s********g
发帖数: 290 | 1 You are out of context now. FOBT in an outpatient setting is valuable.
However, in an inpatient setting, FOBT test does not change too much on
management.
If on rectal exam, you don't see melena, maroon stool, or fresh blood, but
FOBT is positive, in an inpatient setting, you will most likely follow H/H
again. In fact, even if I don't do FOBT, if I see a H/H drop, I'll still
follow H/H again. A responsible GI physician will not do an emergent scope
based on FOBT. FOBT can be positive from a bloo... 阅读全帖 |
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s**********t
发帖数: 217 | 2 Just came back from the NYC CMG seminar, seeing a lot of old friends and
meeting a lot of new friends. Still feel very excited. Many thanks to KDs
organized this wonderful meeting, letting CMGs having this platform to share
information.
As a guy happened started my clinic career couple years earlier, I would
like to share some experience with my young friends. I hope this is going to
help you go through your transition period smoothly.
When an intern reports to me A NEW ADMISSION, what do I wan... 阅读全帖 |
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l********y
发帖数: 2295 | 3 【 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: Tips for IM interns
发信站: BBS 未名空间站 (Sun May 27 09:34:24 2012, 美东)
INTERNS: daily management (orders, consults, pages, calls); replete lytes
daily before rounds (check for renal failure first; if Cr up, run by
resident before ordering repletion); the groundwork to get stuff done and
care for patients
--> BEFORE ROUNDS: arrive by 6am (weekdays), get signout, review all labs
and test results, see all your patients... 阅读全帖 |
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l********y
发帖数: 2295 | 4 GI specific tips:
- if someone needs marked for a para/thoracentesis, order the abdominal
fluid survey (ultrasound) ASAP or do yourself with a senior with you
- Prior to procedures, check coags; does pt need reversed with FFP? do they
need platelets? may need to time it to start at 4am or 6am for morning
procedures (colonoscopy, EGD, etc)
- keep a close eye on Na levels and K levels given diuresis and fluid
overload in these patients
- lactulose and rifaximin key for hepatic encephalopathy (help... 阅读全帖 |
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e****0
发帖数: 678 | 5 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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S******1
发帖数: 44 | 6 今天得知了step3的成绩，210+，心里的石头终于落下。终于轮到我给USMLE说再见了。
回顾从step1自己闭门造车考了只带一个9的分数， step2开始参加小组学习，做了所有
能做的题只为拿个99，虽胸有成竹且考试感觉很好，最终但又得到一个9的分数。虽然
这次成绩不高，依然很高兴，毕竟不用发愁如果没过的话住院医开始后没有时间复习该
咋办。过去的3年中得到太多人的帮助 (此处略去人名20个)，绝大多数甚至从未谋面。
今天发贴也是为了回报我们这个社区吧。
自我介绍：毕业>15年，220+/220+/1st/210+；
复习时间：6月，头4个月每天约2-3小时，周末由于陪孩子们玩（前两年欠的太多，你
懂得）及做点家务（再不做但心被老婆炒掉），反而复习不了多少；最后2个月每天4小
时，鼓励自己考了这个2年内再不用受这个罪。
复习资料：随大流，MTB 3, UW CCS, UW step3 Qbank, UW step2 Qbank;
模拟：考前2月，NBME 1 190+, 考前1周，NBME 2 220+;
体会：难，考过不容易，考高分更难。主要是因为没有合适的复习资料。UW的1300... 阅读全帖 |
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h*******r
发帖数: 182 | 7 CC: Epigastric intermittent pain for 15 days, nausea and vomiting for 1 week.
PE: Patient is awake and alert, not in acute distress. There is tenderness
in epigastric area upon deep palpation. An epigastric mass is noted,
hepatomegaly, supraclavicular lymphadenopathy (#, size, left side?).
FOBT (+), Abd U/S: ascites is noted, hepatomegaly
EGD: 3x2.5 cm irregular lesion found on anterior wall of antrum.
Dx: Gastric cancer, stage IV.
有错请纠正.
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yf
发帖数: 272 | 8 这些都是不能“估计”的，好不好。 “医生临床估计是2-3期，估计无远处转移。”
EUS, EGD, CT, PET, 术前都没有做过吗？医生是凭什么来“估计”这些这么重要的东
西？ |
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yf
发帖数: 272 | 9 这些都是不能“估计”的，好不好。 “医生临床估计是2-3期，估计无远处转移。”
EUS, EGD, CT, PET, 术前都没有做过吗？医生是凭什么来“估计”这些这么重要的东
西？ |
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r*****1
发帖数: 805 | 10 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 | 11 ☆─────────────────────────────────────☆
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*******n
发帖数: 82 | 12 78 yo female was transferred for evaluation of torsades. The patient has one
year history of AF and has been taking amiodarone and coumadine. For the
past 5 months, she has been feeling severe nausea. She was admitted to xxx
Hospital for evaluation. There, her Hgb was 7.8 and TSH was over 40. Then
Amiodarone was stopped for presumed toxicity to thyroid gland. And coumadin
was stopped for suspicious GI bleeding. Levothyroxine was started.She was
also given 2 units of pRBC. EGD was done and found ... 阅读全帖 |
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a*******n
发帖数: 82 | 13 78 yo female was transferred for evaluation of torsades. The patient has one
year history of AF and has been taking amiodarone and coumadine. For the
past 5 months, she has been feeling severe nausea. She was admitted to xxx
Hospital for evaluation. There, her Hgb was 7.8 and TSH was over 40. Then
Amiodarone was stopped for presumed toxicity to thyroid gland. And coumadin
was stopped for suspicious GI bleeding. Levothyroxine was started.She was
also given 2 units of pRBC. EGD was done and found ... 阅读全帖 |
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n****a
发帖数: 2525 | 14 Thanks everyone for replying.
It's been 12 days into her hospital stay, she is still in pain. Her IgG4 to
look for autoimmune pancreatitis was negative, lab ordered for possible
Celiac (which leads to poor absorption of Levothyroxine and pancreatitis
link) also negative. GI still thinks pancreatitis, might have been
exacerbated by cold meds she was taking that has some ETOH content. EGD was
done by GI only showing gastritis. CT ab showed nothing but cysts, no
pancreatic cyst or pseudocyst or oth... 阅读全帖 |
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d******s
发帖数: 136 | 16 嗯， 要是NP\PA 可以做Colonoscopy or EGD, GI fellowship 也许就不会有那么热了
难道各个学科医学学会不会对np pa的职能有一定的限制吗? 岂能轻易的让肥水流入外
人田！
Patients will prefer 医生而不是 NP or PA If they develop serious diseases,
like certain type of cancer or leukemia, right? |
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m**z
发帖数: 787 | 17 2个月前为了诊断H.pylori,做了EGD. 最近收到账单发现其实做了upper GI and small
bowel endoscopy.两个procedure,于是账单也就比预期高了不少。不知道这种情况正常
吗？医生现在说当时觉得有必要，我们当然也没有足够专业知识加以判断，所以来这里
请教。当时也没发现ulcer,只是有点redness，虽然后来h pylori是阳性的。谢谢 |
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l***x
发帖数: 631 | 18 Solo or not solo, it’s a question.
If you are willing to do and are able to do following things, you will be an
excellent candidate to do solo practice.
1. Very strong motivation to make money.
2. Strong motivation to manage a business.
3. Willing to spend 70% of time to do business, 30% for medicine.
4. Spend your spare time to manage your business instead of enjoying your
family.
5. You don’t have many hobbies other than making money.
6. You don’t have young kids to take care... 阅读全帖 |
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A*******s
发帖数: 9638 | 19 挺有意思， 很想逐条回答，不过谁给我付这个consulting fee呢？
前两条和后两条就是成为美国医生必须的，有没有这个能力另当别论，但别跟我说你上
医学院考board是为了公益。
3.瞎掰。 作为solo，你会看你银行的钱是不是多起来，这个上网的时间恐怕就是你说
的70%，钱少了，让manager处理就是了。
8.外行，spouse管钱就好了，manage clinic你怎么着也得请老美，而且是对你忠心耿
耿的老美，让老美对你忠心是你的本领，而让spouse管clinic是一大忌讳。
10. Zestoretic是brand， 所以有sample， 而且copay是0， 你说你是用generic花
copay呢还是先用brand for free， 如果没有副作用，再refill with 0 Copay呢？当
然你的病人如果都是medicare/medicaid就算我没说。
18。 LDL 140， 你当然可以Call in， 然后病人出现rhabdomyolysis and ARF. 我知
道一个病人为此2年不能行走，然后病人说你没跟他交代清楚，或者电话没听清， 或者
你忘了... 阅读全帖 |
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C**T
发帖数: 5379 | 20 哈哈，我的帖子被大段引用，不胜荣幸：D
最后说的对，虽然界面设计的较烂，用多了总会习惯，只是这个learning curve体现了
设计的功力。我觉得最大的问题还是在控制和信息的布局上凌乱，和日德的布局还是有
差距。
另外egde的方向盘重这点和flex不一样，看来三排坐的flex大妈的更加彻底呵呵
V6
45R20 |
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w*******y
发帖数: 60932 | 21 ThinkPad E420 through Barnes and Noble link with coupon code "LENOVOVIP"
link:
http://shoplenovo.i2.com/SEUILibrary/controller/e/barnesnoblego
1.Login into Barnes and Noble a/c and select think pad egde laptops.
2. select ThinkPad Edge E420
3. select ThinkPad Edge E420 laptop with $664 price
4. Upgrade to i7 processor and select the Genuine Windows 7 Home Premium 64
rest all select the options as below.
Intel Core i7-2620M Processor (2.70GHz, 4MB L3)1
Genuine Windows 7 Home Premium 6... 阅读全帖 |
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y*****l
发帖数: 5997 | 22 【 以下文字转载自 Apple 讨论区 】
发信人: wavelets02 (消失), 信区: Apple
标 题: [合集] kindle 3 vs. kindle 2 vs. ipad/iphone 4 (转载)
发信站: BBS 未名空间站 (Thu May 3 08:11:07 2012, 美东)
☆─────────────────────────────────────☆
axii (qing) 于 (Fri Aug 27 00:47:29 2010, 美东) 提到:
发信人: axii (qing), 信区: PDA
标 题: kindle 3 vs. kindle 2 vs. ipad/iphone 4
发信站: BBS 未名空间站 (Fri Aug 27 00:41:34 2010, 美东)
拿到了kindle 3，比起2代，手感不错，小不少，按键也更合理点，而且后背用的类似
以前ibm模拟皮肤的材质，比起以前的金属好多了，感觉不用带套了直接手握就很好，
当然也没什么，ipad官方的套子也是类似感觉，就是少了数字键，不是很爽，其实完全
有空间放数字键的... 阅读全帖 |
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