Showing posts with label USMLE Step 1. Show all posts
Showing posts with label USMLE Step 1. Show all posts

Tuesday, May 3, 2022

USMLE STEP1 just changed! You need to too!

 

On 26 Jan 2022, the USMLE Step 1 changed its score reporting format to Pass/Fail only. This means, that those who give their exam after this date cannot see their 3 digit score, and neither can anybody else (yes, not even PDs)

Saturday, May 29, 2021

The Happy face

 Hi everyone!

Lets talk about a 2 year old girl with a h/o seizure disorder who presents to your clinic for the first time for routine care. Past medical records shows that the patient is on anti-seizure medication since the last year. There is no family history of seizures. Parents report poor feeding and sleep disturbances. The girl appears to be very happy, laughing all the time for no reason. On examination, her head circumference is in the 10th percentile and is noted to have hand flapping behavior. She has not met the expected milestones for her age. What is the diagnosis?

???

ANGELMAN SYNDROME 























Fun fact: Angelman Syndrome was previously known as "Happy Puppet Syndrome"πŸ˜„


- Padma Sri Katikaneni

Sunday, May 23, 2021

Ehler-Danlos Syndrome (EDS) - High yield only

Hi! So let's learn EDS together. I've tabled a list of high-yield points of all the types of EDS. It requires little bit of revision but once you get a pictorial familiarity you should be able to recall them all. 

Have fun!

So, how to remember?

Step 1. Divide the table into 2 halves. Sl no. 1,2,3 have in common a lot of features:
  • They are all Autosomal Dominant. 
  • They have common Clinical features - skin HYPERelasticity, joint HYPERmobility and HYPER (easy) bruising. 
  • Go serially, Classical has the first 2, Type I and II and HYPERmobile is III and lastly Vascular is type I
  • Vascular type has additionally - arterial & uterine rupture.
Step 2. Now the second section Sl no. 4,5,6
  • EDS types with enzyme defects are Autosomal Recessive. So, 4 and 6 are AR. 
  • Kyphoscoliotic EDS is Type VI (K rearranged is a V and I)
  • For the last 2, mnemonic is ABCDπŸ˜› Arthrochalasia VII a, b and VII c is Dermatosparaxis.
  • KyphoSCOLIOTIC EDS - defective lysyl hydroxylase (=> abnormal cross linking of collagen or KOLLAGEN => think of bones 🦴 => congenital SCOLIOSIS)
  • ARTHROchalasia is COL IA (1st letter is A) and hence presents with severe JOINT hyper mobility.
  • DERMATospARaxis is AR and a defective Procollagen-N-peptidase and presents with CUTIS laxa. (Cuties are Pros ;)

Step 2. For the Gene types, come down in descending order: 5 4 3 2 1


Step 3. Remember Type V - DOEST NOT EXIST. 

Step 4. Revise again πŸ˜‰

That's it! Stay safe 🌸
- Anagha :)

Saturday, May 8, 2021

Creatinine clearance in elderly - basic notes

 Hi!


Elderly people have a decrease in creatinine clearance (CrCl), which means an increase in serum Cr. It is observed that annual rate of this decrease in CrCl is approximately 1 ml/min. after the age of 50 years.

Therefore, it is important to calculate the dose and dosing intervals of nephrotoxic drugs (eg., aminoglycosides) in these patients in order to prevent the precipitation of ARF.

In general,

CrCl <100 ml/min is abnormal.

However, CrCl <10 ml/min signifies the onset and worsening of acute renal failure.

Note -

• GFR is directly proportional to CrCl.

• GFR decreases by age, but not always accompanied by rise in Cr.

• Cockcroft-Gault formula is commonly referred to for calculating CrCl.

CrCl = (Ucr × V)/Pcr (~GFR)

• Double the Cr = Half the GFR.


Note that those patients with signs of worsening diabetes and resulting glomerulopathies, an increase in both GFR and CrCl is seen, which thus causes hyper filtration injury. 


That's all

- Jaskunwar Singh

Rigler's triad mnemonic

 Hi!

Rigler's triad in gall stone ileus mnemonic:

GALL in GIT

Friday, May 7, 2021

Simvastatin combination with fibrates in clinical practice

 Hi!

High-yield in clinical practice:

DO NOT combine simvastatin with gemfibrozil (class-X interaction; high risk of acute liver damage and rhabdomyolysis). Inhibition of CYP450 enzyme by gemfibrozil plays the role in increasing levels of simvastatin 2-3x.

Combination of simvastatin with fenofibrate is relatively safer, although close observation and regular monitoring is required (class-C interaction). Serum levels of simvastatin remain unchanged.


- Jaskunwar Singh

Saturday, May 1, 2021

Lyme's disease - a review

 Hi!

Lyme's disease/ Lyme borreliosis

A patient with a typical history of frequent visits to the woods with bull's eye rash, neurologic features, cardiac abnormalities, and musculoskeletal features.

Monday, April 26, 2021

Menkes disease and Wilson's disease - DDx

 Hi!

Okay so maybe they are the two of the options for a patient's clinical scenario question and you have a blurred memory for which is which in context to copper metabolism?

Let's clear the basic facts here...

Saturday, April 24, 2021

Ampicillin-rash in infectious mononucleosis

 Hi!


Penicillins such as amoxicillin and ampicillin are currently not recommended in patients with infectious mononucleosis with bacterial secondaries (streptococcal tonsillo-pharyngitis). Why?

Sunday, February 28, 2021

Essential tremor - a mnemonic.

Do you often forget the features of 'essential tremor'? Well shake no more, 'coz here's a mnemonic that will straighten things up for ya!

Friday, December 11, 2020

Conus medullaris syndrome vs. Cauda equina syndrome

Both of these are orthopedic/neurosurgical emergencies! But in general, CM syndrome is more severe than CE syndrome.

Here's a comparison between the two...


Monday, November 2, 2020

USMLE STEP 1: Resources and preparation

USMLE STEP 1: RESOURCES AND PREPARATION

1.1 MAIN RESOURCES
These two resources are inevitable for Step 1 preparation.
First Aid for Step 1
Uworld question bank
UWSAs and NBMEs

SUPPLEMENTAL RESOURCES:
Kaplan videos (subject wise)
Boards and Beyond videos
Sketchy videos for microbiology and pharmacology
Pathoma videos and notes for pathology
UW biostats review for biostatistics
BRS books for behavioral science.
Conrad Fischer’s 100 cases for ethics

FLASHCARDS
ANKI

SUPPLEMENTAL Q-BANKS
Amboss
Kaplan
USMLE Rx

1.2 HOW TO USE THESE RESOURCES
1. FIRST AID
Read FA 3-4 times, from cover to cover.
FA provides every single concept in brief. You may need supplemental resources and videos in order to understand these concepts, but once you do, the final high yield topic is mentioned in FA.
Consider it the most concise version of take away points of all subjects.
Read a section/ topic/ subject/ system from first aid, and always solve MCQs simultaneously for reinforcement. 
If you find it difficult to understand a particular subject, supplement it with videos at that time.

EG: I started reading biochemistry from first aid and couldn’t grasp the concept. What do I do?
Watch Kaplan videos (or BNB or any other resource) for biochemistry. 
Annotate important points from the videos into my FA.
Read the same sub-topic from FA simultaneously.
Finally, when I have a good grasp of the concept, I will solve only biochemistry MCQs from UW (or any other q-bank)
This way, I have consolidated learning biochemistry by using FA, UW and videos to understand the concept
If you work well with flashcards, I will make my own flashcards using ANKI or used pre-formed flashcards from ANKI for intermittent learning.

2. UWORLD
This is a question bank which has various options for subscription. Understand that you will need this q-bank until the date of your exam, so either take a 6 month or 1-year subscription.
This needs to be done TWICE. Period.

MODES
1. Timed: You get 60 minutes to solve 40 questions (You cannot read the explanation until you have finished the whole block)
2. Tutor: No limit on solving questions. (You can exceed 60 minutes for 40 questions)
3. Timed-tutor: You will be timed, but there will be an option of “show answer”, which will give you the explanation right away after you have marked an answer and clicked on it.

FIRST PASS: Use timed-tutor mode.
Always use timed mode as it will help you overcome the time issues in the final exam, especially if you are within 6 months of your exam date. 
If you have just begun and are using uworld to solve questions along with your first reading of FA, you may prefer using the tutor mode.
Make sure to annotate extra information from UW into your FA. FA does not have enough space, so get it spiral binded and add pages within or make an extra notebook.
If you are not comfortable writing so much extra information into FA and prefer flashcards, make flashcards in UW of all the info which is not mentioned in FA.

Remember, in the end UW and FA will be your final resources during your dedicated phase, so you need all information consolidated at one place.
How to make flashcards: Keep all the tables and flowcharts under one deck. Make separate decks according to subjects. Make a deck of super volatile concepts and concepts not mentioned in FA.

SECOND PASS: Use timed mode
Timed mode will help you prepare for your test.
Reset UW again and start from scratch in the 2nd pass. Alternatively, if you don’t have enough time, solve your incorrect and marked questions only.
Keep revising a few pages of FA daily.

3. SKETCHY MICRO
If you are a visual learner, this is an amazing tool. It will help you to remember these bugs till your Step 3 exam as well. 
Keep revising the pictures at regular intervals as it is easy to forget them.
If it gets too much, just focus on sketchy for viruses and fungi. 
Do sketchy for VIRUSES and keep your FA open. Read from both places and learn simultaneously. Sketchy really helps with virology.

4. PATHOMA
Go through the videos and annotate in FA.
Solve MCQs after finishing each sub-topic

5. BNB VIDEOS and KAPLAN VIDEOS
These are needed during the early part of your prep to understand the concepts.
Keep FA open and annotate important points from the videos or make your own notes in a separate notebook.
Don’t underestimate their importance in building your base in these concepts as they will help you with Step 2 and Step 3 as well.

AMBOSS Q-BANK

Use this in the end. After you have gone through UW twice and still want additional practice, use Amboss.
They have tougher questions, so don’t get discouraged.
No need to annotate information unless it seems high yield.
Use it to practice as many questions.

UWSAs AND NBMEs (ASSESSMENTS)

These are assessments which give you a score at the end. They may or may not be able to predict your final score, so use them to see how much improvement is needed, but do not rely on them blindly.
Take an online NBME or UWSA1 after the first pass of UW (which would coincide with at least the 2nd or 3rd reading of FA)
Find out your weaknesses. See videos, re-learn FA, solve UW incorrects to improve upon those weak areas.
When you are within 3 months of your step 1 date, start taking assessments every 10-15 days.
Leave NBME 18 and UWSA 2 for the last one month as they are ‘considered’ to be predictive.

1.3 TIMELINE ( MOST IMPORTANT, NEEDS TO BE INDIVIDUALIZED) 
In the descending order:

Dedicated Study Period: Last 2-3 months (8-10 hours per day)
Final revision of FA
UW incorrects
Amboss questions for practice
Assessments every 15 days

Pre-dedicated period: 2-3 months (4-8 hours per day)
2nd and 3rd revision of FA
Start UW with annotation in FA/ make separate notes/ make flashcards of high yield points not mentioned in FA
Take an assessment (NBME or UWSA1) and see your weakness. Go through supplementary material for those weak areas (videos, other books)

Initial Phase: 4-6 months (4-8 hours per day)
1st reading of FA
Videos and text for establishing basic concepts
Solving any q-bank for practice and reinforcement
Annotating important points

Written by Amrin Kharawala

Friday, October 9, 2020

Mechanism of action of lipid-lowering drugs

Hey everyone! 

I wanted to talk about the new lipid-lowering drug, bempedoic acid. But first, let’s just quickly go through the mechanism of action of the existing lipid-lowering drugs:

Statin reduces cholesterol synthesis by HMG-CoA Reductase inhibition.

Ezetimibe inhibits cholesterol absorption from the intestine.