c**i
发帖数: 6973 | 1 (1) Sorry, (originally from Taiwan but having lived in US for a quarter
century) I simply have no faith in medicine of China. (Read my previous
postings in this board.) So I am skeptical about the diagnosis. Are the
doctors there competent to make the diagnosis? It is not easy: the family (
including you)--and possibly the doctors there--probably do not know what
subtype of spinal muscular atrophy* (type 1 or 2?) or what gene goes wrong (
SMN** or some other genes). It is important to know this... 阅读全帖 |
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v*****z
发帖数: 3067 | 2 【 以下文字转载自 Automobile 讨论区 】
发信人: DoubleWhy2 (why2), 信区: Automobile
标 题: 修车的奇异经历，教训和请教
发信站: BBS 未名空间站 (Sun Mar 20 00:27:29 2011, 美东)
为了节省银子，找了一个mobile mechanic（个人）修车，更换valve cover gasketz（因为
oil leak，修车铺诊断的），同时帮着换来机油（我自己买的机油和oil filter），这个
mechanic的人工报价也就是修车铺的一半多一点点。但是更换完了后（修车的过程中我不在现
场），取车的时候发现车子出了新问题，一个是check engine light 亮，后来读了code是
P0102，解释是massive air flow circuit input low；另外一个问题更严重，症状是车子
的档位一拉到D档，车子就感觉抖一下，叫jerk或者jolt。拉动到别的档位就没问题，然后在开车的
时候，车子也偶尔会突然抖一下，和在D档的那个抖感觉是一样的，开车的过程中出现这个现象感觉很
恐怖。第一个问题... 阅读全帖 |
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I*D
发帖数: 40035 | 3 Role Title Description Start Date End Date Status Level From
Level To Standard Role Work Location Role Specialty 1 Level 1
Role Specialty 1 Level 2 Role Specialty 1 Level 3 Role Specialty 1
Level 4 Role Specialty 1 Level 5 Skill & Proficiency
PeopleSoft Administrator This person will be part of a team that supports
a PeopleSoft Financial system with several associated custom applications
and batches using ASP .NET, Hyperion, PL/SQL, SQL, and SQR. This ... 阅读全帖 |
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g*2
发帖数: 658 | 4 我也感觉像pre-stress fracture
诊断的话看看这个：
Diagnosis of a tibial or fibular stress fracture is suggested by such a
history in a patient with risk factors and the following clinical findings:
Pain localizes to one specific area
Local swelling and discrete bone tenderness are present
Pain increases with the impact from running or jumping
An inability to hop on the symptomatic leg for 10 repetitions (positive hop
test) without excessive pain is also suggestive of the diagnosis. In this
setting,... 阅读全帖 |
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a****o
发帖数: 6612 | 5 这种转述几遍的话，加上你的英文理解能力，实在让别人反驳你都没劲。
你有本事就把us medicine 上面Dr. Steve Cunnion原文贴出来。我没有找到原文。如
果你找到原文和你的帖子一致而不是下面的引用的话，我删除此帖。
看看下面这个原文引用（加了引号），明显Dr. Steve Cunnio只是参加了internet
diagnosis!!而且是说zhu ling没有在有铊盐的实验室中工作过。
@@ Dec. 1995, U.S. Medicine published an article regarding the work of Dr.
Steve Cunnion, a U.S. Navy physician who participated in ZHU Ling's Internet
diagnosis.
The article mentioned "ZHU Ling, it seems, was the victim of a murder
attempt, linked at this point to a jilted suitor. According to... 阅读全帖 |
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c***t
发帖数: 383 | 8 ☆─────────────────────────────────────☆
nova888 (nova) 于 (Fri May 3 13:14:59 2013, 美东) 提到:
Dear Xun,
I am indeed one of the doctors who assisted in the diagnosis and treatment
of Zhu Ling. I also visited Beijing in October, 1998 and spent time with
Zhu Ling and her family.
The source of the thallium was, according to what I was told by sources in
China, from a young woman, a contemporary of Ling, who was in
competition with Ling for a fellowship in the USA, and allegedly, this
woman poiso... 阅读全帖 |
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t******n
发帖数: 2939 | 9 ☆─────────────────────────────────────☆
lovesunny123 (lovesunny123) 于 (Wed May 1 19:48:36 2013, 美东) 提到:
首先声明：投毒人， 拿钱发帖的人 都不得好死，断子绝孙。
孙维赫宿舍其他人早就看朱令不爽，决定让她吃点苦头。
孙维从外面买来一些老鼠药，放在自己的热水瓶里，并提醒其他宿舍人员不要使用。
朱令每日晚归，不打水，偷用孙维的热水洗脸洗头，导致暂时性失明，脱发，入院。
朱令身体素质很好，在家调理一段时间回来之后，回到宿舍，依然不改行为作风。
孙等人决定加大惩罚力度，去买了毒性更大的老鼠药（黑市上的铊含量很高的），导致
朱令再次中毒。
孙等人一直认为自己无罪，而是朱未经允许，侵犯别人财产在先。所以不构成犯罪。
孙家利用层层关系，把其送出国。此案最终以朱意外中毒结案，却也一定程度上反应了
事实。
清华根本没有那么多的铊，能让孙维等人长期（半年）多次投毒，还不被注意到。想购
买铊，或者含铊鼠药，非常容易，这点在以后的铊投毒案件中都被证明了。
［参考资料］
老鼠药种类
http://t... 阅读全帖 |
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f*****c
发帖数: 424 | 10 首先，替我家宝宝谢谢所有关心他的叔叔阿姨们，看到那么多bless，真的很感动。
下午收到了医生的email，内容如下：
As you can see most of his bloodwork looks fine but he does have a high
corona titer. While a high titer does not automatically mean he has FIP
given the fact that he is thin, has a fever and his abdomen is distended it
makes it very likely he does indeed have FIP and as such his prognosis is
very guarded. We can attempt at some point to drain the fluid from his
abdomen to see if that gives him some relief but his long term outlook is
n... 阅读全帖 |
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b******a
发帖数: 12216 | 11 医生有说给什么抗病毒的药么？
你说的高的那两项都是跟发炎有关，跟发烧相符合。医生说的high corona titer怎么
测出来的？在什么里边？血还是腹腔液？
首先，提我家宝宝谢谢所有关系他的叔叔阿姨们，看到那么多bless，真的很感动。
下午收到了医生的email，内容如下：
As you can see most of his bloodwork looks fine but he does have a high
corona titer. While a high titer does not automatically mean he has FIP
given the fact that he is thin, has a fever and his abdomen is distended it
makes it very likely he does indeed have FIP and as such his prognosis is
very guarded. We can attempt at some point to drain the fluid fr... 阅读全帖 |
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a********k
发帖数: 2273 | 12 这个不太同意。
陈竺有政治成分，但是贡献也还是很大的，我觉得比一公大。Dennis Lo也算国际临床
诊断的老大级人物了
，直接创造的产值绝对1B$以上了，对生物医学比一公大。
Yuk-Ming Dennis Lo, MD
AACC-NACB Award for Outstanding Contributions to Clinical Chemistry in a
Selected Area of Research
Dr. Lo is the director of the Li Ka Shing Institute of Health Sciences and
chair of the department of chemical pathology of The Chinese University of
Hong Kong. In 1997, Dr. Lo and his co-workers reported the presence of cell-
free fetal DNA in the plasma of pregnant women. This discovery... 阅读全帖 |
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c********n
发帖数: 67 | 13 Surgical treatment for tubal disease in women due to undergo in vitro
fertilization
Transvaginal ultrasonic needle guided aspiration of pelvic inflammatory
cystic masses before ovulation induction for in vitro fertilization
Evidence-based diagnosis and management of tubal factor infertility
Tubal factor infertility: diagnosis and management in the era of assisted
reproductive technology
Tubo-peritoneal factor of infertility: diagnosis and treatment
Tubal disease and fertility outcome
A reassessm... 阅读全帖 |
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l**********2
发帖数: 104 | 14 帮转
China Pharmaceutical University (CPU) is inviting applications worldwide as
leaders and key researchers in Molecular Diagnosis
China Pharmaceutical University (CPU), founded in 1936, is one of the
“211 Project” key universities with top-ranking pharmaceutical related
disciplines and innovative platforms affiliated directly to the Ministry of
Education of China. Located in Nanjing, Jiangsu Province, CPU was China’s
first independent school of pharmacy and after 78 years of development it... 阅读全帖 |
|
h********c
发帖数: 223 | 15 About ADHD diagnosis, I've heard that the schools and teachers sometimes
would push for diagnosis and medication because it makes their job easier,
and that's one reason that people are questioning about over-diagnosis in
ADHD. Has anyone heard of or encountered it before? |
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b***i
发帖数: 31 | 16 Do you mean the soap notes?
It's not that hard, especially if you have been following your patients for
a couple of days.
My habit of writing SOAP notes is like this:
58 yo M here with blah, blah,blah,...s/p (procedure) day....
24 hr events: blah...
S: pt felt... complained...
O: VS
PE
Labs
A/P: 1,
2,
A/P is the most important part of your notes, you have to think about all
of the diagnosis, what support your diagnosis, what your plan is for every
diagnosis, what you differential |
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l**x
发帖数: 296 | 17 面试可能会要参加morning conference.
这个时候是show interest的好时机，所以抓住机会问一个或者两个问题是有必要的。
大家都会assumeyou know nothing about pathology,所以问什么问题并不重要，关键
是你问了。
当然，也不能问太离谱的，举两个例子说说可以问什么问题吧：
1.如果当时某一个case可能的diagnosis 是A,differential是B的话，可以问：
Which one is more common?
2.如果一个case，大家讨论有几个histopathological features leading to
diagnosis A, 可以就某一个feature问一下这是不是necesserily to have， to make
the diagnosis.
大家可以就着这个思路发挥想象。 |
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k**e
发帖数: 2728 | 18 ☆─────────────────────────────────────☆
stardust (水晶) 于 (Wed Aug 18 09:38:53 2010, 美东) 提到:
Test Center:
Houston - very nice center, all the SPs are very nice, no accent! Highly recommend!
Study materials:
FA - practiced all the cases 2-3 times. I tried to follow FA for history taking, but I never pushed myself to cover all the questions because it is impossible and it is too much time consuming. I classified the questions to the following categories:
ing questions which will be asked for ... 阅读全帖 |
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g******e
发帖数: 389 | 19 I got some feedback from an indian friend.
my q: did you cancel orders in last 5 minutes if patients were getting
better, eg. to discontinue iv fluids? if cancel orders, will it be
considered as not ordering it before?
her reply: honestly, i rarely felt the need to cancel orders, as I thought
tht the patient may need another day of hospitalisation.
i think i cancelled orders only in 2-3 cases if getting better
one thing- if ur adding counselling part in ur final orders and the pt is
getin schedu... 阅读全帖 |
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l********y
发帖数: 2295 | 20 【 以下文字转载自 Pre_Resident_Club 俱乐部 】
发信人: lovelypony (pony), 信区: Pre_Resident_Club
标 题: case presentation 学习笔记
发信站: BBS 未名空间站 (Tue Feb 22 20:03:05 2011, 美东)
昨天第一次参加了由现任斑竹chipmunk和元老knockingdown主持的case presentation
，觉得收获很大，后面慢慢的把自己的学习笔记贴出来，后面的同学看了可以少犯些我
们犯过的低级错误，这样前辈们也可以省些力气。前辈们牺牲自己宝贵的私人时间，聆听我们支离破碎，毫无章法的presentation ，耐心细致的指出错误，提出建议，pony真的觉得没有更好的语言来表达自己的感激之情。就希望能抛砖引玉，大家能互帮互助，提高我们CMG的整体水平，这样前辈们的心思也算没有白花，希望大家都能来补充和指出错误，多谢了！
要present一个case，结构一定要完整。
1. CC: 第一句话永远是chief complaint，怎么样用一句话简明扼要的把CC说好了，还是要花大... 阅读全帖 |
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A*******s
发帖数: 9638 | 21 Alzheimer's diagnosis = great diagnosis. Are you sure?
I know Ronald Reagan started to have symptoms 13 years prior to the
diagnosis. If you were able to call him "an idiot" during his presidency,
which I bet he had been called multiple times, you were probably great. But
that kind of call does not take a doctor's degree to make, lol.
Bring it up, let us enjoy...
不支持我的诊断。 |
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O****y
发帖数: 79 | 22 【 以下文字转载自 Physician 俱乐部 】
发信人: Oldray (麦地.prajnaparamitahrdayasutra), 信区: Physician
标 题: Last dark report's webinar about pathology fellowship application
发信站: BBS 未名空间站 (Tue May 10 10:25:23 2011, 美东)
The Essential Guide to Achieving the Perfect Pathology Fellowship:
Useful Advice and “Must-Do’s” for First-, Second- and Third-Year
Residents
The Dark Report
4/28/11
Justin Clark
Hello, everyone, I’d like to welcome you to the latest Dark Report’s new
PREP webinar series. The Pathology Resident Ed... 阅读全帖 |
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g******p
发帖数: 111 | 23 Update:
I attended an webinar by NCCN on adjuvant therapy for NSCLC pts and asked the case. The presenter is leaning towards using adjuvant chemo therapy. I am still collecting more openion on this. My mom will have first first follow up CT in Aug. I guess (guess only) if obvious disease progression were seen, chemo should be used. I still have the hope that if she can rest well and build up her immuine system, she will be able to keep the cancer in check.
Also I put together my mom's diagnosis ... 阅读全帖 |
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w***0
发帖数: 222 | 24 unfortunately you can not make the diagnosis without the history of
infection. This question is not designed for making the diagnosis; even you
may have your points.
when you make the diagnosis of rheumatic fever, don't forget the history of
strep infection. LOLLLLLLL, got you!
take it easy.
fever |
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m******r
发帖数: 1904 | 25 ☆─────────────────────────────────────☆
PKCalpha (PKCalpha) 于 h 提到:
参加了好几次的match talk， 无以为报。写点CS的准备经验，希望对大家有所帮助。
准备时间：2个月 每天2小时practice via skype
复习资料：First Aid 41 个case，加上USMLE World的体检录像
辅导班：考前一周上的goldusmlereview
考试结果： passed with high performance in data gathering, questioning
skills and spoken English proficiency
体会： 1. 最重要的就是practice, practice and practice. 很幸运的是，网上找到
了一个好partner，和我的考试日期就差一个礼拜，两个人每天很守时， 一人装病人，
一人装医生，轮流着练，对着FA找出不足。两个月把41个case过了三遍，mini case过
了两遍。针对不同的主诉，有自己的protocol。考试的时... 阅读全帖 |
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s*********0
发帖数: 4 | 26 2.Matched IM
220+/240+/200+. CS 2nd pass, 8month OB.
Prepare one page CV to interviewers.
If have done many OB, make a clear CV for interviewer
Matched three years and finally succeeded.
Show advantages, and hide weakness. Let interviewers ignore your weakness.
4 years clinical experience in CHINA, 6M OB in US
How to impress interviewers?
Career plan? Prepare cases especially for your future subspecialty.
If interviewer asks you about a case, you need to think about all the
possible diagnosis, d... 阅读全帖 |
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h*******y
发帖数: 1220 | 27 Sorry for hacking your thread. Those who have not taken CK may learn a point
or two:
From wiki
VIPoma：A VIPoma (also known as Verner Morrison syndrome, after the
physicians who first described it)[1] is a rare (1 per 10,000,000 per year)
endocrine tumor,[2] usually (about 90%) originating from non-β islet cell
of the pancreas, that produce vasoactive intestinal peptide (VIP). It may be
associated with multiple endocrine neoplasia type 1.
The massive amounts of VIP in turn cause profound and chro... 阅读全帖 |
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M***D
发帖数: 249 | 28 1. I agree with you that "in reality we do need to consider individual's
function level to make appropriate diagnosis".
2. I do NOT agree with you that "in this question setting, I think it's
reasonable to assume this is an average student, not a rock star." Because
the question asks about appropriate diagnosis based on DSM diagnosis
criteria not based on "reasonable" assumption.
3. The question "does not mention about her family, her sexual orientation,
religion, or if she's in the US or China"... 阅读全帖 |
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t********o
发帖数: 228 | 29 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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U******u
发帖数: 5829 | 30 in English term: Fibrosarcoma,
but this term is abbandoned by new version of Cancer diagnosis by WHO, and
IMO, this is one of the most difficult diagnosis in soft tissue sarcoma and
mostly depending on exclusive diagnosis. No special immunostaining can be
used to help for rule in, but just for rule out! also, mainland pathology is
in questionable level and very difficult to use by oncologist or radiation
oncologist, as no acurate staging!
note: one of my major fellowship is soft tissue tumor trf... 阅读全帖 |
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T****g
发帖数: 705 | 31 共同讨论, [so fun to discuss cases]
1. E
Patient has candida vaginitis, needs treatment. Typical starting with local
antifungal.
2. E
Unsatisfied wound healing is common for DM patient, especially when his
blood glucose is not very well maintain. Even thought there is no sign of
wound infection, the copious amount of fluid expressing from wound warrant a
good look at the wound. A proper drainage might help the wound healing.
3.A
This is a hard one. I had to do a little research.
Patient has thromboc... 阅读全帖 |
|
发帖数: 1 | 32 Step 3 经验分享。
相对于step 1 和 step 2CK，step3 的经验是最少的。其实step 3 一点也不会容易。
尤其是对于没有 internal medicine intern year经验的人来讲。对于内科的同学，
intern year 做完了，去考试应该没有大问题。对于非 medicine, peds, family med
之类的专业来讲，step 3还是需要好好规划。
我的复习情况：2个月，白天上班，晚上复习。 材料 uworld （为主），一点点MTB 3.
考试前做了 NBME form 4 （两周），还有uworld self assessment. 所有的分数都差
不了几分，基本卡在平均线上。最后的成绩也是平均分.
1） 时间计划好。如果不是medicine之类的专业，或者step 2考完挺久了，或者不
能全职复习，我觉得至少两个月的复习时间。
2） 材料： uworld不用多提。剩下很重要的复习材料就是archer，对于ccs很重要
。还有就是 USMLE step 3 网站上自己CCS的六道模拟题。
3） Step 3分... 阅读全帖 |
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M******C
发帖数: 623 | 33 ☆─────────────────────────────────────☆
oxhorn (^_^) 于 (Sat Mar 5 18:44:57 2011, 美东) 提到:
第一次graded care plan，写完了不太确定，请前辈帮忙看看
pt c/o N/V and diarrhea x 3days, Dx:Hypovolemia
3mm cool area on coccyx
24hr I/O 2000/3600
mucous membranes pink and dry, - saliva pool
ate 10 % of lunch
81% of IBW
Diabetes x20yrs
根据这些data，需要写四个nursing diagnosis，我写了：
1.Deficient fluid volume r/t active fluid volume loss AMB N/V and diarrhea x
3days, I/O(– 1600 ml) previous 24 hours, and – saliva pool
2.Imbalanced nu... 阅读全帖 |
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s*******y
发帖数: 1739 | 34 Forgot to mention one thing: When I was in nursing school, my instructor did
not like " Risk for...." as a priority nursing diagnosis. ( can be
sencondary nursing diagnosis) Because these kinds of diagnosis did not
really happen on the patients. |
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m********t
发帖数: 121 | 35 I don't think you have depression, according to the prevailing DSM diagnosis
. For major depression, a sub-type of depression, you have to have each
episode for at least 2 weeks. The following link can give you more
information about mood disorder:
http://www.falseallegations.com/dsm-dprj.htm
However, I would say the diagnosis for mental disorders (e.g., depression,
anxiety) is rather more arbitary and subjective than that for the diagnosis
for physical disorder (e.g., brain tumor). To my point |
|
j****e
发帖数: 245 | 36 A basic principle: Diagnosis should NEVER be made without first-hand
interview and clinical data.
Even with first-hand data, it is often referred as Diagnosis Impression,
instead of Diagnosis.
A scientific and ethical attitude is essential for any scientific assessment. |
|
c**t
发帖数: 316 | 37 【创伤后应激障碍的临床研究新进展（DSM-5新标准）】
邓明昱 博士
美国东西方健康科学学院心身医学教授，美国纽约
【摘要】创伤后应激障碍（PTSD）是一种严重的心理障碍。PTSD常在一个人暴露于一个
或多个创伤性事件后产生，如重大的刺激、性侵犯、恐怖主义、或对一个人的生活的其
他严重威胁。主要症状包括令人不安重复闪回，对事件的回避或记忆麻木，警觉性增高
等。PTSD的诊断是在创伤性事件发生后持续一个月以上。
美国精神病学会在2013年5月出版了《精神疾病诊断与统计手册》第5版（DSM-5）。DSM
-5将PTSD的核心症状修改为四组：（1）在创伤事件发生后，存在1种（或多种）与创伤
事件有关的重新体验症状；（2）创伤事件后开始持续地回避与创伤事件有关的刺激；
（3）与创伤性事件有关的认知和心境方面的消极改变，在创伤事件发生后开始出现或
加重；（4）与创伤事件有关的警觉性或反应性有显著的改变，在创伤事件发生后开始
或加重。
近年来，对PTSD的临床研究成为精神病学、心身医学和临床心理学的热点。根据DSM-5
的标准和新的临床研究成果，本文对PTSD的病因和发病机制、临床表现、诊断标准、... 阅读全帖 |
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c**t
发帖数: 316 | 38 自闭症谱系障碍的临床研究新进展（DSM-5新标准）
邓明昱 劳世艳
国际华人医学家心理学家联合会，美国纽约
【摘要】自闭症谱系障碍(ASD)和自闭症为一组大脑发育障碍的复杂疾病。其特征是在
不同程度上的社交互动障碍、语言和非语言的沟通有问题，以及重复的动作。
美国精神病学会在2013年5月出版了《精神疾病诊断与统计手册》第5版（DSM-5）。在
DSM-5诊断手册中，所有的自闭症障碍合并为一个诊断：自闭症谱系障碍（ASD）。在此
之前，它们被认为是不同的亚型，包括自闭症、儿童期瓦解性障碍、阿斯伯格综合征、
雷特氏症和待分类的广泛性发育障碍。
自闭症的一些表现似乎呈现在非常早期的大脑发育时。然而，自闭症的最明显的标志和
自闭症的症状往往出现在2-3岁。
近年来，对自闭症谱系障碍（ASD）的临床研究成为精神病学、心身医学和临床心理学
的热点。根据DSM-5的标准和新的临床研究成果，本文对自闭症谱系障碍（ASD）的病因
和发病机... 阅读全帖 |
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D**g
发帖数: 739 | 39 Did you use SAS? If you use SAS, you should be able to get AUC (area under
curve) from output. If AUC is lower than 0.7, then the test may not be a
good discrimination tool. http://gim.unmc.edu/dxtests/ROC3.htm )
In addition, getting a significant association using logistic regression
doesn't guarantee a good accuracy of diagnosis, especial when your data came
from a design which is not for the purpose of diagnosis.A significant
effect and a satisfied AUC are two different things.
By the way, i... 阅读全帖 |
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t*******0
发帖数: 64 | 40 大概有30-60个病人如下的data:
第一组是patient variable(demographics: age, race, etc)(5-10 variables)
第二组是patient clinical diagnosis 结果(10 variables: continuous or ordinal
，从不同的方面对病人的诊断)
第三组是一种新的检查仪器的结果(about 300 variables)
想知道：
1. 第二，三组之间的correlation， 由于变量太多， 传统的pearson/spearman
correlation不好用
2. 第三组数据能不能 predict 第二组数据： clinical diagnosis是gold standard，
是否
patient 检查仪器的结果能predict clinical diagnosis的结果, 要对每个clinical
variable做regression（clinical variable is dependent variable, 检查仪器的
variables as independent var... 阅读全帖 |
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s**********8
发帖数: 25265 | 41 Frequently Asked Questions About the IRB:
The following is a compilation of questions frequently asked regarding
Institutional Review Boards, human subject protection and compliance with
federal regulations. These questions are organized according to whether they
pertain to:
I. Institutional Review Board regulations;
II. Informed Consent regulations;
III. Clinical investigations involving drugs;
IV. Clinical investigations involving medical devices; and
V. Other
I. INSTITUTIONAL REV... 阅读全帖 |
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V*****G
发帖数: 337 | 42 I do have a few questions to ask:
1st about the diagnosis: is diagnosis clear when the biopsy result is clear
or when gluten free diet worked? To me, it's the later. It will be more
helpful to ask patient if there is traveling history to Caribean, India,
Southeast Asia etc.If no such a history, then giving diagnosis when biopsy
result is clear might be reasonable to me. Maybe LZ said this somewhere in
the description that I missed. Anyway I am not clear no this at this point.
The other thing is... 阅读全帖 |
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y***d
发帖数: 33 | 43 Sorry for the absence yesterday. Lost my labtop to burglary. What a pain!
Anyway, looks like VictorG kept everyone entertained at least.
So I believe we left off at labs. Since this is a relative short case, I
will post the initial labs along with the hospital course today. Final
diagnosis tomorrow.
Na 135 TB 1.0 WBC 2.8 PT 16.2
K 4.4 AST 55 Hgb 15.2 PTT 30.6
Cl 103 ALT 105 Hct 43.8 INR 1.3
HCO3 24 ALP 119 PLT 55
B... 阅读全帖 |
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y******a
发帖数: 590 | 44 I still put parasitic infection on the top of the list
then the second on the list is autoimmune disease/vasculitis
Both of them, you need a good lab and pathology department to support the diagnosis.
That's part of the reason I recommmend PUMC-XieHe
TB and malignancy are also possible. These two diagnosis need more invasive
tests to comfirm or exclude. Here in US, rarely we will treat pt with anti
-TB meds without a pathology diagnosis, but I know in China and India, if it
's highly suspecte... 阅读全帖 |
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M***D
发帖数: 249 | 45
1. atypical 不能算诊断。
Answer:
The DSM-IV-TR defines Atypical Depression as a subtype of Major Depressive
Disorder with Atypical Features, characterized by:
a) Mood reactivity (i.e., mood brightens in response to actual or potential
positive events)
b) At least two of the following:
Significant weight gain or increase in appetite;
Hypersomnia (sleeping too much, as opposed to the insomnia present in
melancholic depression);
Leaden paralysis (i.e., heavy, leaden feelings in arms or legs);
Long-stand... 阅读全帖 |
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A*******s
发帖数: 9638 | 46 This patient knows our diagnosis, but he would like to accept Lymes as the
diagnosis. Now he is happy with the wrong diagnosis.
Like Dr.Chiusmd said, very likely the stem cell would not do anything instad
of takeing the risk for the procedure. So I feel better if I do not offer
him the option. |
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d**o
发帖数: 618 | 47 Thanks for all your comments. Here is my 如梗在喉 part:
The basic dilemma here: trust HbA1c or glucose tolerance test?
Unfortunately, at this encounter, PCP did not really ask about diet like
Rubyheart did. PCP's plan included:
1) started pt with metformin 500mg, and told pt to cut down carbohydrate
intake (without asking pt first what pt was eating),
2) ordered vit B12, folic acid, blood smear tests, which all came back as
normal.
3) RTC in some months.
Before next visit, pt had HbA1c, BMP and gluc... 阅读全帖 |
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A*******s
发帖数: 9638 | 48 “ MRI is about $2000." The interpretation could be either way.
I said it depends. A patient was suspicious about your diagnosis, and
wanted a MRI, you told the patient “ MRI is about $2000." This is
definitely inapproperiate.
However, If a patient came in for MRI because of headache, for instance. He
already had a CT. After you see him, you made a diagnosis of migraine,
and the patient was happy with the diagnosis and treatment plan. You told
him you do not need MRI. The patient would appr... 阅读全帖 |
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k**********h
发帖数: 162 | 49 我自己翻译了一遍，哪位有经验的大拿能给看看吗？ 提前多谢了！
> 标本类型：血清
> 初步诊断：肾功能异常
Sample: Serum
Initial diagnosis: abnormal renal function
> 2. 2014年4月22日影像检查报告
> 检查部位：胸部正位片、胸部侧位片
> 检查所见：两侧胸廓对称未见异常。两肺纹理清楚走向规则，右下肺野内带、左下肺
野见絮状密度增高影，边缘模糊；余肺野未见实变影。纵隔影未见增宽，肺门影未见增
大；心影大小形态未见异常。两膈面光滑，两侧肋膈角锐利。
> 诊断意见：两下肺炎症。
>
April 2014 Chest PA & LAT
Observations: two sides thorax are symmetrical and normal, bilateral lung
marking are clear, right lower lung field and left lower lung field have
floccus high density shadow with blurry edge.
Initia... 阅读全帖 |
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