A*******s
发帖数: 9638 | 1 Today I got a phone call from a collegue. His previous nurse who is 54
years old female, presented with right foot pain for 4 days. The pain was
so severe that she could not walk. He did a MRI of L-spine and vascular u/s
which were all normal. ESR is 30. He wanted me take a 2nd look if he missed
something.
PMH. Lung Ca for 2 yrs. DM. HTN. Depression.
SH/FH/ROS: not remarkable.
What are you going to do at Exam if you suspect something? |
|
k********n
发帖数: 756 | 2 Male, 40s, no PMH, sub-acute onset, VS WNL
hearing loss
encephalopathy
blurry vision
MRI: multi-focal contrast enhancing/demyelinating changes, corpus callosum involved.
Hint: not MS |
|
s******t
发帖数: 579 | 3 age? PMH? SH? SxH? VS?
Progressive multifocal leukoencephalopathy? Just a wild guess. |
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p*********1
发帖数: 65 | 4 It counts by lines not words and I did in the real exam this Monday and got one warning say "you reach the limitation".So I immediatly backtab the next line into the previous line and at the subsequent cases, I did PMH:----, Allergies---, Medication---. never did by line as Fa indicated. By PE: you can do that way as it has enough space. |
|
A*******s
发帖数: 9638 | 5 昨天有同仁对我的一个case感兴趣， 我今天查了下病历， 给大家写个完整的。
53 yrs old WM, previously healthy, presented with intractable fatigue and
weight loss for 3 months. A comprehensive workup by his PCP including a CT
of chest was reported as unremarkable.
PMH: Asthma, seeing a pulmonologist who reviewed CT and agreed with
radiologist's report.
Soical. Smoker 1 ppd. No ETOH/Drug.
FMH: neg for CA.
ROS: Not remarkable, no diplopia, dysphagia, no fever, no joint pain, no
muscle ache.
PE: Vital normal.
No positive findings on P... 阅读全帖 |
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m**5
发帖数: 54 | 6 I just received my report and I passed cs. I learned lots from the others
and I promised to myself I would share no matter pass or fail when I got the
score. Now I got the score and pretty high performance, I can say what I
think about this exam. But it could be my own thinking, 大家自己衡量. Here
is my brief prepared process:
I prepared around 7 weeks parttime. the first 2 weeks, I spent 2-3 hrs on
weekday and 5-6 hr on weekend to get to understand what is cs and which
material I need to use and sear... 阅读全帖 |
|
D**6
发帖数: 68 | 7 1. He gave one free case practice.
55 y/o F Ms. Hemme, c/o unusual sensation in her chest, BP- 160/95, HR-101,
RR-18, temp 99
...HPI....PMH....Challenge Qs.... PE....Closure....
2. He analyzed the problems from this encounter.
3. Discussed the diff Dx and focused exam.
4. He introduced his workshop and answered Qs.
I haven't attend his workshop though plan to go in Mar. He provides 1 to 1
SP practice in his workshop, 12/day. Teach you PE, Judge ur Dx and Patient
notes, as he introduced to us.
我个... 阅读全帖 |
|
d******0
发帖数: 296 | 8 Case 1
Opening scenario:
Sharon Smith, a 48-year-old female,comes to the clinic complaining of
abdominal pain. Married with four children.
Vital signs:
BP:135/70 mmHg
Temp:98.5 F
RR:16/minute
HR:76/minute, regular
Protocol:
Knock three times with confidence, a smile, walk in and say:
Good morning, Ms Smith. I am Dr. Dora, and I am here to see you today as
your physician. Nice to meet you .Shake hands. Is everything in the room
alright for you? Let me cover you with this to make you a little m... 阅读全帖 |
|
c*****t
发帖数: 625 | 9 1.考试里的那些简写，包括：
NAD, AAOX4, NC/AT, MRG, C/C/E, LAD, etc...
到底可不可以这样写？考试会不会因此而扣分？
2. 前面的那些categories,如果用bullet points 写出来的话，到底需要不需要把他们
列出来？
HPI, ROS, PMH, FH, SXH.
请过来人，或者知道的同学解答。 万分感谢！！！ |
|
s*****1
发帖数: 273 | 10 Suggestions from tele
提醒大家结成对子，按照ＳＰ和Ｉｎｔｅｒｎ来训练问病史。
几大常见主诉，每次２０分钟问病史
Syncope, alcohol withdrawal, GI bleed, COPD exacerbation, Chest pain
Cough, fatigue, infection, fever
要问全HPI, PMH, SH, FH, Medication
还有code status
Practice writing the notes and dictation |
|
f*******u
发帖数: 48 | 11 听很多前辈们说，在做observation的时候或现在就要留意有兴趣的case准备面试时可
以用。那么想请教在准备是应该注意些什么呢？比如：
1.时间长度应控制在多久？通常会给你几分钟？
2.是要每项内容（包括chief complaint，HPI，PE,PMH，MEDS，Allergy，family
history，social history，ROS，dignosis，assessment plan 逐一报告，还是只汇报
相关的内容？
3.lab test 也要汇报具体数字吗？
3.有没有重点要强调？
4.要不要查一些新的进展或是大规模临床试验？并把这些也放进去？
非常感谢大家的意见！ |
|
n***j
发帖数: 184 | 12 考试的时候，enter是占格的。但是全一起写又太难看了，我是分成下面的几个块写的
，下面有空行的地方考试的我没有空行。最后PN是*，希望能有帮助。 good luck
CC: A 45 yo M c/o bloody vomiting.
HPI: 2 episodes, 2 hours ago and 30 mins ago, w/o known causes. Feels dizzy.
A cupful each time, bright red, no clots, smelly. Epigastric pain at the
same time,dull, buring, 6-8/10, radiating to the back, intermittent,
aggravated with drinking fluids, no alleviating factors. Heartburn for a
long time. No previous episode of bloody vomiting/ nausea/ fever/ chest pain
/ cough/ bla... 阅读全帖 |
|
d****y
发帖数: 2180 | 13 ☆─────────────────────────────────────☆
Jane27 (小简) 于 (Sun Nov 25 23:53:22 2012, 美东) 提到:
在USMLE官方网站上面练习PN的链接， 如果每次点enter的话就会take up 很多的space
,结果是我的PN上面的history taking 部分总是不够space。听人说在真正的考试的时
候，这个问题是不存在的，只要你字数不超就可以，你可以按enter来分行。
因为我写PN用的是bulletin的格式，需要分行很多，所以这个问题大大困扰了我。 有
考过的同学可以进来说说吗？
谢谢！
☆─────────────────────────────────────☆
largebird (largebird) 于 (Mon Nov 26 00:04:46 2012, 美东) 提到:
不能分行，要不写不下。一气呵成吧。没办法
☆─────────────────────────────────────☆
Jane27 (小简) 于 (Mon Nov 26 10:51:23 2... 阅读全帖 |
|
m******r
发帖数: 1904 | 14 ☆─────────────────────────────────────☆
dora2010 (dora) 于 (Wed Feb 29 16:55:46 2012, 美东) 提到:
Case 1
Opening scenario:
Sharon Smith, a 48-year-old female,comes to the clinic complaining of
abdominal pain. Married with four children.
Vital signs:
BP:135/70 mmHg
Temp:98.5 F
RR:16/minute
HR:76/minute, regular
Protocol:
Knock three times with confidence, a smile, walk in and say:
Good morning, Ms Smith. I am Dr. Dora, and I am here to see you today as
your physician. Nice to meet you .Shake ha... 阅读全帖 |
|
J*********4
发帖数: 1274 | 15 HPI:------------------
----------------------
----------------------
ROS-------------------
Allergy---------
PMH-------------------
FMH-------------------
PSH-------------------
Medication----
SH--------------------
PE:
DDx:
Diagnostic workup |
|
J*********4
发帖数: 1274 | 16 今年的新Intern马上要开始最艰苦的头三月了。为了给大家鼓劲和提供survival tips，
经Dr. Againstwind (逆风而行)同意，把她以前的精彩帖子重新分段贴下. 谢谢！BTW,
Dr. Againstwind is the winner of the best resident in her program at her
graduation.
Intern汇报病史小tips
被花厘鼠抓去参加了几次skype case presentation，想想自己当年一match上就回国腐
败得昏天黑地，呵呵，大家的起跑线已经高了很多，有点感触，跟大家分享一下。
1。汇报病史的顺序：第一句话主诉，然后现病史，然后PMH/PSH/SH/FH/ALL/MEDS/ROS,
条理要分明。现病史第一句话通常是 this is a 63 year old male with history of
DM-2, HTN, CAD presented with .... 然后把故事加入细节。
2。汇报的重点：
如果CAD病人是胸痛/SOB等主诉，那么一定要知道的病史包括：有没有MI, 什么时... 阅读全帖 |
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i**********d
发帖数: 853 | 17 Step2 CS 考经 + 考后感想(我是Jeff）
和很多伙伴一样，在等了2个多月后，终于在昨天拿到了CS成绩。除了ICE碰到了
borderline，CIS和SEP都是high performance，这一结果和在Xmedus的最后模考成绩基
本一致。
我周围的伙伴们也都通过了。
按惯例，感谢所有和我一起学习过的伙伴们，感谢家人的支持，尤其是老婆在考试前一
天，用了10个小时陪我突击过了FA上的最后20个cases。
第一部分：基本情况
见下及旧帖
复习时间：2个月
地点：Atlanta
所用书籍，学习班及相关评价：见我附在后面的以前帖子。
考试经历：见我附在后面的以前帖子。
补充：有2-3个诊断很难的Cases，估计就是这个原因导致ICE碰到了borderline，其他
的都是FA上的case。
第二部分：一些小技巧
###关于Patient Note：
在Xmedius得到了一些关于PN有用的信息和技巧，和大家分享一下（二手信息，无法确
认其真实性，请大家根据自己的理解来判断）：
1). DD最好写3个诊断，这样风险比较小。如果只写一个，如果是第一诊断，拿全分；
如果不是前... 阅读全帖 |
|
h******I
发帖数: 229 | 18 提心吊胆的一个多月过去了，早上看到score report available, 经过一个多小时的心
理建设以后，打开成绩单，过了。ICE 3个在borderline, 其他在比较靠近high
performance的地方，完全没有概念究竟自己做的那里好那里不好，觉得有必要记录一
下，也给后来的考友一些参考。
背景：YOG>10, step 1 平均分，没有考 step 2 ck.
准备： 3个月，kaplan辅导班， first aid CS.
复习初期：因为在cs大组里面没有找到合适的partner, 只好在usmleforum上找了一堆
亚非拉大联盟的战友，大家操着各种口音的英语，有的很难听懂，也很难找到固定的
partner. 比较幸运的是最后有一个巴基斯坦的女生和加拿大的和我名字一模一样的中
国人成为了比较固定partner,他们的水平都比我高很多，我完全没有概念的把FA的大
case过了一遍，他们也没有嫌弃我。十几天之后去参加kaplan辅导班，同样，也是亚非
拉联盟，还有两个墨西哥和加勒比的美国毕业生，年纪也都挺大的。这个学习班完全颠
覆了我对cs的印象，自己复习的时候总... 阅读全帖 |
|
d*********n
发帖数: 18 | 19 Confusion case: O CFDP P ADL, IADL, TIA/stroke, depression, DM, thyroid,
normal pressure hydrocephalus, PAMHUGSFOSS
insulin induced hypoglycemia
Electrolyte abnormalities
Vitamin B12 deficiency
Medications
TIA
Multi-infarct dementia
Chronic subdural hematoma
Alzheimer’s dementia
Normal pressure hydrocephalus
Intracranial tumor
Neurosyphilis
Depression
Hypyothyriodism
DDx Confusion
DEMENTIA
D-Diabetes /Dementia/ Drugs
E-Epilepsy
M-Migraine/Mult Infarct Dementia
E-Ethanol (withdrawl / Toxicity)
N... 阅读全帖 |
|
d******g
发帖数: 258 | 20 How to manage step3 CCS?
It’s hard in the beginning, kind of clueless for me. But you will be able
to get the idea pretty quickly after 5-6 cases in computer. Here’s my
thoughts how to manage it quickly and try not to miss things.
1. Differential if need urgent care.
All Chest pain, SOB, AMS, post-trauma, little infant all need to be ordered
with ER order before physical exam.
ER order mnemonic will be POC IV, ( have to poke someone for IV line)
Pulse oxygen
Oxygen
Cardiac monitor and BP mon... 阅读全帖 |
|
r*****1
发帖数: 805 | 21 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，但更有效更人性化。比如ER 所有
diagnostic test直接设置为STAT。
Experience:
1. Mnemonic：
what＇s to be managed？
V: abn... 阅读全帖 |
|
z******8
发帖数: 844 | 22 ☆─────────────────────────────────────☆
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 |
|
t********o
发帖数: 228 | 23 Just found out i passed it. Well, not a big surprise and finally, I can say
good by to USMLE
Material: MTB3 and UptoDate. Step 1/Step2: 250/249 but those were 3 years
ago. Step 3: 227. Time: on/off for 3 months.
Good luck to everybody.
Not a whole lot of thoughts about this test. if you can memorize MTB3 and UW
, then there should be NO problem to pass it.
here are some thoughts about this CCS (combined mine and others)
Step I: patients: VASCULAR
Vitals/Age/Sex/Chief complaint/Urgent sympt... 阅读全帖 |
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F********1
发帖数: 151 | 24 今天和skype上两位学友谈到CS准备，我翻出自己以前写的CS总结，在这里贴一下仅供
参考。Hope it helps. 另外，我觉得面对面练习非常重要。希望大家一定要找同城考
友面对面练习。
1) Encounter may begin.
开始阅读doorway信息。last name, 性别，主诉，快速瞄一眼要不要求体检。然后快速
写下OCDFPPAAAGUWASFT PFHAMOSS, 女性把o改为OB/GYN。在AAA旁边写上2-3个鉴别诊断
名词，同时写上体检项目（心、肺、腹、神、头、甲）。同时，这些也是需要询问的大
系统。这一步40-50秒，争取不要超过1分钟。
2) 走到病人面前，微笑，建立眼神接触之后再说话，伸出手准备握手。Hi, Mr. Smith
, I am Dr. X, I am a physician in this hospital. I will be taking care of
you today. Very nice to meet you!
SP: Nice to meet you too.
Before we start, let me cove... 阅读全帖 |
|
发帖数: 1 | 25 4/24/2017 费城考的， 考完非常焦虑， 担心过不了。Xingxing 老版主说只要好好准
备的， 都能过。后来成绩单下来， 还比及格线高很多。叶子版主让我写份考经，拖到
现在。
考点选择：Houston 应该是最IMG friendly. 一个在那考的朋友说考场里满场老印，旅
馆里也是。很多是直接从印度飞来考试的， 一个个土的掉渣。我们的英语虽然遣词造
句不如老印， 发音还是比他们好的。LA 据说 SP 非常习惯 Asian accent, 而且SP 年
轻男性多， 这也是优点。因为中年女性SP是最难对付的。费城SP 我考时是6 黑6 白 6
男 6 女。年龄分布老中青都有。一个在Atlanda 考的朋友也是这种分布。芝加哥考场
不清楚， 但没听到过恶评。
CS 考试准备：
Tutors: Ali and Marisa，早期练病例找的Ali, 后期练语言找的Marisa.
Partners: 3个， 2 Chinese, 还有一个美国长大，孟加拉读的医学院的小伙伴。练习
是很重要的，一不练嘴就生了。
Training courses: Gold NYC (早期) and Kap... 阅读全帖 |
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u******8
发帖数: 32 | 26 Was is PMH? If it was, then you should hear from them soon! let us know!
Good Luck! |
|
l*******8
发帖数: 1745 | 27 40y AAF severe obese,new onset massive PE, b/l upper and lower lobes and R
middle lobe pulmonary artery emboli, r back pain and sob 4 days, no any PMH
except psych histry, no travel histry, not taking OCP, no family histry of
DVT or PE, this is her first time onset
the key is vitals are stable, oxygenation is good on room air, little bit
sinus tacky, I report to PCP and asked him what his treatment plan is:
anticoagulation v.s. thrombolytic therapy ( acturally only unstable pt will
use thromboli... 阅读全帖 |
|
b*****o
发帖数: 6080 | 28 嗯，承蒙教诲。多谢！
PMH
will
heparin
such |
|
g****i
发帖数: 2269 | 29 good job, I need to learn a lot from you. Sometimes, I am too
straightforward and people around me feel I gave them a hard time. It is all
about communication skills.
PMH
will
heparin
such |
|
o******h
发帖数: 198 | 30 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 |
|
b*****o
发帖数: 6080 | 31 Admitted on ____ for ____. Stable? For the acute issues what have been done,
and what are expected to be done.
PMH
PSH
Code status
Isolation____, for _____ (here also about culture results).
System by system: what was done, what is scheduled; mention important
medications, especially drips, the imaging test result or abnormal labs,
need supplements?
If surgical: when, what, who, why, drainage, dressing change, further
procedures needed?
Repeat any extremely significant information in the end so ... 阅读全帖 |
|
Y*****3
发帖数: 427 | 32 nystudent 谢谢你的回复！
去医院和护士还有病人沟通确认的确很重要，我们也要求得去医院！有时会从中得知答
案，不过有时连病人和护士也不确定他们什么时候出院，或许我们跟我们实习的医院基
本都是medical, Medicaid, homeless病人有关？不懂了，不过去还是比不去保险，。
我们clinical作业一开始觉得很难，第一次时班上同学都通宵了，没通宵的也都只睡一
两个两三个小时，现在觉得好一些了，但还是很花时间，病人chief complaints,
addmission diagnosis, current的disgnosis,PMH, SH, ,primary diagnosis,
phathophysiology, secondary diagnosis, phatophy.,complications, treatments,
abnormal labs, normal labs, drug therapy, medical information, 病人自己的所
有parameters, notify MD 的orders， 一整天的organization ... 阅读全帖 |
|
w**d
发帖数: 362 | 33 多谢您回复。
那天早上preceptor和我一走进病房，马上就发现异常。夜班RT把Ventilator调到了 AC
32 500 100%, peep 15. 这是开足马力确保病人不要在夜班去世。
白班RT来了，马上查ABG. 我们俩一算，paO2/FiO2=105, fatal rate 38-45%。马上打
电话给家属。
HR 125, 12-lead EKG显示A-fib with multiple PVC，但是没有MI。
peep 15是极限了，RT说他已经把ventilator弄到极限了。
到下午，我也把vasopressor弄到极限了。
都打到极限了，那为什么BP还是控制不住呢？该用的我们都用了。没招了,第一次感到
很无助。
事后想想，应该要弄个cvp和arterial pressure看看。
是什么导致的ARDS我也不太清楚。入院诊断是acute respiratory failure, UTI.
PMH: chronic hypercapnic respiratory failure, COPD, CHF, HTN.
%. |
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w**d
发帖数: 362 | 34 多谢您回复。
那天早上preceptor和我一走进病房，马上就发现异常。夜班RT把Ventilator调到了 AC
32 500 100%, peep 15. 这是开足马力确保病人不要在夜班去世。
白班RT来了，马上查ABG. 我们俩一算，paO2/FiO2=105, fatal rate 38-45%。马上打
电话给家属。
HR 125, 12-lead EKG显示A-fib with multiple PVC，但是没有MI。
peep 15是极限了，RT说他已经把ventilator弄到极限了。
到下午，我也把vasopressor弄到极限了。
都打到极限了，那为什么BP还是控制不住呢？该用的我们都用了。没招了,第一次感到
很无助。
事后想想，应该要弄个cvp和arterial pressure看看。
是什么导致的ARDS我也不太清楚。入院诊断是acute respiratory failure, UTI.
PMH: chronic hypercapnic respiratory failure, COPD, CHF, HTN.
%. |
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b**o
发帖数: 5769 | 35 考试题不能贴啦。
给一个我们的作业好了。
O.D. is a 18 YO F who presented to your hospital 5 days ago following an
intentional ingestion of Seroquel® after a verbal disagreement with her
mother. O.D. admitted to taking 20—300 mg extended release Seroquel®
tabs. Several hours later, O.D. collapsed and her eyes rolled back in her
head. The paramedics noted seizure activity, and O.D. was transferred to
the hospital for further care. She was noted to have a tonic-clonic seizure
lasting 30 minutes and was int... 阅读全帖 |
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s********4
发帖数: 64 | 36 CC: Axillofemoral bypass surgery for an occluded right limb
HPI: 62 yo male with antiphospholipid syndrome presents to VAMC for
scheduled axillofemoral bypass surgery on 10/22. Patient was instructed to
hold warfarin and start enoxaparin for bridging prior to surgery. Patient
was admitted pre-op on 10/21 and switched to a heparin drip for
anticoagulation. Surgery was completed successfully with no complications
on 10/22. Post operatively patient feels much better with minimal pain in
his fo... 阅读全帖 |
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A*******s
发帖数: 9638 | 37 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 |
|
A*******s
发帖数: 9638 | 38 昨天有同仁对我的一个case感兴趣， 我今天查了下病历， 给大家写个完整的。
53 yrs old WM, previously healthy, presented with intractable fatigue and
weight loss for 3 months. A comprehensive workup by his PCP including a CT
of chest was reported as unremarkable.
PMH: Asthma, seeing a pulmonologist who reviewed chest CT and agreed with
radiologist's report.
Soical. Smoker 1 ppd. No ETOH/Drug.
FMH: neg for CA.
ROS: Not remarkable, no diplopia, dysphagia, no fever, no joint pain, no
muscle ache.
PE: Vital normal.
No positive finding... 阅读全帖 |
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A*******s
发帖数: 9638 | 39 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 |
|
A*******s
发帖数: 9638 | 40 昨天有同仁对我的一个case感兴趣， 我今天查了下病历， 给大家写个完整的。
53 yrs old WM, previously healthy, presented with intractable fatigue and
weight loss for 3 months. A comprehensive workup by his PCP including a CT
of chest was reported as unremarkable.
PMH: Asthma, seeing a pulmonologist who reviewed chest CT and agreed with
radiologist's report.
Soical. Smoker 1 ppd. No ETOH/Drug.
FMH: neg for CA.
ROS: Not remarkable, no diplopia, dysphagia, no fever, no joint pain, no
muscle ache.
PE: Vital normal.
No positive finding... 阅读全帖 |
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I****a
发帖数: 407 | 41 From hematological point of view, I would like a entire diff including RBC
indices and reticount before and after the blood transfusion.
From the cardiology point of view, I would like to have electrolytes
including Mg and an ECHO.
From endocrinology point of view, I would like a complete thyroid panel, FT3
, FT4 and TSH.
In addition, I also like information of her PMH/PSH, medication including
any OTC stuff, habits etc.
My hunch at this point is that everything is originated from her thyroid.
... 阅读全帖 |
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a*******n
发帖数: 82 | 42 They are all valuable points!
She was given Zofran, Phenergan and compazine in the other hospital.
MRI of brain was done for evaluation of severe nausea.
For her PMH/PSH, significant for iron-deficiency anemia, treated with iron
supplements in the past; HTN; DLP; h/o C. diff colitis 6 months ago; pAF
with RVR 8 months ago; yearly normal mammogram; normal colonoscopy 3 years
ago; chronic lymphedema from lower extremities; lung nodule with stable CT
followup. She was on dig, amiodarone, coumadin, ... 阅读全帖 |
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I****a
发帖数: 407 | 43 From hematological point of view, I would like a entire diff including RBC
indices and reticount before and after the blood transfusion.
From the cardiology point of view, I would like to have electrolytes
including Mg and an ECHO.
From endocrinology point of view, I would like a complete thyroid panel, FT3
, FT4 and TSH.
In addition, I also like information of her PMH/PSH, medication including
any OTC stuff, habits etc.
My hunch at this point is that everything is originated from her thyroid.
... 阅读全帖 |
|
a*******n
发帖数: 82 | 44 They are all valuable points!
She was given Zofran, Phenergan and compazine in the other hospital.
MRI of brain was done for evaluation of severe nausea.
For her PMH/PSH, significant for iron-deficiency anemia, treated with iron
supplements in the past; HTN; DLP; h/o C. diff colitis 6 months ago; pAF
with RVR 8 months ago; yearly normal mammogram; normal colonoscopy 3 years
ago; chronic lymphedema from lower extremities; lung nodule with stable CT
followup. She was on dig, amiodarone, coumadin, ... 阅读全帖 |
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y***d
发帖数: 33 | 45 在板上潜水有一会了，好像发case的不多啊。是不是这儿attending太多，都没时间写
case了呢？我来抛砖引玉好了。
从今天开始，每星期我会上一个case。 周一history, 周二physical， 周三initial
labs/work up, 周四additional work-up, 周五final diagnosis. 欢迎大家跟贴讨论
。这些case基本上是面向内科resident的。不过attending们也可以复习一下哈。如果
受欢迎的话我会一直贴下去。废话到此为止。 先上第一个case试试反响如何。
CC: bilateral leg swelling and diarrhea
HPI: 72 yo f h/o HTN, diarrhea and pneumatosis intestinalis of unclear
etiology presented to ER for worsening bilateral lower extremity edema and
ongoing diarrhea.
Initially presented 2 month PT... 阅读全帖 |
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k********n
发帖数: 756 | 46 A 45 YOF PMH eclampsia no other risk factors presented with right carotid
dissection but left ischemic stroke in the motor strip.
Forgot to take a close exam on her skin. Therefore, I missed the
opportunities to impress attendings and peers.
The skin finding is Livedo Reticularis
What is the syndrom? |
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y***d
发帖数: 33 | 47 Looks like people enjoyed last week's case. Here's the second one. This one
is shorter and more straightforward.
CC: fever, abdominal pain and arthralgias
HPI: 31 yo merchant ship worker p/w 3 days of acute febrile illness. 16 days
PTA, he flew from India to Long beach, where he had a negative pre-ship
exam including labs. Then patient boarded an oil tanker and sailed up west
coast. 3 days PTA, he developed mild mid-epigastric and LUQ pain. Over the
first day, pain worsened and was associated wi... 阅读全帖 |
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A*******s
发帖数: 9638 | 48 84 yrs old WF, presented with right eye vision loss for the past 10 days.
Her left eye went blind 1 year ago. She was seen by an optometrist who
diagnosed her as GCA. Her daughter brought her to me for a 2nd opinion.
PMH: Left eye blindness for 1 year. DM. HTN and CRF.
On exam: Temporal tenderness bilaterally. VA: 20/70 OD, 20/400 OS. (+)APD.
fundoscopy suggests ischemic changes, no papillary edema.
Lab: ESR 20; CRP: 0.6.
What are you going to tell the daughter? |
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W***2
发帖数: 60 | 49 sorry for the second, I forgot the PE. Should be like this?
76 yo M p/w RUQ pain for 2 days with N/V. F/C. For the PMH, he had HTN, COPD
, CHF, Hypothyroidism, He is on Lasix, antenolol, ASA, Levothyroid. PSH:
gastric cancer 10 yrs ago, ventral Hernia repair 5 yrs ago.
PE indicated ABD soft, RUQ tenderness, no rebound, no guarding.
pt is afebrile, WBC 17, TB 1.2, DB 0.3. U/S showed GS. |
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A*******s
发帖数: 9638 | 50 今天被一个医生朋友的电话揪到了医院， 他给他一个亲戚做了个手术， 今天是第2天。
67 yrs old female had a cervical laminectomy for her cervical myelopathy
yesterday. Her initial symptoms include gait disturbance. After the surgery
, she was found to have a right arm weakness and right pupil dilatation. She
had been in respiratory failure after the surgery and currently she was on
biPAP.
ICU nurse was apparently panic after she saw the dilated right pupil which
was new and confirmed by her family members.
PMH: HTN， Glucoma.
Social/fami... 阅读全帖 |
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