繁华已谢，梦重新开始，转战SUB

zhangheng1020UID: 2130513

每天的临睡前都是我最痛苦的时候

计划没有完成，或是觉得不够

心里害怕~~~

大家是如何克服的？？


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妈妈在旁边打呼噜，希望永远这样下去~~~~

record for the anatomy wedsite:$
http://hcs.anatomy.kmu.edu.tw/anatomyweb/index.html

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昨天除了李笑来和真题，阅读
一章的专业
还有5list 红宝忘说了。

[ Last edited by zhangheng1020 on 2005-12-22 at 20:29 ]

kito9695UID: 209685

Originally posted by zhangheng1020 at 2005-12-22 00:43
每天的临睡前都是我最痛苦的时候

计划没有完成，或是觉得不够

心里害怕~~~

大家是如何克服的？？

我的一个同学告诉我，如果心里真的有个目标，就无论如何都要抓紧时间把当天的任务完成，哪怕不去吃饭，不去睡觉~至于够不够那无所谓，不去考虑，制定计划的时候就想好了！
当然，负荷也不能太重，不能累垮了~现在不能很深刻地体会你此时的感受，所以只能说A za a za fighting~

zhangheng1020UID: 2130513

Originally posted by kito9695 at 2005-12-22 01:08


我的一个同学告诉我，如果心里真的有个目标，就无论如何都要抓紧时间把当天的任务完成，哪怕不去吃饭，不去睡觉~至于够不够那无所谓，不去考虑，制定计划的时候就想好了！
当然，负荷也不能太重，不能累垮了 ...

谢谢~~~
:handshake:handshake

今天第二遍李笑来10个
5list单词
一套真题（没有限时）
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一会儿
专业
作文


one post I met today:L:L:L
https://bbs.gter.net/viewthre ... &extra=page%3D2

Originally posted by relive at 2005-12-22 12:55
没别的，狂练狂总结，别把自己当人看

:L:L:L

[ Last edited by zhangheng1020 on 2005-12-22 at 22:46 ]

esmeirasUID: 202885

真不愧是张家的猛女啊......~~~

zhangheng1020UID: 2130513

[share]USMLE     
http://www.dxy.cn/bbs/post/view?bid=56&id=5178452&sty=1

[fly]不活了不活了不活了不活了不活了不活了[/fly]



our father in heaven, holy be your name, your kindom come....

although I walk in the dark valley, Ifelt no evil, cause I knew you are with me...


holly be my soul!!!

father!!! father!!!
please, rise me up and let me fall
in the paradise regain, I saw your golory.....


humble those who be proud, rise up those who headed down......

let me die, my father!!!! if only you can be that mrecy!!!
life for me is endless, endless suffering, and please,if there is any mercy left,please kill me, end up my tiny life and let me fall.... no more eternal test please...

I felt dark and envy in my soul, how could all those happened? tell me my tomorrow, if there is still teh sun shine.....

I might in sain...

tired,, wear out........
no more writting today.. the major will be feed up... sigh....

[ Last edited by zhangheng1020 on 2005-12-22 at 23:40 ]

zhangheng1020UID: 2130513

非常想死~~~~~现在~~~
痛苦极了~~~
先睡觉~
daily burn... endless burn......:(:(:(
:confused::confused:
The following concepts underlie the remainder of the chapter:
1. Disease presentation is often atypical in the elderly, especially in those >75 to 80 years old. Homeostatic strain caused by onset of a new disease often leads to symptoms associated with a different organ system, particularly one compromised by preexisting disease. For example, fewer than one-fourth of older patients with hyperthyroidism present with goiter, tremor, and exophthalmos; more likely are atrial fibrillation, confusion, depression, syncope, and weakness. Significantly, because the “weakest link” is so often the brain, the lower urinary tract, or the cardiovascular or musculoskeletal system, a limited number of presenting symptoms predominate—acute confusion, depression, incontinence, falling, and syncope—no matter what the underlying disease. Thus for the most common geriatric syndromes, regardless of the presenting symptom, the differential diagnosis is often largely similar. The corollary is equally important: The organ system usually associated with a particular symptom is less likely to be the source of that symptom in older individuals than in younger ones. Compared with middle-aged individuals, for example, acute confusion in older patients is less often due to a new brain lesion, depression to a psychiatric disorder, incontinence to bladder dysfunction, falling to a neuropathy, or syncope to heart disease.
2. Because of decreased physiologic reserve, older patients often develop symptoms at an earlier stage of their disease (Fig. 8-1). For example, heart failure may be precipitated by mild hyperthyroidism, cognitive dysfunction by mild hyperparathyroidism, urinary retention by mild prostatic enlargement, and nonketotic hyperosmolar coma by mild glucose intolerance. Paradoxically, therefore, treatment of the underlying disease may be easier because it is frequently less advanced at the time of presentation. A corollary is that drug side effects can occur with drugs and drug doses unlikely to produce side effects in younger people. For instance, a sedating antihistamine (e.g., diphenhydramine) may cause confusion, loop diuretics may precipitate urinary incontinence, digoxin may induce depression even with normal serum levels, and over-the-counter sympathomimetics may precipitate urinary retention in men with mild prostatic obstruction.
Unfortunately, the predisposition to develop symptoms at an earlier stage of disease is often offset by two factors. First, symptoms may present later if there is functional limitation in another system. Coronary artery disease or aortic stenosis may not cause symptoms as early in patients whose mobility is compromised by arthritis. Second, a change in illness behavior occurs with age. Raised at a time when symptoms and debility were accepted as normal consequences of aging, the elderly are less likely to seek attention until symptoms become disabling. Thus, any symptom, particularly those associated with a change in functional status, must be taken seriously and evaluated promptly.
3. Since many homeostatic mechanisms may be compromised concurrently, there are usually multiple abnormalities amenable to treatment, and small improvements in each may yield dramatic benefits overall. For instance, cognitive impairment in patients with Alzheimer's disease may respond much better to interventions that alleviate comorbidity than to prescription of a cholinesterase inhibitor (Fig. 8-2). Similar approaches apply to most other geriatric syndromes, including falls, incontinence, depression, delirium, syncope, and fracture. In each case, substantial functional improvement can result from treating the contributing factors even if—as in Alzheimer's disease—the disease itself is largely untreatable.
4. Many findings that are abnormal in younger patients are relatively common in older people—e.g., bacteriuria, premature ventricular contractions, low bone mineral density, impaired glucose tolerance, and uninhibited bladder contractions. However, they may not be responsible for a particular symptom but only be incidental findings that result in missed diagnoses and misdirected therapy. For instance, the finding of bacteriuria should not end the search for a source of fever in an acutely ill older patient, nor should an elevated random blood sugar—especially in an acutely ill patient—be incriminated as the cause of neuropathy. On the other hand, certain other abnormalities must not be dismissed as due to old age—e.g., there is no anemia, impotence, depression, or confusion of old age.
5. Because symptoms in older people are often due to multiple causes, the diagnostic “law of parsimony” often does not apply. For instance, fever, anemia, retinal embolus, and a heart murmur prompt almost a reflex diagnosis of infective endocarditis in a younger patient but may reflect aspirin-induced blood loss, a cholesterol embolus, insignificant aortic sclerosis, and a viral illness in an older patient. Moreover, even when the diagnosis is correct, treatment of a single disease in an older patient is unlikely to result in cure. For instance, in a younger patient, incontinence due to involuntary bladder contractions is treated effectively with a bladder relaxant medication. However, in an older patient with the same condition but who also has fecal impaction, takes medications that cloud the sensorium, and suffers from arthritis-associated impairments of mobility and manual dexterity, treatment of the bladder spasms alone is unlikely to restore continence. On the other hand, disimpaction, discontinuation of the offending medications, and treatment of the arthritis are likely to restore continence without the need for a bladder relaxant. Failure to recognize these principles often leads to prescribing “ineffective” therapy and to unjustified therapeutic nihilism toward older patients.
6. Because the older patient is more likely to suffer the adverse consequences of disease, treatment—and even prevention—may be equally or even more effective. For instance, the survival benefits of exercise, as well as thrombolysis and beta-blocker therapy after a myocardial infarction, are as impressive in older patients as in younger ones; and treatment of hypertension and transient ischemic attacks, as well as immunization against influenza and pneumococcal pneumonia, are more effective in older patients. A proactive approach is even more effective in acute care, in which it decreases the risk of delirium by 30 to 60%. In the outpatient setting, such an approach can delay functional decline and institutionalization. In addition, prevention in older patients must often be seen in a broader context. For instance, although interventions to increase bone density may be limited in older patients, fracture may still be prevented by efforts to improve balance, strengthen legs, reduce peripheral edema, treat other contributing medical conditions, replete nutritional deficits, eliminate environmental hazards, and remove adverse medications—not so much those that affect bone metabolism, but rather those that induce orthostasis, confusion, and extrapyramidal stiffness.
In summary, optimal treatment of the older patient generally requires treating much more than the organ system usually associated with the disease or symptom, and often permits ignoring that system entirely.

谢谢我的朋友，每次到了过节的时候，就是我心情最不好的时候
昨天难过得拼命吃（饼干一袋，花生，面条，馒头，花生），然后吐了2次，拼命的喝水（昨天喝光了2个保温壶的开水6+6磅）。
今天也是，吐了2次，喝水喝到低血钾~~~~~
一天没有吃东西，刚刚又开始狂吃~~~~~

今天不睡了，自虐到累得没有力气难过为止。

[ Last edited by zhangheng1020 on 2005-12-24 at 20:42 ]

yogurt4UID: 198389

Originally posted by zhangheng1020 at 2005-12-24 01:39
今天不睡了，自虐到累得没有力气难过为止。

陪你

小duoUID: 2124666

我加啦~

yogurt4UID: 198389

Originally posted by zhangheng1020 at 2005-12-24 02:30
不用了，酸奶，您还小，要多多休息，注意身体。

你也是.好好休息.EVERYDAY A NEW U;)

zhangheng1020UID: 2130513

写得太开心了，一不小心，写成ISSUE~~~~~
time 60 min words 657
https://bbs.gter.net/viewthre ... &extra=page%3D1

Albert Einstein said his theory is “上帝不执股子”
这话用英语怎么说来着？？:L:L:L

[ Last edited by zhangheng1020 on 2005-12-25 at 18:44 ]

小duoUID: 2124666

真刻苦
看见你我又惭愧了

我还这HONEY HONEY呢..

果小冻UID: 208370

恩,姐姐你要好好注意身体的撒,自己开心最重要,呵呵,有空找我一起发发小花痴撒.西西

果小冻UID: 208370

Originally posted by yogurt4 at 2005-12-24 01:40

陪你

哈哈 酸奶姐姐怎么从来不陪我捏?吃醋了,嫉妒了------

yogurt4UID: 198389

HENG,你的作文我这两天给你
圣诞吃多乐= =+

zhangheng1020UID: 2130513

Originally posted by yogurt4 at 2005-12-24 19:27
HENG,你的作文我这两天给你
圣诞吃多乐= =+

:handshake:handshake我也吃多了:$
师傅这几天好好休息一下，您前一段时间太辛苦了。祝您节日快乐！！

[ Last edited by zhangheng1020 on 2005-12-26 at 00:37 ]