Step 2 CK: Investigating thyroid nodule

Hello! 

If you find a thyroid nodule on clinical examination, the next best step is to get a TSH level.

Why? Because it helps you decide which investigation to order next!

If TSH is low, you need to do a radionucleotide scan first.

Why? Because it helps you decide whether or not you need a fine needle aspiration cytology (FNAC)

If the nodule is functioning, do not do a FNA. It just means hyperthyroidism. Observe or treat depending of FT4, T3 levels.

If the nodule is non functional, however, you must do a FNAC for a possible malignancy.

If TSH is normal or elevated, it means there could be something suspicious in the glad, do FNAC of the nodule.

Why not do a scan? Because the nodule will likely be non functional and will tell you nothing else to change your management,

UpToDate mentions sonographic criteria for biopsy before jumping to a FNA, but Master The Boards says that USG can never exclude malignancy and you must always do a FNAC.

 Investigating thyroid nodule

That's all!

-IkaN

Pendred syndrome mnemonic

Hello!

What is pendrin?
An iodine transporter, pendrin, is located on the apical surface of thyroid cells which mediates iodine efflux into the lumen.

What is pendred syndrome?
Mutation of the pendrin gene causes Pendred syndrome, a disorder characterized by defective organification of iodine, goiter, and sensorineural deafness.

How do I remember this?

Diabetes insipidus and SIADH mnemonics

"Do you have any mnemonics on vasopressin related disorders? I always mix up diabetes insipidus and syndrome of inappropriate anti-diuretic hormone!"

Sorry for replying so late. You are probably in your second year med school because once you get old, you can never mix up the two. Anyway, I made these mini mnemonics for ya, hope they help! :)

Normal sodium, potassium and serum osmolality values mnemonic

Hello!

In my last post, I helped you guys remember normal arterial blood gas values. Now, we are going to remember a few electrolytes. Yaay! :D

Step 2 CK: Conjunctivitis in newborn

Hello! 

These are some points that I felt are high yield while studying conjunctivitis in newborn =)

Cystic fibrosis and prolonged neonatal jaundice

Why does cystic fibrosis cause prolonged neonatal jaundice? 

Friedreich's ataxia mnemonic

Mini post for the day :)

Step 2 CK: Treatment of Pneumocystis carinii pneumonia (PCP) mnemonic

Hello my old friend!

Today's post is on  Pneumocystis carinii pneumonia (PCP)!

Here are my notes and mnemonics :D

Fetal Hydantoin syndrome mnemonic

This is a short post on fetal hydantoin syndrome.

Step 2 CK: Anterior and posterior urethral injuries and mnemonic

Hello!

I was studying about urethral injuries today for my Step 2 CK exam and these are my notes :)
I put them in a question and answer format. Hope it helps! 

What are the pats of the male urethra?
The male urethra is anatomically subdivided into anterior and posterior segments at the level of the urogenital diaphragm.

Posterior urethra:
Prostatic urethra
Membranous urethra

Anterior urethra:
Bulbous urethra
Penile urethra

Mnemonic: PM BP

Parts of male urethra mnemonic

Step 2 CK: Blunt pancreatic trauma

Happy Monday everyone!

Today, I am going to be talking about a uncommon condition, blunt pancreatic trauma.

Blunt pancreatic trauma occurs when high energy force is applied to the upper abdomen, which crushes the retroperitoneal structures against the vertebral bodies.

Superficial and deep veins in upper and lower extremity mnemonic

Hello!

It's important to know the superficial and deep veins of the extremities.

Why?

Because management of thrombosis of a deep vein differs from thrombosis of a superficial vein.

Myasthenia gravis and muscles involved

Today, in the study group, someone asked about nerves not involved in MG.

Myasthenia gravis can present as a pupil-sparing third nerve palsy with ptosis.

Why is the pupil spared?

Step 2 CK score 251 experience by Saminathan Anbalagan

So in this post, Saminathan Anbalagan, IMG from India talks about how he scored a 251 on Step 2 CK and his journey.

Saminathan:
There are a lot of experience posts which are excellent guides.. I actually went through many of them and took the one which suited me.. So I’ll first write about few areas where I felt difficult.. And then give the whole experience..

I didn't have proper guidance for the assessments.. CMS, NBME and UWSA.. I didn't know how to go about.. I guess many people are feeling the same.. So lemme give an overview..

Step 1 score 256 experience by Satish Advani

So in this post, Satish Advani, CMC Pakistan talks about how he scored a 256 on Step 1 and his journey.

Satish:

I’ll try to make this guide as helpful as possible. Whatever I write here is based on my own experience and the experiences of top scorers I observed during my preparation. 

Resources:

This is the most important part of your preparation and probably most variable also because it depends on your previous knowledge and your way of studying so you have to find out what works for you.

Kaplan, highyield, roadmap, BRS, etc etc the list goes on and on. Important thing is to stick with one book for one subject. If you have difficulty understanding anything google it. It will take sometime but it is going to be worth it.

Here is the list of stuff I used, whether or not I found them helpful and what was my previous knowledge in these subjects (on a scale of 0 to 10)

Physiology: 4/10

I never read Guyton or Ganong in my medical school. Just glanced at a review book to but still I never found this subject too hard.

Kaplan notes - Read the notes and watched the videos . I didn’t like this book. Dragged myself upto the renal system then decided to skip. And then started BRS.

BRS physiology - Hands down the best book for physiology. Probably somewhat difficult to understand at first because its written in a concise way but it’s GOLD my friends. It's questions are important also specially the CVS and respiratory part. Owe my star to this book for these systems.

Testicular swellings and transillumination mnemonic

Hello!

In today's post, I'll be shedding light on your testes! :P

For those who don't know what transillumination is, it is shining of light through a swelling and seeing if the light is transmitted through it or not.

In this post, I'll be talking about swelling of testes.

Electives: How much does it cost and how to be cost effective

Hello!

This post is on how to reduce your expenditure when you travel for studies.

When I went to US for electives, I was on a really low budget and had to save every cent. I couldn't afford spending lavishly and no blog briefs you about the finances clearly. So I thought of writing a blog on how to be cost efficient during electives so that it would help someone who was chasing dreams with loans like I am :)

Pulmonary contusion vs ARDS for Step 2 CK

Hey everyone!

Because the radiographic findings in pulmonary contusion and ARDS are so similar, I thought of writing a small post on it :)

Both have patchy irregular alveolar interstitial opacities on x-ray. Also, both these conditions present with tachypnea and hypoxemia.

So how do we differentiate the two?

Nail changes in psoriasis mnemonic

Hello! Here's a mnemonic on nail changes in Psoriasis!

Proximal - BLOP
Beaus line
Leuconychia
Onycholysis
Pitting

Special and differentiating investigations in Anemia

Here, we would try to summarize all the investigations useful to differentiate various types of anemias--

1. Microcytic hypochromic anemias
-S. Ferritin, Total Iron Binding capacity, Transferrin saturation help in distinguishing IDA, AOCD, Beta thal trait.
HbA2 levels between 3.5-8% are diagnostic of beta thal trait.

2. Macrocytic anemias
S. VitB12 and S.Folic acid assays to differentiate megaloblastic from non megaloblastic macrocytic anemias.
PBS f/s/o megaloblastic anemia - macovalocytes, hypersegmented neutrophils, pancytopenia +/-

3. Warm Antibody against P antigen and cold antibodies (I antigen) to detect AIHA and also to differentiate AIHA from HS.

4. G6PD Assays- suspected G6PD deficiency anemias

Redistribution of drug

I knew what is is Distribution of drug but I think somewhere along my medical school I might have missed reading about REdistribution of drug. Here's what it is:

Biochemistry – How to study?

We see many requests coming to our study groups, asking for few tips to study Biochemistry. Today I thought we should talk about it for the sake of our 1^st year Medicowesomites!! Yay!

Ok, Biochemistry, as the name itself implies is about Chemistry in Biological systems. So what do we most encounter in Biochemistry and how to tackle them?

Ulcerative Colitis, Crohn's disease and rectal involvement

Greetings everyone!

Here's a short post on how to remember that rectum is involved in Ulcerative Colitis (And spared in Crohn's disease.)

ICE syndrome mnemonic

Hello!
A short post of mnemonics on one of the coolest syndrome of the eyes.....

Thalassemia mnemonic

Hello!

I was reading thalassemia today and I thought of sharing few facts and this trick for learning the beta chain variants of hemoglobin (Hb) in Thalassemia.

Facts about thalassemia:

Zollinger Ellison syndrome mnemonic

Hello! Here's a short concept for the day!

Normally, secretin decreases gasrtin and gastric acid production,

In Zollinger Ellison syndrome, however, secretin increases gastrin production.

Non caseating granulomas mnemonic

Hello!

The mnemonic for non caseating granulomas is RBCS

Bernard Soulier syndrome mnemonic

This mnemonic would not help you to remember all the aspects of the syndrome but two quite important points would be on the tip of tongue for sure.

Remember the dog - St. Bernard's

Age of completion of ossification mnemonic

Hello!

For those who forget the age at which ossification centres close, this post is for you!

Bartters, Gitelmans and Liddles syndrome mnemonic

Hello!

Bartters, Gitelmans and Liddles syndrome present with chloride resistant (high urinary chloride) hypokalemic metabolic alkalosis.

What differentiates them:
Bartters: Hypercalciuric (Furosemide like! Loops lose calcium, remember?)
Gitelman: Hypocalciuric (Thiazides don't!) and Hypomagnesemia. Presents with cramping and spasms.
Liddles: Presents with hypertension, metabolic alkalosis and hypokalemia (Aldosterone excess like, but it is truly pseudohyperaldosteronism!)

It is characterized by: Hyporeninemic hypoaldosteronism, hypertension, hypokalemia and enhanced erythrocyte sodium influx

Here's a mnemonic for it!

"FaceBook GoT ALL pseudo HYPER about a Little syndrome"

FB - Bartter's is like Furosemide
GoT - Gitelman Thiazide
All pseudo hyper little - Liddles is like pseudo HyperALdosteronemia (Remember, it is pseudo - aldosterone levels are normal/low)

These syndromes are rare, so it’s important to rule out more common causes (Like diuretics)

That's all!

Here's an aphorism by Sir William Osler: “Care more for the individual patient than for the special features of his disease.” :)

-IkaN