candlelit─自信。承擔。勇敢─weishan的心情日誌

Neuropathy v.s. Myopathy:

http://www.cidpusa.org/weakness.htm

Aphasia Classification:

http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/aphasia.jsp

http://www.aphasia.com/wordpdf/CCMCAphasiaClassif25A255.pdf

CNS

http://biology.about.com/gi/dynamic/offsite.htm?site=http://www.geocities.com/HotSprings/3468/11%2D01.html%23Medulla

Sensory Tract (Chinese)

http://homepage.mac.com/mehu2000/CSMU/Neuroanatomy/Sensory%20System.htm

are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male).
2. Normal levels of creatinine in the blood are approximately 0.6 to 1.2 mg/dl (male) and 0.5 to 1.1  mg/dl (female)
3. Normal BUN levels are 5-18 mg/dL for children; 7-18 mg/dL for adults; and 8-20 mg/dL in the elderly.
4.  Prolactin level: adult male: 0-20 ng/ml , adult female: 0-20 ng/ml , pregnant female: 20-400 ng/ml

cf. 2. http://www.medicinenet.com/creatinine_blood_test/article.htm
3. http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/blood_urea_nitrogen_test.jsp
4. http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/prolactin_test.jsp

http://en.wikipedia.org/wiki/Combined_oral_contraceptive_pill#Formulations

Formulations

Oral contraceptives come in a variety of formulations. The main division is between combined oral contraceptive pills, containing both estrogen and progestins and progestin only pills(mini-pills). Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progestin changes from week to week.

Progestin only pills:
http://en.wikipedia.org/wiki/Oral_contraceptive_formulations

有音調連續音:
  Wheezing--高頻
  Rhonchi--低頻

無音調不連續音:
Crackle:
  Coarse--粗
  Fine crackle (=rales?)--細(類似小泡泡破掉的聲音)

ANC: absolute neutrophil count
ANC=(band+segment)%*WBC count

ANC: absolute neutrophil count
絕對嗜中性白血球
1500以下不能打化療藥
1500-2000以下  保護性隔離
500以下  無菌性嚴格隔離

"止痛藥"是一種泛稱，究竟是代表哪些藥物呢?

原來NSAID也算是止痛藥~~消炎鎮痛阿:P

An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- ("without") and -algia ("pain"). Analgesic drugs act in various ways on the peripheral and central nervous systems; they include paracetamol (acetaminophen), the non-steroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, narcotic drugs such as morphine, synthetic drugs with narcotic properties such as tramadol, and various others.

In choosing analgesia, the severity and response to other medication determines the choice of agent; the WHO "pain ladder", originally developed in cancer-related pain, is widely applied to find suitable drugs in a stepwise manner.^[1] The choice of analgesia is also determined by the type of pain: for neuropathic pain, traditional analgesia is less effective, and there is often benefit from classes of drugs that are not normally considered analgesics, such as tricyclic antidepressants and anticonvulsants.<sup>[2]

From wikipenia</sup>

神經科：
EEG判讀 (alpha, beta waves..)
Hx 的重點事項(語言發展遲緩：特別注意和家人、他人的互動情形)
Development milestone(時間點很重要)

健兒門診：
小兒PE(五官鏡：檢查是否斜視、ears、throat)(眼底鏡：對稱的橘紅色亮點，若變白點，要注意)
  (DDH-development dysplasia of hip的檢查)
Hemangioma、脂漏性皮膚炎
cephalohematoma
G6PD

Introduction

Cellulitis is an inflammation of the connective tissue underlying the skin that can be caused by bacterial infection. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, or sites of intravenous catheter insertion. The mainstay of therapy remains treatment with appropriate antibiotics. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. Cellulitis may be superficial — affecting only the surface of the skin — but cellulitis may also affect the tissues underlying the skin and can spread to the lymph nodes and bloodstream.

Cellulitis is unrelated to cellulite, a cosmetic condition featuring dimpling of the skin.

Symptoms

Early symptoms may include fever, headache, nausea, and early signs of redness on the affected area.

Cellulitis is characterized by redness, swelling, warmth, and pain or tenderness. Cellulitis frequently occurs on exposed areas of the body such as the arms, legs, and face. Other symptoms can include fever or chills and headaches. In advanced cases of cellulitis, red streaks (sometimes described as 'fingers') may be seen traveling up the affected area. The swelling can spread rapidly.

Causes

Cellulitis is caused by a type of bacteria entering by way of a break in the skin. This break need not be visible. Group A Streptococcus and Staphylococcus are the most common of these bacteria, which are part of the normal flora of the skin but cause no actual infection until the skin is broken. Predisposing conditions for cellulitis include insect bite, animal bite, tattoos, pruritic(搔癢症的) skin rash, recent surgery, athlete's foot, dry skin, eczema, injecting drugs (especially subcutaneous or intramuscular injection or where an attempted IV injection "misses" or blows the vein); plus burns and boils, though there is debate as to whether minor foot lesions contribute and also morbidly(不健全地,病態地) obese people can experience it.

The appearance of the skin will help a doctor make a diagnosis. The doctor may also suggest blood tests, a wound culture or other tests to help rule out a blood clot deep in the veins of the legs. Cellulitis in the lower leg is characterized by signs and symptoms that may be similar to those of a clot occurring deep in the veins, such as warmth, pain and swelling.

This reddened skin or rash may signal a deeper, more serious infection of the inner layers of skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the bloodstream and spreading throughout the body.

In rare cases, the infection can spread to the deep layer of tissue called the fascial lining. Necrotizing fasciitis, also called by the media "flesh-eating bacteria", is an example of a deep-layer infection. It represents an extreme medical emergency.

Risk factors

The elderly and those with weakened immune systems are especially vulnerable to contracting cellulitis. Diabetics are more susceptible to cellulitis than the general population because of impairment of the immune system; they are especially prone to cellulitis in the feet because the disease causes impairment of blood circulation in the legs leading to foot ulcers. Poor control of blood glucose levels allows bacteria to grow more rapidly in the affected tissue and facilitates rapid progression if the infection enters the bloodstream. Neural degeneration in diabetes means these ulcers may not be painful and thus often become infected.

Immunosuppressive drugs, HIV, and other illnesses or infections that weaken the immune system are also factors that make infection more likely. In addition, chickenpox and shingles(帶狀皰疹) often result in blisters(水泡) which break, providing a gap in the skin through which bacteria can enter. Lymphedema, which causes swelling on the arms and/or legs, can also put an individual at risk.

       Diseases that affect blood circulation in the legs and feet, such as chronic venous insufficiency and varicose veins, are also risk factors for cellulitis.

Cellulitis is also extremely prevalent(流行的) amongst dense populations sharing hygiene facilities and common living quarters. Military installations which require communal showers provide such an environment, as it is prevalent among many recruits going through boot camp.

Diagnosis

Cellulitis is most often a clinical diagnosis, and local cultures do not always identify the causative(成為原因的) organism. Blood cultures usually are positive only if the patient develops generalized sepsis. Conditions that may resemble cellulitis include deep vein thrombosis, which can be diagnosed with a compression leg ultrasound, and stasis dermatitis, which is inflammation of the skin from poor blood flow.

Duration

In many cases, cellulitis takes less than a week to disappear with antibiotic therapy. However, it can take months to resolve completely in more serious cases, and can result in severe debility(衰弱) or even death if untreated especially if the symptoms are caused in women. If it is not properly cured it may appear to improve but can resurface again even after months and years.

Treatment

Antibiotics — typically a combination of intravenous and oral antibiotics — are administered. Bed rest and elevation of affected limbs is also recommended. Often physicians suggest patients drink plenty of fluids as well.

Homans sign is said to be present when passive dorsiflexion of the ankle by the examiner elicits(引發) sharp pain in the calf(小腿). It is caused by a thrombosis of the deep veins of the leg. This sign is frequently elicited in clinical practice because of the ease of use, although it is falling into disfavor(不利) because of risk of producing an embolism and because it is frequently positive in individuals without DVT. It is named for the American physician John Homans.

To test for Homans' sign, flex the patient's knee slightly with one hand and, with the other, dorsiflex the foot. The complaint of calf pain with this procedure is a positive sign and often indicates venous thrombosis. Absence of Homans' sign does not preclude(排除) venous thrombosis.

  http://intermargins.net/intermargins/IsleMargin/DrugLib/articles/article03.htm

• Grade 1 - Trivial lack of awareness; Euphoria or anxiety; Shortened attention span; Impaired performance of addition. 67% of cirrhotic patients may have 'minimal hepatic encephalopathy'.^[5]
• Grade 2 - Lethargy or apathy; Minimal disorientation for time or place; Subtle personality change; Inappropriate behavior; Impaired performance of subtraction
• Grade 3 - Somnolence to semistupor, but responsive to verbal stimuli; Confusion; Gross disorientation
• Grade 4 - Coma (unresponsive to verbal or noxious stimuli) http://www.gastroresource.com/gitextbook/en/chapter14/14-13.htm

  Table 289–4. Clinical Stages of Hepatic Encephalopathy

  Stage Mental Status Asterixis EEG I Euphoria or depression, mild confusion, slurred speech, disordered sleep +/– Triphasic waves II Lethargy, moderate confusion + Triphasic waves III Marked confusion, incoherent speech, sleeping but arousable + Triphasic waves IV Coma; initially responsive to noxious stimuli, later unresponsive – Delta activity

  Table 289–3. Common Precipitants of Hepatic Encephalopathy

  Increased nitrogen load  Gastrointestinal bleeding  Excess dietary protein  Azotemia  Constipation Electrolyte and metabolic imbalance  Hypokalemia  Alkalosis  Hypoxia  Hyponatremia  Hypovolemia Drugs  Narcotics, tranquilizers, sedatives  Diuretics (see "Electrolyte imbalance") Miscellaneous  Infection  Surgery  Superimposed acute liver disease  Progressive liver disease  Portal-systemic shunts