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mytopeka

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About mytopeka

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  1. CD's are now gone. For the PANCE and first PANRE, I got three of the review books and read each of them cover to cover, taking notes for each chapter. Took about three months to study. Took and passed the tests with no huge problems other than the usual anxiety about passing. This last PANRE....I tried studying from the book for about a week and gave up. I used the CDs (listed here) to get an overview but needed more. I flew to Vegas and took the 3 day CME Resources review. Took the PANRE 1.5 weeks later and did better than any of the prior tests. It was awesome and got to hang out with PA school friends for three days. There's my story.
  2. I bought this set of 7 CD's last year for a PANRE review. I took and passed the PANRE last September. These CDs are just sitting here on my desk going unused. Put up some money for shipping (let's say $10) and maybe a Starbucks card. $35 total? Sure. Let's go with that. The set itself was hundreds of dollars last year. Let me know. These might as well go to use for someone. NO CME is available with this. I already used it up. CDs only.
  3. There's also Hutchinson's teeth, a sign of congenital syphilis. https://radiopaedia.org/articles/hutchinson-teeth
  4. As of 4/20/17, codeine and Tramadol are contraindicated in pediatric patients, per FDA: https://www.fda.gov/Drugs/DrugSafety/ucm549679.htm
  5. http://www.medscape.com/viewarticle/854652 "On the morning of the attack, the emergency response teams at the Paris SAMU had conducted a rehearsal of the White Plan, simulating multisite terrorist attacks. This extraordinary timing suggests a maximum alert level, rather than an astonishing coincidence."
  6. Ok, time to ask. I've seen a couple of older folks, 70 to 90, with renal failure. None have them have been terribly complicated, came in with urinary retention or UTI, not septic, not admitted. I get concerned at that age and would some guidance on treating their UTIs. What are the upper levels of BUN and creatinine before I need to adjust their antibiotics doses? Is there a particularly safe antibiotic to use as outpatient therapy? Discussed it with attendings but still didn't get numbers to hang my hat on for next time.
  7. I got a call from The Wal Mart pharmacy last week asking me to switch an rx from doxy to something else due to the price. I thought it was going to be the usual "just switch it from monohydrate to hyclate" but the pharmacist told me that doxy hyclate has been taken off of the $4 formulary. I looked at both WM and Target's $4 list and sure enough, doxy is nowhere to be found. Usually I wouldn't post for such a specific change like this, but I know that I give doxy for a lot of my uninsured folks with pneumonia/lung crud and certainly for MRSA. Now with no insurance a patient would be looking at $40-$60 for a course.
  8. I got a call from The Wal Mart pharmacy last week asking me to switch an rx from doxy to something else due to the price. I thought it was going to be the usual "just switch it from monohydrate to hyclate" but the pharmacist told me that doxy hyclate has been taken off of the $4 formulary. I looked at both WM and Target's $4 list and sure enough, doxy is nowhere to be found. Usually I wouldn't post for such a specific change like this, but I know that I give doxy for a lot of my uninsured folks with pneumonia/lung crud and certainly for MRSA. Now with no insurance a patient would be looking at $40-$60 for a course.
  9. I got a call from The Wal Mart pharmacy last week asking me to switch an rx from doxy to something else due to the price. I thought it was going to be the usual "just switch it from monohydrate to hyclate" but the pharmacist told me that doxy hyclate has been taken off of the $4 formulary. I looked at both WM and Target's $4 list and sure enough, doxy is nowhere to be found. Usually I wouldn't post for such a specific change like this, but I know that I give doxy for a lot of my uninsured folks with pneumonia/lung crud and certainly for MRSA. Now with no insurance a patient would be looking at $40-$60 for a course.
  10. 2 times with success. One was a drunk lady who flat out said, "I'm drunk. Don't give me a bunch of medicine that will make me stop breathing. Just get it back." Can't beat that for getting the thumbs up from the patient. Number two was a guy on his 6th or 7th dislocation. He straight up said he couldn't afford the x-rays or the sedation medication, refused both, and just wanted me to reduce it then and there in the triage chair. The piercing scream when you initially go to exam the shoulder is usually the tip-off to "Cunningham ain't gonna work."
  11. Back in March I posted about a kid who gets brought into the department very often by his mom for, most of the time, no good reason. About 50 visits and the kid is a little over two years old now. We have never found anything seriously wrong with the kid. Mom brings the other kids in too, but this is the kid with the most visits. Last week in our local newspaper I see that the kid's dad was arrested for long term molestation of the kid's sister, 15 years old. So, yeah. Ugly. If anything, I post this as a reminder than we have probably have no idea what the hell is really going on with our patients when they are at home. We just see these tiny little slices of their lives and try to make some sense of it.
  12. We call Child Protective Services from our ER if the social workers can't make it. We're a small town and things like child abuse will get the system started pretty quickly. For me, the important thing is to not get emotional so as not to do or say something stupid. I don't tell the parents we are calling so they don't cause a scene and try to leave. I document document document everything I can, giving the authorities plenty of information to go on when the parents/family/others are investigated. And we call security and have them hang out right outside the room so no one tries to leave.
  13. Guy with a 20 cm screwdriver in his rectum came in. During our conversation I asked why he chose that particular item. "Well, it's my favorite screwdriver." He liked it a little too much, in my opinion.
  14. NPI is free and you'll need it, just as bradtPA states. https://www.cms.gov/NationalProvIdentStand/03_apply.asp
  15. Good lord, I'm glad I'm not alone. In my early 20's I spent a year working for a marketing subsidiary of the good folks who bring you Camel and Winston brand cigarettes. I can tell you that this has NEVER come up as a provider and had no influence on my getting into PA school. It is just an interesting sidebar. Just have a quick witty response if it gets brought up, but I doubt it will. If they DO bring it up though, just tell them that some doctors LOVE to smoke.
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