Saturday, March 19, 2016
Step 2 CS: Do you think I have cancer?
How to study for final year MBBS
- Asked on Tumblr
Packing for electives
Packing is tough because you've got limited space and weight. I carried a 23 kg big bag. My carry on was of the appropriate luggage compartment size. They do not weigh carry on bags if they are in the dimension range. I also took a bag pack for my laptop and a hand bag for work. You can carry the coat & umbrella with you, they don't mind. Do not put food / sharps in the carry on, they'll remove it.
One of my friends luggage bag got misplaced during his flight change. He only had his carry on bag with him for the initial 2-3 days (Till the airlines resent his bag!) So make sure you have at least a few set of clothes and necessary documents in your carry on, in case this rare incident happens to you.
Here's a list of what I packed and suggestions on what you should pack. You can use this list to guide yourself and make sure you don't forget anything!
Clothes and linen:
1 warm coat, 2 gloves, 2 scarves, 2 thermals, 1 knit winter cap, lots of socks, umbrella.
I didn't carry blankets because I knew I would be provided with them.
(They say you should buy winter wear like coats and snow boots in America but I advice you to carry it from your home country anyway in case you can't go shopping immediately.)
8-10 formal shirts, 3 pants, 1 lab coat with long sleeves.
1 formal shoes, make sure your toes are covered. (You can wear sports shoes with scrubs in surgical rotations.)
3 track pants and tops to go with it
2 hoodies, 2 sweaters, 2 jeans
1 pretty dress (My birthday was around that time so :D )
1 big towel, 1 small towel
1 semi open shoes for wearing at home. (I didn't pack flip flops because I knew I would wear socks most of the time due to the cold.)
Documents:
Passport copies (Keep one copy in each bag)
Visa copy
Step 2 CS exam copy
Immunization
Health insurance
Malpractice insurance
Acceptance letters
Medicines:
Paracetamol
Allergy medication
Cough medication
Antibiotics
Vicks balm
Bandages
Anything you can find at home
(It's important to carry medicines because they are really expensive in the US)
Skin care:
Vaseline
Moisturiser
Cold cream
Sunscreen
Make up
Optical stuff:
2 Glasses
Lens solution
Lens
Academics:
First Aid for Step 2 CS
Pens, pencil, sharpener, eraser
Electronics:
Laptop with every ebook ever
Phone charger
Universal adapter
Pen drive
Iron (I didn't carry it because the clothes dryer doesn't leave a lot of creases and you don't really need to press any clothes)
Crockery:
1 mug, 1 big spoon, 2 small spoons, 1 butter knife, 1 sharp knife, 2 plates and 2 bowls. Everything microwavable, unbreakable and not too heavy.
Apartments that you rent may give you utensils for cooking, so don't carry too much like frying pan and heavy utensils.
I think you should also carry a water bottle and a tiffin box. Sometimes, it is easier to carry a lunch box with home food than to eat from the canteen.
Toiletries:
Tooth paste and tooth brush
Shampoo, oil, conditioner
Comb, Hair ties, Clips
Bathing soap, perfume, body spray
Washing powder, soap for clothes
Soap for utensils, utensils scrubber
Sanitary napkins
Mug for water (Because there are no jet sprays here)
Others:
Scissors
Nail clipper
Safety pins
Wrist watches
Needle and thread
Weighing scale
Stethoscope
Hammer (If neuro rotation)
Spiritual:
Diary
Religious books
A photo frame :)
Food: You don't need to carry them from India because you will get most of the food in America as well. I think tea bags are hard to find. Also, I froze a few home made chapatis so I had something to eat if the weather was too bad and I wouldn't be able to make it for groceries in the first few days. It was a good decision.
Tea bags
Milk powder
Sugar
Salt, pepper
Ghee
Frozen franks
Frozen chappatis
Nutella
Peanut butter
Honey
Biscuits
Soup
Chocolates
You can always buy stuff from here even if you forget a few items here and there. So don't stress too much like I did :D
Friday, March 18, 2016
Milrinone in congestive heart failure
For those of you who don't know, Milrinone is a phosphodiesterase inhibitor and it enhances cardiac contractility by increasing intracellular levels of cyclic AMP.
Milrinone has a lot of beneficial hemodynamic actions short term. It can provide acute hemodynamic and symptomatic benefit in patients with advanced heart failure with reduced ejection fraction, improving functional status and reduce hospitalization [1].
BUT long-term therapy with oral milrinone increases the morbidity and mortality of patients with severe chronic heart failure [2]. The mechanism by which the drug exerts its deleterious effects is unknown.
Milrinone causes more harm than benefit in patients with ischemic cardiomyopathy [3].
That's why, like my resident called it, milrinone is also known as Killrinone! I just like how he made the kill pun, so I wrote about it and wanted to let you guys know :D
To summarize: Even though milrinone is used in patients with refractory heart failure for symptomatic relief, it has no long term mortality benefit.
That's all!
If you've noticed, I am trying to level up my blogs by referencing articles, I won't get too technical and you will still see the smiley faces. But I think it's time for Medicowesome to grow up and be more evidence based :)
-IkaN
References:
[1] Safety and clinical utility of long-term intravenous milrinone in advanced heart failure.
AUMehra MR, Ventura HO, et-al. Am J Cardiol. 1997;80(1):61. PMID 9205021
[2] Effect of Oral Milrinone on Mortality in Severe Chronic Heart Failure
Milton Packer, Joseph R. Carver, et-al. N Engl J Med 1991; 325:1468-1475 November 21, 1991 DOI: 10.1056/NEJM199111213252103
[3] Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study.
Felker GM1, Benza RL, et-al. J Am Coll Cardiol. 2003 Mar 19;41(6):997-1003. PMID: 12651048
Wednesday, March 16, 2016
Ibutilide
Hey guys.
So here is a random fact. Ibutilide is the only drug that converts atrial fibrillation to sinus rhythm.. All the other drugs..propranolol, verapamil, digoxin etc reduce the ventricular rate only.
Tuesday, March 15, 2016
A short post on how to apply for electives
What is electives?
Electives is hands on clinical experience in the US.
Why do I need it?
To show the residency program you are applying to that you have experienced the US clinical setting and that you are comfortable in it.
To get a letter of recommendation required for the residency application.
It also helps you know a lot of people in your field, that can help you get a research or an interview.
When can I go for electives?
In the final year of your medical school. BEFORE you graduate. Once you graduate, you can't do electives.
Mechanism of pulsus paradoxus in pericardial diseases like constrictive pericarditis and pericardial tamponade
Normally, during inspiration, a decrease in intrathoracic pressure is transmitted to the right heart, augmenting venous return.
What happens to the left heart?
During inspiration, expansion of the lungs and pulmonary tissues causes pulmonary blood volume to increase, which transiently decreases the flow of blood from the lungs to the left atrium and therefore, left ventricle.
Understood this? Okay, cool.
Right ventricular volume increases, pushing the interventricular septum towards the left ventricle.
Submissions: Klumpke's paralysis notes
Monday, March 14, 2016
Step 2 CS: Upper limb neurological examination
I recommend watching videos and making your own "Set of dialogues" and practicing over and over again. Here are mine for upper limb neurological examination:
Sunday, March 13, 2016
Submissions: Kawasaki disease mnemonic
F- Fever (for more than 16 days)
E- Enanthem
B- Bulbar conjunctivitis
R- Rash, redness of lip, tongue, finger tips
I- Inflammation of blood vessels (vasculitis)
L- Lymphadenopathy (mostly cervical
E- Extremity affection
One more with same mnemonic
Submissions: Lymphatic drainage of the breast diagrams
Diseases and their twins.
1. Wolf-Parkinson-White and
Lown-Ganong-Levine syndrome-
-What's similar?
The tachycardia, short PR
interval, pre- excitation
-What's different?
While in WPW syndrome,the
culprit is a naughty extra pathway,
the bundle of Kent, in LGL the AV
node itself is naughty.(The
hypothesized bundle of James
hasn't been discovered yet)
Conduction through the AV node
occurs rapidly.
ECG findings- WPW syndrome has
a short PR interval and a Delta
wave on the QRS complex. No
Delta waves occur in the LGL
syndrome.
Also, the risk of sudden death
remains lower in LGL syndrome.
Saturday, March 12, 2016
Study group discussion: ESR, HbA1c and diabetes
Friday, March 11, 2016
Don't let the score get you down
Thursday, March 10, 2016
Studying anatomy again
-Asked by Anonymous
Hey. I can understand that what you are going through must be really tough. Studying for the same subject again and again is really boring and can be frustrating at times. I am so sorry you have to go through this :(
Alright! So what can we do?
Tip 1: Fake it till you make it.
Pretend you are a super awesome anatomy professor and teach it to yourself after reading.
Write cool things and fun facts about anatomy. Make colorful notes.
Celebrate after every page you read. Be happy while studying.
You have to fake interest in the subject. Because otherwise you won't be able to study for it.
Tip 2: Figure out what went wrong in the previous attempts.
I think you can tell what went wrong. Was there an easy question in your viva that you did not answer? Was there a question with high weight age that you didn't about? Did you mark more than half MCQ's wrong? Did you fail to draw diagrams? Did you forget the answer or did you not know about it? Are you just studying important questions and not reading everything that is supposed to be read? What are your weak points: Neuroanatomy? Abdominal anatomy? Embryology?
Work on it.
Tip 3: Get another book or resource
Maybe your textbook isn't good enough for you any more. Stick to you but get new books just to have a read in other words.
Google for diagrams.
Make mnemonics.
YouTube songs on anatomy. Play them and sing them!
There is a lot of help available, just look for it.
Tip 4: Visualize it
Palpate your brachial artery and tendons while studying. Imagine the muscles in your feet. Visualize how your skull looks like on the inside. Look at diagrams, cadavers and notice the origin and insertion of various muscles. If you can't see it, you won't be able to answer questions related to it.
Tip 5: Live in anatomy
So here's a fun thing you can do. Talk to yourself in anatomy.
Today, when I didn't know the answer to the question, I used my trapezius with my 11th cranial nerve to shrug my shoulders.
To tease my friend, I used Genioglossus to protrude my tongue :P
I used my facial nerve and orbicularis oculi to wink at my girl friend ;)
I am glad I have strong pelvic muscles iliococcygeus and my internal organs aren't prolapsing.
Maybe you could write a "Life in anatomy" diary! xD
Make stupid anatomy jokes. (Soleus has a soul and heart?) Play anatomy games and quizzes.
Have fun with studying, please. But please, study everyday. Make a study plan and study a lil bit of everything. An hour everyday of: Head and neck, limbs, neuroanatomy, embryology, etc. Revise. Revise. Revise. Anatomy is all about memorization and you are likely to forget if you don't revise. Have someone keep a track of your progress. If you can't, email me. I would love to help you out and see you kick anatomy's gluteus maximus this year :D
-IkaN
Related posts:
Giving the exam you failed in
When you get tired of studying
Did you know soleus is known as the second heart?
The heart is not the only pump in the body. While the heart pumps blood out towards the extremities, deep muscles assist in pumping blood back towards the heart. One of the most important muscles for assisting blood flow back to the heart is the soleus muscle!
Cocaine and beta blockers
But just to cover the basics:
Cocaine blocks the reuptake of norepinephrine and dopamine at the presynaptic adrenergic terminals, causing an accumulation of catecholamines at the postsynaptic receptor (Mnemonic). That makes it a powerful sympathomimetic agent. Cocaine causes increased heart rate and blood pressure.
Study tips on preparing for PG CET
So many of you have been asking me how to prepare for the Indian PG exams. As you all know, I am preparing for studies abroad and I don't find myself competent to answer the question. But, we convinced Dr. Prateek Charuchandra Joshi to share his study tips with us.. And he agreed! How cool is this guy! Thanks, Prateek! ^__^
I asked him a few questions focusing on the strategy of studying and irrelevant questions like - how many months/attempts did you take, what were your MBBS scores, how was internship, etc. were not asked simply because these are variable for all of you and you can't do anything about it. What you can do is get a general idea from this post, and make your personalized study schedule :)
Wednesday, March 9, 2016
Cocaine blocks the reuptake of norepinephrine mnemonic
Cocaine blocks the reuptake of norepinephrine, dopamine and serotonin.
How do you remember this?
Tuesday, March 8, 2016
Lipoprotein A and Thrombosis
Monday, February 29, 2016
Random mnemonic on multiple sclerosis
Saturday, February 27, 2016
Drugs causing SIADH mnemonic
I: Indomethacin (Analgesics)
A: Antidepressants (Tricyclics)
D: Diuretics (Thiazides)
Desmopressin
H: Hello :D
Study group discussion: GI hemorrhage and urea
Glucose in pleural fluid analysis
A low pleural fluid glucose concentration (less than 60 mg/dL, or a pleural fluid/serum glucose ratio less than 0.5) narrows the differential diagnosis of the exudate.
Causes of low glucose in pleural fluid include:
Symptoms of Legionella pneumonia mnemonic
The mnemonic for Legionella is in the word itself - LEGIONella.
L: Lungs - Atypical pneumonia.
Relatively nonproductive cough
Dyspnea
Pleuritic or non pleuritic chest pain
Confluent or patchy infiltrates on x-ray
Random fact: Interstitial infiltrates aren't seen often like in other atypical pneumonias.
COPD: Tips for step 2 CK and rounds
During rotations, you may be asked what you want to do for the patient. I have written "Plan" for what you might want to answer to impress your attending. I've included a few common brand names too :)
Inhalers: Remember inhalers only improve symptoms and have no mortality benefit and do not affect the progression of the disease.
Friday, February 26, 2016
Tuesday, February 23, 2016
Submissions: Anticoagulants mnemonic
Hidden bleeds
Guess before you read the answer! :D
Sunday, February 21, 2016
In my words: Diagnosing a PE
Disclaimer: I am talking to myself in the blog. I hope it makes sense.
I'll be talking about two scenarios -
High pretest probability scenario: Dude who sat in a 24 hour flight, smokes a lot, is taking OCP's, got his hip replaced and can't move at all.
Low pretest probability scenario: Dude who is dyspneic, hypoxic and has a normal chest x-ray.
Let's start with scenario #1 - The high pretest probability:
If there's a high index of suspicion and a treatment option is given in the options, choose the treatment one because you don't want to waste time in imaging.
If there's a high index of suspicion and a treatment option is not given in the options, they want you to choose a diagnostic modality. The "next best step" in the diagnosis. What do you choose?
Friday, February 19, 2016
Why does oxygen cause hypercapnia in COPD?
Tuesday, February 16, 2016
How would you look upside down?
Antipseudomonal antibiotics mnemonic
Ciprofloxacin (Fluoroquinolones)
Carbapenems (Meropenem, Doripenem)
Colistin
Polymyxin B
Piperacillin tazobactam (Anti pseudomonal penicillins)
Monday, February 15, 2016
Organisms covered by Azithromycin mnemonic
PS: They were talking in context to community acquired pneumonia (CAP) and so does this post.
Monday, February 8, 2016
Phagocytes, Monocytes, Macrophages, Histiocytes?! What's the difference between them?
If you've always found it difficult to make a distinction between those terms about wha they mean then this post is for you. Let's just settle it once and for all.
Sunday, February 7, 2016
Study group discussion: Lipid Metabolism Deficiency Enzymes
Saturday, February 6, 2016
DNA viruses mnemonic
Wednesday, February 3, 2016
Medical humour: Face-lift
"Face-lift is like a prolapse repair of the face."
- Sim, my medical friend rotating in urology talking about plastics.
Mnemonics - Dermatomal distribution easiest way to remember
Saturday, January 30, 2016
Mnemonic for the layers of the skin (Epidermis)
Here's an easy mnemonic to remember the layers of the epidermis and some other fun facts.
The Epidermis consists of 5 layers (From base to top)
- Stratum basale
- Stratum spinosum
- Stratum granulosum
- Stratum lucidum
- Stratum corneum
Mnemonics
Bottom to Top:
Stratum Basale (as it is the basal layer) :
These cells multiply and produce the keratinocytes which move up the layers.
Melanocytes are present in this layer which produce melanosome (melanin packed in granules) and ship them to the keratinocytes in other layers through their dendrites.
Stratum Spinosum / prickle cell layer (contains desmosomal bridges which look like spines.) :
Polygonal cells.
Connected to each other by the aforementioned desmosomal bridges.
Stratum Granulosum (contain keratohyaline granules) :
Diamond shaped cells.
Granules contain protein filaggrin (filament aggregation) which is responsible for the aggregation of keratin filaments.
Stratum Lucidum:
Flat cells.
Present only in palms and soles.
Stratum Corneum (horny layer) :
Most superficial layer.
Cells are fully keratinised and end up as anucleate dead cells which later desquamate.
Basale, spinosum and granulosum together are called as the living layer.
Corneum is called as the dead layer.
Dermis consists of the superficial papillary dermis and the deep reticular dermis.
Fun facts:
Skin is the largest organ in the body.
Keratin is synthesised in the Spinosum layers but accumulates in the granulosum layer.
The migration of cells from basal layer to desquamation is known as the Turn over Time which is normally 4-5 weeks.
Merkel cells(sensory end organ) present in the basal layer are responsible for the touch sensation.
P.S. The image has been taken from another site.
- Ved
Signs seen in Aortic regurgitation mnemonic
Friday, January 29, 2016
Causes of inverted T waves
Causes of inverted T waves :
1. Normal in lead V1 , V2 and V3 ( V3 only in blacks ) , normal in avR too
2. Ventricular hypertrophy
3 . ischemia / infarction
4. Digoxin toxicity
5. Bundle branch block
Written by Huzaifa Bhopalwala (Previously known as mist amidst)
ST elevation other than MI
Causes of ST elevation other than MI:
1. Prinzmetal angina
2. Hyperkalemia
3. Acute pericarditis and myocarditis
4. Brugada syndrome
5. Arrhythmogenic RV cardiomyopathy
6. PE (Pulmonary embolism )
7. LBBB
8. And Normal variants ( high Take off and early repolarization )
Written by Huzaifa Bhopalwala (Previously known as mist amidst)
Thursday, January 28, 2016
Zika-The next Ebola?
Okay, it's just another virus.Who cares?
Zika virus spreads by a mosquito bite,Aedes aegypti. 80% of the affected population are asymptomatic. Its manifests itself as a fever, headache, joint pains and rarely conjunctivitis just like any other flu. Basically you don't know you have it.
A headache and joint pain epidemic? Stop kidding me.
Wednesday, January 27, 2016
Is diarrhoea really that bad?
Since I haven't found a solid topic to post on I'll be doing this bit.
Remember that dreaded diarrhea which struck when you were traveling off on a trip far from home and you thought you could trade your life for a toilet? That might be a saviour though.
Whaaa? Stop that Shit? No really. Read on.
Serotonin is primarily produced by enterochromaffin cells in the crypts of Leiburkuhn. These are
Mnemonic for the laryngeal muscles and their actions
We've all tried to remember the laryngeal muscles time and again but it just doesn't stick right?
I devised an easy way which helped me.
Tuesday, January 26, 2016
Mnemonic: Organisms penetrating an intact Cornea
But some do so despite it being intact, by creating a CHNL.
Hypoxia and radiotherapy
Okay I know this. Hypoxia kills cells so it should help right?
I'm afraid you couldn't be more wrong.
Thursday, January 21, 2016
Mnemonic for Vit B complex
With all due respect to my classmates who are future physicians, here is my mnemonic! :)