Journals

satchmo15 years ago2009-03-17 14:36:10 UTC 2 comments
As I toured the city of Taipei, I realized that I was touring the personal computer capital of the world.

I saw the headquarter of ASUS and Gigabyte, among other highly recognizable companies for hardware enthusiasts.

It was like a kid in the candy store.

Too bad that I didn't get a chance to get off the car and visit those companies.
satchmo15 years ago2009-03-13 14:11:04 UTC 18 comments
So I have returned from Taiwan.

It was a nice trip, minus the five hours of screaming my son had on the airplane on the way there.

One thing I noticed in Taiwan was that gaming is taken very seriously there. There are prime-time television programs devoted to gaming. And I see plenty of Counter-Strike commercials on TV.

I also saw this gigantic billboard of Warhammer at a popular strip mall:

User posted image
satchmo15 years ago2009-03-01 10:52:31 UTC 12 comments
I will be leaving for Taiwan tomorrow.

It's my birth place, and it's probably the birth place of the computer you're using now, if you build your own computers.

ASUS, G-Skills, Gigabytes . . . all of those well known and well respected companies for any computer hardware enthusiast are based in Taiwan. Some of my compatriots were responsible for putting your computer together.
satchmo15 years ago2009-02-28 18:00:10 UTC 5 comments
Falling asleep while eating.
satchmo15 years ago2009-02-26 13:51:58 UTC 19 comments
You are evaluating a 15-year-old girl who complains of malaise, fatigue, and occasional abdominal discomfort. You diagnosed hypothyroidism due to chronic lymphocytic thyroiditis (Hashimoto thyroiditis) 6 years ago. She has normal serum immunoglobulin A concentrations. A tissue transglutaminase antibody study was negative 1 month before this visit, and free thyroxine and thyroid-stimulating hormone (TSH) values were normal at that time. She has normal menses. She reports that she has been eating poorly and has lost 5 lb since you saw her at the beginning of the summer, but she obviously has had a good summer and has a tan.
Of the following, the MOST important laboratory studies to obtain at this time are

complete blood count and erythrocyte sedimentation rate

duodenal biopsy for cryptic celiac disease

measurement of cortisol and adrenocorticotropic hormone (ACTH)

measurement of free thyroxine and TSH

mononucleosis spot test and liver function study
satchmo15 years ago2009-02-13 20:06:23 UTC 17 comments
This should be an easier question (and non-technical):
The mother of one of your patients is in the process of getting a divorce and has just moved into a small apartment. Due to her new work schedule, she has not been able to unpack the boxes left in the kitchen. She brings her 4-year-old daughter to your office because the child cut herself with a knife trying to open one of the unpacked boxes. The mother is visibly upset. After you bandage the daughter 's injured hand, you sit down to talk with the mother.
Of the following, you are MOST likely to

explore what support system the mother has to help her family settle into their new home

recommend that the mother place her child in time-out for playing with the knife

recommend that the mother have a psychiatric evaluation

refer the mother to parenting classes

tell the mother that you are obligated to report her to the child welfare agency
satchmo15 years ago2009-02-10 14:25:47 UTC 14 comments
I diagnosed a boy yesterday with brain tumor.

It was a hard news to break to the mother.

He's getting brain surgery today. It was the largest brain tumor that I have ever seen.
satchmo15 years ago2009-01-29 15:37:25 UTC 17 comments
A 5-day-old child is brought to the emergency department because he has been difficult to arouse over the last 6 hours. His parents report that he has not been interested in feeding today and that he has been breathing rapidly and with a grunting noise. On physical examination, the infant's heart rate is 185 beats/min, respiratory rate is 80 breaths/min, and blood pressure is 55/40 mm Hg. A pulse is palpable in the right brachial region, but not in the feet. All of his extremities are cool and mottled, with a capillary refill of more than 2 seconds.
Of the following, the MOST appropriate next step is to

arrange for echocardiography at the first appointment in the morning

initiate a furosemide infusion

initiate a prostaglandin infusion

obtain a computed tomography scan of the head

obtain a lumbar puncture
satchmo15 years ago2009-01-24 11:34:55 UTC 16 comments
Obama details his economic recovery plan in the weekly YouTube address.
satchmo15 years ago2009-01-21 03:16:06 UTC 5 comments
I never thought that I would bookmark the White House website.

But I just did.

Obama gave the site a new life.
satchmo15 years ago2009-01-20 16:14:46 UTC 11 comments
A historical moment, witnessed at home: Obama inauguration.
satchmo15 years ago2009-01-18 21:42:47 UTC 3 comments
A term infant is delivered by emergency cesarean section following the acute onset of maternal vaginal bleeding and profound fetal bradycardia. The Apgar scores are 1, 2, and 3 at 1, 5, and 10 minutes, respectively. Resuscitation includes intubation and assisted ventilation, chest compressions, and intravenous epinephrine. The infant is admitted to the neonatal intensive care unit and has seizures 6 hours after birth.
Of the following, a TRUE statement about other organ-system injury that may occur in the infant is that:

cardiovascular injury is uncommon

hypoxic-ischemic encephalopathy usually is an isolated condition

liver injury may result in a coagulopathy

most infants who have seizures develop cerebral palsy

necrotizing enterocolitis does not occur in term infants
satchmo15 years ago2009-01-17 06:52:26 UTC 12 comments
You are urgently called to the newborn nursery to evaluate a 3-day-old term male infant who is lethargic. The baby was taking formula well for the first 2 days but vomited after his last 2 feedings and has become increasingly difficult to arouse. A review of the record reveals that he was born at 36 weeks ' gestation to a 30-year-old gravida 2, now para 2 woman. The mother is Rh-negative and received Rh immune globulin during the pregnancy. Pregnancy, labor, and delivery were uneventful; Apgar scores were 8 and 9 at 1 and 5 minutes. Family history is noncontributory. On physical examination, the baby appears well developed, is very jaundiced, and has hypotonia and tachypnea. He responds with a grimace to sternal rubbing but does not arouse to voice or to touch. Findings on abdominal examination are normal. You order a series of laboratory tests, start intravenous fluids, and arrange for transfer to the neonatal intensive care unit. A laboratory technician subsequently notifies you of some critical laboratory values, including a platelet count of 35x103/mcL (35x109/L), serum carbon dioxide of 4 mEq/L (4 mmol/L), anion gap of 28 mEq/L (28 mmol/L), serum ammonia of 250 mcmol/L, and total bilirubin of 20 mg/dL (342 mcmol/L). There are large ketones in the urine.
Of the following, the MOST likely diagnosis is:

bilirubin encephalopathy

citrullinemia

hypoxic-ischemic encephalopathy

propionic acidemia

transient hyperammonemia of the newborn
satchmo15 years ago2009-01-16 14:59:46 UTC 16 comments
A 2-week-old infant presents to the emergency department with a 1-day history of decreased feeding, pallor, diaphoresis, and increasing somnolence. He was born at term, and the delivery was uncomplicated. On physical examination, his heart rate is 190 beats/min, his respiratory rate is 80 breaths/min, his blood pressure is 50/30 mm Hg, and his extremities are cool and pale with poor pulses. You place the infant on a cardiorespiratory monitor and begin your assessment and management.
Of the following, the MOST appropriate pair of tests to consider in this child is:

complete blood count and bone scan

electrocardiography and echocardiography

electroencephalography and head ultrasonography

lumbar puncture and head computed tomography scan

serum electrolytes and chest computed tomography scan
satchmo15 years ago2009-01-15 22:16:44 UTC 17 comments
Question 2 of 250

An 8-month-old infant presents with the primary complaint of irritability. He has been exclusively breastfed since birth. His mother was not interested in providing any supplemental foods because her milk supply has been adequate. Physical examination reveals a fussy infant who has frontal bossing and whose weight and height are both at the 25th percentile. The infant becomes irritable with movement of the left arm. Arm radiography reveals a humeral fracture and bowing of both radii. Chest radiography demonstrates enlargement of the costochondral junctions.
Of the following, the MOST likely diagnosis is ____________.