Step 3 CCS tips & Frequently Asked Questions

Hey!
This post is all about how to study for CCS.

How to study for CCS?
Use the UW software. It is more than enough.

Should I do Archer videos?
They are just 5 videos and are not mandatory to do. It's just that most students do not know how to fast forward the clock, change location, etc. and Archer does a pretty good job at explaining it. (I might do a video later!)

Should I opt for softwares other than UW?
It is not necessary because UW has just enough. Other softwares might train you to do "extra" unnecessary orders which maybe sub-optimal in the real exam because there is not enough time to do everything.

MUST DO before the real exam: Practice the CCS cases on the usmle.org website. You have to be comfortable with the software and the different orders available.

Interesting physical exam finding in Henoch-Schonlein purpura

Hello everyone!

Here's a cool fact that someone I absolutely adore shared with me: The Pediatricians call Henoch-Schonlein purpura as, “Butt-itis” because the rash frequently coalesces on the pressure points and is gravity dependent, in other words, on the buttock!

Henoch Schonlein purpura

HSP is also known as Anaphylactoid purpura.

• Most common vasculitis in children.
• Most common Leucocytoplastic vasculitis.
  It predominantly affects small vessels (venules, capillaries, arterioles).
  It is usually self limited but may progress to end stage renal disease.
 
Clinical features:
1) Skin: rash, palpable purpura (non-thrombocytopenic purpura).
2) Joints: arthritis, arthalgia.
3) Kidneys: glomerulonephritis (proteinuria, hematuria).
  ° Severe renal failure occurs in about 1-2%, characterized by crescenteric glomerulonephritis which is treated with intravenous methyl prednisolone.
4) GIT : colicky abdominal pain.

   On investigation: total Ig A increases.
Renal biopsy: mesangial Ig A deposits.

Treatment: conservative treatment
    Oral prednisolone may be given.

Thanks for reading.

Madhuri Reddy.

Differentiating restrictive lung disease

Hello!

Let's talk about restrictive lung diseases today.

We know that an increased FEV1 / FVC ratio is suggestive of a restrictive lung disease.

However, you want to get lung volumes and confirm it by looking at the reduced TLC.

There are two types of restrictive lung diseases that you want to differentiate - pulmonary and extrapulmonary.

In pulmonary restrictive lung disease, all lung volumes are reduced due to fibrosis.

In extrapulmonary restrictive lung disease, the residual volume will be normal or even increased.

Why? Because in neuromuscular diseases, the muscles don't have the strength to blow air out.

DLCO is another way you can differentiate the two.

In pulmonary restrictive lung disease, the surface of alveolar membrane that participates in gas exchange is reduced and the DLCO is low.

In extrapulmonary restrictive lung disease, the DLCO is normal.

That's all!

-IkaN

My USMLE journey by IkaN

Hey!

A couple of you wanted me to write about my USMLE journey - I am almost at the end so lemme start telling you about my story.

Ocular Therapeutics (DYES)

Hello Awesomites! :D

Today I will discuss here

DYES:-

USES OF FLUORESCEIN DYE
-This dye stain damaged corneal epithelium bright green best seen under cobalt blue and ultraviolet light.
1. To detect breach in continuity of corneal epithelium.
2. Contact lens fitting.
3. Applanation tonometer.
4. Test for leaking wound (Seidel test)
5. Patency of nasolacrimal duct.
6. Fluorescein angiography.
7. Diagnosis of lacrimal fistula.
8. Treatment of pediculosis (Fluorescein dye strips, which are used in the diagnosis of corneal abrasions, may be used in combination with white petrolatum. The strips are applied to the eyelashes for 3 nights)
9. Differential stain along with Rose bengal.

Pattern of stain:-
- interpalpebral staining of cornea & conjuctiva is common in aqueous tear deficiency
-superior Conjuctival Staining in superior limbic keratoconjuctivitis
-Inferior corneal &conjuctival staining in blepheritis & exposure keratitis.


USES OF ROSE BENGAL:-
-Stain the devitalized corneal and conjuctival epithelium. The drawback with rose bengal is it stings.
-Seen under white light /red free light. (Red-free light is absorbed by the RPE, creating increased contrast)

1. CORNEA -Staining corneal ulcer,erosion and abrasion.
2. LID- Meibomian gland dysfunction.
3. CONJUCTIVA- Conjuctival staining and evaluation of ocular surface disorder.

I hope it helped.
More is coming up in this section.

-Upasana Y. :)

Nasotracheal intubation

Hello!

This post is about the indications and contraindications of nasotracheal intubation.

Indications:
1) Oral surgery
2) Fracture mandible
3) Inadequate mouth opening
4) Tube to be kept for longer time
5) Awake fibre-optic intubation

Contraindications:
1) Fracture of base of skull (may directly enter inside skull)
2) CSF rhinorrhea (increases infection - meningitis)
3) Nasal mass (do not allow tube to pass)
4) Adenoids
5) Coagulopathy
6) Decreased movement of endotracheal tube
7) Nasal mucosal damage.

Thanks for reading.

Madhuri Reddy

Malignant hyperthermia

Malignant hyperthermia is a syndrome of rapidly rising temperature.

It occurs due to abnormality of Ryanodine receptors which cause release of large amount of calcium from sarcoplasm reticulum leading to sustained muscular contraction.

It is triggered by:
1) Succinylcholine (50%) - most common
2) ether
3) methoxyflurane
4) halothane
5) enflurane
6) isoflurane
7) Desflurane
8) sevoflurane

Clinical features:
1) Masseter muscle spasm - most initial sign
2) Rise in end tidal CO2
3) Tachycardia
4) Respiratory/ metabolic acidosis
5) Hyperkalemia
6) Pulmonary edema
7) Cerebral edema
8) Myoglobinuria
9) Renal failure
10) Rise in temperature - late sign

Treatment:
1) Stop all anesthetic agents (because one of it is a triggering factor).
2) Hyperventilate with 100% O2.
3) Inj.Dantrolene - 2 mg/kg  intravenously every 5 minutes to a maximum dose of 10 mg/kg.
Dantrolene can be continued for next 48 hours.
4) Sodabicarb to correct metabolic acidosis.
5) Cooling of body.
6) Other symptomatic treatment.

To detect malignant hyperthermia:
BEST DIAGNOSTIC TEST -> Halothane Caffeine muscle contraction test.
BEST SCREENING TEST -> Creatinine kinase test.

Thanks for reading.

Madhuri Reddy

Transient Tachypnea of Newborn notes

Hello!

What is Transient Tachypnea of Newborn (TTN)?

Step 3 NBME Form 4 Answer key

Hey, here is the answer key.

Lemme know if I accidentally typed some wrong!

Foreign body aspiration - Flexible or rigid bronchoscopy?

Foreign body aspiration (FBA) - Which bronchoscopy should you do? Flexible or rigid?

#TLDR:
Life threatening - Rigid bronchoscopy
Diagnosis not clear - Flexible bronchoscopy

Children - Rigid bronchoscopy
Adults - Flexible bronchoscopy

Mnemonic: childRen thReatening - Rigid bronchoscopy

So first ask - is this a life threatening FBA? Yes - Rigid bronchoscopy (after airway stabilization of course)

Then ask - Is the diagnosis clear? No - Flexible bronchoscopy

If the diagnosis is clear and the FBA is not life threatening - See the age.

If it is a child - Rigid bronchoscopy
If it is an adult - Flexible bronchoscopy

Here's a looooong copy paste explanation from UpToDate:

Varenicline mnemonic

Hello!

A short post on Varenicline :)

Mirtazapine mnemonic

Hello!

Here's a short post on the atypical antidepressant, Mirtazapine! It's an alpha 2 antagonist that increases release of NE (norepinephrine) and 5-HT (serotonin)

Mirtazapine causes sedation (desirable in depressed patients with insomnia)

Mnemonic: MirtaZZZZapine
Zzz for 😴 sleep

Mirtazapine increases appetite, causes weight gain (desirable in elderly or anorexic patients)

Mnemonic:
M - Mirtazapine makes you motu
(Motu in Hindi / Urdu is fat)

-IkaN