A*******s
发帖数: 9638 | 1 The MRI is normal.
This is a real case. MRI is defensive medicine and I was compromised on that
. This case has Right CN2 involvement as well as Left CN5 and right CN3
symptoms. The latter is persistent so the patient will have diplopia for a
while. Where is the localization? Brain, of course.
I was joking with the ER Doc that CN2 + CN5 + CN3= CN10. There is no such a
disease. Stroke? maybe, but MRI is negative. And I have never seen a stroke
with pure pupillary sparing CN 3 palsy.
So the diagn... 阅读全帖 |
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A*******s
发帖数: 9638 | 2 There must be something causing the diplopia. He sounds like having a
seizure as well. You may use USAyisheng.com to present your case in details
including MRI and lumbar puncture results. All info will be confidential
there.
题。 |
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A*****a
发帖数: 52743 | 3 Diplopia may signal serious problems of brain in elder people. Go see a
doctor if you are not an internet troll. |
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A*******s
发帖数: 9638 | 4 Very well summarized, impressive!
Botulinum toxin causes descending paralysis started with diplopia,
dysartheria or dysphagia and facial paralysis. Vertigo is rare.
I agree with you on bacteria toxin. More common symptoms are N/V ,abdominal
pain and diarrhea. Dizziness is common but not vertigo.
When patient says dizzy, make sure if patient means lightheadedness or
vertigo. Big difference. |
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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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L********r
发帖数: 37 | 6 7. A 27-year-old woman is brought to the physician because of a 3-day
history of visual loss and aching discomfort in her right eye. Three years
ago, she had vertigo, diplopia, and an ataxic gait and was diagnosed with an
inner ear infection. Her symptoms resolved within 1 month without treatment
. Examination today shows markedly reduced visual consensual response.
Funduscopic examination shows no abnormalities. She has an ataxic gait.
Babinski sign is present bilaterally. Which of the followin... 阅读全帖 |
|
r**********n
发帖数: 9 | 7 Sorry for the sad news about your lovely baby.
ATRT的预后非常差，是肯定的。
如果你想尝试St. Jude or Boston，您可以直接与他们联系。复制并翻译所有的医疗记
录。如果他们接受你的宝宝，通常你需要提前支付作为一个国际病人。St. Jude 是研
究医院，可能对美国人免费。不知对国际病人如何。
因为它是ATRT，你要想清楚你花代价是想要什么结果。
以下转自UpToDate:
Atypical teratoid/rhabdoid tumors — CNS atypical teratoid/rhabdoid tumors (
ATRTs) are highly malignant tumors primarily occurring in young children
less than three years old [91]. Histologically, ATRTs are characterized by
rhabdoid cells and are similar to that of other small ro... 阅读全帖 |
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d*********n
发帖数: 18 | 8 this one of my CS protocols, hope can help whoever going to take the test, I
don’t need any more.
not perfect, but good to figure out diagnosis, should not miss the diagnosis
,
do not need to ask all questions , must adjust base the case,
if better ideas, pleas modify to make easier for people who may need
Amenorrhea
Mental check list:
Pregnancy,
hyperprolatinemia,
hypothyroidism,
PCOS,
premature menopause,
depression
asheman syndrome,
anorexia nervosa,
strenuous exercise
Patricia Garrison, a 36... 阅读全帖 |
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s********o
发帖数: 3319 | 9 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
A*******s
发帖数: 9638 | 10 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 |
|
s********o
发帖数: 3319 | 11 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
A*******s
发帖数: 9638 | 12 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 |
|
A*******s
发帖数: 9638 | 13 An EMS guy, 41 yrs old, previous healthy, had a sudden onset blurry vision
out of right eye for 1 min, resolved completely. 30 mins later, he had
another episode of left cheek numbness for 5 mins, better afterwards. 1
hour later he suddenly noticed he could open his right eye. His wife said
his right eye could not move towards the nasal side.
He was otherwise normal.
On exam, he has a pupillary sparing third nerve palsy.
ER physician was very nervous about missing something so he went ahead fo... 阅读全帖 |
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d**o
发帖数: 618 | 14 The most likely MRI finding in this situation is no finding, totally normal,
lol |
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A*******s
发帖数: 9638 | 15 Why?
normal,
★ 发自iPhone App: ChineseWeb 8.6 |
|
M***D
发帖数: 249 | 16 Right cavernous sinus lesion. |
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A*******s
发帖数: 9638 | 17 An EMS guy, 41 yrs old, previous healthy, had a sudden onset blurry vision
out of right eye for 1 min, resolved completely. 30 mins later, he had
another episode of left cheek numbness for 5 mins, better afterwards. 1
hour later he suddenly noticed he could open his right eye. His wife said
his right eye could not move towards the nasal side.
He was otherwise normal.
On exam, he has a pupillary sparing third nerve palsy.
ER physician was very nervous about missing something so he went ahead fo... 阅读全帖 |
|
d**o
发帖数: 618 | 18 The most likely MRI finding in this situation is no finding, totally normal,
lol |
|
A*******s
发帖数: 9638 | 19 Why?
normal,
★ 发自iPhone App: ChineseWeb 8.6 |
|
M***D
发帖数: 249 | 20 Right cavernous sinus lesion. |
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d**o
发帖数: 618 | 21 "EMS guy" just like "nurse" is a red flag for munchausen, lol
Seriously, the vision problem is clearly pre-chiasm and not a brain
parenchymal stroke for which MRI is useful. Yes cavernous sinus may be
implicated as both CN 3 and 5 are affected, but the symptoms are too acute
and transient for anatomical MRI to pick up something, in the *most likely*
scenario. |
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A*******s
发帖数: 9638 | 22 Very good. The CN 3 palsy is persistent though.
★ 发自iPhone App: ChineseWeb 8.6 |
|
