，也可能不是细菌，是化学物比如胃酸对肺部的刺激等。 如果是细菌感染，胸部X光
片应该可以看出。留深部痰做多次药敏选择抗生素应该能够找到合适的药物，如果是吸
入性肺炎，抗菌素是一线的clindamycin克林霉素，或ampicillin-sulbactam氨苄西林-
舒巴坦。头孢，环丙沙星等其他的抗菌素不是很推荐的。如果是化学性的或者气道阻塞
导致的肺炎，抗菌素是不管用的，只是支持肺部的呼吸功能的治疗。所以，根据病人的
具体情况，看他到底是那种原因导致的肺炎，好治疗和预防。
的确如A医生说的，增加血液的粘稠度，比如脱水，蛋白过多，没有抗凝治疗，还会导
致缺血性脑梗发作。需要找到导致脑梗发生的原因，预防再次... 阅读全帖 |
|
m******r
发帖数: 1904 | 15 ☆─────────────────────────────────────☆
oldclock (oldclock) 于 (Wed Apr 18 10:59:11 2012, 美东) 提到:
1。step2 CS的UW video要单买还是在CS的UW题库里都包括了？
2。patient note可以写ABBREVIATIONS吗？除了FA上的ABBREVIATIONS，还有其他哪些
地方的ABBREVIATIONS可以用呢？
3。此外，看到麦地里有提到过patient note用子弹体方式书写，什莫是子弹体啊？哪
里可以找到范文呢？ 给扫扫盲吧。
多谢各位了！
☆─────────────────────────────────────☆
medwater (小麦) 于 (Wed Apr 18 11:08:03 2012, 美东) 提到:
1.没用过。不懂。
2.Common abbreviations for SP note
BP Blood pressure
P pulse
R respiatory rat... 阅读全帖 |
|
e****0
发帖数: 678 | 16 • 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 |
|
j****i
发帖数: 496 | 17 Female, 36y, no family hx of CRC or gyn cancers.
Personal hx of rectal cancer stage 1 pT1N0M0 s/p LAR w/TME in Dec 12, NED as
of Jun 13.
6mo hx of pelvic pain & diffuse abd pain, nausea, bloating, indigestion,
fatigue, weight loss. Acute onsite of LUQ pain radiating to back & McBurney
tenderness 3 wks ago, radiologists differ in opinion (omental infarct vs.
peploic appendagitis), not sure related to acute sx, both recommend
conservative tx. Pain still not resolving, currently managed w/ Ultram ... 阅读全帖 |
|
u*******8
发帖数: 497 | 18 脑梗塞,cerebral infarction |
|
l******p
发帖数: 71 | 19 NBME 1 Block 2 question 25
A clone of cancer cells is resistant to vincristine, doxorubicin, and
dactinomycin but not to methotrexate and various alkylating agents. The
mechanism of resistance is most likely to involve
a) absence of superoxide dismutase
b) altered DNA polymerase
c) enhanced drug transport out of cell
d) inability to form polyglutamates
e) increased DNase
NBME 1 Block 2 question 42
A 49 yrs old man has a 1week history of shortness of breath ,with no fever ,
chills or cough.Breath... 阅读全帖 |
|
j*****o
发帖数: 137 | 20 Twelve days after sustaining a cerebral infarction, a 72-year-old man has
fever and cough. Initial symptoms included inability to move his right arm
and leg, swallow, speak, or respond to questions. He has been receiving a
diet of pureed foods since he recovered his ability to swallow 3 days ago.
He is wearing false teeth. His temperature now is 38.8°C
(101.8°F), blood pressure is 135/85 mm Hg, pulse is 94/
min, and respirations are 28/min. Examination shows... 阅读全帖 |
|
k******e
发帖数: 80 | 21 我是08年10月底开始申请加州考试的，今年1月底通过审核。中间因为找学校教务处盖
章很麻烦，耽误了2个多月，材料才得以从学校寄出。个人觉得申请算是比较顺利。把
我当时准备的情况跟大家说一下也许对将要申请的人有一点帮助。
我个人从这里寄出去的材料包括：
1.国内护士执照的公正，在这里网上找的公证处，在纽约，叫最佳公正，电话
7183212810
2.指纹卡，就在我住的地方的警察局办的，free
3.handbook上的申请表，贴一张照片在右下角（handbook链接：http://www.rn.ca.gov/pdfs/applicants/exam-app.pdf）
这一页有一项是填社会安全号，我当时没有就空着的，没有关系。
4.两张支票，一张办指纹的($51)，一张申请的($75)
5.写了一封信，表示感谢，一张纸，很客气的几句话
从学校寄出的材料：
1.中英文成绩单（学校有，我来之前到学校教务处办好的）
2.学位证书和毕业证书中英文版（来之前自己办好到学校教务处办好的，盖好了章）
3.课程描述9门（内外妇儿、精神科护理、生理、解剖、免疫、微生物，好像是这些，
请参考的人自己再斟酌。）... 阅读全帖 |
|
h*****i
发帖数: 40 | 22 1. morphine for myocardial infarction 的主要作用是什么？
a。 for pain decrease
b。 for decrease anxiety
我记得我们老师说的是主要还是答案b对，虽然也有止疼作用，当时在MI里是anxiety
呢。 我记错了？
2. 给病人suppository是left Sims position 还是left recumbent position？
谢谢大家帮忙。。 |
|
|
w******e
发帖数: 42 | 24 Before the release of EMPHASIS-HF in 2011, the usage of spiro was limited to
current or recent NYHA class IV HF with LVEF ≤35 based on RALES trial, and
recent myocardial infarction with LVEF ≤40 plus symptomatic HF and/or
diabetes based on EPHESUS trial.
EMPHASIS-HF trial showed a 37% reduction in the primary end point of the
composite of death from cardiovascular causes or hospitalization for heart
failure, a 24% reduction in cardiovascular death, and a 42% reduction in
hospitalization for hear... 阅读全帖 |
|
qk
发帖数: 14 | 25 Tissue Eng. 2006 Jul 1
Collagen-GAG Scaffolds Grafted onto Myocardial Infarcts in a Rat Model: A
Delivery Vehicle for Mesenchymal Stem Cells.
Xiang Z, Liao R, Kelly MS, Spector M.
Department of Orthopaedic Surgery, Huaxi Hospital, Sichuan University,
Chengdu, China., Tissue Engineering, VA Boston Healthcare System, Boston,
Massachusetts., Department of Orthopaedic Surgery, Brigham and Women's
Hospital, Boston, Massachusetts., Harvard Medical School, Boston,
Massachusetts.
MY Email: q**[email protected] |
|
l*****r
发帖数: 687 | 26 Journal of the American College of Cardiology
Dose of Jogging and Long-term Mortality: The Copenhagen City Heart Study
Peter Schnohr, MD, DMSC; James H. O'Keefe, MD; Jacob L. Marott, MSC; Peter
Lange, MD, DMSC; Gorm B. Jensen, MD, DMSC
Disclosures
J Am Coll Cardiol. 2015;65(5):411-419.
Abstract and Introduction
Abstract
Background People who are physically active have at least a 30% lower risk
of death during follow-up compared with those who are inactive. However, the
ideal dose of exercise for... 阅读全帖 |
|
s**********8
发帖数: 25265 | 27 来自主题: MedicalDevice版 - FDA The Food and Drug Administration (FDA or USFDA) is an agency of the United
States Department of Health and Human Services, one of the United States
federal executive departments. The FDA is responsible for protecting and
promoting public health through the regulation and supervision of food
safety, tobacco products, dietary supplements, prescription and over-the-
counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals,
blood transfusions, medical devices, electromagnetic radiati... 阅读全帖 |
|
A*******s
发帖数: 9638 | 28 For primary prevention in patients with elevated blood pressure, anti-
platelet therapy with ASA cannot be recommended since the magnitude of
benefit, a reduction in myocardial infarction, is negated by a harm of
similar magnitude, an increase in major haemorrhage.
No ASA for my friend, my friend. :)
啦！ |
|
A*******s
发帖数: 9638 | 29 For primary prevention in patients with elevated blood pressure, anti-
platelet therapy with ASA cannot be recommended since the magnitude of
benefit, a reduction in myocardial infarction, is negated by a harm of
similar magnitude, an increase in major haemorrhage.
No ASA for my friend, my friend. :)
啦！ |
|
A*******s
发帖数: 9638 | 30 来自主题: Medicalpractice版 - a case A good case.
My suggestions:
When you present a neuro case, you'd better give a good neuro exam.
1. Mental status, brain stem/thalamic infarct can cause MS changes.
2. CN. what about the eyes? Did the patient has a Horner's sign?
3. Sensory: Any sensory deficits on the right face and leg?
4. Motor: Any weakness in the right leg?
5. What about his gait?
6. What is the reflex of right biceps?
7. Any babinski's?
Stroke usually does not cause pain. Since he was playing Golf, did he
injure his s... 阅读全帖 |
|
s******t
发帖数: 579 | 31 MRA - to see aneurysm (hx of HTN) and any infarction (post-operational
stasis and embolization). |
|
g*2
发帖数: 658 | 32 刚看到有趣病例活动，想到 broken heart syndrome。 在我短短的几个月住院第一年
中，居然看到了2例。 一例是copd induced, 例外一例可能是GBS induced.
basically broken heart syndrome is transient stress induced cardiomyopathy,
aka Takotsubo cardiomyopathy/apical ballooning syndrome
a sudden onset of congestive heart failure associated with ECG changes
suggestive of an anterior wall myocardial infarction. in my 1st case, pt's
ECHO when admitted showed basal segment thickening w/ remaining hypokinetic
ventricle walls, severely decreased LV systolic ... 阅读全帖 |
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A*******s
发帖数: 9638 | 33 I had a patient who has asymptomatic carotid stenosis. He had a CEA and
ended up with a complete carotid occlusion and a large infarct.
carotid
his |
|
R*******t
发帖数: 367 | 34 Me too. Right before thanksgiving last year, a patient walked in for a
diagnostic cardiac cath, probably thinking he could rest a little during the
holiday time off. He ended up having dislodged emboli into his basilar
artery and infarcted both his cerebellums.... He was in the units for about
10 days before he passed. It was very sad to see his cerebellums got swollen
, then slowly dissolved away, day by day.
There are always risks for those interventions. Gotta think twice before
putting loved... 阅读全帖 |
|
d****y
发帖数: 2180 | 35 选B， J， I的都有，到底哪个是正确的？ A++ 有没有建议？
For each patient with cognitive impairment, select the most likely
diagnosis.
A ) Acute stress disorder
B ) Dementia, Alzheimer's type
C ) Dissociative amnesia
D ) General paresis
E ) Head trauma
F ) Hepatolenticular degeneration (Wilson's disease)
G ) HIV encephalitis
H ) Huntington's disease
I ) Major depressive disorder
J ) Multi-infarct (vascular) dementia
K ) Niacin deficiency
L ) Normal-pressure hydrocephalus
M ) Parkinson's disease
N ) Pick's disease
O ) ... 阅读全帖 |
|
d****y
发帖数: 2180 | 36 How about Multi-infarct (vascular) dementia? |
|
n*******c
发帖数: 501 | 37 I always start warfarin with bridging LWMH because warfarin can cause
transient hypercoagulable state, not because I want A/C to treat TIA.
I have seen one case who was on warfarin for afib but then stopped because
of dental procedure. warfarin was recommenced ?1-2 days after the procedure
with no LWMH cover and he ended up having a pontine infarct. Although I am
not 100% sure if warfarin is the culprit, I would use LWMH cover if it is
not contraindicated. The risk of stroke is small but real. |
|
b******a
发帖数: 704 | 38 Carotid U/S: Retrograde basilar artery flow? --subclavian artery steno-occlusive disease caused by thromboembolism? lacunar infarcts? brain stem stroke caused by vertebral artery (VA) diseases such as dissection?
The Subclavian steal phenomenon SSP may additionally cause a basilar artery (BA) steal phenomenon (BSP). When this occurs, the inversion of flow in the subclavian artery provokes additional retrograde flow in the basilar artery. However, this patient had same bilateral BPs. |
|
A*******s
发帖数: 9638 | 39 Anyone mentoned subclavian steal will get Baozi。
Any other thoughts？
occlusive disease caused by thromboembolism? lacunar infarcts? brain stem
stroke caused by vertebral artery (VA) diseases such as dissection?
artery (BA) steal phenomenon (BSP). When this occurs, the inversion of flow
in the subclavian artery provokes additional retrograde flow in the basilar
artery. However, this patient had same bilateral BPs. |
|
n*******c
发帖数: 501 | 40 I see.If this is the case. The patient would expect recurrent episodes if
leaving SSS untreated.
I thought this acute event is mainly due to the acute infarct because she
has no syncope before.
I am just wondering if the doppler ultrasound reported retrograde flow on
vertebral as well.
Again, thanks for sharing. |
|
b******a
发帖数: 704 | 41 Carotid U/S: Retrograde basilar artery flow? --subclavian artery steno-occlusive disease caused by thromboembolism? lacunar infarcts? brain stem stroke caused by vertebral artery (VA) diseases such as dissection?
The Subclavian steal phenomenon SSP may additionally cause a basilar artery (BA) steal phenomenon (BSP). When this occurs, the inversion of flow in the subclavian artery provokes additional retrograde flow in the basilar artery. However, this patient had same bilateral BPs. |
|
A*******s
发帖数: 9638 | 42 Anyone mentoned subclavian steal will get Baozi。
Any other thoughts？
occlusive disease caused by thromboembolism? lacunar infarcts? brain stem
stroke caused by vertebral artery (VA) diseases such as dissection?
artery (BA) steal phenomenon (BSP). When this occurs, the inversion of flow
in the subclavian artery provokes additional retrograde flow in the basilar
artery. However, this patient had same bilateral BPs. |
|
n*******c
发帖数: 501 | 43 I see.If this is the case. The patient would expect recurrent episodes if
leaving SSS untreated.
I thought this acute event is mainly due to the acute infarct because she
has no syncope before.
I am just wondering if the doppler ultrasound reported retrograde flow on
vertebral as well.
Again, thanks for sharing. |
|
M***D
发帖数: 249 | 44 Is the patient a smoker? Hypertensive?
If so, he likely had a small pontine tegmental infarction.
Agree MRI the patient and 让糖姐赚一笔 :)) |
|
n*******c
发帖数: 501 | 45 让糖姐姐赚的意思是明知MRI正常也要order，所以糖姐姐轻松发报告赚钱lol
to have a pontine tegmental infarct affecting CN vii only,without any gaze
palsy or abduction deficit is highly unlikely, if not impossible...
btw, if one can explain one-and-a-half syndrome clearly in the round, he
will impress most of the neurology attendings :) |
|
A*******s
发帖数: 9638 | 46 A brain stem infarct or MS could present with Bell's palsy. So 上街要饭
will never happen. There are a plenty of Docs practicing defensive medicine
. :) |
|
I****a
发帖数: 407 | 47 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 |
|
|
A*******s
发帖数: 9638 | 49 Cerebellar infarct is tricky. Make sure there is no 4th ventricle
obstruction which is life threatening.
I always put these patients in Snowforest's unit and do a daily CT. I had a
patient found to be in coma and had a wallenberg's syndrome. I called
Neurosurgery who operated him STAT. Amazingly, 2 yrs later, he was able to
go for deer hunting and he sends me greeting card yearly.
|
|
e******e
发帖数: 118 | 50 i can't load it now, but the reading is L thalamocapsular hypodensity may
represent acute infarct, no ICH |
|
