Aortic Stenosis

Aortic Stenosis with post obstructive dilation and coarction.

Osteosarcoma

Osteosarcoma
Osteosarcoma with cartilage cap

Giant Cell Tumor

Giant Cell Tumor

Some Employers Are Offering Free Drugs

http://www.nytimes.com/2007/02/21/business/21free.html?ref=business

Employers provide free prescriptions for common, chronic medical conditions hoping to prevent more costly complications from non-compliance. Employees benefit with more access to prescription medications. Employers benefit with lower long-term healthcare costs. Medical system benefits with hopefully decreased incidences of complications from diabetes, asthma, and high cholesterol.

Doctors Who Deliver - Forbes.com

Doctors Who Deliver - Forbes.com
Doctors will visit you in your hotel room or business for $300. Compare this to the alternative of waiting in an ER for nine hours and getting a larger bill.

Bayesian Analysis - Odds Ratio Calculator

Bayesian Analysis - Odds Ratio Calculator

Technorati tags: odds ratio, calculator, bayes

Odds Ratio = (a/b)/(c/d)

"estimates relative risk in case-controlled studies"

Iodinizing Salt and global health

In Raising the WorldÂ’s I.Q., the SecretÂ’s in the Salt - New York Times

This article looks at the progress in iodinizing salt in developing countries and what is left to do. Iodinizing salt is one of the most cost effective public health initiatives.

Technorati tags: health, iq, salt, iodine

electronic health record - Google Patents

electronic health record - Google Patents
Search results for "electronic health record" in the patent database at the US Patent Office.

Five big firms to promote electronic health files - U.S. Business - MSNBC.com

Five big firms to promote electronic health files - U.S. Business - MSNBC.com
Walmart, BP, and Intel are promoting a centralized electronic health record system for its employers.

Lure of Great Wealth Affects Career Choices - New York Times

Lure of Great Wealth Affects Career Choices - New York Times
Physicians are switching from their practices to other fields such as finance.

dry patches

Subjective

34 year old white male presents with dry patches on his scalp, back of his elbows, and the front of his knees. They have been present for several months. No itching.

Objective

Vital signs stable. Skin - dry, scaling plaques, well-circumscribed, silver present on scalp, extensor surfaces of elbow and knee

Assessment and Plan

A- Psoriasis P- topical corticosteroids, other options include ultraviolet light (sunlight), lubricants, and keratolytics

Created with SOAP Note

ulcers in the mouth

Subjective

75 year old male presents with ulcers in his mouth. Started five months ago. Ulcers have progressed to around his mouth and on his forearms.

Objective

Vitals signs stable. Oral- multiple bullae in mucosa Skin - multiple bullae Labs - biopsy shows antibody pattern in fish-net immunofluorescence pattern

Assessment and Plan

A- Pemphigus P- corticosteroids

Created with SOAP Note

SOAP Note

SOAP note: "SOAP Note will create a standard patient encounter document. Please comment with any suggestions."

painful red nodules

Subjective

45 year old female presents with painful, red nodules on her shins. Started 1 month ago. Patient was recently diagnosed with ulcerative colitis.

Objective

Vital signs stable Extremities - pretibial, tender, erythematous nodules

Assessment and Plan

DDX - sarcoidosis, coccidiomycosis, ulcerative colitis, streptococcal infection, idiopathic A - erythema nodosum due to ulcerative colitis P - treat ulcerative colitis

Created with SOAP Note

Growth on forehead

Subjective

25 year old patient notes a growth on her forehead which is the color of her skin. It started about 2 months ago and has stopped growing.

Objective

Vital signs stable. Skin - flesh colored lesion on forehead with central crater, crater contains keratinous material

Assessment and Plan

A - Keratocanthoma P - Lesion will likely resolve in a few months, observation for few months, biopsy if needed.

Created with SOAP Note

One for the Ages: A Prescription That May Extend Life - New York Times

One for the Ages: A Prescription That May Extend Life - New York Times
Calorie restriction diet in rhesus monkeys shows health advantages, however other scientists believe the research may not translate to humans as well.

Growing Debate as Doctors Train on New Devices - New York Times

Growing Debate as Doctors Train on New Devices - New York Times

The Genographic Project - Human Migration, Population Genetics, Maps, DNA

The Genographic Project - Human Migration, Population Genetics, Maps, DNA

Forgive Us Our Student Debts - New York Times

Forgive Us Our Student Debts - New York Times

Student loan repayment by serving in underserved areas or working for the NIH as a researcher.

While in Surgery, Do You Prefer Abba or Verdi? - New York Times

While in Surgery, Do You Prefer Abba or Verdi? - New York Times

The benefits of music in the OR are several including improved psychomotor performance.

Cheap Airfare, Hotel Reservations, Car Rentals - Pinpoint Travel

Cheap Airfare, Hotel Reservations, Car Rentals - Pinpoint Travel

Going home for break? Here's AOL meta travel site which will search through 100s of sites to find the best deals. Also try the Deals section and the Fare Buzz section. Under Fare Buzz, you can search for top deals from one airport to any location in the world.

Histology of Cartilage and Bone

Histology of Cartilage and Bone

Body language Tiscali

Body language Tiscali A guide to body language at the work place.

Ripples in Water

Several ripples across a water surface
Changing every moment
Sometimes several, sometimes few
Changed greatly by small influences
Once the disturbance resolves, the surface flattens again
And the water remains
-J. S. 5/29/06

Framingham Study

http://www.nhlbi.nih.gov/about/framingham/

Heart still beats

For research, saw a pig heart being extracted about five minutes after the big was killed. Amazingly, it was still beating by itself when it was removed and placed in a pan. It kept on beating weakly for at least a minute.

Naegele's Rule for Pregnancy

Calculates pregnancy due date based on LMP - Calculator.

Doctors Object to Gathering of Drug Data - New York Times

Doctors Object to Gathering of Drug Data - New York Times
California and other states are considering legislation to prevent pharmaceutical representatives access to information about physician prescribing behavior.

Resume Advice - The New York Times Job Market

Resume Advice - The New York Times Job Market

US Senior Match

How US senior medical graduates matched in 2005 by specialty.
http://www.nrmp.org/res_match/tables/table10ab_05.pdf

USMLE faq

USMLE faq provided by uic.edu

A new plastic surgery blog

http://aesthetic-surgery.blogspot.com/

This site has been created to facilitate information sharing for plastic surgeons. See the site for details about e-mailing articles to the blog for publication. Ideas for articles could be interesting news articles, summaries of new research, and interesting patient cases.

A new orthopedics blog

http://orthopaedic-surgery.blogspot.com/

This site has been created to facilitate information sharing for orthopaedic surgeons. See the site for details about e-mailing articles to the blog for publication. Ideas for articles could be interesting news articles, summaries of new research, and interesting patient cases.

Baby Boomers Stay Active, and So Do Their Doctors - New York Times

Baby Boomers Stay Active, and So Do Their Doctors - New York Times
People over 50 want to excercise into their 70s, leading to more wear and tear on their joints.

Baby Boomers Stay Active, and So Do Their Doctors - New York Times

Baby Boomers Stay Active, and So Do Their Doctors - New York Times

Eye Infections May Be Tied to a Solution for Lenses - New York Times

Eye Infections May Be Tied to a Solution for Lenses - New York Times

Medical Specialty Aptitude Test

Medical Specialty Aptitude Test
Questionairre for selecting a residency.

BMI Calculator

BMI Calculator: "Fill in your height and weight, and this BMI calculator will show your BMI. It will also show your ideal weight range."

Cheese Quesadilla Recipe

Ingredients
-Flour Tortilla
-Cheese - American, Cheddar, etc.
-Optional: Meat, Pasta Sauce, hot sauce
Directions
Place tortilla on microwave safe plate and cover one half with cheese. Add meat or sauce if necessary. Microwave on high for 1 minute, and fold tortilla. Cut into fourths with a pizza cutter.
Health Benefits:
Less greasy than fried version.
Cheese is a good source of calcium.
Tortilla can have lower carbs than white bread.
Pasta sauce's tomatos can have heart protective factors.

Bread Recipes:
http://opossumsally.homestead.com/bread.html

BRAIN NEUROTRANSMITTERS

BRAIN NEUROTRANSMITTERS

Chemistry 8, SMA 7, Chem-7 Analyzer

Chem 7 Analyzer - Analyzes analyzes serum sodium, potassium, chloride, carbonate, BUN, creatinine, glucose, and calcium.

Substance Abuse

Substance	Intoxication	Withdrawal
Alcohol	- (1+) Slurred speech - Incoordination - Unsteady gait - Nystagmus - Impairment in attention or memory - Stupor or coma (t) folate 1mg , thiamine 100mg	- (2+) Autonomic hyperactivity - Increased hand tremor - Insomnia - Nausea or vomiting - Transient visual, tactile, or auditory hallucinations - Psychomotor agitation - Anxiety - Grand mal seizures (t) Benzodiazepines - oxazepam, IV; Dilantin; Haldol
Cocaine / Amphetamine	- (2+) Tachycardia or bradycardia - Pupillary dilation - Elevated or lowered blood pressure - Perspiration or chills - Nausea or vomiting - Evidence of weight loss - Psychomotor agitation or retardation - Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias - Confusion, seizures, dyskinesias, dystonias, or coma (t) self-limited, anti-psychotics	- (2+) Dysmorphic mood - Fatigue - Vivid, unpleasant dreams - Insomnia or hypersomnia - Increased appetite - Psychomotor retardation or agitation (t) self-limited, observation
Opiates - morphine - codeine - meperidine - hydromorphone	- papillary constriction (dilation) - (1+) drowsiness or coma - slurred speech - impairment in attention or memory - euphoria > dysphoria - psychomotor agitation or retardation - impaired judgement (t) Methadone 5-20 mg> 60-100 mg	- (3+) dysphoric mood - nausea or vomiting - muscle aches - lacrimation or rhinorrhea - papillary dilation, piloerection, or sweating - diarrhea - yawning (t) Clonidine

Sources : Diagnostic Criteria from DSM-IV, Blueprints Psychiatry 3^rd ed

Is Microsoft Dropping Cryptic Hints About a New Gadget? - New York Times

Is Microsoft Dropping Cryptic Hints About a New Gadget? - New York Times

A tablet style pc with wireless internet access would be good for some of the medical related web pages I've posted.

Prescription Writer

Medsoft : Prescription Writer: "Creates a prescription which can be printed, stored on a USB flash drive, or e-mailed. "

How to write a prescription:
Zoloft 500mg 1 tablet PO qday Dispense: 30 Refill: 2
Drug Dosage tablets route frequency Dispense: Refill:

History and Physical for Paper or USB

History and Physical for Paper or USB: "Create a history and physical document, then store it on a USB key chain drive or print it out to present to healthcare professionals."

Combined Plastics Residencies

http://www.med.nyu.edu/irps/residency/

http://www.surgery.vcu.edu/content/edu-plas.htm

http://www.hopkinsmedicine.org/plasticsurgery/Program/combinedletter.htm

http://www.brighamandwomens.org/surged/Medical/harvardPlasticSurgery.asp

http://www.surgery.upmc.edu/Plastics/Residency/Integrated_Program.htm

http://www.massgeneral.org/plasticsurgery/training/

http://www.mc.uky.edu/surgery/Plasurgery/plasrez.asp

http://www.dhmc.org/plastic_surgery_residency.cfm

http://www.um-surgery.org/education/gme/training/plastic.shtml

http://www.siumed.edu/surgery/plastics/integrated.htm

http://www2.kumc.edu/plastics/gen/resdcy.htm

http://www.siumed.edu/surgery/plastics/resdiency.htm

http://faculty.washington.edu/engrav/PSResLong.htm

http://www.ucdmc.ucdavis.edu/surgery/residency/plastics/index.shtml

http://www.surgery.usc.edu/plastics/Residency.html

http://www.llu.edu/llu/medicine/plastics/resltr.html

http://cpmcnet.columbia.edu/dept/cs/residency/plastics.html

http://www.urmc.rochester.edu/smd/Surg/Plastic_Surgery_Residency.html

Incision

8 AM - My first surgical incision
Made three incisions in the surgery that totaled less than 3 cm. They were for a suburethral sling. Also got to close in both surgeries.

Ovarian Tumors

Ovarian Tumors

1. Introduction

a. Malignant ovarian tumors are the leading cause of death from reproductive tract cancer.

b. Majority of ovarian tumors are benign.

c. General lifetime risk is 1.6% and 5% with a first degree family relative.

d. Lifetime risk with BRCA1 gene is 45% and with BRCA2 gene is 25%.

2. Clinical Findings

a. Symptoms and Signs

i. Most patients are asymptomatic.

ii. Mild nonspecific gastrointestinal symptoms or pelvic pressure

iii. Pelvic exam can detect early disease.

iv. Advanced disease can present with bloating, abdominal pain, ascites, and palpable abdominal mass.

b. Lab Findings

i. CA 125 level greater than 35 units can indicate malignancy.

ii. CA 125 elevated in 80% of epithelial ovarian cancer and only 50% in early disease.

c. Imaging Studies

i. Transvaginal Ultrasound for screening

ii. Ultrasound helps differentiate from benign and malignant neoplasm.

3. Differential Diagnosis for an Ovarian Mass

a. Functional

b. Benign Neoplastic

i. Premenopausal woman, asymptomatic, mobile, unilateral, simple cystic mass less than 7.5 cm

c. Potentially Malignant

d. Predictive factors include age, size of the mass, ultrasound configuration, CA 125 levels, symptoms, and symmetry

4. Treatment

a. Malignant neoplasm – surgical staging, abdominal hysterectomy, bilateral salpingo-oophorectomy

i. Advanced disease

1. removal of all visible tumor

2. post-operative chemotherapy

a. cisplatin or carboplatin with paclitaxel

b. Benign neoplasms – tumor removal or unilateral oophorectomy

5. Prognosis (5 yr survival)

a. Distant metastases – 17%

b. Local spread – 36%

c. Early disease – 89%

Source:

1. Tierney, Jr, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2005. 44th ed. New York: McGraw Hill, 2005: 719-722.

Old Main at Penn State

A picture of Old Main, the administrative building at Penn State with snow on the ground. The color picture was changed using the filter photocopy in Adobe Photoshop.

Pregnancy, Preeclampsia, Severe Preeclampsia, Eclampsia

	Normal Pregnancy	Preeclampsia	Severe Preeclampsia
Blood Pressure	Fall in first 24 weeks, rises to baseline by term	140/90 after 20 weeks gestation	>160/100
Kidneys	GFR increases 50%, renal plasma flow increases serum urea and creatinine decrease; enhanced waste metabolite removal; glycosuria	Vasospasm and capillary endothelial swelling -> reduction in GFR Serum uric acid and creatinine increased Proteinuria > 300 mg in a 24 hour collection	proteinuria > 5 g/24h, oliguria (<500cc/24h) Oliguria <>
Edema	Normal	Presenting sign but 1/3 don’t have it
Hemostatic	Venous stasis from hypercoagulable state	Systemic vasospasm, coagulation system activation, abnormal hemostasis Cycle – endothelial injury, platelet activation, platelet consumption
Prostanoid Changes	Both prostacyclin (PGI) and Thromboxane A2 (TXA) elevated, PGI > TXA	TXA > PGI PGI – vasodilator and inhibitor of platelet aggregation TXA – vasoconstriction and platelet aggregation
Autonomic		Increased sympathetic state – vasoconstriction
Nitric Oxide		Reduced
Free radical oxidation products		Increased
Hematologic	Plasma vol inc, RBC mass inc à “physiologic anemia” of pregnancy Hgb 11.5 mg/dl WBC count increases Hypercoagulable state – inc fibrinogen, factor VII to X increase – venous stasis		- Thrombocytopenia - <100,000 class="MsoNormal">- fibrinogen decreased - coagulation time increased (PT, PTT) -Can progress to DIC
Hepatic	Signs of liver disease Spider angiomata and palmar erythema – elev estrogen Serum – dec albumin, elev alk phos, elev cholesterol Estrogen increased proteins – fibrinogen, thyroid hormone binding globulin, ceruloplasmin Hepatic enzymes – AST/ALT, PTT unchanged	10% - transaminase elevation	impaired liver function (AST/ALT >70)
Pulmonary			pulmonary edema
Neurological			Cerebral or visual disturbances Headache
GI			Epigastric pain - hepatic subcapsular hemorrhage -stretch or rupture of liver capsule
Seizures			Severe cases -> Eclampsia

HELLP Syndrome - hemolysis, elevated liver enzymes, low platelets - severe preeclampsia.

Sources:

1. Rubin, Emanuel . Rubin's Pathology: Clinicopathologic Foundations of Medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2005 : 986-7.

2. Tierney, Jr, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2005. 44th ed. New York: McGraw Hill, 2005: 747-9.

Sensitivity Specificity Positive Predictive Value and Negative Predictive Value Calculator

Sensitivity Specificity Positive Predictive Value and Negative Predictive Value Calculator: " calculator will determine these values based on true positives, false positives, true negatives, and false negatives"

First Day of Ob-Gyn

Today was my first day of Ob-Gyn, and I saw two deliveries. One patient was having frequent contractions and she started to have the baby while I was telling a resident about the patient. Actually, she was having such bad contractions, I hurried my interview and told my resident about her. She was rushed into the delivery room, and while my fellow medical student and I were looking for shoe protectors, in two minutes, she had the baby. The second delivery was a caesaraen section which was iminent. The whole process of deciding to do the C-section and taking the baby out took about 15 minutes. It was truly amazing how fast labor and delivery can progress.

Parkland Formula - Fluid Resucitation for Burns

Parkland Formula - Fluid Resucitation for Burns

Nagel's Rule for Pregnancy Due Date

Nagel's Rule for Pregnancy Due Date
Can calculate a due date based on LMP. Similar to a Pregnancy Wheel and Ovulation Calendar.

Christmas Babies, One After Another, After Another

http://www.nytimes.com/2005/12/27/health/27case.html

Marketing Fortified Food to Those Leery of Drugs

http://www.nytimes.com/2005/12/28/business/28food.html

Citation Machine

Fill out a form, and it will create citations.

http://citationmachine.net/

History and Physical for Pulmonary Embolism

Chief Complaint

chest pain and shortness of breath

History of Present Illness

23 year old female with past medical history significant for birth control use of five years and 15 smoke pack years presents witch chest pain and shortness of breath. Four days prior to admission, she started to experience a dull, substernal pain with deep breaths. Two days prior to admission, she experienced shar pain in lower left anterior axillary line with deep breaths. One day prior to admission, she started to experience upper left sided chest pain. While at her Ob-Gyn office on the morning of admission, she was experiencing shortness of breath, and she was told to go to the ER. Currently, her chest pain is constant on the left side. She says she can walk ten steps before becoming short of breath. She denies palpitations, leg pain, nausea, vomiting, diarrhea, cough, pain radiation. Previously, she experienced chest pain during this current summer which went away in four days without hospital admission.

Past Medical History

Patient denies hypertension, diabetes, stroke, coronary artery disease, rheumatic fever, asthma, or spontaneous abortions. Patient has been on Depo-provera for five years prior to current birth control of Norgestrel.

Past Surgical History

Patien did not have previous surgeries.

Medications

Norgestrel Unisom

Immunizations

Patient has not received her pneumococcal, hepatitis, or flu vaccine.

Allergies

NKDA

Family History

Father is alive, 52 years old without hypertension, diabetes, coagulopathy, or coronary artery disease. Mother is alive, 46 years old. She has hypertension. She has no history of coronary artery disease, coagulopathy, or diabetes.Both grandmothers had strokes at old ages. Her family has no history of cancer or coagulopathy.

Social History

Alcohol - She drinks up to 12 beers during the weekend over one to two nights. Tobacco - She has been smoking 1.5 packs per day for 10 years Substance - She denies any substance abuse. Psychosocial - She denies any changes in her general behavior. She lives with her friend after leaving her family residence. Functional - She believes she has normal function.

Review of Systems

General: () weight loss () fever () night sweats () weakness/fatigue () appetiteEndocrine: () heat intolerance () decreased energy () thyroid/reanl dz () polydipsia () polyuriaLympatics: () lymphadenopathySkin: () itching () pale () palmar creases Hematology: () anemia () bruising () bleedingHead: () seizures () trauma () loss of conscioussness () headache () vertigo () dizzinessEyes: () visual changes (X) blurred vision () loss of vision () dischargeEars: () discharge () ear pain () tinnitus () ototoxic drug history () hearing lossNose: () discharge () rhinorrhea () epistaxisMouth and Throat: () lip cracking () gum soreness () gum hypertrophy () dryness () thirst () excessive salivation () throat pain () hoarsenessCardiorespiratory: (X) SOB () valvular disease (X) orthopnea (X) dyspnea on exertion () nocturia () edema (X) paroxysmal nocturnal dyspnea () cough () cyanosis () hemoptysisGastrointestinal () dysphagia () abdominal pain () vomiting () hematemesis () melena () hematochezia () change in appetite () diarrhea () constipation () jaundiceGenitourinary: () change in bladder function () change in amount () dysuria () hematuria () dischargeNeuropsychiatric: () weakness () motor/sensory deficit () depression () anxietyPain: Chest pain on left side

Physical Exam

General Appearance:Vital Signs:Temperature: 98.1 F Oxygen Saturation: 100% on RA Blood Pressure: 125/82 Respiratory Rate: 18 Pulse Rate: 117Skin/Nails:Head:Eyes:Ears:Nose:Throat/Mouth:Neck:Lymph:Pulmonary: CV:Abdomen:Breasts:Rectal:Genitals:Peripheral pulses:Musculoskeletal:Neurologic:Mental StatusCN ICN IICN III,IV, VI CN V, VIICN VIICN VIIICN IX, XCN XICN XIICerebellarDTRs

Labs

Troponin I <0.05,>D-Dimer 3.20 Imaging CT - Multiple pulmonary embolisms on the right upper lobe, right lower lobe, left upper lobe, and left lower lobe in the segmental and subsegmental branches. Her right middle lobe does not have a pulmonary embolism. Na:138 Cl:103 BUN:9 Glucose:80 K:4.1 CO2:24 Cr:0.8 Ca:9.6 WBC:11.0 Hgb:14.1 Hct:41.9 Plt:254 MCV:in PT: 13.7 PTT: 30 INR: 1.05

Assessment/Plan

23 year old female with a past medical history significant for smoking and contraceptive use presenting with multiple, acute pulmonary embolisms. She presented with some classic signs of pulmonary embolism including dyspnea and chest pain (1). 1. Tierney, Lawrence M., ed. Current Medical Diagnosis & Treatment. 44th ed. New York: McGraw Hill, 2005.

Created with H and P

MP3 Player comparisson

Amazon Comparisson

Open CD 2.0

http://theopencd.org/index.php?option=com_frontpage&Itemid=1

Provides free programs such as Open Office, Blender, Mozilla, GAIM, and others. Can be bought or downloaded for free.

Lobectomy Sites

http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-.html

http://www.surgeryencyclopedia.com/La-Pa/Lobectomy-Pulmonary.html

Chronic Diarrhea

• Secretory Causes
  
• Medications
  
• Bowel Resection, Mucosal Disease, Enterocolic Fistula
  
• Hormones
  
  
  
  • Carcinoid Tumor
    
  • Serotonin
    
  • Histamine
    
  • Prostaglandins
    
  • Kinins
    
  • Gastrinoma
    
  • VIPoma
    
  • Calcitonin
    
  • Somatostatinoma
    
  
  
• Congenital Defects in Ion Absorption
  
• Osmotic Causes
  
• Osmotic Laxatives
  
• Carbohydrate Malabsorption
  
• Steatorrheal Causes
  
• Pancreatic Exocrine Insufficiency
  
  
  
  • Chronic Pancreatitis
    
  • Cystic Fibrosis
    
  • Pancreatic Duct Obstruction
    
  
  
• Mucosal Malabsorption
  
  
  
  • Tropical Sprue
    
  • Whipple's Disease
    
  • Abetalipoproteinemia
    
  • Medications - colchicine, cholestyramine, neomycin
    
  • Chronic Ischemia
    
  
  
• Postmucosal Lymphatic Obstruction
  
• Inflammatory Causes
  
• Idiopathic Inflammatory Bowel Disease
  
• Eosinophilic Gastroenteritis
  

History and Physical for SOB

Informant: Patient - mostly reliable
Age: 79 Sex: Male

CC: Chest pain, SOB for one day
Reason for Admission: Chest pain, SOB for one day

HPI: 79 yo AAM c right sided CP, not radiating, sharp, pleuritic, no aggravating or relieving factors. CP accompanied with SOB with acute to sub-acute onset. Pt has cough producing whitish sputum. He has chills, and currently, the patient is feeling better than last night.

PMH:
Sarcoidosis
COPD
PVD
DM
Glaucoma BL
Immunizations - he recieved his pneumo and flu vaccines last year.

PSH:
Fem-Pop bypass on left leg

Injuries/Disabilities: none

Medications:
Lovastatin 20 mg PO qday
Lasix 20 mg PO qday
Prednisone 5 mg PO qday
Lasix 40 mg PO qday PRN edema
Calcium 600 mg PO bid

Immunizations:
Pneumo and Flu received in 2004

Family History:
NA

Social History:
lives alone
past smoker for 50 years
past etoh
no IVDU


Review of Systems:
nausea, vomiting 2-3 times, no change in bowel movements, no dysuria

Physical Exam:
VS: Temp-101.5 BP-127/70 HR-90 Pulse Ox 80s in Er, currently went from 90 to 99, 101.5 degrees
Gen: mildly tachypnic, AO*3
HEENT: -JVD, carotid pulse- 2+ with no bruits, PERRL
Chest: CTA BL, -w/c/r
CVS: irregular rhythm, SEM II/VI
Abdomen: NT/ND, soft, +BS
Ext: -edema. -DP, Left calf tenderness
Neuro: no focal deficits present

Imaging:
CXR - Infiltrates R side and base

Labs:
Na - 140
K - 4.1
Cl - 101
CO2 - 29
BUN - 14
Cr - 1.0
Glucose - 137
Ca - 8.4
WBC - 11.4
HGB - 13.2
HCT - 39.3
PLT - 268
MCV - 81
EKG - freq PACs, LAD, Q waves in V2-V3, TWI in V1
CKMB - 1.3
Myoglobin - 142
Troponin - 0.05

Assessment:
79 yo AAM presented with intermittent SOB and chest pain on right side.

Problems List:
1. SOB
2. Chest pain

Differential Diagnosis:
1. COPD exacerbation - can present with cough, sputum production, and SOB.
2. Pulmonary Embolism - Pain in left calf could be a sign of a DVT and subsequent clot could have moved to the lungs. This could have caused the current symptoms of SOB and chest pain.
3. Pneumonia - CXR infiltrates, SOB, and chest pain can be from a community acquired pneumonia. Possible organisms include Streptococcus pneumoniae, Haemophilus influenza, Mycoplasma pneumoniae, Chlamydia pneumoniae, Staphylococcus aureus, Neisseria meningitidis, Moraxella catarhallis, and Klebsiella pneumoniae.
4. Sarcoidosis - a sarcoid inflammation of the lung can present with malaise, fever, and dyspnea. No hilar lymphadenopathy was present on CXR. No other findings of sarcoidosis were present: erythema nodosum, parotid gland enlargement, hepatosplenomegaly, and lymphadenopathy. Symptoms referable to other organs were not present either.
5. MI - a myocardial infarction can present with chest pain and SOB. The patient's location of pain on the right side, and lack of radiation make this less likely. His cardiac chemistry levels were well within normal limits.

Diagnostic Plan:
1. CT angio scan of chest
2. Pulmonary function tests
3. Pulse oximetry
4. Consult pulmonology

Therapeutic Plan
1. DVT prophylaxis
2. Heparin qtt
3. Antibiotics - Zithromax 500mg IV qday
4. O2 support 2L
5. Steroids

History and Physical for Sickle Cell Crisis

H and P SC Crisis

Informant: Patient - reliable
Age: 43
Sex: M

CC: pain in head, neck, arms, stomach, and legs
Reason for Admission: pain in head, neck, arms, stomach, and legs

History of Present Illness:
Patient 43 yo AAM presented with pain in arms, back, stomach and legs which started yesterday morning. His last crisis was 2-3 years ago. It is well localized to the areas mentioned. He tried using Percocet and Oxycontin but they were ineffective in controlling his pain. He also complains of a productive cough with yellow phlegm for 2-3 weeks. He had no associated chest pain. He had no nasal congestion, but he did have post nasal drip. He has no nausea, vomiting, diarrhea, fever or chills.



Past Medical History:
Sickle Cell Disease (SC) diagnosed at age 12. Not significant for any other chronic conditions such as diabetes or hypertension.

Past Surgical History:
No surgical history.

Injuries/Disabilities: Considers SC a disability.
Medications:
Oxycontin 80 mg po bid
Percocet 5 mg 1-2 tablets q 4-6 hours prn pain
Folic Acid 1mg po qday

Herbal Meds: none
Immunizations: Pneumo and flu vaccines up to date since last year
Allergies: hay
Drugs: Morphine - lack of coordination, nervous; toradol - lack of coordination
Food: none
Family History:
Mother has sickle cell disease and diabetes. His family has no history of hypertension, cancer, cardiac diseases, or thalassemia.
Social History:
He lives in an appartment with his fiance. He's currently unemployed due to his sickle cell disability. He has no history of alcohol abuse. He smokes 3-4 cigarettes per day.

Review of Systems:
Summary: - f/c, -n/v/d, -dysuria, + cough for 3 weeks, - rhinorrhea, - headache

Physical Exam
General Appearance: Pt in acute distress from pain
Vital Signs:
Temperature: 96.7 F Oxygen Saturation: 98% Room Air
Blood Pressure: 100/46
Respiratory Rate: 16 Pulse Rate: 68
Skin/Nails: no clubbing
HEENT: PERRL, clear nasal turbinates, non-erythematous pharynx, no thyroid enlargement, no lymphadenopathy
Pulmonary: CTA BL, -w/c/r
CV: S1S2, RRR, II/VI SEM
Abdomen: soft, NT, ND
Peripheral pulses: 2+ DP
Musculoskeletal: pain in both arms, legs, and neck
Imaging:
CXR - clear and normal

Labs:
WBC 18.4
HGB 7.3
HCT 21.8
PLT 482
Na 138
K 4.7
Cl 108
CO2 26
BUN 6
Cr 0.6
Glucose 81
Ca 8.4
Retic 8.71
Retic Index 8.9




Assessment: 43 yo AAM with sickle cell crisis in arms, legs, neck, and head.

Problem List:
1. sickle cell crisis
2. increased white count

Differential Diagnosis:
He's presenting with acute onset of pain which is most likely related to a sickle cell crisis. He presents with no other signs, symptoms, or lab values suggesting other etiologies such as acute rheumatic fever, osteoid arthritis, or any other polyarticular arthritis. His pain is spread throughout his bones and joints which makes an SC crisis more likely.
His white blood count could be due to an infection, but he is not presenting with fever or any inflammatory reaction symptoms. He has no tachypnea, but he does have upper respiratory infection symptoms. His pulse ox is normal. His CXR is clear and this does not appear to be pneumonia. He should be worked up with urine cultures, urine analysis, and blood cultures.
Diagnostic Plan:
1. CBC w diff
2. Screen 8
3. Retic count and Retic Index
4. Blood Cx
5. Urine Cx
6. Urine Analysis
Therapeutic Plan:
1. Dilautid 4mg IV q4h
2. 125 cc/hr D5W

Causes of Chest Pain

Chest Pain

Non-Cardiac

Pulmonary

pulmonary embolus pleuritis pneumothorax COPD

Gastrointestinal

Gastroesophageal Reflux Diseases (GERD) esophageal ulcer peptic ulcer disease Boerhaave's syndrome Mallory Weiss Tear

Musculoskeletal

Chostochondritis

Other

psychiatric

Cardiac

myocardial infarction ST elevation MI non-ST elevation MI Angina stable angina unstable angina pericarditis tamponade myocarditis

Internal Medicine

I started week five of twelve for Internal Medicine. The hours are from 7 to 5 most days. I should be personally responsible for 1 to 3 patients, and we round on all patients in the morning with the senior resident or attending. On a regular day, patients are seen from 7 AM to 8:30 AM, and progress notes are written. From 8:30 to 10:30 AM is morning rounds. 10:30 to 12:00 PM is teaching rounds. After a one hour lunch break, the rest of the day till 5 PM involves placing orders and other tasks for patients. Call is every four days, and we stay until 10 PM. A typical day in Internal Medicine provides time for reading textbooks.

Podscope

Podscope
Search through audio broadcasts with text.

H and P for PDA

Here's a typed up H and P for a PDA. You can put in on a Palm PDA as a memo or a Dataviz Documents to Go file. Fill in the details during the patient encounter, and then synch it with a desktop for printing. Feel free to make adjustments and post them as comments on this site.

H and P
Patient Name:
Hospital Unit:
Time of Admission:
Informant:
Birthdate:
Age:
Sex:

CC:
Reason for Admission:

History of Present Illness:






Past Medical History:

Past Surgical History:

Injuries/Disabilities:
Medications:




Herbal Meds:
Immunizations:
Allergies:
Drugs:
Food:
Family History:
Social History:

Review of Systems:
General: ( ) weight loss ( ) fever ( ) night sweats ( ) weakness/fatigue ( ) appetite
Endocrine: ( ) heat intolerance ( ) decreased energy ( ) thyroid/reanl dz ( ) polydipsia ( ) polyuria
Lympatics: ( ) lymphadenopathy
Skin: ( ) itching ( ) pale ( ) palmar creases
Hematology: ( ) anemia ( ) bruising ( ) bleeding
Head: ( ) seizures ( ) trauma ( ) loss of conscioussness ( ) headache ( ) vertigo ( ) dizziness
Eyes: ( ) visual changes ( ) blurred vision ( ) loss of vision ( ) discharge
Ears: ( ) discharge ( ) ear pain ( ) tinnitus ( ) ototoxic drug history ( ) hearing loss
Nose: ( ) discharge ( ) rhinorrhea ( ) epistaxis
Mouth and Throat: ( ) lip cracking ( ) gum soreness ( ) gum hypertrophy ( ) dryness ( ) thirst ( ) excessive salivation ( ) throat pain ( ) hoarseness
Cardiorespiratory: ( ) SOB ( ) valvular disease ( ) orthopnea ( ) dyspnea on exertion ( ) nocturia ( ) edema ( ) paroxysmal nocturnal dyspnea ( ) cough ( ) cyanosis ( ) hemoptysis
Gastrointestinal ( ) dysphagia ( ) abdominal pain ( ) vomiting ( ) hematemesis ( ) melena ( ) hematochezia ( ) change in appetite ( ) diarrhea ( ) constipation ( ) jaundice
Genitourinary: ( ) change in bladder function ( ) change in amount ( ) dysuria ( ) hematuria ( ) discharge
Neuropsychiatric: ( ) weakness ( ) motor/sensory deficit ( ) depression ( ) anxiety
Pain:


Physical Exam
General Appearance:
Vital Signs:
Temperature: Oxygen Saturation: Blood Pressure:
Respiratory Rate: Pulse Rate:
Skin/Nails:
Head:
Eyes:
Ears:
Nose:
Throat/Mouth:
Neck:
Lymph:
Pulmonary:
CV:
Abdomen:
Breasts:
Rectal:
Genitals:
Peripheral pulses:
Musculoskeletal:
Neurologic:
Mental Status
CN I
CN II
CN III,IV, VI
CN V, VII
CN VII
CN VIII
CN IX, X
CN XI
CN XII
Cerebellar
DTRs

Labs:




Assessment:

Problem List:

Differential Diagnosis:

Diagnostic Plan:

Therapeutic Plan:

Flash Drives Make Any Computer 'Personal'

Flash Drives Make Any Computer 'Personal': Financial News - Yahoo! Finance
Flash drives with built in software such as Migo allow users to carry their personal settings and files to any computer. Apparently, plugging in the USB flash drive will allow access to personal documents, e-mail, and internet favorites. It's a great idea for people who work in places with several computers and move among them, such as a hospital.

CMDT Review by MS3

Although CMDT appears as a tome of medicine at 1888 pages, its proven to be a good home reference book. Diseases are covered in a few pages, while still maintaining good attention to detail in presentation and management. This book is all text with a few tables and no pictures. More pages are dedicated to common diseases with varying presentations like pneumonia. It's main advantage over other books is it's updated every year.

Washington Manual Handbook Review by an MS3

The Washington Manual of Medical Therapeutics is a good handbook reference for the internal medicine rotation. It's descriptions of diseases can be succinct, but the book covers other aspects such as imaging and treatment well. The main drawback to the book is its size. The spiral bound can add a couple of pounds of weight to a white coat; a paper bound copy seems to be more compact. Overall, The Washington Manual is a good reference to have when free time is available during the day.

Removing an Ink Stain from a Silk Tie

Today was a busy day in the hospital, and I was running around when I accidently left some pen marks on my tie. Luckily I found this site, and it suggested using alcohol to wipe away the stain. So I had some alcohol swabs from the hospital, and I was able to take away the marks.

Tom Evans' ECG Cribsheets - PDA Version

http://medicine.ucsf.edu/housestaff/ecg/pda.html

This is a great guide to reading ECGs, and this can also be downloaded to a Palm PDA device. Download the zip file for Pocket PCs, and then install Pluckr for your Palm PDA and Sunrise Desktop for your computer. After extracting the zip file, send the index.html file to Sunrise, and then synch your Palm PDA.

More than 100 Links for Medical Students

http://www.medicalstudent.com/

This page links to several free online resources. I especially like the anatomy links.

Indications for Oxygen Therapy to Treat COPD

COPD is a disease of airflow obstruction. It can be caused by chronic bronchitis and emphysema. Most of the people with COPD have an extensive cigarette smoking history. Patients are eligible for oxygen therapy at home if their room air resting ABG shows an SaO2 less than 88% or a PaO2 less than 55 mm Hg. With a PaO2 of 56-59 mm Hg or a SaO2 less than 89%, people who have polycythemia, heart failure or pulmonary hypertension can receive oxygen therapy. Oxygen therapy as a treatment for COPD has been shown to reduce mortality and morbidity.

Source:
The Washington Manual of Medical Therapeutics, 31st edition.

Books for MS3 Internal Medicine Rotation

Practice questions for USMLE Step 2

I've heard good reviews for this book of practice USMLE step 2 questions. The questions are considered to be very similar to the ones found on the shelf exams.

Books for MS3 Surgery

I would recommend the books below for the third year medical student on a surgery rotation. Blueprints was a superficial review of all subjects, while Essentials gave a thorough explanation of surgical conditions. Sabiston provides a good pocket reference. Surgical Recall is excellent at the hospital or in lecture situations. The basic important questions surgeons will ask can be found in Surgical Recall; however, this book lacks any depth to the coverage of its subjects. Appleton & Lange's Surgery Review provides great questions with explanations. Combining several books for studying will provide a good foundation for MS3 surgery.

USMLE STEP 2 CS TIPS AND TRICKS

USMLE STEP 2 CS TIPS AND TRICKS

A good blog of USMLE Step 2 tips.

Free USMLE Step 1 and Step 2 practice questions

USMLEasy.com (http://www.usmleasy.com) has free access to 1700 questions for USMLE Step 1 and Step 2 with registration. The questions can be organized by subject, and after taking a practice exam, full answer explanations are given. This free offer is only available to students at medical colleges with subscriptions to AccessMedicine. Anyone can buy ne month access to all 3000 questions along with analysis for $99.

Percutaneous Interventions for Lower Extremity Peripheral Vascular Disease- December 15, 2001 - American Family Physician

Percutaneous Interventions for Lower Extremity Peripheral Vascular Disease- December 15, 2001 - American Family Physician

Medical Student Surgery Hours

Wake up 4 am
Start seeing patients 5 am
Round with the team 6 am
Operating Room 8 am to 4 pm
Evening Sign Out 6-7 pm
Sleep 9pm
Overnight Call every four days, Weekend call 24 hours starting at 6 am

Scrub Attire

Scrubs are the most comfortable type of clothing invented. Currently, I'm doing surgery, and it's great wearing scrubs daily. It takes a lot less time than putting on a shirt and tie; also, the laundry is a lot simpler when wearing scrubs all week.

AccessMedicine on a PDA

AccessMedicine is Lange publishing group's website with access to all their textbooks. For each article found on the website, it can be saved to a PDA. After downloading the PDA program from the website, users can save the documents for PDA synchronization. With the articles on the PDA, it's easier to read selected chapters from books during down time at the hospital.

Technology in Medicine

Currently, I'm learning how to use computer software for managing patient information. However, during the last month in outpatient care, after learning about the computer software, the software has been of little use. I've never used it to look up patient information. Basically, all the patient information can be found in the patient's folder. A computer's not needed in this situation. At the hospital, I could see the use of having patient information from several different sources in one point. One specific situation would be having lab information delivered instantly. Otherwise, all the patient information could be put into one folder. Software could be used to collect data and analyze data based on diseases and symptoms.

USMLE Score Reports

Step 1 scores are being released for those people who took the test this summer. Apparently, they're being released weekly, and arrive in the mail.

Blueprints in Pediatrics

Blueprints in Pediatrics is part of a line of textbooks for third year of medical school. It's got a very concise review of important topics for the clinics. Each topic has sections for diagnosis, differential diagnosis, evaluation, and treatment. For more detail, look at the textbooks and handbooks found in the hospital clinics and nursery.

Buying a PDA on eBay

I just recently bought a Tungsten E on eBay, and I'm disappointed with my purchase. After noticing my battery was drained within one day of use, I noticed on the internet several posts about the E having a battery that wore out after 6 months or less. I would have to advise against getting a used PDA on ebay, and only buying new models. Although even with buying a new PDA, eventually the battery will stop holding its charge for very long. Its a large problem since the Palm battery is not replaceable. I've read this is a common problem with many lithium ion battery powered products like mp3 players. Why would somebody pay 200 dollars plus for a device that will function optimally for only 6 months to 2 years?

Babies in Peds

One of the greatest aspects of pediatrics is taking care of newborn babies. They're anywhere from three days old to a month old, and you're one of the first people to take care of them and make sure they're doing well.

First Full Day of Peds

I saw a grand total of three patients by myself. The emphasis is on being by myself. Basically, I see a patient and report the findings to the attending. Then, the attending sees the patient for the final assessment and plan. It's similar to being an intern with a lot less responsibility.

What I learned my first day of pediatrics

Little kids punch anything at their level, so watch out for low blows from 2.5 year olds. Sick kids are still hyper-active.

PDAs on eBay

USMLE Step 1 Books on ebay

PDA for Rotations

I have to get a PDA as I start rotations for third year. Minimum requirements are 32 megabytes in memory space for medical programs.

	Palm LifeDrive Its got a 4 gigabyte hard drive, which sets it apart from any other PDA on the market. Another distinguishing aspect is its price, $500. It might be more than I need for rotations at the hospital, but it would also serve as an mp3 player.
	Treo 650 This PDA has everything bundled into one small package, including a a camera and a phone. I would only have to carry one device to the hospital, and its memory is expandable with SD cards. One drawback is its small size. The Treo has a much smaller screen than other PDAs after seeing it at an electronics store. The size is good for carrying it around as a phone, but I wouldn't be too happy staring at a small screen in the hospital.
	Tungsten T5 The T5 is the top of the line flash drive based PDA, with a large 256 mb of internal memory. This is its main selling point, along with its fast processor and large screen.
	Tungsten T3 The T3 is probably the best value for the money among the high end PDAs. Its got a large screen accessible by pulling open the PDA. Its a unique design, but I would rather have a large screen available at all times.
	Tungsten E This is the minimum suggested PDA for rotations. Its got 32 mb of internal memory, which is enough for medical applications.

First Aid for Step 1

This book provided a good foundation for reviewing for the boards.

Books for Medical School

USMLE Books on Amazon

BRS Books

Merck Manual Online

http://www.merck.com/mrkshared/mmanual/sections.jsp

Two Days Before Step 1

I'm glad I put in this much work; it's one reason I feel calm about the upcoming test, putting in everything I had for this time.

bald 1

bald 1
Originally uploaded by jks184.

Advantages of being bald - less shampoo, no need to dry hair, no need for a comb.

bald 2

bald 2
Originally uploaded by jks184.

I lost about 2 pounds of hair since the previous picture.