Postcard from Nepal
星期二, 12月 09, 2014
星期日, 11月 30, 2014
Taiwan Root Medical Peace Corps 台灣路竹醫療和平會 #298次 高雄屏東義診
屏東滿州鄉
這次的高屏義診很特別. 除了是路程最遠之外，這次資深義工董大哥親自帶隊確保行程和大家的安全, 三天有不同的主治醫師看診，有三位很優秀的醫學生可以一起討論cases, 與facebook多年朋友但一直沒機會見面的中國醫實習醫師Betty見面, 有緣認識一位去過十幾個國家的福建背包客Earo，有位白雪公主的精神支柱Jane，有Amy姐請的辦桌(謝謝Amy姐), 有姝廷這位很利害有夢想的烘焙師，有機會跟二姐深入聊，坐車時認識去過20多國家義診的彰基NP學姐, 和認識許多其他好夥伴.
星期三, 10月 22, 2014
[Taipei 台北] Wine Tasting Event at Bellissimo Bistro 向日葵餐廳 Valdivieso Chilean Wines Mushroom Risotto Braise Osso Bucco
Six Varieties of Valdivieso Chilean Wine
Bellissimo Bistro 向日葵餐廳
Address: 台北市和平東路一段141巷7號之2Phone: 02 2391 9722
Date: 2014/10/18
Price: 1600 NT (dinner included)
Valdivieso Wine Tasting Event
I haven't written a restaurant review for a while. Instead I have been busy getting familiar with the research at Harvard and planning the life in Boston. Moreover, this imminent medical relief mission to Nepal requires some preparations as well. Last week, I was contacted by Taiwan Root Medical Peace Corps for an interview on the police radio station pertaining to my recent volunteering and future plans. The orientation for the Nepal trip was on the following Monday, so I planned the trip to get the most out of it. I messaged Kelly, a wine retailer and blogger of the famous Les Femmes Co. 微型輕熟女人類誌, for a meetup to learn about her trip to Spain, how she decided to become a wine retailer and start the blog, and her planned trip to Cambodia. Unfortunately, she was busy this weekend because her company was hosting a wine tasting event on Saturday. As a wine novice, I am eager to learn more about wine. So I asked her to sign me up.
星期二, 9月 16, 2014
Taiwan Root Medical Peace Corps 臺灣路竹醫療和平會 斯里蘭卡和緬甸義診 Sri Lanka and Myanmar Medical Missions -- 心得報告 A Single Tread in the Tapestry
Shwedagon Pagoda 仰光大金塔
A Single Tread in the Tapestry
What does it take to make a
difference? An important reason why I chose to become a doctor is to help
others, the ones who need others’ help. I see several homeless people on the
streets, may it be at the underground crossroads, outside of the hospital or
out on the streets. A good Samaritan or fellow citizen would give them some
change or a bill to ease their miseries. Some even took the extra step and post
on the internet for more people to notice. I gave them some spare change a
couple of times. And I was delighted to find out that some are genuine.
However, I also saw some who used the money to buy alcohol or cigarettes and
some who faked their medical conditions. I was disappointed and went out to
search for other ways to help the truly miserable people.
星期二, 7月 22, 2014
哈佛個人管理課：成大事必備
成大事必備的九種能力
1、擺正心態，敢於面對現實
2、讓你擁有過硬的自制能力
3、把情感裝入理性之盒
4、獨處可以激發思考的力量
5、壓力是最好的推動力
6、以變應變，才有出路
7、自信心是人生的堅強支柱
8、把精力投入到自己的強項上
9、要專心地做好一件事
星期一, 6月 02, 2014
LOGGED OUT! Internship 結束了! 端午節快樂!!
恭喜各位台大INTERN!
倒數完大家一起拍照~
還有怕吵到別人而帶的牌子叮嚀要小聲一點 :P
Best Wishes to All of You!
星期三, 5月 21, 2014
Hepatocellular Carcinoma: Clinical Frontiers and Perspectives
Recent Advances in Clinical Practice
Background
Hepatocellular Carcinoma (HCC) is a major health concern:
1. Over 700,000 cases are diagnosed annually
2. One of the leading causes of cancer-related death
3. Main event leading ot deaeth in patients with cirrhosis
Risk Factors:
1. HBV
2. HCV
3. Alcohol-related cirrhosis
4. Non-alcoholic steatohepatitis
5. Smoking
6. Metabolic syndromes?
7. Coffee may diminish risk
Molecular Events: What Have We Learned?
Expectations from the biomedical community for genetic studies:
1. Easily risk-stratify patients
A. Risk for developing HCC
B. Risk for HCC recurrence following "curative: therapy
C. Disease prognostication for existing HCC
2. Identify common and dominant oncogenic pathways
A. Carcinogenesis
B. Invasion and metastases
3. Institute targeted and curative therapies using a personalised medicine approach
Background
Hepatocellular Carcinoma (HCC) is a major health concern:
1. Over 700,000 cases are diagnosed annually
2. One of the leading causes of cancer-related death
3. Main event leading ot deaeth in patients with cirrhosis
Risk Factors:
1. HBV
2. HCV
3. Alcohol-related cirrhosis
4. Non-alcoholic steatohepatitis
5. Smoking
6. Metabolic syndromes?
7. Coffee may diminish risk
Molecular Events: What Have We Learned?
Expectations from the biomedical community for genetic studies:
1. Easily risk-stratify patients
A. Risk for developing HCC
B. Risk for HCC recurrence following "curative: therapy
C. Disease prognostication for existing HCC
2. Identify common and dominant oncogenic pathways
A. Carcinogenesis
B. Invasion and metastases
3. Institute targeted and curative therapies using a personalised medicine approach
星期六, 5月 10, 2014
[Taipei 台北] 大安臨江街 Zoca Pizza 佐佧披薩屋 My Number One Place for Pizza in Taipei!
The Venezia Pizza with seafood and my favorite cheese，Mozzarella
Zoca Pizza 佐佧披薩屋
Address: 台北市安和路二段69巷3號 (信義安和站)
Phone: 02 2707 2212
Date: 2014/2
Price: + 10%，around 400~500 per person
Friends' Gathering (3J1K)
Since the start of the internship，our 3J1K group (Jason，Jeffrey，Joey and Kevin) hardly has the opportunity to meet up due to our different rotation schedules。Thus，we planned this date for us to meet up and relax from work。I have read about Zoca pizza from food blogs and thought that pizza is a nice break from eating pork chops，beef noodle soups，chicken drumsticks，and whatever other bentos are out there。Zoca Pizza is prestigious for their wood-fire Italian pizzas and classic Italian desserts。The owner is from Verona，Italy and has been making pizza and desserts since he was a boy。He offers over 40 kinds of different thin crust pizzas on the menu，which is spectacular。In the U.S., we usually get pepperoni，four cheese，supreme deluxe，mushroom or vegetarian。It is interesting to know that there are that many tasty combinations available。
星期五, 5月 02, 2014
OSCE必備影片! 各部位PE快速學習法! Essentials for Physical Examination
A very useful website for learning physical examination techniques! Thank you Geeky Medics!
https://www.youtube.com/user/geekymedics123
OSCE on Sunday and on duty Saturday...EEEKS! :(
https://www.youtube.com/user/geekymedics123
OSCE on Sunday and on duty Saturday...EEEKS! :(
星期三, 4月 30, 2014
14 Tips I Wished I Knew In High School, But Hey, It is Not Too Late Now!!
1. Start saving for retirement
2. Take care of your body now!
3. Learn to manage and balance your time. Do not put things off for later
4. Figure out who you really are and become independent early
5. Travel as much as you can, remember that a larger world exists beyond your doorstep. Do not buckled down!
6. Pursue passion, not money
7. Ignore the voice that tells you to give up
8. Accept your mistakes and learn from them
9. You cannot have everything. Focus on doing one or two things very well
10. Overcome complacence! You must continue to grow and develop yourself
11. Nobody knows what they are doing or if they are doing the right thing. Take risks! 不要當乖乖牌!!!
12. Get as much education as possible, be it in the classroom or not
13. Do not spend time with people who do not treat you well, and be good to the people you care about. Invest in Your Family, do not wait until it is too late!
14. Put down your smartphone. Save some time to think for yourself
星期六, 3月 22, 2014
Extracorporeal Membrane Oxygenation (ECMO) Current Use and Evolving Applications
Introduction
1. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for severe forms of respiratory failure.
2. Indications of ECMO have expanded beyond acute respiratory distress syndrome (ARDS) to include bridging therapy for pulmonary hypertensive crises, lung transplantations, and refractory hypoxemic/hypercarbic respiratory failure
Principles and Circuitry
1. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for severe forms of respiratory failure.
2. Indications of ECMO have expanded beyond acute respiratory distress syndrome (ARDS) to include bridging therapy for pulmonary hypertensive crises, lung transplantations, and refractory hypoxemic/hypercarbic respiratory failure
Principles and Circuitry
N
Engl J Med 2011; 365:1905-1914
星期五, 3月 07, 2014
Daily Fluids and Nutrition
Fluid Management
1. Total body water (TBW): 60% of lean body weight in men, 50% in women
A. 2/3 Intracellular fluid (ICF), 1/3 Extracellular fluid (ECF)
B. TBW: 0.6 x W = X
C. Intravascular compartment: 1/4 x ECF = Y
D. Interstitial compartment: 3/4 x ECF = Z
2. Disturbances in TBW change serum osmalality and electrolyte concentrations. Majority of water contained in intracellular space, the loss of water alone does not typically result in hemodynamic changes.
3. Total body Na+: 85~90% of total body Na+ is extracellular, and constitutes predominate solute in ECF. Changes lead to contraction or expansion of ECF, manifests as volume depletion or expansion.
4. Maintenance fluids:
A. Minimum water requirements for daily fluid balance = U/O + Stool water loss + insensible losses + drain losses
a. Minimum urine output necessary = solute per day/(maximum amount of solute that can be excreted/L urine)
1) ~600 - 800 mOsm/d / 1, 200 mOsm/L in healthy kidneys = > 0.5 L/d
b. Water loss in stool ~ 200 mL/d
c. Insensible water losses:
1) Skin + respiratory tract: ~400 - 500 mL/d
2) Endogenous metabolism: ~250 - 350 mL/d
B. Total: 1400 mL/d or 60 mL/hr
C. 75 - 175 mEq Na+/d (2 g Na+ diet gives 86 mEq Na+/d)
a. 0.9%: 154 mEq/L
b. 0.45% 77 mEq/L
D. 20 - 60 mEq K+/d for normal renal function
E. 100 - 150 g/d dextrose given to minimize protein catabolism and prevent starvation keotacidosis
a. D5W 50 g dextrose/L
1. Total body water (TBW): 60% of lean body weight in men, 50% in women
A. 2/3 Intracellular fluid (ICF), 1/3 Extracellular fluid (ECF)
B. TBW: 0.6 x W = X
C. Intravascular compartment: 1/4 x ECF = Y
D. Interstitial compartment: 3/4 x ECF = Z
2. Disturbances in TBW change serum osmalality and electrolyte concentrations. Majority of water contained in intracellular space, the loss of water alone does not typically result in hemodynamic changes.
3. Total body Na+: 85~90% of total body Na+ is extracellular, and constitutes predominate solute in ECF. Changes lead to contraction or expansion of ECF, manifests as volume depletion or expansion.
4. Maintenance fluids:
A. Minimum water requirements for daily fluid balance = U/O + Stool water loss + insensible losses + drain losses
a. Minimum urine output necessary = solute per day/(maximum amount of solute that can be excreted/L urine)
1) ~600 - 800 mOsm/d / 1, 200 mOsm/L in healthy kidneys = > 0.5 L/d
b. Water loss in stool ~ 200 mL/d
c. Insensible water losses:
1) Skin + respiratory tract: ~400 - 500 mL/d
2) Endogenous metabolism: ~250 - 350 mL/d
B. Total: 1400 mL/d or 60 mL/hr
C. 75 - 175 mEq Na+/d (2 g Na+ diet gives 86 mEq Na+/d)
a. 0.9%: 154 mEq/L
b. 0.45% 77 mEq/L
D. 20 - 60 mEq K+/d for normal renal function
E. 100 - 150 g/d dextrose given to minimize protein catabolism and prevent starvation keotacidosis
a. D5W 50 g dextrose/L
星期六, 3月 01, 2014
[Taipei 台北] 忠孝復興 Caldo Cafe 咖朵咖啡 舒芙蕾 抹茶熔岩蛋糕 Soufflé and Matcha Green Tea Molten Lava Cake
Classic Soufflé with Caramel sauce and Mango Sorbet
Caldo Cafe 咖朵咖啡
Address: 台北市大安區復興南路一段107巷5弄2號 (忠孝復興站)
Phone: (02) 2731 8023
Website: https://www.facebook.com/caldocafe
Date: 2014/2/23 11:00 AM
Price: 680 NT + 10% = 748 NT
Father and Son Bonding Time
Dad has been very busy lately so I thought I would take him to a restful environment for him to relax for a bit。Caldo Cafe came to mind, because of the big popularity online。Plus, several colleagues have gone and highly recommend their coffee，souffle and molten lava cake。Once dad informed me that he was coming to Taipei to visit me，I immediately made the reservation。This place will be packed in the afternoon，and there are no time restraints on weekdays，so make sure you make the reservation early，like a couple of days before。
星期四, 2月 20, 2014
Neonates - General
1. Nutrition
A. 110 ~115 kcal/kg/day，growth rate: 30 g/day
B. Newborns usu. begin feeding within 6 hrs of life
C. Breastfed or formula fed Q3H~Q4H thereafter
a. The more often baby sucks on the nipple, the more milk will be produced.
D. If the child stops losing weight by 5 ~7 days, and begins to gain by 12 ~14 days, then feeding is okay.
E. No juice or water before 6 months
F. Solid food should be introduced btw 4-6 months。New foods needs to be introduced individually and a week apart to identify allergies and intolerance.
a. Bland to sweetest: Veggies --> green to orange --> fruits
b. Ready for solid foods?
1) Hand-to-mouth coordination
2) ↓ tongue protrusion reflex
3) Sits with support
4) Improved head control
5) Drooling
6) Opens mouth to spoon
A. < 6 wet diapers/day after age 1 wk，1 diaper/day for 1st wk
B. Continual hunger and crying
C. Continually sleepy and lethargic baby
D. <7 feeds/day
E. Long intervals btw feedings
F. Sleeping through the night w/o feeding
G. >10% wt loss
H. Increasing jaundice
A. 110 ~115 kcal/kg/day，growth rate: 30 g/day
B. Newborns usu. begin feeding within 6 hrs of life
C. Breastfed or formula fed Q3H~Q4H thereafter
a. The more often baby sucks on the nipple, the more milk will be produced.
D. If the child stops losing weight by 5 ~7 days, and begins to gain by 12 ~14 days, then feeding is okay.
E. No juice or water before 6 months
F. Solid food should be introduced btw 4-6 months。New foods needs to be introduced individually and a week apart to identify allergies and intolerance.
a. Bland to sweetest: Veggies --> green to orange --> fruits
b. Ready for solid foods?
1) Hand-to-mouth coordination
2) ↓ tongue protrusion reflex
3) Sits with support
4) Improved head control
5) Drooling
6) Opens mouth to spoon
A. < 6 wet diapers/day after age 1 wk，1 diaper/day for 1st wk
B. Continual hunger and crying
C. Continually sleepy and lethargic baby
D. <7 feeds/day
E. Long intervals btw feedings
F. Sleeping through the night w/o feeding
G. >10% wt loss
H. Increasing jaundice
星期三, 2月 19, 2014
[Taipei 台北] 忠孝敦化 PS TAPAS 西班牙餐酒館 香脆培根菠菜雞肉捲佐雪莉酒小紅莓醬 甜蜜熔岩巧克力蛋糕
PS Tapas 西班牙餐酒館
Address: 台北市大安區安和路一段21巷19號 (忠孝敦化站)
Phone:(02) 2740-3636
Website: https://www.facebook.com/PSTapas
Date: 2014/2/14 6:30 PM
Price: 1364 NT (including 10%)
Valentine's Day Special
How long does it take for both Valentine's AND the Lantern Festival (元宵節) to be on the SAME day? The answer is, 19 years!
Therefore for this rare holiday, I planned ahead and scheduled myself to be free for the night。After handing over the shift, I was set to embark on a culinary journey with Eunice to explore Spanish cuisine。Eunice hasn't had many chances to try Spanish food。She had only gone to La Paella once in Gongguan, which I thought was decent，but there are definitely better restaurants out there。Plus, I haven't had Tapas for a long while now, the last time was at the Tapeo Restaurant & Tapas Bar in Boston more than a year ago。There is room for improvement, but the $5 Tapas menu at Tapeo was cheaper compared to many other places。I decided to give it a try in Taiwan, and wanted to book MVSA Spanish Restaurant & Bar，but it was fully booked。So I went online to search for another。PS Tapas is highly recommended by Eztable and many bloggers，so I chose this restaurant for this very special night。
星期二, 2月 18, 2014
Peds - Acute Tummyache Differentials and Workup!
When should you call your senior, if there is one..
Acute Abdominal Pain by Age
Common to Uncommon
Acute Abdomen
1. Trauma
A. Motor vehicle collisions, falls, child abuse
2. Appendicitis
A. Most predictive: RLQ pain, abd. wall rigidity, and migration of periumbilical pain to the RLQ
B. Pediatric Appendicitis Score (PAS)
1. For 1-17 y/o, total 10 pts
2. Point System:
a. 2 pts: cough/percussion/hopping tenderness; RLQ tenderness;
b. 1 point: fever > 38° C, anorexia, N/V, migration of pain, WBC >10 000 cells/mm3 , and PMN >7500 cells/mm3
3. Score
PAS≧ 7: dx of appendicitis
PAS 3-6: Need image studies
PAS≦ 2: exclusion
(Reference: Journal of Pediatrics 153.2 (2008): 278-282)
C. Perforation rarely occurs within the first 24 hrs
3. Intussusception
A. 2 months - 2 yrs, peak at 6 months
B. Triad (<15%):
1. Intermittent, colicky pain (88%)
2. Palpable sausage-shaped abd. mass (48%)
3. Currant-jelly stool (25%)
Others: Inconsolable crying, drawing legs towards abd., bilious emesis. 15-20 min intervals. Progressive
C. Dx: Ultrasound
1. Target sign/coiled spring sign
2. Most common: ileocolic (95%)
D. Tx:
1. Hydrostatic (ex. Barium) /pneumatic enema under Ultrasound guidance <48 hrs of onset
2. Surgery (esp. small bowel)
4. Malrotation with midgut volvulus
1. S/S: Bilious/Non-bilious vomiting + abd. pain
5. Incarcerated inguinal hernia
1. S/S: irritable and crying, vomiting, abdominal distention, palpation of a firm inguinal mass that may extend to scrotum/labia majora in the groin
6. Adhesions with intestinal obstruction
1. Hx of abd. surgery + abd. pain
7. Necrotizing enterocolitis
1. S/S: vomiting, abd. distention, and tenderness
2. Prematurity, congenital heart diseases more common
8. Peptic ulcer disease
1. >10 yrs: Meds (ex. NSAIDs)/Stress
2. H.pylori less common
9. Ectopic pregnancy
1. Postmenarchal girls
2. S/S: abd. pain, amenorrhea, vaginal bleeding
Acute Abdominal Pain by Age
Common to Uncommon
| Age | Neonate | 2 m- 2yrs | 2 m - 5 yrs | >5 yrs |
| ER | Volvulus | Trauma | Trauma | Appendicitis |
| NEC | Incarcerated hernia | Appendicitis | Trauma | |
| Adhesions | Intussusception | Intussusception | DKA | |
| Foreign body ingestion | Foreign body ingestion | PPU | ||
| Hirschsprung disease | Adhesions | Adhesions | ||
| Adhesions | HUS | HUS | ||
| HUS | Primary bacterial peritonitis | Myocarditis/pericarditis | ||
| Primary bacterial peritonitis | ||||
| Common/ER | Colic | AGE | AGE | AGE |
| Viral illness | Viral illness | Viral illness | ||
| Pharyngitis | Constipation | |||
| Constipation | Pharyngitis |
Acute Abdomen
1. Trauma
A. Motor vehicle collisions, falls, child abuse
2. Appendicitis
A. Most predictive: RLQ pain, abd. wall rigidity, and migration of periumbilical pain to the RLQ
B. Pediatric Appendicitis Score (PAS)
1. For 1-17 y/o, total 10 pts
2. Point System:
a. 2 pts: cough/percussion/hopping tenderness; RLQ tenderness;
b. 1 point: fever > 38° C, anorexia, N/V, migration of pain, WBC >10 000 cells/mm3 , and PMN >7500 cells/mm3
3. Score
PAS≧ 7: dx of appendicitis
PAS 3-6: Need image studies
PAS≦ 2: exclusion
(Reference: Journal of Pediatrics 153.2 (2008): 278-282)
C. Perforation rarely occurs within the first 24 hrs
3. Intussusception
A. 2 months - 2 yrs, peak at 6 months
B. Triad (<15%):
1. Intermittent, colicky pain (88%)
2. Palpable sausage-shaped abd. mass (48%)
3. Currant-jelly stool (25%)
Others: Inconsolable crying, drawing legs towards abd., bilious emesis. 15-20 min intervals. Progressive
C. Dx: Ultrasound
1. Target sign/coiled spring sign
2. Most common: ileocolic (95%)
D. Tx:
1. Hydrostatic (ex. Barium) /pneumatic enema under Ultrasound guidance <48 hrs of onset
2. Surgery (esp. small bowel)
4. Malrotation with midgut volvulus
1. S/S: Bilious/Non-bilious vomiting + abd. pain
5. Incarcerated inguinal hernia
1. S/S: irritable and crying, vomiting, abdominal distention, palpation of a firm inguinal mass that may extend to scrotum/labia majora in the groin
6. Adhesions with intestinal obstruction
1. Hx of abd. surgery + abd. pain
7. Necrotizing enterocolitis
1. S/S: vomiting, abd. distention, and tenderness
2. Prematurity, congenital heart diseases more common
8. Peptic ulcer disease
1. >10 yrs: Meds (ex. NSAIDs)/Stress
2. H.pylori less common
9. Ectopic pregnancy
1. Postmenarchal girls
2. S/S: abd. pain, amenorrhea, vaginal bleeding
星期三, 2月 12, 2014
[Taipei 台北] 大直 Danny's Steakhouse 教父牛排 木香烤爐 美國頂級肋眼牛排 USDA Prime Ribeye Steak
A 16 oz. succulent, rich, and hearty prime ribeye steak
Danny's Steakhouse 教父牛排
Address: 台北市樂群三路58號(捷運劍南路站)
Phone #: 02-8501-1838
Website: http://dannyssteakhouse.com.tw/
Date: 2014/2/09 12:00 PM
Price: NT 1530 + 60 NT + 10% = 1749 NT/Person
Danny's Steakhouse (教父牛排) is 牛排教父 鄧有癸's third restaurant north in Dazhi (大直) ，a high class steakhouse directly opposite of Osteria by Angie。 It was opened in 2013 and has been getting lots of attention for its tender，juicy steaks baked by the wood-fired oven (木香烤爐) ，which not only gives steaks a crispy crust,，but also the faint, smoky smell of white oak(白橡木)，hickory(胡桃木) or cherrywood (櫻桃木)。
Grilling steaks over a wood fire has been a traditional way of grilling steaks in the U.S。Although many have shifted to the grill, pan or the conventional oven nowadays，many popular steakhouses still use the wood oven for its distinct taste, crispy texture, and fragrant smell。Having been in the steakhouse business for around 40 years, Chef 鄧有癸's impressive resume includes leading kitchens at the Sonoma Grill，國賓A CUT，and No. 168 PRIME, importing the wood-fire grill from the U.S., and introducing the concept of the dry- aged steak in Taiwan。He cooks steak by first pan-searing for two minutes， then putting it into the refrigerator for the temperature to diffuse to the center， which raises the internal temperature to 40 degrees Celsius。After five minutes，the steak is placed into an oven with the capability of increasing the temperature quickly to 1000 degrees Celsius to seal the juices。The steak is then taken out and set it to rest for five to ten minutes。Lastly，the steak is grilled with the wood oven over open fire。Doneness is judged by looking and touching the steak with fingertips，the so-called "finger test"。
(Simple tutorial of the "finger test" can be found here: http://www.simplyrecipes.com/recipes/the_finger_test_to_check_the_doneness_of_meat/)
星期四, 2月 06, 2014
外國人對台灣人的看法
身為在台灣出生的美國僑生，我一直都對文化差異很好奇。查google時出現了國光幫幫忙的影片，就好奇了看了兩集邀請來自不同國家的男生分享他們對台灣男生女生的看法。分別有來自法國，義大利，德國，美國，韓國和日本的男生。內容整理如下:
外國男生眼中的台灣男生:
1. 不夠man (這點被提到很多次)
Ex. 幫女生提手提包，背包
有些男生有baby face，讓女生覺得不夠man
2. 太過於害羞，太有禮貌
3. 過度照顧女方，以女生利益為優先。事事都聽女生的，也都幫她付錢
4. 過於在乎別人的想法，沒有主見
5. 太聽話，沒有先明辨是非，不獨立
6. 社交能力不夠
7. 沒有國際觀? 大材小用?
外國男生眼中的台灣女生:
1. 很會打扮，很可愛。
但有些妝太濃也花太多時間打扮。沒有化妝不出門。晴天時撐傘。
2. 公主病
據說有統計說台灣公主病最多
3. 雙重標準
對外國人的攻勢覺得很帥，溫柔體貼。但對於台灣男生就覺得怪怪的，噁心?
4. 很強勢。緊迫逼人，常看手機，讓男生覺得沒有自由
5. 沒有獨立性，沒有主見。常常要男方出錢。
6. 易受騙，容易上當。尤其對方男性是外國人或ABC
7. 比較會照顧男生，但有些把男人當小孩
外國人最受不了的:
1. 碎碎念 (Big turnoff!)
2. 每天見面，沒自己的空間
3. 檢查手機
4. 娃娃音
5. 裝可愛
嘟嘴, 吐舌頭, 幼稚的熟女。
6. 假睫毛，彩色隱形眼鏡
7. 整形
8. 太瘦，但常常講自己很胖
9. 網上照片和真實判若兩人
其實外國人也不是都具有他們講的那幾點；不man，anti-social的，沒有主見和媽寶也不少。所以根本的問題是台灣女生有雙重標準? 有人提出對外國人tolerance比較高是因為台灣女生比較愛玩，更想要嘗鮮。但這不奇怪吧，台灣男生不也覺得白皮膚的女生很稀奇? 交到白皮膚的女友就說是台灣之光?
對於外國人最受不了的那幾點，有些我也認同。碎碎念對我來講真的是一個big turnoff，特別是那種不明原因的碎碎念。以前認試一位對我有好感的女生不管我做什麼都會念。像有一次我跟朋友們吃飯，我晚到在看menu時，她就在旁念說我menu看太久，沒有早點想到我要吃什麼。適當的還可以接受，但有時真得讓人會抓狂! 要求每天見面和檢查手機我還沒遇過，但我想如果我女友這樣我也會有意見吧。每個人都要有自己的目標，不能因為交往而放棄自己原本的goals。每天跟女友見面就等於時間都在約會；書不用念了，沒時間思考人生目標，事情也都沒時間做了。關於打扮，可能是因為在美國的女生打扮得比較自然，也比較喜歡自然的美。除了special occasions不然也不會特地化濃妝，所以我也不是很習慣化濃妝的女生。不過，公平來講，有些女生濃妝確實還蠻漂亮的，很有美感。Kawaii我覺得還好，有些時候其實還蠻讓我心動的。不要常常裝 (除非她本來音就是這樣..) 好像有加分效果。
我對於台灣女生tolerance比較高不知道是因為我來台灣已經6年多了，被台化的，還是我周遭的女性朋友這幾點都不太明顯。也有可能是我感情經驗不多. 之後有些其他想法再補充好了。
(Reference: 國光幫幫忙- 台灣男生好命苦，國光幫幫忙 -台灣女生都是被寵壞的)
外國男生眼中的台灣男生:
1. 不夠man (這點被提到很多次)
Ex. 幫女生提手提包，背包
有些男生有baby face，讓女生覺得不夠man
2. 太過於害羞，太有禮貌
3. 過度照顧女方，以女生利益為優先。事事都聽女生的，也都幫她付錢
4. 過於在乎別人的想法，沒有主見
5. 太聽話，沒有先明辨是非，不獨立
6. 社交能力不夠
7. 沒有國際觀? 大材小用?
外國男生眼中的台灣女生:
1. 很會打扮，很可愛。
但有些妝太濃也花太多時間打扮。沒有化妝不出門。晴天時撐傘。
2. 公主病
據說有統計說台灣公主病最多
3. 雙重標準
對外國人的攻勢覺得很帥，溫柔體貼。但對於台灣男生就覺得怪怪的，噁心?
4. 很強勢。緊迫逼人，常看手機，讓男生覺得沒有自由
5. 沒有獨立性，沒有主見。常常要男方出錢。
6. 易受騙，容易上當。尤其對方男性是外國人或ABC
7. 比較會照顧男生，但有些把男人當小孩
外國人最受不了的:
1. 碎碎念 (Big turnoff!)
2. 每天見面，沒自己的空間
3. 檢查手機
4. 娃娃音
5. 裝可愛
嘟嘴, 吐舌頭, 幼稚的熟女。
6. 假睫毛，彩色隱形眼鏡
7. 整形
8. 太瘦，但常常講自己很胖
9. 網上照片和真實判若兩人
其實外國人也不是都具有他們講的那幾點；不man，anti-social的，沒有主見和媽寶也不少。所以根本的問題是台灣女生有雙重標準? 有人提出對外國人tolerance比較高是因為台灣女生比較愛玩，更想要嘗鮮。但這不奇怪吧，台灣男生不也覺得白皮膚的女生很稀奇? 交到白皮膚的女友就說是台灣之光?
對於外國人最受不了的那幾點，有些我也認同。碎碎念對我來講真的是一個big turnoff，特別是那種不明原因的碎碎念。以前認試一位對我有好感的女生不管我做什麼都會念。像有一次我跟朋友們吃飯，我晚到在看menu時，她就在旁念說我menu看太久，沒有早點想到我要吃什麼。適當的還可以接受，但有時真得讓人會抓狂! 要求每天見面和檢查手機我還沒遇過，但我想如果我女友這樣我也會有意見吧。每個人都要有自己的目標，不能因為交往而放棄自己原本的goals。每天跟女友見面就等於時間都在約會；書不用念了，沒時間思考人生目標，事情也都沒時間做了。關於打扮，可能是因為在美國的女生打扮得比較自然，也比較喜歡自然的美。除了special occasions不然也不會特地化濃妝，所以我也不是很習慣化濃妝的女生。不過，公平來講，有些女生濃妝確實還蠻漂亮的，很有美感。Kawaii我覺得還好，有些時候其實還蠻讓我心動的。不要常常裝 (除非她本來音就是這樣..) 好像有加分效果。
我對於台灣女生tolerance比較高不知道是因為我來台灣已經6年多了，被台化的，還是我周遭的女性朋友這幾點都不太明顯。也有可能是我感情經驗不多. 之後有些其他想法再補充好了。
(Reference: 國光幫幫忙- 台灣男生好命苦，國光幫幫忙 -台灣女生都是被寵壞的)
Seven Habits of Highly Successful Medical Students
Habit 1: Learn how you learn. Then just do it.
Figure out how you learn best and the most efficiently. Field of medicine requires life-long learning. As a doctor, we will need to constantly update our knowledge of our field by reviewing textbooks, reading journals, attending conferences, and discussing interesting cases with colleagues and learning from them. Thus, it is best to know you learn best early.
Habit 2: Look beyond your books.
Get involved in extracurricular activities, you will never know what benefits you will get, such as establishing connections with department chairs.
Habit 3: Give back.
Volunteer experiences are not only for getting into medical school. Medical school provides numerous opportunities for you to give back to the community. This gives you the chance to meet new people, develop and hone skills, and even better, they can go on your residency application.
Habit 4: Be adventurous, both professionally and personally – you never know where it may lead you.
Early exploration helps you to make your decisions - your specialty, the type of hospital environment you want to work in, the medical cultures, etc.
Habit 5: Recognize your own strengths and weaknesses.
Identify strengths and weaknesses. Feed your strengths and work on your weaknesses.
Habit 6: Establish a circle of mentors.
Some schools have formal mentoring programs, while some schools only have mentors who you can connect if you have any questions. Take advantage of these, and try to establish connects from various backgrounds and fields. These can range from senior medical students to professors and chairs. They can provide fruitful advice on perspectives and issues that you are going through as they have seen students and peers go through the ups and downs of medical school.
Habit 7: Take time for you.
Medical school is not everything, live the life! Finding the balance is critical for your career.
(Source: Faculty of Medicine)
http://forum.facmedicine.com/threads/the-seven-habits-of-highly-successful-medical-students.17646/
Figure out how you learn best and the most efficiently. Field of medicine requires life-long learning. As a doctor, we will need to constantly update our knowledge of our field by reviewing textbooks, reading journals, attending conferences, and discussing interesting cases with colleagues and learning from them. Thus, it is best to know you learn best early.
Habit 2: Look beyond your books.
Get involved in extracurricular activities, you will never know what benefits you will get, such as establishing connections with department chairs.
Habit 3: Give back.
Volunteer experiences are not only for getting into medical school. Medical school provides numerous opportunities for you to give back to the community. This gives you the chance to meet new people, develop and hone skills, and even better, they can go on your residency application.
Habit 4: Be adventurous, both professionally and personally – you never know where it may lead you.
Early exploration helps you to make your decisions - your specialty, the type of hospital environment you want to work in, the medical cultures, etc.
Habit 5: Recognize your own strengths and weaknesses.
Identify strengths and weaknesses. Feed your strengths and work on your weaknesses.
Habit 6: Establish a circle of mentors.
Some schools have formal mentoring programs, while some schools only have mentors who you can connect if you have any questions. Take advantage of these, and try to establish connects from various backgrounds and fields. These can range from senior medical students to professors and chairs. They can provide fruitful advice on perspectives and issues that you are going through as they have seen students and peers go through the ups and downs of medical school.
Habit 7: Take time for you.
Medical school is not everything, live the life! Finding the balance is critical for your career.
(Source: Faculty of Medicine)
http://forum.facmedicine.com/threads/the-seven-habits-of-highly-successful-medical-students.17646/
星期日, 1月 26, 2014
Shocks in Adults
Types:
1. Hypovolemic - decreased preload due to volume loss
2. Cardiogenic - cardiac pump failure
3. Distributive (vasodilatory) - severely decreased SVR
4. Combined - ex. septic shock
1. Hypovolemic - decreased preload due to volume loss
2. Cardiogenic - cardiac pump failure
3. Distributive (vasodilatory) - severely decreased SVR
4. Combined - ex. septic shock
| Types | Preload | Pump Function | Afterload | Tissue Perfusion |
Measurement
|
PCWP | CO | SVR | SvO2 |
| Hypovolemic | ↓ | ↓ | ↑ | ↓ |
| Cardiogenic | ↑ | ↓ | ↑ | ↓ |
| Distributive | ↓/↔ | ↑ | ↓ | ↑ |
Stages of Shock:
1. Preshock
2. Shock
3. End-organ dysfunction
Septic Shock
Mortality: 20~50%
Goals:
1. Early initiation of supportive care to correct physiologic abnormalities, ex. hypotension/hypoxemia.
2. Distinguishing sepsis from SIRS to treat infections ASAP
Management
1. Stabilize respiration
A. Supplemental Oxygen + monitor w/ pulse oximetry
a. Intubation/mechanical ventilation
b. CXR + ABG
2. Assess Perfusion
A. Inadequate perfusion
a. Hypotension: SBP <90 mmHg, MAP <70 mmHg, ↓ SBP >40 mmHg
a) Causes: loss of plasma volume into the interstitial space, decreased vascular tone, and myocardial depression.
b. S/S: cool, vasoconstricted skin, HR>90/min, obtundation/restlessness, and oliguria/anuria, serum lactate >1 mmol/L
c. If BP labile --> A-line
Goals:
1. Early initiation of supportive care to correct physiologic abnormalities, ex. hypotension/hypoxemia.
2. Distinguishing sepsis from SIRS to treat infections ASAP
Management
1. Stabilize respiration
A. Supplemental Oxygen + monitor w/ pulse oximetry
a. Intubation/mechanical ventilation
b. CXR + ABG
2. Assess Perfusion
A. Inadequate perfusion
a. Hypotension: SBP <90 mmHg, MAP <70 mmHg, ↓ SBP >40 mmHg
a) Causes: loss of plasma volume into the interstitial space, decreased vascular tone, and myocardial depression.
b. S/S: cool, vasoconstricted skin, HR>90/min, obtundation/restlessness, and oliguria/anuria, serum lactate >1 mmol/L
c. If BP labile --> A-line
Notes (備忘) - 2
1. Anion Gap Metabolic Acidosis
A. Anion-gap = [Na+] - ([Cl-] + [HCO3-])
MUDPILES
M. Methanol intoxication
U. Uremia
D. Diabetic or alcoholic ketoacidosis
P. Paraldehyde
I. Isoniazid/Iron overdose
L. Lactic acid
E. Ethylene glycol intoxication
S. Salicylate intoxication
Non-Anion Gap Metabolic Acidosis
HARDUP
H. Hyperalimentation/hyperventilation
A. Acetazolamide
R. RTA
D. Diarrhea
U. Ureteroenteric fistula
P. Pancreatic fistula/parenteral saline
2. Dialysis Indications:
AEIOU
A. Acid-base problems (severe acidosis or alkalosis)
E. Electrolyte problems (hyperkalemia)
I. Intoxications
O. Overload, fluid
U. Uremic symptoms
A. Anion-gap = [Na+] - ([Cl-] + [HCO3-])
MUDPILES
M. Methanol intoxication
U. Uremia
D. Diabetic or alcoholic ketoacidosis
P. Paraldehyde
I. Isoniazid/Iron overdose
L. Lactic acid
E. Ethylene glycol intoxication
S. Salicylate intoxication
Non-Anion Gap Metabolic Acidosis
HARDUP
H. Hyperalimentation/hyperventilation
A. Acetazolamide
R. RTA
D. Diarrhea
U. Ureteroenteric fistula
P. Pancreatic fistula/parenteral saline
2. Dialysis Indications:
AEIOU
A. Acid-base problems (severe acidosis or alkalosis)
E. Electrolyte problems (hyperkalemia)
I. Intoxications
O. Overload, fluid
U. Uremic symptoms
星期一, 1月 20, 2014
Notes (備忘) - 1
1. Glasgow coma scale (GCS)
| GCS | Response | |
| Eye | Open Spontaneously | 4 |
| Open to Verbal Command | 3 | |
| Open to Pain Stimulus | 2 | |
| No Response | 1 | |
| Verbal | Talk Spontaneously | 5 |
| Confused, Disoriented Speech | 4 | |
| Inappropriated words | 3 | |
| Incomprehensive words | 2 | |
| None | 1 | |
| Motor | Obeys | 6 |
| Localizes to Pain | 5 | |
| Withdraws from Pain | 4 | |
| Abnormal flexion, decorticate posture | 3 | |
| Extensor response, decerebrate posture | 2 | |
| None | 1 | |
| Total | 3 to 15 | ??? |
2. White and Grey Matter
| Outside | Inside | |
| Brain | Grey | White |
| Spinal Cord | White | Grey |
3. Mean Arterial Pressure (MAP)
(From wikipedia)
星期日, 1月 19, 2014
Chronic Complications of Spinal Cord Injury (SCI)
Life Expectancy:
1. Mortality rates highest during 1st year
2. >1 yr, then ~90% of normal
Cardiovascular Complications:
1. Autonomic dysreflexia: SCI>T6 due to uninhibited sympathetic responses
A. Occurs in 20~70%, >1 m to <1 yr
B. Not Below T6 b/c intact splanchnic innervation allows for compensatory dilatation of the splanchnic vascular bed.
C. Prevent stimuli, ex. bladder distention, bowel impaction, pressure sores, bone fracture, or occult visceral disturbances
D: S/S: HA, diaphoresis, HTN, flushing, piloerection, blurred vision, nasal obstruction, and nausea.
a. profound bradycardia, OHCA, ICH, seizures
E. Tx:
a. Measure BP
b. Sitting the patient upright to orthostatically lower BP
c. Search for noxious stimuli
d. BP meds: nitrates, nifedepine, sublingual captopril, IV hydralazine, IV labetalol
2. CAD
A. Risk factors: decreased muscle mass, increased fat, and inactivity, 3~10X more likely. Esp. >T5 level
B. Tx same as non-SCI pts
3. Orthostatic hypotension
A: More common in 1st several months of SCI, but can still occur due to excessive bed rest+ low fluid intake
4. Bradycardia (>T6)
A: baseline pressure reduced
1. Mortality rates highest during 1st year
2. >1 yr, then ~90% of normal
Cardiovascular Complications:
1. Autonomic dysreflexia: SCI>T6 due to uninhibited sympathetic responses
A. Occurs in 20~70%, >1 m to <1 yr
B. Not Below T6 b/c intact splanchnic innervation allows for compensatory dilatation of the splanchnic vascular bed.
C. Prevent stimuli, ex. bladder distention, bowel impaction, pressure sores, bone fracture, or occult visceral disturbances
D: S/S: HA, diaphoresis, HTN, flushing, piloerection, blurred vision, nasal obstruction, and nausea.
a. profound bradycardia, OHCA, ICH, seizures
E. Tx:
a. Measure BP
b. Sitting the patient upright to orthostatically lower BP
c. Search for noxious stimuli
d. BP meds: nitrates, nifedepine, sublingual captopril, IV hydralazine, IV labetalol
2. CAD
A. Risk factors: decreased muscle mass, increased fat, and inactivity, 3~10X more likely. Esp. >T5 level
B. Tx same as non-SCI pts
3. Orthostatic hypotension
A: More common in 1st several months of SCI, but can still occur due to excessive bed rest+ low fluid intake
4. Bradycardia (>T6)
A: baseline pressure reduced
星期六, 1月 18, 2014
Acute Traumatic Spinal Cord Injury (TSCI)
Incidence:
40 million persons per year
Causes of TSCI:
●Motor vehicle accidents: 47 percent
●Falls: 23 percent
●Violence (especially gunshot wounds): 14 percent
●Sports accidents: 9 percent
●Other: 7 percent
S/S: Based on severity, assess by American Spinal Injury Association Scale (ASIA):
1. Complete cord injury (ASIA grade A): reduced S+M at the level below, then no sensory + motor at all
Acute: reflex (-), flaccid muscle tone, plantar stimulation (-), bulbocavernosus reflex (-), anal sensation (-), urinary retention, bladder distension, (priapism)
2. Incomplete cord injury (ASIA grades B through D): S+M partially preserved below the level of injury.
1. S preserved>M b/c more peripheral
2. bulbocavernosus reflex, anal sensation (+)
3. Central cord syndrome: preexisting cervical spondylosis + mild trauma
1. M impairment > S in upper ext. than lower ext.
2. Bladder dysfunction
3. Sensory loss below level of lesion
*esp. hyperextension injury
4. Anterior Cord Syndrome: usu. anterior spinal a. injury by bone fragments
1. Weakness and reflex changes
2. Bilateral loss of pain and temperature sensation
3. Urinary incontinence
4. Tactile, position, and vibratory sensation are normal (Dorsal column spared)
Spinal shock: hrs ~ wks
Immediately after injury, loss of all spinal cord function caudal to level of injury
●Bradycardia, hypotension, flaccid paralysis, anesthesia, bowel and bladder control (-), reflex (-), (priapism)
Mechanism: reduced axonal transmission due to K+ loss in cells of the cord
40 million persons per year
Causes of TSCI:
●Motor vehicle accidents: 47 percent
●Falls: 23 percent
●Violence (especially gunshot wounds): 14 percent
●Sports accidents: 9 percent
●Other: 7 percent
S/S: Based on severity, assess by American Spinal Injury Association Scale (ASIA):
1. Complete cord injury (ASIA grade A): reduced S+M at the level below, then no sensory + motor at all
Acute: reflex (-), flaccid muscle tone, plantar stimulation (-), bulbocavernosus reflex (-), anal sensation (-), urinary retention, bladder distension, (priapism)
2. Incomplete cord injury (ASIA grades B through D): S+M partially preserved below the level of injury.
1. S preserved>M b/c more peripheral
2. bulbocavernosus reflex, anal sensation (+)
3. Central cord syndrome: preexisting cervical spondylosis + mild trauma
1. M impairment > S in upper ext. than lower ext.
2. Bladder dysfunction
3. Sensory loss below level of lesion
*esp. hyperextension injury
4. Anterior Cord Syndrome: usu. anterior spinal a. injury by bone fragments
1. Weakness and reflex changes
2. Bilateral loss of pain and temperature sensation
3. Urinary incontinence
4. Tactile, position, and vibratory sensation are normal (Dorsal column spared)
Spinal shock: hrs ~ wks
Immediately after injury, loss of all spinal cord function caudal to level of injury
●Bradycardia, hypotension, flaccid paralysis, anesthesia, bowel and bladder control (-), reflex (-), (priapism)
Mechanism: reduced axonal transmission due to K+ loss in cells of the cord
Neck, Shoulder and Arm Pain
Differential Diagnosis
| Origin | Pain Location | Exacerbation | Physical Examination | Diseases |
| Cervical Spine | Back of neck/head + shoulder/upper arm | Neck movements | 1. Limitation of neck motion 2. Tenderness to palpation over the cervical spine | OA, Osteophytes, Cervical disc herniation, RA, Trama, Whiplash injury, cervical spondylosis, thoracic outlet syndrome |
| Brachial Plexus | Supraclavicular region/ axilla/shoulder | Arm and neck movements/maneuvers (ex. external rotation) | Palpable abnormality above the clavicle | Brachial neuritis, metastatic infiltration, radiation damage to the plexus |
| Shoulder | Shoulder + (arm) | Shoulder motion | Tenderness and limitation of movement (internal/external rotation/abduction) sensorimotor and reflex changes (-) | Rotator cuff injury/tear, subacromial/subdeltoid bursitis, periarthritis or capsulitis (frozen shoulder), tendonitis, and arthritis, MI, Sudeck atrophy or Sudeck-Leriche syndrome |
*Whiplash injury: If NE (+), consider brain, spinal cord injury, or carotid or vertebral artery dissection
Disc Herniation
Definition: tear in outer ring, annulus fibrosis (AF), and bulging of nucleus pulposus (NC). Usu. posterolateral
Most common: 30 ~40 y/o
b/c NC still gelatin-like.
>40 y/o
NC dehydrated, reduced risk of herniation
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