[好康] 陳景祥學長Q&A回應
以下是同學交出一個question 學長給的回應:
Q1: 英文的聽力訓練
以下工具可以幫助大家學習正確的醫學英文發音
網路字典工具
http://www.thefreedictionary.com/ (免費)
http://www.dorlands.com/wsearch.jsp (付費)
下載 iTune 訂閱 NEJM podcast or Journal Watch podcast
Q2:Clerk 在各科學習目標
1.學各科基本的核心概念
2.學會如何詢問病史 如何做完整的身體評估
3.學習病歷寫作
4.利用每科的rotation去看看該科所做的事情 看看自己是否有興趣 作為未來選科的參考
5.熟悉clinical procedure. (例如:放鼻胃管 ...)
Q3:什麼是Qualified Clerk?
基本上一個所謂Qualified Clerk只需要具備自我學習的能力,在各科把握每個與病人接
觸的機會,能夠從病人身上學習到該科應有的專業知識。
Q4 心音的輔助教學網站
http://www.med.ucla.edu/wilkes/inex.htm
http://heartsoundslab.com/index.html
Q5 X光的輔助教學網站
http://www.learningradiology.com/
Q6:有效的學習方法為何?
A:傳統的教學方式所教的東西不一定馬上可以用 但是臨床的學習是你遇到問題 然後就上
網去查資料庫 讀完所查到的資料 就可以馬上應用在病人身上 並且可以透過每天去看病
人 知道這些知識應用在病人身上的情況 所以臨床的學習一定要實際參與照顧病人 才能
夠學到東西 詳細的方法我將在下次上課告訴大家
Q7:出國見習是否有幫助學習?
不見得有幫助,但是出去國外多看看是好的
Q8:臨床與基礎如何連結?
臨床的知識與技術都建構在基礎的知識之上 所以兩個之間有密不可分的關係 但是因為臨
床的知識實用 不需要知道詳細的原理 就可以使用 所以有些人會提出基礎知識無用的論
點
但是如果大家想要當一個真正有能力的醫師 應該就要在clerk時期 遇到臨床的問題 都能
夠在複習基礎學科的知識 這樣在剖析臨床問題時 可以比較不用記很多東西 第一堂的緒
論 我用拉肚子的例子就是要告訴大家 基礎的知識是可以運用在實際的臨床學習
Q8 學習筆記如何做?
很多人會在主治醫師查房的時候 拼命記主治醫師所說的東西 不過有時候這樣的學習方式
與課堂上課沒兩樣 我建議大家要做筆記 學習用patient oriented
這個意思是 用你照顧的病人為核心來做學習筆記
比如說這是某個學生照顧的病人
This 70 y/o woman with a history of OA knee s/p Op one weeks before, HTN
visited our ED because she was refered from Nanto Hospital due to "suspected
pancreatic lesion" in abd CT.
She had right knee pain for years, and takes pain killer casually ( unknown
drugs, suspected NSAID). She just received total knee replacement one week
before. About three days before this visit, epigastric pain developed with
radiation to her back. This pain was not related to posture change or food
intake. There was an episode of hematemesis three days ago. Besides, there
was also black unformed stool in the recent three days. She denied having
fever, body weight loss, alcoholism, and shortness of breath in the recent a
week.
On exams, she is alert. Obese. Surgical wound at her right knee. Pale
conjuntiva. anicteric. non-palpable lymph nodes over neck or supraclavicle
fossae. Clear breath sounds, normal S1, S2.
Ovoid abd. active bowel sounds. Tenderness at epigastric region w/o rebound
tenderness. Pitting edema at her legs, especially at her right leg.
Lab
Hb 6.3 WBC 19.97 seg 76.9
AST/ALT 27/21 Bil T 1.06. CREA 0.62. Na 132
Amy/Lipase 39/46
Image
Abd CT with contrast ( no official report, reading by myself)
liver cyst at right lobe of liver
enlarged pancreatic head?
active bleeding at second portion of duodenum
Recommendations
#epigastric pain with hematemesis, and tarry stool
DDx peptic ulcer with bleeding ( Hx of OA knee, pain killer use. )
ampulla vater neoplasm( less likely, no intermittent jaundice)
pancreatic head tumor ( less likely, no elevated level of bilirubin.)
- admission
- blood transfusion
- arrange EGD after admission
- anti-acid medication ( If pepetic ulcer is comfirmed, prescribe PPI for her)
- consider arrange EUS if there is negative finding in stomach or duodenum.
-blood transfusion carefully.
# pitting edema at her legs
Op related?
hypoalbuminemia?
DVT?
- obtain level of albumin after admission
-observe the circumference of thigh and leg, if ipsilateral swelling, DVT
should be ruled out.
arrange sonography for her.
這裡面有很多我不懂的 於是就把想要學習的重點列出
Peptic ulcer disease
DVT
GI bleeding
然後上網(建議Uptodate) 讀完後把 自己的心得記下 這就是自己的學習筆記
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