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7月4日 说明最近忙于考试，疏于对space的管理，有些对不起大家了，明天开始正常营业，希望大家积极参与。
王葆青老师还是经常关心我们的活动的，以后还有一些活动，大家可以自主选择参与。
最后还有一次总结活动，由王老师和张老师出席，希望大家能找个时间聚一下。 6月5日 challenge yourself 5A 71-year-old male patient was admitted to the emergency Dept. because of a sudden onset of chest discomfort, shortness of breath, palpitation and syncopye
The patient had a long history of paroxismal chest discomfort, shortness of breath and palpitation for 30 years, howerer, syncope is newly onset. The patient had no history of hypertension, no diabetes, no hyperlipidemia, no alcohol nor cigarette abuse.
The physical examination was unremarkable except for irregular heart beat and pulse, while the EKG was indicating.
Q: As an cardiologist, what's your impression, and your management suggestion?
Challenge rank:  Challenge yourself 4A 15-year-old boy had the sudden onset of sharp, piercing, centralized chest pain while at rest. He had no important medical history. He also reported a sore throat and said there had been no history of trauma. The results of a physical examination, routine complete blood count, and serum biochemistry profiles were unremarkable. A chest radiograph and a tomography were then requested as follows,
What's your impression on the radiograph and essential differential diagnosis to your impression?
What will you do next as an ER resident?
Challenge rank: 6月4日 6月6日 C组辩论赛，陈雪芳同学专题介绍时间：6月6日晚 6：30~8：30
地点：中山医院三号楼三楼第四示教室（急诊讲座的教室）
活动内容：
1. C组辩论赛：
正方：原发性开角型青光眼，一旦诊断明确了，先使用药物控制眼压
反方：原发性开角型青光眼，一旦诊断明确了，马上手术降低眼压
2. 陈雪芳同学专题介绍——院外急救 About challenge yourself原本想在space上放一些病例讨论之类的，希望拓宽大家的思路，引起大家的积极讨论。无论大家以后从事哪一科室，心电图和读片都是比较重要的基本功，每周一练帮大家复习一些基本知识。可惜没人踊跃发言，我也不知道题目难度如何，该怎么走下去，新生事物可能就是这样迷茫的吧...
ps:大家有好的素材也可以提供给我，不胜欢迎。 A to Q for challenge yourself 3Answer: the first impression of the may indicate an aspect of atrial fibrillation, however, in view of the brief history of that patient, hypokalemia must be taken into account as to evaluate the condition of the status of patient, and a serum electrolyte biochem analysis is a must in the first place. Here the analyisis is as follows:
A 77-year-old man with a remote history of atrial fibrillation presented to the emergency department reporting fatigue and weakness. The patient said he had not made any recent changes in his diet and that he did not have nausea, vomiting, or diarrhea. He also said he had no palpitations or sensations of a rapid heart rate. He was not taking any atrioventricular nodal blocking agents. An electrocardiogram was obtained, and an atrial flutter with a conduction ratio of 4:1 was diagnosed (Panel A). Laboratory values were remarkable only for a serum potassium level of 2.8 mmol per liter. One month before this visit, the patient had begun to receive 25 mg of hydrochlorothiazide daily for hypertension. After the electrocardiogram was obtained, potassium supplementation was prescribed, and treatment with the diuretic medication was discontinued. Repeated electrocardiography demonstrated sinus rhythm (Panel B). The pseudoatrial flutter, or "T-U-P" syndrome, as seen in Panel A, with small T waves (large arrow), followed by U waves (asterisk), followed by P waves (small arrow), with first-degree atrioventricular block, was attributed to the presence of hypokalemia as a result of the hydrochlorothiazide therapy. In Panel B, the T waves (large arrow) and P waves (small arrow) are shown. A to Q for challenge yourself 2Answer: Unilateral pulmonary edema and the presence of a chest tube in the right thorax suggest reexpansion pulmonary edema as the diagnosis.
Case in detail: A 50-year-old smoker presented with acute-onset breathlessness and right-sided chest pain of four days' duration. There was no history of chest trauma. A posteroanterior chest radiograph (Panel A) demonstrated a right-sided pneumothorax. His symptoms improved immediately on placement of a chest tube. Two hours later, he again became breathless, and examination revealed extensive right-sided chest crackles. Chest radiography was repeated and showed a fully expanded right lung (Panel B), albeit with features of pulmonary edema. The arrowheads in Panel B show the position of the chest tube. The patient's condition improved after continuous positive airway pressure was delivered through a face mask overnight. The chest tube was removed after three days. At follow-up six weeks later, the patient was asymptomatic and well. The results of further investigations were consistent with the presence of mild chronic obstructive pulmonary disease. A to Q for challenge yourself 1Answer: The lateral chest radiograph shows complete left atrial calcification. In combination with the Starr Edwards mitral prosthesis, the most likely diagnosis is rheumatic heart disease.
Case in detail: A 71-year-old man who had had rheumatic fever as a child presented with prosthetic-valve endocarditis. A mitral valvotomy had been performed 37 years before, and 21 years later, his mitral valve was replaced with a Starr–Edwards prosthesis. Lateral chest radiography showed complete calcification of the left atrial wall (Panel A, arrows). A transesophageal echocardiogram showed calcification of the interatrial septum (Panel B, arrow). This rare condition was first described in 1898, in association with chronic rheumatic mitral disease, and is more common in women, most of whom have symptoms for more than 20 years. The condition is assumed to be the end result of extensive rheumatic pancarditis. The calcification may be confined to the left atrial appendage or, rarely, to the posterior left atrial wall — owing to a regurgitant mitral jet — in which case the calcified patch is called the MacCallum's patch. Massive calcification usually spares the interatrial septum, but when the septum is affected (as in Panel B, arrow), any further surgery near the mitral valve is hazardous. Radiography of the left lateral side of the chest is recommended to assess long-standing rheumatic mitral-valve disease. Complete calcification has been described as a "coconut atrium" or "porcelain atrium." Challenge yourself 3A 77-year-old man with a remote history of atrial fibrillation presented to the emergency department reporting fatigue and weakness. The patient said he had not made any recent changes in his diet and that he did not have nausea, vomiting, or diarrhea. He also said he had no palpitations or sensations of a rapid heart rate. He was not taking any atrioventricular nodal blocking agents. An electrocardiogram was obtained. (panel A)
Laboratory values were remarkable only for a serum potassium level of 2.8 mmol/L. One month before this visit, the patient had begun to receive 25 mg of hydrochlorothiazide daily for hypertension. And an EKG was obtained as contrast. (panel B)
What's your impression on the EKG in this visit?
Challenge rank:  5月29日 Challenge yourself 2Q: What is the most likely cause of the abnormality on the chest radiograph?
Challenge rank: Challege yourselfNow ZSdebate features some of the most compelling medical graphics and illustrations found anywhere. The Challenge yourself provides our members an opportunity to use these images to test their diagnostic and visual skills.
At least one image and question will appear weekly. The answer will be available in one week. We require your passion and participation.
Q: What diagnosis explains the combination of findings on this lateral chest radiograph? Challenge rank: 5月30日讲座 急诊室的故事主讲人：姚晨玲，中山医院急诊科副主任，副教授
时间：5月30日晚6：45分，地点：中山医院三号楼三楼小教室（第一教室旁） 明晚讲座主讲人：姚晨玲，急诊科副教授
主题：急诊的相关知识，主要为互相之间的讨论。
时间：5月23日晚上六点半
地点：中山医院三号楼三楼 明晚的讲座明晚的讲座老时间，地点改为三号楼三楼的一个小教室 下周活动下周的讲座我们有请到的是中山医院急诊科副主任，姚晨玲副主任医师。姚医生主要研究方向，心脑血管系统缺血再灌注急救的病理生理机制和临床实践。
原本我们打算在此方面要求老师给我们拓宽一定知识，但考虑到基础研究比较难，比较枯燥，老师会给我们多介绍一些临床方面的工作。老师也表示大家有什么要求和问题可以及时和她联系。
具体活动地点可能会有变动，请详见通知。 5月14日 辩题意向征集眼科辩论的题目： 1、近视眼算不算病？如果患了2.00度以上的近视，需要不需要去手术矫正近视？ 2、原发性开角型青光眼，一旦诊断明确了，是先使用药物控制眼压，还是马上手术降低眼压？
说明： 1、目前有人认为，近视眼不是病，不应该鼓励大家去做手术。也有人认为近视就是一种疾病，需要手术等治疗。假如近视不是病，我们的招工升学，应该不应该将近视作为限制项目？或者说，这种限制是否算是一种歧视？ 2、原发性开角型青光眼，以往认为首先是用药物治疗，在药物无效时，才考虑手术。手术是第二位的。目前有人提出原发性开角型青光眼，一旦诊断成立，应该马上手术，这样可以提高疗效。 因此，根据目前的医学知识，我们应该作何种选择？如何做才对病人最为有利？
请大家注意，尤其是C组准备同学，从两则题目中选择一题作为我们的辩题。本次活动安排在精神病考试后的一周，具体时间等待我们与老师磋商。 |
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