銅筋鐵肋的秘密基地

每次看到誰又結婚了,誰開心的分享婚紗照,
或是誰表示好想結婚......
我都在想,結婚這檔事,真的是籬笆外的拼命想進去,而籬笆內的吶喊想出來的一場鬧劇(?).
 

1. 分出血性/神經性.

神經性記得雨傘節就好,台灣眼鏡蛇還是以出血症狀為主(神經性為局部麻,局部麻不準.誰被咬了一口不會麻)

[FDA兩項藥物警訊]
1. HES: (201306)
1) 不建議用在住ICU的sepsis病人,開心手術有裝體外循環機或有excessive bleeding的人,或是本身腎功能不全者

 
[圖片來源:The Internet Journal of Asthma, Allergy and Immunology ISSN: 1532-0642]

woman passenger in motorcycle collision
Is there's anything wrong in this CT?

天啊,我認真了~~~~

Woman with RLQ pain

Woman with acute abdominal pain.
What's the lesion and what's the diagnosis?

TEACHING TOPIC
1. Case: Renal Failure, Stiff Joints, and Skin Fibrosis
A 46-year-old woman with end-stage renal disease developed stiffness of her joints and skin. She had been well until 7 years before when an episode of group A streptococcal pneumonia complicated by septic shock left her with chronic kidney disease and peripheral neuropathy. The patient also has respiratory distress and congestive heart failure. What is the differential diagnosis?

TEACHING TOPIC
1. Case: Hemoptysis
CLINICAL PROBLEM-SOLVING
A 26-year-old man presented with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood. He reported mild pleuritic chest pain but had no dyspnea, fever, chills, night sweats, or weight loss. The patient had had no epistaxis or episodes of sinusitis. A course of azithromycin did not resolve his symptoms. His medical history was notable for pneumothorax and renal-artery dissection. What single disease could be responsible for these previous illnesses as well as his current hemoptysis?

Clinical Pearls
 Hemoptysis: Differential Diagnosis
Hemoptysis can be caused by diseases of the airways, particularly bronchitis or bronchiectasis. Other causes include bronchogenic carcinoma, metastatic cancer or bronchial carcinoid. Kaposi's sarcoma involving the airways may cause hemoptysis in patients infected with HIV. Hemoptysis can also arise from the lung parenchyma. Autoimmune diseases (such as SLE, mixed connective tissue diseases, etc.), cocaine inhalation, and infections (including tuberculosis, bacterial pneumonia, and lung abscess), as well as pulmonary embolism, pulmonary arteriovenous malformation, mitral stenosis, severe left heart failure, and Wegener's granulomatosis should also be included in the differential diagnosis of hemoptysis.
 Aspergillus in Respiratory Cultures
Aspergillus species are ubiquitous in the environment, and growth in respiratory cultures often represents contamination rather than infection. (A lung biopsy is needed for definitive diagnosis.) Common risk factors for invasive aspergillosis include severe neutropenia, hematopoietic stem-cell and solid-organ transplantation, HIV infection, and chronic granulomatous disease.