Medicowesome

Wednesday, December 16, 2020

Tips on creating a Rank Order List (point system) for residency and fellowship

Types of Left Ventricular Hypertrophy (LVH)

LVH = increase in the mass of the left ventricle (LV)

Caused due to:

1. enlargement of the muscle cells

2. extracellular fibrosis

Concentric LVH

- occurs in response to pressure overload

- examples: aortic stenosis or hypertension

- associated with: reduced cavity size

Eccentric hypertrophy

- occurs in response to volume overload

-examples: aortic or mitral regurgitation

- associated with: dilation

LVH is also classified based on the cause

Due to primary condition (hypertrophic cardiomyopathy)

Secondary to pathology (hypertension, myocardial infarction, and valvular heart disease)

That's all!

-IkaN

Pediatrics | Male Reproductive System | CK Uworld

J-1 visa: Statement of Need and surety bond for Indian International Medical Graduates (IMGs)

Histoplasmosis mnemonic

Bubonic plague mnemonic

COVID-19 Vaccine Development

The worldwide magnitude of the COVID-19 pandemic is ineffable; it is unsurprisingly compared to the Spanish flu pandemic, which ravaged the world during the First World War (adding fuel to the fire!). One of the pandemic's various positive impacts has been the unprecedented research collaboration and data sharing across the world. Such singular efforts made it possible to cut down the usual time to achieve an approved vaccine from 10⁺ years to less than a year.

To put things into perspective, it took 60 years from the time of the first polio outbreak to developing its vaccine; in the case of Ebola, it took 15 years. Vaccine candidates for SARS-CoV-1 and MERS did not receive the necessary impetus to advance into fruition. However, with SARS-CoV-2, the situation is very different. Global initiatives such as ACTIV (Accelerating COVID-19 Therapeutic Interventions and Vaccines), a public-private partnership comprising of bigwigs like CDC, FDA, EMA (European Medicines Agency), and numerous leading biopharmaceutical enterprises. Another project on a similar scale is Operation Warp Speed, which has invited comparison to the infamous Manhattan Project.

What is an "ideal" COVID-19 vaccine? There are three criteria from the immunological perspective: 1) It induces a robust humoral immune response that produces long-lasting neutralizing antibodies against SARS-CoV-2 antigens, 2) It generates a strong cell-mediated immunity that includes the production of memory T cells, 3) It should be free of any serious local or systemic adverse effects. Considering the logistics of vaccinating the entire world, there are three more criteria: 1) It should be easy to administer, preferably in one or two doses, 2) It should be easy to produce on a large-scale, 3) Its storage should be uncomplicated, ideally possible at room temperature.

Source: Front. Pharmacol., 19 June 2020 | https://doi.org/10.3389/fphar.2020.00937

Let us discuss the vaccines that are currently in development. We all have heard about a few of them in the news and social media, namely, Pfizer, Moderna, Covaxin, Astra Zeneca, and so on. There are, impressively, 125⁺SARS-CoV-2 vaccines in development globally. Broadly, there are six platforms currently being utilized for vaccine development –

1. DNA

2. mRNA (examples – Moderna, Pfizer)

3. Protein (Subunit vaccines)

4. Viral vector – replicating/non-replicating (examples - Oxford/Astra Zeneca, Johnson & Johnson)

5. Live attenuated virus

6. Inactivated virus

Almost all of the above models have targeted the spike glycoprotein, which is present on the surface of SARS-CoV-2, to interfere with the viral entry into a cell.

This article is an oversimplified summary of the vaccine development process. I haven't covered the vaccine platforms, molecular targets, and vaccine candidates in detail. With the advent of vaccine administration, whether it's Pfizer's or any other, there will be a massive surge in vaccine-related information. There will be challenges at every step, from distribution to underdeveloped areas of the world to alleviate the concerns of the skeptical anti-vaxxers. Let us hope that these vaccines start the end of the pandemic.

-Vinayak

J-1 visa: Statement of need (SON) attestation from Indian Consulate

PDA dependent Congenital Heart Diseases mnemonic for step 2 CK

About the Pfizer BioNTech COVID-19 Vaccine trial

Important things we know about the Pfizer BioNTech COVID-19 Vaccine

• From roughly 44000 participants, vaccine and placebo were administered 1:1 ratio, the vaccine participants demonstrated 95% efficacy in preventing COVID-19 in those without prior infection 7 days or more after the second dose.

• Partial protection from the vaccine candidate appeared as early as 12 days after the first dose.

• The vaccine has shown consistent results in people of different ages, races, BMI, and with various co-morbid conditions.

Emoticon game: Acute Liver Failure answers

If you haven't tried the emoticon game, check it out here: https://www.medicowesome.com/2020/12/emoticon-game-causes-of-acute-liver.html

The answers are posted below.

Pediatrics Allergy & Immunology UWorld Step 2 CK

COVID-19 and the increased risk of Parkinson's disease

Hi!

Currently posted in psychiatry, I was reading articles on Parkinson's disease and came through this important finding in context with the coronavirus disease.

Cosmetic surgery and Nontuberculous Mycobacterial infections

There has been an increase in plastic surgery tourism because some countries offer cheap cosmetic surgery. Common surgical procedures sought are breast augmentation surgery, liposuction, eyelid surgery, facelift, labiaplasties, and gluteal lift procedures. [1]

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...

Guidelines for management of gout by ACR 2020

Hi!

Long time..

Urate-lowering therapy indications and important guidelines for management of gout, as updated by ACR in 2020:

TORCH syndrome + mnemonic

TORCH syndrome is caused by congenital infection by a group of infectious agents.

Respiratory fluoroquinolones

Why are moxifloxacin, gemifloxacin, and levofloxacin also known as respiratory fluoroquinolones?

Mechanical ventilation

Terms you need to know

1. PaO2: Oxygen saturation in arterial blood (N = 80-100)

2. PaCO2: Carbon Dioxide saturation in arterial blood (N = 35 – 45)

3. FiO2: Fraction of inhaled O2 (N = 21% i.e. the fraction of O2 in atmosphere air which we inhale)

4. PEEP: Positive End Expiratory Pressure – The pressure needed at the end of expiration to keep the alveoli open.

5. RR: Respiratory rate (N = 12-16)

6. TV: Tidal Volume (N = 6-8 ml/kg = approx. 500 ml)

Shunt fraction and its importance

Hello Awesomites! :D

When should you start sodium bicarbonate in CKD patients? Mnemonic

When should you start sodium bicarbonate in CKD patients?

Data Collection Methods

DATA COLLECTION METHODS

Neurology examination template

Hi everyone!

Here is my template for documenting the basic bare minimum neurology examination.

It's a Carny Problem

Carney's Triad - ENCHONDROMA + PARAADRENAL GANGLIOMA + GIST

Carney's Syndrome - multiple benign tumors, mainly of heart and skin

Carney Stratakis Syndrome - Pediatric GIST (Gastrointestinal Stromal Tumor)

Friday, November 6, 2020

Shock by Dr. Ganti (Pulm/Crit)

Blood Donation

BLOOD DONATION

PRE-DONATION

HISTORY:

Men can donate safely once every three months while women can donate every four months
Age between 18 and 60 years
The donor should be in a healthy state of mind and body
Past one year - not been treated for Rabies or received Hepatitis B immune globulin
Past six months - not had a tattoo, ear or skin piercing or acupuncture, not received blood or blood products, no serious illness or major surgery, no contact with a person with hepatitis or yellow jaundice.
Past three months - not donated blood or been treated for Malaria
Past one month - had any immunizations
Past 72 hours - had dental work or taken Aspirin
Past 48 hours - taken any antibiotics or any other medications (Allopathic or Ayurveda or Siddha or Homeopathy)
Past 24 hours - taken alcoholic beverages
Presently - not suffering from cough, influenza or sore throat, the common cold
Women should not be pregnant or breastfeeding her child or menstruating.
No diabetes, chest pain, heart disease or high BP, cancer, blood clotting problem or blood disease, unexplained fever weight loss, fatigue, night sweats, enlarged lymph nodes in armpits, neck or groin, white patches in the mouth, etc.
No history of TB, bronchial asthma or allergic disorder, liver disease, kidney disease, fits or fainting, blue or purple spots on the skin or mucous membranes, received human pituitary - growth hormones, etc.

EXAMINATION:

Temperature - Normal (oral temperature not exceeding 37.50 C)
Pulse - between 50 and 100/minute with no irregularities
Blood Pressure -Systolic 100-180 mm Hg and Diastolic 50 - 100 mm Hg
Bodyweight - not less than 45 Kg
Hemoglobin - not less than 12.5 g/dL-

Procedure to measure Hb using CuSO4:

i) Massage the finger to be pricked (preferably ring finger)
ii) Disinfect it
iii) Prick using disposable needle/ lancet
iv) Put the drop of blood in CuSO4 containing beaker
v) If the blood drop sinks, Hb is more than 12.5, hence the person can donate blood (provided no other contraindication).

PROCEDURE:

Identify donor and label blood collection bag and test tubes
Ask the donor to state their full name
Ensure that:

the blood collection bag is of the correct type;
the labels on the blood collection bag and all its satellite bags, sample tubes and donor records have the correct patient name and number;
the information on the labels matches with the donor's information

Select a large, firm vein, preferably in the antecubital fossa, from an area free from skin lesions or scars
Clean the site of venepuncture by alcohol and let it dry
Perform phlebotomy using a 16-gauge needle, which is usually attached to the blood collection bag. Use of a retractable needle or safety needle with a needle cover is preferred if available, but all should be cut off at the end of the procedure.
Ask the donor to open and close the fist slowly every 10–12 seconds during collection
Remove the tourniquet when the blood flow is established or after 2 minutes, whichever comes first
Ask the patient to squeeze a ball intermittently during the procedure
Monitor the donor and the donated unit
Remove the needle and collect samples
Cut off the needle using a sterile pair of scissors
Collect blood samples for laboratory testing

POST-PROCEDURE:

DONOR CARE:

ask the donor to remain in the chair and relax for a few minutes
inspect the venepuncture site; if it is not bleeding, apply a bandage to the site; if it is bleeding, apply further pressure
ask the donor to sit up slowly and ask how the person is feeling
before the donor leaves the donation room, ensure that the person can stand up without dizziness and without a drop in blood pressure
offer the donor some refreshments

BLOOD UNIT AND SAMPLES:

Transfer the blood unit to a proper storage container according to the blood center requirements and the product
Ensure that collected blood samples are stored and delivered to the laboratory with completed documentation, at the recommended temperature, and in a leakproof, closed container

REFERENCES:

http://naco.gov.in/blood-transfusion-services-publications

Written by our guest authors HARSH JOGI and AYUSHI GUPTA

Tuesday, November 3, 2020

Ascitic Tap

Requirements

Written informed consent, Betadine, Spirit, Sterile gloves, Sterile drapes, a 1.5-3.5 cm 20-22 G needle, a 5-20mL syringe is used, 18-20 G needle attached to a non-collapsible tube (can be made by breaking drip chamber of an IV set and putting one end of it in an empty water bottle for therapeutic tap tubing to a sterile collection bag)

Procedure:

1. Follow universal precautions.

2. Skin around the site of puncture to be disinfected with betadine or Chlorhexidine and spirit and draped with sterile drapes.

3. Position: The patient should be in supine position( can be asked to roll slightly to left)

4. Site: a) At the junction of medial two-third and lateral one-third of the line join umbilicus and left Anterior superior iliac spine (left side is preferred over right to avoid damage to caecum)

b) 4 inches above iliac crest, whichever is more dependent

Site has to be lateral to rectus muscle. Avoid areas of scar.

5. Local Anaesthesia:

a) Skin, subcutaneous tissue, abdominal wall layers up to parietal peritoneum to be anesthetized with 2% lidocaine filled syringe using a 22-25 G needle.The needle is advanced into the subcutaneous tissue aspirating every 2-3 mm prior to injecting.

b) Once a loss of resistance is felt and peritoneal fluid is drawn into the syringe, it indicates that we have entered the peritoneal cavity. Additional lidocaine is then injected to anesthetize the pain-sensitive parietal

peritoneum.

(A total of approx. 4-5 ml lidocaine is adequate.)

c) The needle is then withdrawn.

6. Puncture:

For diagnostic tap – a 1.5-3.5 cm 20-22 G needle attached to a 5-20mL syringe

is used.

Technique – The aim is to prevent leak by ensuring the skin puncture site is

not directly over the puncture site into the peritoneal cavity.

Z track technique – Pull skin about 2 cm downward before puncturing

skin→ then leave the skin after entering few mm so as to form a Z

prick the skin, go for some distance in the subcutaneous plane and then change the angle to vertically downwards to enter the peritoneal cavity.

For therapeutic tap - A large bore 1.5-2 cm 16-18 G needle is used instead.The syringe is detached and the needle is attached to a non-collapsible rubber tubing.The ascites fluid is drained slowly through the rubber tubing connected to the needle into a sterile collection bag.

7. Seal : After the puncture, the punctured skin is sealed with a tincture benzoin

seal.

8. Post procedures: T.P.R, B.P to be recorded half hourly and the

patient should not be given feeds for the next 4 hours. If there is pain, analgesics may be given.

- Mitali shroff

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)