tag:blogger.com,1999:blog-73357552897282091472024-03-21T16:07:50.441-04:00Physician Assistant, Finally ThereFalse Starts, Stumbles, and Spectacular Finishes Encountered on the PA Path...Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.comBlogger232125tag:blogger.com,1999:blog-7335755289728209147.post-86891928379362848562014-10-23T19:41:00.001-04:002014-10-23T19:41:27.207-04:00Dr. Rhoton's Anatomy 2D and 3D<div class="body-heading" style="background-color: white; border-top-color: rgb(0, 101, 164); border-top-style: solid; border-top-width: 1px; box-sizing: border-box; font-family: chaparral-pro, Georgia, serif; line-height: 24px; padding: 15px 0px 5px;">
Medtronic and Dr. Rhoton put together an amazing YouTube series on "Rhoton Anatomy" in both 2D and 3D versions. I highly recommend checking them out. An incredible amount of effort and detail went into these!</div>
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<span style="font-family: chaparral-pro, Georgia, serif;"><span style="line-height: 24px;"> 2D: </span></span><span style="background-color: transparent; line-height: 24px;"><span style="color: blue; font-family: chaparral-pro, Georgia, serif;"><a href="https://www.youtube.com/playlist?list=PL6307C9E54B56AD87">https://www.youtube.com/playlist?list=PL6307C9E54B56AD87</a></span></span></div>
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<span style="font-family: chaparral-pro, Georgia, serif;"><span style="line-height: 24px;">3D: </span></span><span style="background-color: transparent; line-height: 24px;"><span style="font-family: chaparral-pro, Georgia, serif;"><a href="https://www.youtube.com/playlist?list=PL202A5006EB93D42D">https://www.youtube.com/playlist?list=PL202A5006EB93D42D</a></span></span></div>
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Dr. Rhoton Biography</div>
<img alt="Dr. Rhoton" class="image-right" src="http://www.stmeded.medtronic.com/wcm/groups/mdtcom_sg/@mdt/documents/images/e-institute-dr-rhoton.jpg" style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; float: right; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px; padding: 10px 0px 15px 15px; vertical-align: middle;" /><br />
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Dr. Albert L. Rhoton, Jr. attended Washington University School of Medicine, graduating with the highest academic standing in the class of 1959. He completed his neurosurgical training at Washington University and joined the staff of the Mayo Clinic in Rochester, Minnesota in 1965. He became Professor and Chairman of the Department of Neurological Surgery at the University of Florida in 1972.</div>
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Dr. Rhoton has served as President of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the Society of Neurological Surgeons, the North American Skull Base Society, the International Interdisciplinary Congress on Craniofacial and Skull Base Surgery, the Florida Neurosurgical Society, and the International Society for Neurosurgical Technology and Instrument Invention. He served as the Honored Guest of the Congress of Neurological Surgeons and was awarded the Cushing Medal of the American Association of Neurological Surgeons in 1998, the highest honor given by the two largest neurosurgical societies in the United States. He has been awarded the Medal of Honor of the World Federation of Neurosurgical Societies, and has served as the Honored Guest or been elected to Honorary Membership in neurosurgical societies in Africa, Asia, Australia, Europe, and North and South America.</div>
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He has published over 400 scientific papers. He has received the Golden Neuron Award of the World Academy of Neurological Surgeons and was selected as the 2011 “Neurosurgeon of the Year” by the journal World Neurosurgery. He completed the Millennium and Anniversary Issues of Neurosurgery and a book entitled “Cranial Anatomy and Surgical Approaches,” which has been translated into several languages. He has received an Alumni Achievement Award from Washington University School of Medicine and both a Distinguished Faculty Award and a Lifetime Achievement Award from the University of Florida.</div>
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Friends, colleagues, and former residents contributed nearly $2 million to the University of Florida Foundation to create the Rhoton Chairman’s Endowed Professorship at the University of Florida, a gift that has grown to more than $6 million. This is in addition to 11 endowed chairs that Dr. Rhoton has raised for neurosurgery over the years. He and his wife, Joyce, have four children, all pursuing medical careers.</div>
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<span style="font-size: xx-small;">Source: http://www.stmeded.medtronic.com/anatomy-courses/rhoton-biography/index.htm</span></div>
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Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com3tag:blogger.com,1999:blog-7335755289728209147.post-14607914841744370582014-09-04T10:32:00.000-04:002014-09-04T10:32:03.702-04:00SMS Texting is Not HIPAA CompliantJust wanted to share a great article on <a href="http://www.physicianspractice.com/pearls/five-ways-ensure-secure-text-messaging-your-medical-practice/page/0/1?GUID=CD64E2F5-5ED6-44B8-9D7D-3572D8F90DC5&rememberme=1&ts=04092014" target="_blank">texting and HIPAA Compliance</a>: <i>Five Ways to Ensure Secure Text Messaging in Your Medical
Practice</i><br />
<br />Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com3tag:blogger.com,1999:blog-7335755289728209147.post-85316609199349704442014-04-27T13:20:00.001-04:002014-04-27T13:20:33.371-04:00PAProgramSearch.com: Great Pre-PA Resource<br />
<br />
I recently received an email from Ken Johnson, the developer of <a href="http://paprogramsearch.com/">PAprogramsearch.com</a>. Ken and his significant other went to the same process that many of us did when searching for PA programs and also encountered the same frustrations. It is difficult to find out which schools have which requirements. I ended up with a spreadsheet of the schools that I was going to apply to, their prerequisites, and checkboxes for the things that I had completed. Since there's no standardization of PA programs and their prerequisites at this time is difficult for students to keep track of.... in comes PAprogramsearch.com.<br />
<br />
This website allows you to check off particular classes that you have taken as well as shadowing hours, etc. And then produces a list of schools with the "match percentage". The site is very easy to use it appears to be up to date. <b>I always recommend going to be official program website to double check the prerequisites (as they can change at any time) but this is a great place to start.</b><br />
<b><br /></b>
<b><span style="color: red; font-size: x-small;">Financial disclosure: </span></b><br />
<b><span style="color: red; font-size: x-small;">I have no monetary or other connections to this website or the developers . Just sharing a resource. </span></b><br />
<b><br /></b>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-f7jqp7oOwJs/U107gPZ4pSI/AAAAAAAAA_0/rjH5hR1ecUo/s1600/Screenshot+2014-04-27+13.12.31.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-f7jqp7oOwJs/U107gPZ4pSI/AAAAAAAAA_0/rjH5hR1ecUo/s1600/Screenshot+2014-04-27+13.12.31.png" height="401" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Home page</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-8LYFr1ujVU8/U107gB_0NkI/AAAAAAAAA_w/SXzy0pMk0sY/s1600/Screenshot+2014-04-27+13.13.12.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://1.bp.blogspot.com/-8LYFr1ujVU8/U107gB_0NkI/AAAAAAAAA_w/SXzy0pMk0sY/s1600/Screenshot+2014-04-27+13.13.12.png" height="442" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Check off the classes that you have completed and add your GPA/Experience in hours at the top.</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-FfF2XtMHISM/U107gIgS56I/AAAAAAAAA_4/HhjapeFOpyk/s1600/Screenshot+2014-04-27+13.13.31.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-FfF2XtMHISM/U107gIgS56I/AAAAAAAAA_4/HhjapeFOpyk/s1600/Screenshot+2014-04-27+13.13.31.png" height="516" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A list of "matches" is generated.<br /></td></tr>
</tbody></table>
<b><br /></b>Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com4tag:blogger.com,1999:blog-7335755289728209147.post-32099395562910536972014-04-23T11:00:00.000-04:002014-04-23T11:00:01.525-04:00Subcuticular SuturingI came across this blog post on how to do a <b>subcuticular closure</b>. It is well written with step by step pictures so why reinvent the wheel. I am just going to repost. Enjoy!<br />
<br />
<div style="text-align: center;">
<a href="http://abnormalfacies.wordpress.com/2012/02/20/running-subcuticular-suture-technique/" target="_blank">Abnormal Facies: Running Subcuticular Suture Technique</a></div>
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<span style="font-size: xx-small;">Source: http://abnormalfacies.wordpress.com/2012/02/20/running-subcuticular-suture-technique/</span></div>
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Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com4tag:blogger.com,1999:blog-7335755289728209147.post-4263885189999784972014-04-20T17:56:00.000-04:002014-04-20T17:56:36.647-04:00Pain Control and Anti-EmeticsWhen prescribing pain medications you must also consider the side effects that those medications may have on your patient such as nausea, constipation, rash, etc.<br />
<br />
We will talk about <b><span style="color: blue;">anti-emetics</span></b> today.<br />
<br />
There are many classes of anti-emetics to consider. Most services have their favorites, but due to patient allergies and the ineffectiveness of some medications on some patients - it is good to have a few back-ups in mind to try. You can also consult the pharmacy team that you work with for additional advice. This list is not comprehensive.<br />
<br />
<b>Dopamine antagonist: </b><br />
Prochlorperazine (good for opiod related nausea), Metoclopramide, Haloperidol<br />
<br />
<b>5HT3 antagonists: </b><br />
Ondansetron* (PO and IV)<br />
<br />
<b>Antihistamines: </b><br />
Diphenhydramine**<br />
<br />
<b>Anticholinergics: </b><br />
Scopolamine<br />
<br />
<b>Antipsychotics: </b><br />
Olanzapine<br />
<br />
<br />
*can lead to headaches and constipation<br />
**can be sedating<br />
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<br />
<br />
<br />
<br />
<span style="font-size: xx-small;">Source: MPR http://www.empr.com/antiemetic-treatments/article/125873/</span><br />
<br />Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com1tag:blogger.com,1999:blog-7335755289728209147.post-73299273064274579792014-03-07T13:30:00.000-05:002014-03-07T13:30:02.620-05:00Pain Control: OpiodsI will go over some general information regarding opioid use for analgesia. In subsequent entries I will go over different opioid use for 1) mild to moderate pain, 2) moderate to severe pain, and 3) severe pain. I would say for my practice most patients fall into the moderate to severe pain, but for a short period of time.<br />
<br />
<span style="color: blue;"><b>Opioids</b></span><br />
<br />
<b><u>Key Points:</u></b><br />
<br />
<ul>
<li><i><u>No ceiling effect</u></i> (as a general statement this means the larger the dose, the larger the effect)</li>
<li>Tolerance can develop with chronic use</li>
<li>Overuse can lead to respiratory depression or seizures</li>
</ul>
<div>
<b><u>Examples</u></b>: </div>
<div>
<br /></div>
<div>
<span style="color: #38761d;">Mild to moderate pain: codeine or tramadol</span></div>
<div>
<span style="color: orange;">Moderate to severe pain: hydrocodone, oxycodone, hydromorphone</span></div>
<div>
<span style="color: red;">Severe pain: morphine, codeine, methadone</span></div>
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<br /></div>
<div>
<span style="font-size: x-small;">**Some of these can crossover between categories based on dosage.</span></div>
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<span style="font-size: xx-small;">Source: Handbook of Neurosurgery, Greenberg 6th ed</span><br />
<br />Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-60917141268831972592014-03-04T22:08:00.000-05:002014-03-04T22:08:07.650-05:00Pain Control: Toradol<a href="http://3.bp.blogspot.com/-7KjmfdbsDrg/UxaU3DfFutI/AAAAAAAAA-4/4rLE6icqfEs/s1600/toradol.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-7KjmfdbsDrg/UxaU3DfFutI/AAAAAAAAA-4/4rLE6icqfEs/s1600/toradol.gif" height="70" width="200" /></a>Working in a surgical specialty, I have had to learn how to manage pain successfully.... and I must admit with some patients, I'm still learning. Pain is subjective so there is no magic recipe that works for every patient... you will have patients that 1) have intolerable side effects or allergies to your normal post op prescriptions, 2) have a history of narcotics abuse, 3) are drug seekers, 4) are people in true pain, and 5) are everything in between. It is good to have an idea of different pharmacological options to treat pain. Over the next few entries I will go over some of the main pain medications we use and some random ones as well.<br />
<br />
<span style="color: blue;"><b>TORADOL (ketoraolac tromethamine)</b></span><br />
<br />
<u><b>Key points:</b></u><br />
<br />
<ul>
<li><span style="color: red;">only parenteral NSAID approved for use in pain control in US</span></li>
<li><span style="color: red;">Analgesic effect is more potent than anti-inflammatory</span></li>
<li>Single dose administration = 30mg IV or 60mg IM (in healthy adult)</li>
<li>Multiple doses = 30mg IV/IM q6hrs (max 120mg/day)</li>
<li>PO is available, but used only as a continuation of IV/IM therapy - comes in 10mg tabs</li>
</ul>
<div>
<b><u>Why might you use toradol?</u></b></div>
<div>
<ul>
<li>if constipation is an issue with your patient</li>
<li>if you are worried about sedation/respiratory depression </li>
<li>patients with narcotic dependency</li>
<li>if your patient gets nausea with narcotics</li>
</ul>
<b><u>Cautions:</u></b></div>
<div>
<ul>
<li>do not use for > 72 hrs of pain control - some say 5 days is the max</li>
<li>can prolong bleeding time (secondary to platelet inhibition) in post op patients - use caution </li>
<li>although injections bypass the GI system, patients can still get GI irritation</li>
<li>monitor for renal side effects</li>
</ul>
</div>
<br />
<br />
<br />
<span style="font-size: xx-small;">Source: Handbook of Neurosurgery Greenberg, 6th Ed</span>Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-21265264816691195392014-02-09T16:10:00.000-05:002014-02-09T16:10:03.909-05:00Autism: Nuts & Bots<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-oiU-gW2OOCI/UvfucathYmI/AAAAAAAAA90/XQgmpKBxTKQ/s1600/autism-awareness.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-oiU-gW2OOCI/UvfucathYmI/AAAAAAAAA90/XQgmpKBxTKQ/s1600/autism-awareness.jpg" height="320" width="172" /></a></div>
<b>Autism</b> is a disorder that we hear a good deal about in the media and you are likely to see some kids on the spectrum during your pediatric rotation. Here are the nuts, bolts, and key terms:<br />
<br />
<ul>
<li>Autism: <b>impaired social interaction/communication/interests</b></li>
<li>Prevalence: 0.4% of the general population (although I have seen wild variations of this number)</li>
<li><b>More common in males</b> than females (5 to 1)</li>
<li>Symptoms generally seen before the age of 3</li>
<li>Social sx: l<b>ack of peer relationships</b>/failure to use non-verbal social cues</li>
<li>Communication sx: absent or weird speech</li>
<li>Behavioral sx: p<b>reoccupation with repetitive activities, rigid adherence to purposeless rituals, </b>mental retardation (present in 75% of patients with autism), no parent-child bond</li>
<li>Physical exam: generally normal, may see results of self-injurious behaviors (biting/head banging)</li>
<li>Tx: family counseling, special education, antipsychotics can be considered for agitation</li>
</ul>
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<span style="font-size: xx-small;">Source: Psychiatry for Medical Students and Residents by Nabell Kouka, MD, DO, MBA</span></div>
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<span style="font-size: xx-small;">Pic source: http://peteking.house.gov/issues/autism</span></div>
Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-83103921121619974892014-01-14T13:22:00.002-05:002014-01-14T13:22:55.538-05:00What is a WADA exam?<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
<b>What is a WADA exam? </b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A WADA exam is also known as an <b>intracarotid amytal test</b>. It
is one of the “non-invasive” tests used to determine which hemisphere is
language dominant in epileptic patients and also assess the ability of the non-affected
side to maintain memory when isolated. For example, if you were to remove the R
hippocampus – could the L side support language and memory alone? </div>
<div class="MsoNormal">
<br /></div>
<b>
</b><div class="MsoNormal">
<b>No test is perfect... here are a couple of the WADA Shortcomings:</b></div>
<br />
<ol>
<li>If patient has a high flow AVM – reading can be inaccurate</li>
<li>A portion of the hippocampus that you are trying to shut
down could get its blood supply from posterior circulation making it hard to
tell how accurately the patient will respond with full resection.</li>
</ol>
<br />
<div class="MsoNormal">
<b>How is it done?</b></div>
<br />
<ol>
<li>Get angiogram (to assess cross flow – which is a
contraindication to shutting down the side of primary supply)</li>
<li>Cath ICA (usually start on lesion side)</li>
<li>Ask pt to hold opposite arm in the arm as amobarbital is
rapidly injected into the ICA</li>
<li>What should happen? An almost immediate flaccid exam of the
arm that begins to wear off in about 8 minutes. If it wears off faster (around
2 minutes) you may think about a high flow AVM.</li>
<li>Assess language by asking pt to name objects and remember
them</li>
<li>Assess memory by asking pt to recall as many of the objects
as possible 15 minutes later</li>
<li>Procedure can be repeated on the other side if needed</li>
</ol>
<br />
<br />
<br />
<img class="irc_mut" height="608" id="irc_mi" src="http://www.instantanatomy.net/diagrams/HN126.png" style="margin-top: 6px;" width="500" /><br />
<br />
<span style="font-size: xx-small;">Photo source: http://www.instantanatomy.net/headneck/vessels/articinskull.html</span><br />
<span style="font-size: xx-small;">Source: <i>Handbook of Neurosurgery</i>, Greenberg 6th Ed </span><br />
Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-71087925195774541222013-11-04T09:30:00.000-05:002013-11-04T09:30:03.377-05:00Rheumatology/Orthopedic Buzz TermsRheumatology. I'm not sure there is a more gray area of medicine... perhaps that's why I don't like it that much. I remember sitting in rheumatology class listening to cases thinking, "it could be any of the rheum diseases that we've talked about!" They all sound the same and there is no ONE test that gives you the answer. I find it immensely frustrating (perhaps why I ended up in a surgical field), but I tip my hats to the providers that work in it. It is so difficult to pin down a diagnosis and successfully treat a patient with rheum issues... so for me, I stick to the basics.<br />
<br />
See below for my knowledge extent on these rheum/orthopedic PANCE/PANRE test-able gems:<br />
<br />
<b>Osteoarthritis (OA)</b><br />
Exercise, PT<br />
If knee joints involves - encourage weight loss indicting<br />
Pool activities<br />
NSAIDS<br />
<br />
<b>Rheumatoid arthritis (RA)</b><br />
Aspirin, other NSAIDS<br />
methotrexate for severe cases<br />
benefits take months to see after therapy initiation<br />
<br />
<b>Ankylosing Spondylitis</b><br />
PT<br />
Indomethacin<br />
Bamboo spine on plain films<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-1t1J-6dAG7s/UnB-aEHjnYI/AAAAAAAAA9E/S9V4PHc-Hog/s1600/250px-Ankylosing_Bamboo_Spine.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://2.bp.blogspot.com/-1t1J-6dAG7s/UnB-aEHjnYI/AAAAAAAAA9E/S9V4PHc-Hog/s320/250px-Ankylosing_Bamboo_Spine.jpg" width="206" /></a></div>
<br />
<br />
<b>SLE</b><br />
NSAIDs for joint symptoms<br />
Benign cases only need supportive care<br />
Systemic corticosteroids for serious complications<br />
Could be a cause of thrombosis in young women (oral contraceptives can also cause this)<br />
<br />
<b>Rickets</b><br />
Vit D deficiency<br />
<br />
<b>Osteomyelitis</b><br />
Aspirate and culture<br />
Immobilize<br />
Generally start with IV antibiotics then follow with PO antibiotics<br />
<br />
<br />
<br />
<br />
<span style="font-size: xx-small;">Source: Medical boards Step 2 Made Ridiculously Simple - A. Carl, MD, PhD</span><br />
<span style="font-size: xx-small;">Photo: wiki.cns.org</span><br />
<br />
<br />Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com1tag:blogger.com,1999:blog-7335755289728209147.post-63636337731197595102013-11-01T09:30:00.000-04:002013-11-01T09:30:03.112-04:00Postoperative management of temporal lobectomy<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-RWWAllYKaKM/Um_nekW1l8I/AAAAAAAAA8s/XN2VtWhO6lU/s1600/Screen+Shot+2013-10-29+at+12.50.05+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="302" src="http://2.bp.blogspot.com/-RWWAllYKaKM/Um_nekW1l8I/AAAAAAAAA8s/XN2VtWhO6lU/s400/Screen+Shot+2013-10-29+at+12.50.05+PM.png" width="400" /></a></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><br /></u></b></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><br /></u></b></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: inherit;">Postoperative
management of temporal lobectomy:</span></u></b></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
</div>
<ol>
<li><span style="font-family: inherit; text-indent: -0.25in;"> OR </span><span style="font-family: inherit; text-indent: -0.25in;">to </span><span style="font-family: inherit; text-indent: -0.25in;">PACU x 1 day </span><span style="font-family: inherit; text-indent: -0.25in;">to</span><span style="font-family: inherit; text-indent: -0.25in;"> floor x 1-2 day – aim for D/C on POD3</span></li>
<li><span style="font-family: inherit; text-indent: -0.25in;">·<span style="font-size: 7pt;">
</span></span><span style="font-family: inherit; text-indent: -0.25in;">Early rise in body temp post op, think about
incentive spirometery</span></li>
<li><span style="font-family: inherit; text-indent: -0.25in;">·<span style="font-size: 7pt;">
</span></span><span style="font-family: inherit; text-indent: -0.25in;">Hep lock as soon as patient starts taking PO
fluids</span></li>
<li><span style="font-family: inherit; text-indent: -0.25in;">·<span style="font-size: 7pt;">
</span></span><span style="font-family: inherit; text-indent: -0.25in;">Encourage sitting and ambulating</span></li>
<li><span style="font-family: inherit; text-indent: -0.25in;">· <span style="font-size: 7pt;"> </span></span><span style="font-family: inherit; text-indent: -0.25in;">Patient remains on preop AEDs for 1-2 years post
op (managed by Epilepsy folks)</span></li>
</ol>
<!--[endif]--><br />
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">·<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;">Possible
complications to look for:<o:p></o:p></b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><!--[endif]-->Hemiparesis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Usually happens after cauterization/tearing of
perforating vessels (from posterior communicating vessels or anterior choroidal
a.)</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Paralysis usually occurs immediately – this
would be known before post op check</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><!--[endif]-->Visual
field defects</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Contralateral superior quadrant anopsia from
damage of the Meyer loop</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Always check visual fields</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><!--[endif]-->Dysphasia</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Usually transient (1-3 weeks post op)</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Approx 50% of dominant temp. lobe resections
have dysphasia</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><!--[endif]-->Aseptic
meningitis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->A complication that usually presents 72 hrs – 1
week post op</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Stiff neck, severe HA, nausea, elevated body
temp</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Diagnosis of exclusion with LP</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><!--[endif]-->Post
operative seizures</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: inherit;"><span style="mso-list: Ignore;">§<span style="font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Sz w/in 1<sup>st</sup> 24hrs does not correlate
to poor long term outcomes</span></div>
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<!--StartFragment-->
<!--EndFragment--><br />
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</span></span><!--[endif]-->Sz after 48hrs (with adequate AED blood levels)
indicate poor long term outcome</span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l0 level3 lfo1; text-indent: -.25in;">
<br /></div>
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<span style="font-size: xx-small;">Source: Neurosurgical Operative Atlas 2nd Ed- Starr, Barbaro, Larson</span></div>
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<span style="font-size: xx-small;">Pic source: http://www.neuros.net/en/epilepsy_surgery.php</span></div>
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<span style="font-family: inherit;"><br /></span></div>
Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-12769137325984224802013-10-29T09:14:00.000-04:002013-10-29T09:14:17.828-04:00Preoperative Patients on Coumadin<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-gqvqJYEfQ1A/Um8cqakZLhI/AAAAAAAAA8c/1V1LCXhurGA/s1600/images.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="296" src="http://2.bp.blogspot.com/-gqvqJYEfQ1A/Um8cqakZLhI/AAAAAAAAA8c/1V1LCXhurGA/s320/images.jpeg" width="320" /></a></div>
If you work in surgery or with the elderly - anticoagulation is an every day part of life. INRs, PTs, PTTs, etc... it is important to know what measures what and what reversal agents (if any) are available. Let's talk about Coumadin today.<br />
<div>
<br /></div>
<div>
<u>Scenario</u>: <i>79 yo patient is coming in for a surgical procedure, but he is on Coumadin. You did your due diligence and had them stop it about 5 days pre-op, but their INR is still 1.6 on preoperative blood work. What are your next steps?</i></div>
<div>
<br /></div>
<div>
Generally if you are going to bring someone to the OR you'd like their INR to be less than 1.5. If it is higher, you would consider a reversal agent.</div>
<div>
<br /></div>
<div>
<b>Your 1st option for reversal is Vit K</b>. </div>
<div>
<ul>
<li>PO is most predictable and is preferred to IV if rapid reversal is not needed. PO Vit K lowers INR in about 24-48 hours. </li>
<li>IV works in approximately 12-24 hrs, but you run a greater risk of anaphylaxis and it must be administered over a longer period of time (approx 20 minutes). </li>
</ul>
</div>
<div>
<b>Your 2nd option for reversal is Fresh Frozen Plasma (FFP).</b></div>
<div>
<ul>
<li>FFP is more expensive than Vit K, but works within 12 hrs. FFP replaces clotting factors.</li>
</ul>
</div>
<div>
So, even though you did your due diligence, why was the INR still high? <b>There are several reasons that can delay the drop of a patient's INR</b>:</div>
<div>
<ol>
<li>Age - Elderly pts</li>
<li>Malignancy (active)</li>
<li>Liver disease</li>
<li>CHF, unstable</li>
<li>Meds that keep Coumadin around in the blood (check their med list)</li>
</ol>
<div>
<br /></div>
</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<span style="font-size: xx-small;">Sources:</span></div>
<div>
<div style="font-family: Tahoma; margin-bottom: 5px; margin-top: 5px;">
<span style="font-size: xx-small;">Ansell, J, Hirsh, J, Poller, L, et al. The pharmacology and management of the vitamin K antagonists: the <b>Seventh </b>ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126:204S. </span></div>
<div style="font-family: Tahoma; margin-bottom: 5px; margin-top: 5px;">
<span style="font-size: xx-small;"><br /></span></div>
<div style="font-family: Tahoma; margin-bottom: 5px; margin-top: 5px;">
<span style="font-size: xx-small;">Normalization of INR After Stopping Coumadin: http://www.fpnotebook.com/mobile/HemeOnc/Surgery/PrprtvAntcgltn.htm</span></div>
</div>
Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-34672143486677246382013-10-27T22:42:00.003-04:002013-10-27T22:42:50.645-04:00Surgical Training for Neurosurgical PAs<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-K9JUkhOsm-g/Um3NofNSHZI/AAAAAAAAA8M/dCKyJG2XAGE/s1600/IMG_2179.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="http://4.bp.blogspot.com/-K9JUkhOsm-g/Um3NofNSHZI/AAAAAAAAA8M/dCKyJG2XAGE/s320/IMG_2179.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Laminectomy</td></tr>
</tbody></table>
Last week I had the privilege of attending a surgical training in San Francisco, California. The event was created by the <a href="http://www.anspa.org/" target="_blank">Association of Neurosurgical Physician Assistants (ANSPA)</a> in conjunction with Ethicon. I must say it was a <b>fantastic experience</b>. I was able to spend a half a day in a live porcine wet lab. The lab was for PAs only so it enabled me to spend more time with the surgical instruments and take the lead on certain aspects of the surgeries that we performed - both opportunities that I don't necessarily get on a day to day basis. <b>It was successful in building my confidence.</b><br />
<br />
We performed a craniotomy and tumor removal as well as a laminectomy with a focus on hemostasis. This is an unusual experience and I learned a great deal from both the PAs that attended and the Ethicon reps regarding hemostasis products. I had the least amount of surgical experience of all the PAs that were there (9 months), however all of the PAs were friendly and helpful and I learned quite a few new techniques. It was also inspirational to see what other PAs around the nation were doing as part of their daily grind. It ranged from PAs that spent the majority of their time in the OR as co-surgeons to those that split their time 50-50 between OR and floor work.<br />
<br />
I was able to meet and spend some time with Josh, a neurosurgical PA for over 10 years, who is the current president of ANSPA. The AAPA recently completed a <a href="http://www.youtube.com/watch?v=tsi7bzfWc7w" target="_blank">video</a> on him and his contributions to his neurosurgical practice. The surgeons that he works with on a daily basis speak very highly of his surgical and patient skill sets. Mike Nido, PA-C and Dean Barone, PA-C were also instrumental in making this event happen.<br />
<br />
All in all, hats off to ANSPA for working hard to make this happen for PAs. They hope to create more of these learning opportunities for neurosurgical PAs in the near future. If you are not a member, I highly encourage you to do so if you're interested in neurosurgery as a physician assistant.<br />
<br />
<br />
<br />
<br />
<br />
<span style="font-size: xx-small;">*Disclosure: I am in no way financial tied to Ethicon. Just attended the event.</span><br />
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<br />Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-89132317315306846532013-09-09T23:16:00.003-04:002014-05-10T19:30:33.823-04:00Antibiotics for Appendicitis?I have had quite the hiatus from blog entries recently. Life gets busy somehow. Ha. I recently had hip surgery and had some blog worthy experiences as a patient that I hope to write about soon - but for now, I came across this interesting article on a PA (Andrew Gray, PA-C) that refused an appendectomy in lieu of antibiotic treatment for his acute appendicitis. He made his choice based on the fact that he did not have insurance and the results of a Swedish study. It is a short read, but very interesting and have evoked some feisty comments.<br />
<br />
Saving My Appendix: <a href="http://www.pulsemagazine.org/">http://www.pulsemagazine.org</a><br />
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Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com2tag:blogger.com,1999:blog-7335755289728209147.post-79151742390523300102013-08-01T22:43:00.003-04:002013-08-01T22:44:51.176-04:00Passing the Time on the T with JAAPA<span style="color: #333333; line-height: 22px; text-align: left;"><span style="background-color: #cccccc; font-family: inherit;">So the PA Journal (JAAPA) now has an application for the iPad. It has been out for a while now and I really like it! I download the most recent journal and am able to read it on the T on the way to work. It is great... it helps me keep up on the newest issues and clinical articles. The only downside is that it is only for the iPad currently... sorry no iPhones or iPods.</span></span><br />
<span style="background-color: #cccccc;"><span style="color: #333333; line-height: 22px; text-align: left;"><span style="font-family: inherit;"><br /></span></span>
<span style="color: #333333; line-height: 22px; text-align: left;"><span style="font-family: inherit;">If you are an AAPA member, you get the journal for free along with the free CMEs in each issue.</span></span></span><br />
<span style="background-color: #cccccc;"><br style="font-family: Verdana, Tahoma, Arial, sans-serif; font-size: 11px; text-align: left;" /></span>
<span class="journalsLWWiPad_subHeaderTxt" style="background-color: #cccccc; color: #333333; font-family: 'Trebuchet MS', Helvetica, sans-serif; font-size: 14px; font-weight: bold; line-height: 24px; text-align: left;">Down load it at the Apple App Store: <i style="color: #004ba1; cursor: pointer; text-decoration: none;"><a href="https://itunes.apple.com/us/app/journal-american-academy-physician/id626650410?ls=1&mt=8" style="color: #004ba1; cursor: pointer; text-decoration: none;" target="_blank">Journal of the American Academy of Physician Assistants</a></i></span><br />
<span class="journalsLWWiPad_subHeaderTxt" style="background-color: white; color: #333333; font-family: 'Trebuchet MS', Helvetica, sans-serif; font-size: 14px; font-weight: bold; line-height: 24px; text-align: left;"><br /></span>
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<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-yAdcAH48wj0/Ufscmu5ypwI/AAAAAAAAA64/upPoWTvD3dc/s1600/Screen+Shot+2013-08-01+at+10.42.00+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="http://3.bp.blogspot.com/-yAdcAH48wj0/Ufscmu5ypwI/AAAAAAAAA64/upPoWTvD3dc/s640/Screen+Shot+2013-08-01+at+10.42.00+PM.png" width="464" /></a></div>
<span class="journalsLWWiPad_subHeaderTxt" style="background-color: white; color: #333333; font-family: 'Trebuchet MS', Helvetica, sans-serif; font-size: 14px; font-weight: bold; line-height: 24px; text-align: left;"><br /></span>Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com1tag:blogger.com,1999:blog-7335755289728209147.post-73446026211966361372013-07-17T16:00:00.000-04:002013-07-17T16:00:04.248-04:00Aphasia<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-WnhcVQCqiQo/UeScvvr9eII/AAAAAAAAA6M/ZKGNZPEtLSo/s1600/brain.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="290" src="http://2.bp.blogspot.com/-WnhcVQCqiQo/UeScvvr9eII/AAAAAAAAA6M/ZKGNZPEtLSo/s320/brain.gif" width="320" /></a></div>
I have always found <b>aphasia</b> incredibly interesting and terrifying all at the same time. Imagine not being able to communicate with language as smoothly as you do everyday. It is something that many of us take for granted.<br />
<br />
<b>Definition:</b><br />
the loss or defect of language (speaking fluency, reading, writing, understanding of written or spoke words)<br />
<br />
<b>What are the 4 types of aphasia?</b><br />
1. <span style="color: #073763;">Wernicke's </span><br />
2. <span style="color: orange;">Broca's</span><br />
3. <span style="color: blue;">conduction</span><br />
4. <span style="color: #274e13;">global</span><br />
<br />
<b>Potential causes:</b><br />
<br />
<ul>
<li>stroke</li>
<li>brain trauma</li>
<li>brain tumor</li>
<li>alzheimer's disease</li>
</ul>
<div>
<span style="color: #073763;"><b>Wernicke's</b></span></div>
<div>
<span style="color: #073763;">-receptive, fluent aphasia</span></div>
<div>
<span style="color: #073763;">-pt has hard time comprehending written or spoken language</span></div>
<div>
<span style="color: #073763;">-fluid speech, but difficult to understand</span></div>
<div>
<br /></div>
<div>
<span style="color: orange;"><b>Broca's</b></span></div>
<div>
<span style="color: orange;">-expressive, nonfluent aphasia</span></div>
<div>
<span style="color: orange;">-speech is slow and requires effort</span></div>
<div>
<span style="color: orange;">-few words used</span></div>
<div>
<span style="color: orange;">-good comprehension of language</span></div>
<div>
<br /></div>
<div>
<span style="color: blue;"><b>Conduction</b></span></div>
<div>
<span style="color: blue;">-disturbance in repetition</span></div>
<div>
<span style="color: blue;">-pathology involves the connections between Wernicke's and Broca's</span></div>
<div>
<br /></div>
<div>
<span style="color: #274e13;"><b>Global</b></span></div>
<div>
<span style="color: #274e13;">-often associated with RIGHT hemiparesis</span></div>
<div>
<span style="color: #274e13;">-defect in all areas of language</span></div>
<br />
<br />
<b>How to treat</b><br />
-many recover spontaneously in 4-6 weeks<br />
-speech therapy<br />
<br />
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<br />
<span style="font-size: xx-small;">Photo source: <span class="irc_ho" style="background-color: #222222; color: white; cursor: pointer; font-family: arial, sans-serif; line-height: 16px; margin-right: -2px; padding-right: 2px; text-decoration: underline;"><a class="irc_hol irc_itl" data-ved="0CAQQjB0" href="http://emedia.leeward.hawaii.edu/hurley/Ling102web/mod5_Llearning/5mod5.2_disorders.htm" style="background-color: #222222; color: #1122cc; cursor: pointer; font-family: arial, sans-serif; line-height: 16px; text-decoration: none;">emedia.leeward.hawaii.edu</a></span></span><br />
<span style="font-size: xx-small;">Source: Step Up to Medicine by Agabegi and Agabegi</span>Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-51690633908612136452013-07-14T21:33:00.000-04:002013-07-14T21:33:03.799-04:00ACA Stroke Basics<b><u>Anterior Cerebral Artery (ACA) Stroke</u></b><br />
<br />
<b><span style="color: #cc0000;">The Anatomy</span></b><br />
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<a href="http://4.bp.blogspot.com/-W_eHWD1Ikx4/UeNQAE3Aw3I/AAAAAAAAA50/ambNDttUEzU/s1600/CerArtDistBlum1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="449" src="http://4.bp.blogspot.com/-W_eHWD1Ikx4/UeNQAE3Aw3I/AAAAAAAAA50/ambNDttUEzU/s640/CerArtDistBlum1.jpg" width="640" /></a></div>
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<a href="http://1.bp.blogspot.com/-Dq2bYNsYS5w/UeNP_3VisCI/AAAAAAAAA5w/f5P8VttbO0g/s1600/CerArtDistBlum2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="562" src="http://1.bp.blogspot.com/-Dq2bYNsYS5w/UeNP_3VisCI/AAAAAAAAA5w/f5P8VttbO0g/s640/CerArtDistBlum2.jpg" width="640" /></a></div>
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<br />
<b><span style="color: #cc0000;">What deficits might you expect to see in a patient?</span></b><br />
<br />
<ul>
<li>contralateral leg weakness (both motor and sensory), frontal lobe behavioral issues, +/- aphasia if prefrontal cortex involved, grasp reflex</li>
</ul>
<div>
<b><span style="color: #cc0000;">Where does the ACA receive its blood supply from?</span></b></div>
<div>
<ul>
<li>Carotid arteries</li>
</ul>
</div>
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<span style="font-size: xx-small;">Source: http://www.neuroanatomy.ca/stroke_model/aca_info.html</span><br />
<span style="font-size: xx-small;">Photo sources: </span><span style="font-size: xx-small;">http://missinglink.ucsf.edu/lm/ids_104_cns_injury/response%20_to_injury/watershed.htm</span><br />
<br />Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-38967996573103929302013-07-11T08:36:00.000-04:002013-07-11T08:36:19.383-04:00OliguriaAs always... back to the basics:<br />
<br />
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<a href="http://1.bp.blogspot.com/-6IsfOL_NRFY/UdyrFHYSxdI/AAAAAAAAA5c/RTki3CMgC-A/s1600/urine_sample.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-6IsfOL_NRFY/UdyrFHYSxdI/AAAAAAAAA5c/RTki3CMgC-A/s320/urine_sample.jpg" width="213" /></a></div>
<b>What is oliguria?</b><br />
Low urine output (UOP)<br />
<br />
<b>What is "normal" adult UOP?</b><br />
About 30cc/hr<br />
<br />
<b>How might you write a post op floor order for this?</b><br />
"call house officer if 2 hour UOP is < 60cc"<br />
<br />
<b>What are the possible causes?</b><br />
Think pre renal/renal/post renal causes<br />
<br />
<b>What is the most common cause?</b><br />
Pre renal!Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-76826082700629526352013-07-08T22:35:00.000-04:002013-07-08T22:35:01.226-04:00Causes of Renal Failure<div class="separator" style="clear: both; text-align: center;">
Causes of Renal Failure broken down by pre-renal, renal, and post-renal.</div>
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<span style="font-size: xx-small;">Source: Clinical Survival Guide for PA Students by G.Broughton, MD, PhD</span></div>
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Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com0tag:blogger.com,1999:blog-7335755289728209147.post-42789396140544146792013-06-12T10:00:00.002-04:002013-06-12T10:00:44.074-04:00What if PAs Couldn't Suture Anymore?This a repost from a call sent out by the AAPA based on a resolution brought to the AMA's House of Delegates. <span style="background-color: yellow;">Read it and take part in your future scope of practice as a PA.</span><br />
<br />
<div style="text-align: center;">
<strong><u>Join AAPA in responding to negative AMA resolution</u></strong></div>
<strong><u></u></strong><strong><u><div style="text-align: justify;">
<br /></div>
</u></strong>While workforce experts are predicting a shortage of providers with the implementation of the Affordable Care Act, the <span style="color: red;">American Medical Association Board of Trustess is proposing a resolution for its House of Delegates that could severely restrict PAs' ability to provide care to patients</span>. <strong>PAs should be very concerned about the resolution</strong>, which will be considered by the AMA HOD when it convenes on Saturday, June 15. The recommendations are very restrictive and display a misunderstanding of the way PAs and doctors provide care as part of a team. <span style="color: red;">Among other restrictions, the resolution expands the definition of surgery to include repair and removal of human tissue and, although parts of the resolution are somewhat unclear, states that surgery as defined in the resolution is to be performed ONLY BY PHYSICIANS</span>. <strong>If adopted as presented, the resolution will call into question procedures like suturing, punch biopsies and vein harvesting, which PAs perform on a daily basis across many medical specialties</strong>. The resolution also proposes that only physicians should perform invasive procedures that utilize radiologic imaging. You can read Report 16 of the AMA Board of Trustees in full here.
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
AAPA is spreading the word about the negative impact this resolution would have on patient care and PA practice, but we need your help. Please review the list of AMA delegates in your state or specialty, and if you have a connection, please let that physician know the true damage that this resolution could create. Also, talk with and encourage physicians in your practice to speak with other physician leaders about the resolution. AAPA's suggestion is that the resolution should be defeated, or modified to specifically state that it does not apply to PAs practicing within the parameters of state law.</div>
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For more information on the AMA resolution please contact Ann Davis, PA-C, MS, Senior Director of Constituent Organization Outreach and Advocacy, at <a href="mailto:ann@aapa.org">ann@aapa.org</a>. </div>
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Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com1tag:blogger.com,1999:blog-7335755289728209147.post-49579449713526850212013-06-08T10:46:00.001-04:002013-06-08T10:47:07.765-04:00The PA Mentoring Project<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: #cccccc;"><span style="color: #222222;">While I was at the national AAPA conference in May in Washington DC, I learned about a new mentoring project that was recently launched. It is called the </span><b><span style="color: red;">National Physician Assistant Mentoring Project</span></b><span style="color: #222222;">. Their tagline is "PAs helping PAs". It was started by Robert Smith, PA–C and Habia Collier, PA–C.</span></span></span><br />
<span style="background-color: #cccccc; font-family: Arial, Helvetica, sans-serif;"><br style="color: #222222;" /><span style="color: #222222;">The idea is to have more seasoned PAs be mentors for younger/new to the field PAs and PA students. These two physician assistants were very passionate about this program when they came to speak to the AOR.</span></span><br />
<span style="background-color: #cccccc; font-family: Arial, Helvetica, sans-serif;"><br style="color: #222222;" /><span style="color: #222222;">This mentoring project is in its infancy, however it needs more PAs that are willing to be mentors in order for it to grow. </span><span style="color: #222222;">Check out their website at: </span><a href="http://www.pamentoring.org/" style="color: #1155cc;" target="_blank">www.PAmentoring.org</a></span><br />
<span style="background-color: #cccccc;"><br /></span>
<span style="background-color: #cccccc;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Hats off to these two for getting such a great idea up and running!</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<a href="http://2.bp.blogspot.com/-kEjnSA1OAPc/UbNDgOIiNiI/AAAAAAAAA4g/b2ioZqd1KVU/s1600/mentor.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="424" src="http://2.bp.blogspot.com/-kEjnSA1OAPc/UbNDgOIiNiI/AAAAAAAAA4g/b2ioZqd1KVU/s640/mentor.jpg" width="640" /></a></div>
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<span style="font-size: xx-small;"><span style="font-family: Arial, Helvetica, sans-serif;">Pic Source: </span><a class="irc_hol irc_itl" data-ved="0CAQQjB0" href="http://www.euphoricbirth.com/2013/01/09/doula-mentoring/" style="background-color: #222222; color: #1122cc; cursor: pointer; font-family: arial, sans-serif; line-height: 16px; text-decoration: none;"><span class="irc_ho" style="color: white; margin-right: -2px; padding-right: 2px; text-decoration: underline;">www.euphoricbirth.com</span></a></span>Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com3tag:blogger.com,1999:blog-7335755289728209147.post-91854127539291184072013-05-30T19:11:00.002-04:002013-05-30T19:11:44.689-04:00Free AAPA appThe AAPA has developed an <a href="https://itunes.apple.com/us/app/aapa/id643301254?mt=8" target="_blank">app</a>! They officially launched it at conference and I wanted to give you a little overview. Cost: FREE<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-CC_UlsKqWzc/UafaVdEohvI/AAAAAAAAA4I/QaZ_FmeW8OU/s1600/photo+5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://2.bp.blogspot.com/-CC_UlsKqWzc/UafaVdEohvI/AAAAAAAAA4I/QaZ_FmeW8OU/s400/photo+5.jpg" width="225" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Easily accessible links to JAAPA, PA Professional, the PA microsite, and Joblink!</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-4n2KOSDLtdw/UafaRlK6BeI/AAAAAAAAA38/j0zRuAw2p9c/s1600/-1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://3.bp.blogspot.com/-4n2KOSDLtdw/UafaRlK6BeI/AAAAAAAAA38/j0zRuAw2p9c/s400/-1.jpg" width="225" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Keep up with the social media buzz and the trending #hashtags.<br /><br /></td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-hT9JV620Q9M/UafaVQAMKzI/AAAAAAAAA4E/_ZDvqnC-J0U/s1600/photo+4.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://1.bp.blogspot.com/-hT9JV620Q9M/UafaVQAMKzI/AAAAAAAAA4E/_ZDvqnC-J0U/s400/photo+4.jpg" width="225" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Keep up with the latest news in the AAPA profession.<br /><br /></td></tr>
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Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com1tag:blogger.com,1999:blog-7335755289728209147.post-36043629187381426252013-05-28T22:31:00.000-04:002013-05-28T22:36:46.578-04:00PA MAN - I Love Conference!This, in a nutshell, is why I love conference. PAs know how to have fun. Hope to see everyone there in Boston next year! Check out the video...<br />
<br />
<div style="text-align: center;">
<span style="font-size: x-large;"><a href="http://youtu.be/JYcfq73tQ5M" target="_blank">PA MAN (Challenge Bowl 2013)</a></span><br />
<i><span style="font-size: x-small;">Click for video</span></i></div>
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<br />Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com1tag:blogger.com,1999:blog-7335755289728209147.post-51022542014067985972013-05-20T21:14:00.000-04:002013-05-20T21:23:11.065-04:00Atrial Fibrillation <div style="text-align: center;">
<span style="color: #cc0000; font-size: large;"><b>AFib, The Basics</b></span></div>
<br />
<b><u>Characteristics</u></b><br />
<ol>
<li>irregularly iregular</li>
<li>irregular RR intervals</li>
<li>not a P wave in front of every QRS</li>
<li>atrial rate = 400-600bpm, ventricular rate = 80-160bpm</li>
</ol>
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<a href="http://3.bp.blogspot.com/-_F3YsFHsWwM/UZrLpylMPTI/AAAAAAAAA3U/MGl0X9LDLnE/s1600/03-best-background-movie-desktop-wallpapers_Pirates-of-the-Caribbean.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="http://3.bp.blogspot.com/-_F3YsFHsWwM/UZrLpylMPTI/AAAAAAAAA3U/MGl0X9LDLnE/s200/03-best-background-movie-desktop-wallpapers_Pirates-of-the-Caribbean.jpg" width="200" /></a></div>
<b><u>Etiologies = PIRATES</u></b></div>
<div>
P = pulmonary (COPD, PE)/pheo/pericarditis</div>
<div>
I = ischemic heart dz +/- HTN</div>
<div>
R = rheumatic heart dz</div>
<div>
A= anemia/atrial myxoma</div>
<div>
T = throtoxicosis</div>
<div>
E = ethanol ("holiday heart)/cocaine</div>
<div>
S = sepsis (post-operative)</div>
<div>
<br /></div>
<div>
<b><u><br /></u></b>
<b><u>Signs/Symptoms</u></b></div>
<div>
<ol>
<li>fatigue (most common)</li>
<li>tachypnea</li>
<li>palpitations</li>
<li>lightheaded</li>
</ol>
</div>
<div>
<br /></div>
<div>
<b><u>Work Up</u></b></div>
<div>
(<span style="color: blue;">Test yourself... why would you order each of these? what are you looking for?</span>) -<span style="font-size: xx-small;"> answers below</span></div>
<div>
<ol>
<li>EKG</li>
<li>ECHO</li>
<li>TSH (?)</li>
<li>Baseline coags</li>
</ol>
<div>
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<a href="http://2.bp.blogspot.com/-M8UIcWrgg00/UZrI7kqNjzI/AAAAAAAAA3E/tUluMj60-VQ/s1600/atrial-fibrillation-lg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="462" src="http://2.bp.blogspot.com/-M8UIcWrgg00/UZrI7kqNjzI/AAAAAAAAA3E/tUluMj60-VQ/s640/atrial-fibrillation-lg.jpg" width="640" /></a></div>
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<div>
<ol>
<li><span style="color: blue;"><i>EKG = narrow complex QRS (<120msec), variable RR, irregular or absent P waves</i></span></li>
<li><span style="color: blue;"><i>ECHO = maybe thrombi, maybe dilated L atrium</i></span></li>
<li><span style="color: blue;"><i>TSH (?) = hyperthyroidism can cause AF</i></span></li>
<li><span style="color: blue;"><i>Baseline coags = getting baseline prior to starting anticoagulation</i></span></li>
</ol>
</div>
<div>
<br /></div>
<div>
<span style="background-color: yellow;"><b><u>Of note:</u></b> </span>if you are looking for THROMBI..."normal" ECHOs (transthoracic) has low sensitivity - transesophageal ECHOs allow for better visualization of<b> L atrial appendage (location where most thrombi form) </b></div>
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<div>
<span style="font-size: xx-small;">source: First Aid for the Wards by Le, Bhushan, Skapik</span></div>
<div>
<span style="font-size: xx-small;">pic source: http://www.saintvincenthealth.com/Services/Heart/Heart-Resource-Library/Atrial-Fibrillation/default.aspx</span></div>
Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com4tag:blogger.com,1999:blog-7335755289728209147.post-38563928277060296452013-05-14T20:01:00.000-04:002013-05-14T20:01:17.548-04:00Diabetes Insipidus, Part 2<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-XUrfVlB0tRE/UZLP7oy4t6I/AAAAAAAAA20/tLhTvCXsx9c/s1600/Diabetes+Insipidus.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="214" src="http://1.bp.blogspot.com/-XUrfVlB0tRE/UZLP7oy4t6I/AAAAAAAAA20/tLhTvCXsx9c/s320/Diabetes+Insipidus.jpg" width="320" /></a></div>
<h3>
Diagnosing DI</h3>
Polyuria = urine vol > 3L in 24 hrs - there are many causes of polyuria and it is important to figure out if the cause is DI or something else prior to establishing treatment<br />
<br />
Urine osmolality (osm) of > 300 mOsmol/kg + high serum glucose --> think diabetes mellitus<br />
Urine osmolality (osm) of > 300 mOsmol/kg + high serum urea --> think renal dz<br />
Urine osmolality (osm) of <span style="color: red;">< 200 mOsmol/kg + polyuria</span> --> <span style="color: red;">think DI</span><br />
<span style="color: red;"><br /></span>
So you have a patient that has urine ohm < 200 + polyuria and you are thinking DI... <span style="color: blue;">how do you differentiate between central DI and nephrogenic DI?</span><br />
<br />
Answer: <b><span style="color: blue;"><a href="http://emedicine.medscape.com/article/117648-workup#aw2aab6b5b2" target="_blank">water deprivation test</a></span></b><br />
<b><br /></b>
<b>Findings:</b><br />
<span style="color: #741b47;"><b><u>Central DI</u></b></span><br />
<span style="color: #741b47;">urine osm < plasma osm after dehydration</span><br />
<span style="color: #741b47;">after ADH injections urine osm increases by >50%</span><br />
<br />
<span style="color: #274e13;"><b><u>Psychogenic DI</u></b></span><br />
<br />
<span style="color: #274e13;">urine osm > plasma osm after dehydration</span><br />
<div>
<span style="color: #274e13;">after ADH injections urine osm increases minimally</span></div>
<br />
<b><span style="color: blue;"><br /></span></b>
<b><span style="color: blue;"><u>Nephrogenic DI</u></span></b><br />
<br />
<span style="color: blue;">urine osm < plasma osm after dehydration</span><br />
<div>
<span style="color: blue;">after ADH injections urine osm increases by <50%</span></div>
<div>
<span style="color: #741b47;"><br /></span></div>
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<span style="background-color: #cccccc; color: #333333; font-family: Arimo; font-size: xx-small;">Source: </span><br style="background-color: #cccccc; color: #333333; font-family: Arimo; font-size: 16px; line-height: 22px;" /><span style="background-color: #cccccc; color: #333333; font-family: Arimo; font-size: xx-small;">Makaryus/Mcfarlane. <i>DI: diagnosis and treatement of a complex disease</i> Cleveland Clinic Journal of Medicine Jan 2006 Vol 73:1</span><br />
<span style="background-color: #cccccc; color: #333333; font-family: Arimo; font-size: xx-small;">pic source: </span><a class="irc_hol irc_itl" data-ved="0CAQQjB0" href="http://medicaltextboks.blogspot.com/2013/05/textbook-diabetes-insipidus.html" style="color: #1122cc; cursor: pointer; font-family: arial, sans-serif; font-size: 13px; line-height: 16px; text-decoration: none; white-space: nowrap;"><span class="irc_ho" style="background-color: #999999; color: white; margin-right: -2px; padding-right: 2px; text-decoration: underline;">medicaltextboks.blogspot.com</span></a>Anonymoushttp://www.blogger.com/profile/00149281557452997665noreply@blogger.com1