COMLEX CE-2 – $495.00. Board review books - $140.00. On-line practice exam questions – $99.00. Gas to Livonia - $24.00. Lunch during my lunch break – $7.76. Beer for after the exam – 12.59. Falling asleep with my lights and TV on - $11.94 or whatever DTE will charge me. Shouldn’t something here be priceless? Stupid MasterCard.
I apologize for the weather. The last time I took the boards (June 2005), the month of May was cold and rainy. Now September has been dreary. It’s my entire fault and I apologize.
I hate the logic behind Notre Dame getting so much press because every Catholic roots for the Fighting Irish. Screw that. There are way more Protestants than Catholics in this country. By this stupid logic every Methodist should root for Southern Methodist University. Or every Baptist should cheer on the Baylor Bears. Notre Dame is pure evil. No one should ever cheer, cheer for ole Notre Dame. And Charlie Weiss is a fat, grumpy old man.
This is a true story. I found a human tooth in my refried beans. Oh my...UNCOOL! I love this Mexican restaurant, but I'm not sure I can go back. I don't need to eat a finger or whatever else may be there.
Nick Saban’s Miami Dolphins are 0-2 heading into week three of the 2006 NFL season. However, this poor start isn’t Nick Saban’s fault or due to his players lackluster performances. Nope, week one the Dolphins were screwed over by the officials and Saban had a little quiver lip in the post-game press conference regarding Heath Miller’s 87-yard TD. Then after their week two loss at home to the Buffalo Bills, Saban said the fans shouldn’t boo the home team. He explained that only fires up the other team and hurts the home team’s chance of winning. So you see it’s not his fault. For being a coach that has made players cry, that has been profiled on ESPN as a hard ass and has a known reputation of being a dictator, he sure does cry like a little bitch a lot.
Safe happens…then I shit my pants. Damn, those Volkswagen commercials that show accident after accident scare the crap out of me. First of all, I don’t want a car like that because it seems like anyone who drives it is doomed to get into an accident. Secondly, I’m not sure some people would be able to just walk away from that like in the commercials. Those are brutal accidents.
Well Scrubs is on Comedy Central from 7-8 EST Monday thru Friday. Awesome. It is a very realistic medical show (especially when compared to shows like Gray’s Anatomy). However, two things bug me about it. The chest x-ray at the beginning of the show is backwards, or the patient has dextrocardia. The former is more likely than the latter. Secondly, during a laparoscopy, an intern tells Turk he has passed Cooper’s ligament twice. It sounds funny except Cooper’s ligament is in the breast and provides structural support to the breast. Oh well, I guess it sounded funny.
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16 comments:
indeed
a plethora of things to bitch about. priceless.
so your took your exam? congratulations. can you give rectal exams legitimately now?
you'll go back. just give it a couple weeks.
can you prescribe antibiotics for a sinus infection yet? b/c the idiot drs at cmu won't give them to me and i know thats all i need!
p.s. call me back about those nov games.
no i cannot prescribe medications yet. why won't they give you an antibiotic. augmentin never hurt anyone...well it'll give you diarrhea, but never really hurt you.
i will call you about the games. i would like the tickets. danke.
i do like to bitch. and that is somewhat priceless, except the cost of my soul...which isn't much. i can officially give rectal exams. if you're interested let me know.
Aren't many sinus infections caused by a virus? and don't antibiotics only work on bacterial infections? shouldn't you avoid taking antibiotics because of antibiotic resistance? plus, don't people normally recover from sinus infections sooner than antibiotic treatment can treat them? and don't antibiotics kills "good" intestinal bacteria? was this on your exam?
I would just squirt some antibacterial soap up my nose and see what happens.
all your talk about mexican food and teeth made me hungry, so I got los amigos....no teeth. what a disappointment.
very good questions. i shall do my best to answer them.
95% of all upper respiratory infections (uri) are indeed due to a virus. sinus infections count as an uri. however, some concerns with sinus infections are bacterial seeding through the nasopharynx into the central nervous system and bam! you have menningitis. that's usually due to a bacteria called streptococcus pneumonaie (strep pneumo to the cool folks).
now much debate has been made about nasal discharge. it is not a reliable predictor of bacterial vs. viral sinus infections. however, a clear drainage is almost always due to allergies. allergies can cause i sinusitis. sinusitis just means inflammation of the sinuses and not necessarily a bacterial infection.
giving antibiotics is a touchy subject. infectious disease folk get mad when primary care docs just give everyone a "z pack" for an uri. and yes they can increase resistance. it is better not to give an antibiotic. generally a rule i think of is if the patient is febrile (has a fever). a high fever is more likely indicative of a bacterial infection...but not always. so it is a somewhat confusing topic. in general, i would prescribe guiafenisen/pseudoephedrine to control the rhinorrhea (runny nose) and nasal congestion. chances are that would help more than an antibiotic.
as for the killing of good bacteria in the gut. yes. most antibiotics will disrupt the gut flora and a bacteria called clostridium difficle (c. diff) will proliferate causing a potentially fatal pseudomembranous colitis or c. diff colitis. this can be treated very effectively with oral or iv metronidazole (flagyl), but if untreated can cause a toxic megacolon which may kill you.
however, c. diff colitis is not considered a risk to outweigh the benefits in most bacterial infections because it can be treated so effectively. so it is something to consider, but rarely hinders a doc from prescribing an antibiotic.
taking a shot of antibiotic soap up the nose has not been studied (to my knowledge) but is an inovative idea. i like it. i'm not sure if that soap has the coverage you need for the nasopharynx bacteria, but it's worth a shot...the pun is intended there.
your questions are excellent. and very well thought out. i agree with you assessment that an antibiotic may not be necessary at this point, but the art of medicine sometimes defies the science and if a person will get better on an antibiotic...well...
i'm sorry you didn't get a tooth in your food. it's not that fun. actually it's gross. los amigos has the best sauce. i love that place.
peace and chicken grease.
Good answers. Thanks! los amigos loves you too.
andy, sometimes i wonder if you're just bullshiting us by putting big words into sentences. but this one i semi understood. i went to a different doc and she gave biaxin and psuedovent for whatever i ended up having... btw can i drink alcohol on an antibiotic or is that bad?
There is always a reason to kick an old man down the stairs, just don't do it!
There is always a reason to hit a woman, just don't do it!
There is always a reason to drink a beer (on anything), JUST don't do it!
I can actually answer that question Brooke! Linds had strep throat last week but I wanted to her to come out with us, and according to Andy you can drink on antiboitics. Though there was one that you can't drink on and I have no idea what it was called. So maybe I don't know the answer after all.
Go Green!
wow, a totally out of place comment from an irish fan. You blew your load too early. I would have waited until a relevant posting was made, but thats just me.
Not sure I'd admit I'm a Catholic...the Pope's a Nazi who denigrated Islam (very Christian, very smart); the church closes inner-city schools because they don't make profits and builds huge schools in affluent suburbs (way to meet the needs of the poor); and the comment from this Catholic is a perfect example of how shallow many Catholics can be. Tell me, did you go to mass this month?
Not to mention the thousands upon thousands of children that the Catholic Church has allowed to be scarred for life.
okay okay.
look i don't like notre dame. i don't like the reasons some root for them. and last nights game michigan state gave the game away in only michigan state classic fashion.
charlie weiss does look like he has hot dogs for a chin. and john l. smith is a moron. but let's all just calm down and remember that it was only a football game. i let my emotions get the better of me last night.
this is the joy and sadness of being a state fan. it's kinda special to figure out a way to lose so many games in such odd ways.
i don't know who wrote the comments, i'm assuming not charlie weiss or a fan of catholicism, but i think we can all agree and root for arctic state...the penguins will rule the college football world.
let's get back to the antibiotic issue. biaxin is clarithromycin...like a z pack but it has less resistance so it is being used more. it has great coverage: gram positive, gram negative (not pseudomonas) and atypicals. it's a fine antibiotic for uri's.
the pseudovent i'm not too familiar with, but i think it is just pseudoephedrine. good for the runny nose.
the antibiotic, metronidazole (flagyl) will have disulfiram (anatbuse) reaction when drinking alcohol - flushing, sweating, abdominal pain and nausea/vomiting.
sorry about the big words...medicine has some big words.
i'm sorry to hear that. c diff is nasty. i had a patient die from it late on a friday afternoon. fun way to start the weekend.
so the tigers are in the post-season for the first time since 1987. they didn't crap the bed for too long.
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