Tuesday, May 15, 2018

Inguinal lymph nodes

Hello Awesomites! :)
Long time. Happy to be back. :D

Today we will study Inguinal Lymph nodes along with its clinical significance.

You know fascia lata is present in our lower limbs.

The Lymph nodes lying above it is called as superficial inguinal Lymph nodes.
The Lymph nodes lying beneath it is called as deep inguinal Lymph nodes.

The superficial Lymph nodes are further divided into horizontal and vertical groups.
The deep lymph nodes are deep to fascia lata and 1-2 nodes can be found in femoral canal. This nodes in the femoral canal are called as deep inguinal Lymph node of Rosenmuller or of Cloquet. This drains glans penis and clitoris.

Through the umbilicus is taken a watershed line of Lymphatic drainage of anterior abdominal wall.
The anterior abdominal wall below the umbilicus drains in the superficial inguinal lymph nodes.
Entire perineum except glans penis and glans clitoris are drained by superficial lymph nodes.
Most of the lower limb is drained by superficial inguinal lymph nodes except the territory of short saphenous vein (This part of lower limb is drained by popliteal group of lymph nodes).

Some part of Uterus and uterine tubes are also drained by superficial inguinal lymph nodes.
Anal canal below pectinate line also drains in superficial inguinal lymph nodes.

Superficial Inguinal lymph node drain lymph from the
1.     gluteal region,
2.      inferior anterior abdominal wall,
3.      perineum
4.     superficial lower limbs
5.     Anal canal below pectinate line
Deep Inguinal Lymph node drains
1.     deep lymphatics of the distal lower extremity
2.      perineum (e.g. glans penis / clitoris),

CLINICAL SIGNIFICANCE:

In sexually transmitted diseases, you will find enlargement of this lymph nodes.
Inguinal lymph nodes are the frequent sites of metastasis for malignant lymphoma, squamous cell carcinoma of anal canal, vulva and penis, malignant melanoma and squamous cell carcinoma of skin over lower extremities or trunk. 

-Upasana Y. :)


Saturday, May 12, 2018

Allergic Broncho-Pulmonary Aspergillosis (ABPA) treatment mnemonic

To remember that Allergic Broncho-Pulmonary Aspergillosis is treated by corticosteroids mainly and not anti-fungals although Aspergillus is a fungus, just write:

Allergic Broncho- Pulmonary Aspergillosis ==> as => Allergic BronC-Orticosteroids Pulmonary Aspergillosis

and that's it :)

-Murad

Sunday, May 6, 2018

Query on Step 2 CS deadline & match timeline

I read this link and I'm confused, it says:

To participate in the National Resident Matching Program® (NRMP®) Main Residency Match®, international medical students/graduates must have passed all exams required for ECFMG Certification. If you plan to participate in the 2019 Match (in March 2019) and still need to pass Step 2 Clinical Skills (CS), you should register now to take the examination.

To help ensure that your result will be available in time to participate in the 2019 Match, you must take Step 2 CS by December 31, 2018. If you do not register now and schedule soon, it is possible that you will not be able to obtain a test date in 2018. At the time of this writing, the earliest available test date at any test center is in August 2018.

Link: April 2018 https://www.ecfmg.org/news/2018/04/09/imgs-participating-in-2019-match-should-apply-for-step-2-cs-now/

I plan to apply for matching in 2019, do I need to take the exam in December 2018?

- Sent through email

Hello,

Let me clear terminologies before I start explaining.

Match 2018 means: Application in September 2017, results in March 2018, Residency starts in July 2018.

You said apply for matching in 2019, which means apply in September 2019 for the March 2020 match, yes?

Let's talk about the 2019 match mentioned in the link you sent. It says currently, there will be no availability of testing centres for this year's match (September 2018 application, March 2019 Match, Residency starts in July 2019). The ECFMG website is able to predict the number of applications that they are going to receive. This year, they predict there will be no testing centers available, which is why I am guessing they are asking you to register in April (register now).

Your confusion arises because of two reasons:
You don't know the match terminologies with respect to the year.
You don't know the timeline for the match.

When they mean apply right now and give the exam before December, they are talking as a general mandatory requirement. IT IS A ABSOLUTE MUST HAVE.

To be a competitive candidate, IMGs tend to give the exam in such a way that the results are out before September so that we have all the exam results before the application cycle of the match. IT IS OPTIONAL BUT PREFERRED.

So really, the virtual deadline to give the exam for us is July. We also prefer to graduate before September to get ECFMG certified, however, it's not mandatory.

It is quite vigilant of you to keep an eye out for these notices on the ECFMG website.

Since the dates are not easily available, when you plan to go for an elective, try to register in advance.

If you go to the ECFMG website, there is a site called a step 2 CS scheduling and you can view the dates available at various centres. So register as soon as possible if you want to get your desired dates. Here's the link https://csess2.ecfmg.org/calendar.aspx

PS: The step 2 CS permit is available for one year and it does not expire quickly (compared to other exam permits that expire in 3 months) which is a huge advantage.

So to summarize, July is the ideal deadline for Step 2 CS to get results before September (Application submission). December is the mandatory deadline to get result before February (ROL submission, to be eligible for the match).

Google the step 2 CS reporting schedule to help plan for your match.
https://www.ecfmg.org/news/2018/04/18/results-reporting-schedule-for-step-2-cs/

Hope that helps!

-IkaN

Saturday, May 5, 2018

Enamel Rods


  • An enamel rod is the basic unit of tooth enamel. 
  • Measuring 4 μm wide to 8 μm high, 
  • An enamel rod is a tightly packed, highly organized mass of hydroxyapatite crystals
  • It provides rigidity to the rods and strengthens the enamel.
  • Enamel rods normally have a clear crystalline structure
  • Light can pass through rods
  • Many rods have a fish scale appearance
  • Shape: Hexagonal
  • Pattern: Keyhole or paddle-shaped prism pattern


Number: 

  • 5 million= mandibular lower incisor to
  • 12 million= maxillary first molar

The direction of rods:

  • Rods are rarely straight, they follow a wavy course from dentin to the enamel surface
  • Generally, they are oriented at the right angles to Dentin surface 
  • Horizontal direction in the cervical and central part of the Crown
  • Oblique to vertical direction in the incisal regions
Striations: 

  • Rods are built up of segments separated by Dark Line in a rhythmic manner
  • Visible by the action of mild acids
  • Striations are uniform of 4 centimetre
- Written by Anisha Valli


Hertwig's Epithelial Root Sheath- HERS


Hertwig's epithelial root sheath
  • It originates from the cervical portion of the enamel organ.
  • It plays an important role in determining shape length size and number of roots.
  • It is a double layer of cells which consists of outer enamel epithelium and inner enamel epithelium.
  • Root sheath extends around dental papilla and separates it from surrounding dental follicle all through except the Basil portion.
  • Inner enamel epithelial layer of root sheath influences the formation of odontoblast from the outer portion of the radicular dental papilla. 
  • These odontoblasts lead to the formation of the first layer of radicular dentin.

As the first layer of radicular dentin is laid down:
  • HERS loses its continuity 
  • The cells of the dental follicle or dental sac invade double layer of HERS 
  • Root sheath degenerates to form epithelial Islands

Therefore, it allows connective tissue of dental follicle to come in contact with newly formed radicular dentin. 

This causes differentiation of cementoblast from dental follicle which deposits cementum on newly formed radicular dentin.

Transitory Sutures

Transitory Sutures are found in cap stage of tooth development

Enamel Knot: Enamel organ cells form a knob-like extension which extends to the underlying dental papilla.

Enamel cord: it is a vertical extension of enamel knot

Enamel septum: when enamel cord extends to meet outer enamel epithelium it divides stellate reticulum into two parts

Enamel navel: Depression present at the junction of enamel septum and Outer enamel epithelium is known as enamel navel and it resembles umbilicus

Enamel Knot signals determine the shape of the tooth
Enamel Knot and Enamel cord act as a reservoir of dividing cells 

- Written By Anisha Valli

Tuesday, May 1, 2018

Human Papilloma Virus mnemonics

To remember that HPV vaccination starts at 11 years old and that HPV is the most common STD in the US, use the following mnemonics:

=> Write Human Papilloma Virus with 11 instead of the 2 Ls so it becomes as follows:
Human Papi11oma Virus

the 11 in papilloma will remind you of number 11 :)

=> remember HPV as the Highest Prevalent Virus :P
so this will remind you that it is the commonest STD

and that's it

-Murad

MDMA mnemonic

Hello! 

This post is about MDMA.

MDMA? Yep. It's short for 3,4-methylenedioxymethamphetamine.

Commonly called “Molly” or “ecstasy”.
MDMA can elicit feelings of euphoria, wakefulness, intimacy, and disinhibition.

Intoxication causes dangerous side effects such as:
Hypertension
Hyperthermia
Delirium
Psychomotor agitation
Hyponatremia
Intracranial hemorrhage
Myocardial infarction
Aortic dissection
Disseminated intravascular coagulation
Rhabdomyolysis
Seizures
Serotonin syndrome

Here's a mnemonic!



That's all!
-IkaN

Monday, April 30, 2018

Conjunctival xerosis mnemonics

Conjunctival Xerosis

Hello everyone today let's discuss the causes and treatment of conjunctival xerosis.

So basically there are two types of conjunctival xerosis.
a. Epithelial xerosis
b. Parenchymatous xerosis

Epithelial xerosis.
The most common example is Xerophthalmia i.e. Vitamin A deficiency.

Let us discuss Xerophthalmia.

The cause of vitamin A deficiency is mostly its dietary deficiency or defective absorption.

The new WHO classification of Xerophthalmia

XN:   Night Blindness
X1A: conjunctival xerosis
X1B: bitots spots
X2:   corneal xerosis
X3A: keratomalacia <1/3rd of cornea
X3B: keratomalacia >1/3rd of cornea   
XS: corneal scar
XF: fundal changes – known as Uyemura spots, these are defects in the Retinal
Pigment Epithelium.

Treatment:
It consists of local ocular therapy with artificial tears along with vitamin A therapy.
Schedule for vitamin A is as follows :

>1 year of age – 1lakh IU i.m. given on 0 1 14 days
                                OR
 2lakh IU orally given on 0 1 14 days

<1 year of age – half the dose.

This has to be carried along with treatment of underlying causes like malnutrition or other disorders like diarrhoea dehydration.

Other causes of night blindness:
1. High myopia
2. Late stage of angle closure glaucoma
3. Oguchi syndrome
4. Gyrate atrophy of choroid
5. Retinitis pigmentosa

Parenchymatous Xerosis
It mainly involves the adenoid layer of the conjunctiva.
It can take place due two main reasons     holla! We have a mnemonic here
1. Due to cicatrizing disorders  (cicatrizing disorders turn conjunctiva reasonably shrivelled)
2. Due to over exposure to atmosphere ( marked exposure causes parenchymatous xerosis)

Cicatrizing disorders
1. Cicatricial phemphigoid
2. Diptheric membranous conjunctivitis
3. Trachoma
4. Chemical burns
5. Radiotherapy
6. Stevens-johnson syndrome


Overexposure to atmosphere
1. Marked proptosis
2. Ectropion
3. Coma (lack of blinking)
4. Palsy of cranial nerve 7 (facial palsy)

That’s all for now,
Stay Awesome!
Keep calm and keep studying!

- Ashish G. Gokhale

Wednesday, April 25, 2018

Step 2 CK: Blunt abdominal trauma

Hello!

When you are presented with a case of blunt abdominal trauma (BAT) in your exam, first determine whether the patient is stable or unstable.

Saturday, April 21, 2018

Medicowesome secret project: Trouble in St. Bowel High School

Coronary circulation: Fun fact about blood flow to the myocardium

Hello everyone, here is a post busting a myth about coronary circulation.

Many of us have always thought that the heart itself receives blood during diastole which is only partially true. Here is the complete story.

Getting back to basics, let us revise a bit about the cardiac anatomy.

Tuesday, April 17, 2018

USMLEowesome: United States Clincal Experience (USCE), electives and obs...

United States Clinical Experience - An overview

Intended audience: Those who want to know more about USCE


What this video will cover:
Why do you need USCE?
Types of USCE
Deciding where to apply, which electives?
Paperwork required for electives (brief overview)
Strong letter (applicable for USCE and the match)
CV (brief overview)
Visa interview: Important! Do not mess it up!
If you are not accepted: Have back ups!
If you are accepted: Video for another time :)

Links from the video:

Types of USCE:
http://www.medicowesome.com/2016/03/a-short-post-on-how-to-apply-for.html
http://www.medicowesome.com/2016/04/dr-thinker-united-states-clinical.html
http://www.medicowesome.com/2017/06/my-elective-experience.html
http://electives.us/typesofusce.html

Paperwork:
http://www.medicowesome.com/2016/03/a-short-post-on-how-to-apply-for.html
http://electives.us/electiveapplication.html 

Read this before your visa interview: http://electives.us/usvisaandelectives.html

Link to the powerpoint:
https://drive.google.com/open?id=1aRH5u4Vk7RfHIKrBsDl0TjTMtuVmlVnW

That's all!

-IkaN

Sunday, April 15, 2018

USMLEowesome: Studying for the USMLE Step 1 exam

Hello!

The intended audience for this video is those who have decided to give the exam and are starting to study for it.

Friday, April 13, 2018

Facebook: Microbiology Candida.

So, this post is the answer to our previous question asked on medicowesome facebook page. Question was

#Medicowesome #Microbiology

A vitreous aspirate from a case of metastatic endopthalmitis on culture yields Gram-positive round to oval cells, 12-14 mm in size. The aspirate on Gram staining show the presence of pseudohyphae. Which of the following is the most likely aetiological agent?

1)  Aspergillus.
2)  Rhizopus.
3)  Candida.
4)  Fusarium.

Answer: Option 3) Candida.

Let's analyse the question and extract the information one by one.
So, we get two things from the question.
a) The causative organism has pseudohyphae and
b) It is stained by gram stains.

Among the given options, only Candida can form pseudohyphae. All other options are filamentous fungi forming true mycelia and Candia is the only fungi that are usually gram positive on smears.

Some awesome points that must be known on Candida infections.

1) Candida is unicellular organism belonging to yeast like fungus categories. All Candida species are commensals of humans. So, their mode of transmission is endogenous while most of the fungus have mode of transmission as inhalation.
2) They form pseudohyphae.
3) Candida albicans is different from other candida because :-
   a) It forms true hyphae or germ tubes when grown in serum.
   b) It forms thick walled large spores called chlamydospores.
   c) It is dimorphic. It means it grows as yeast at 37°C and as molds at 25°C.

4) Test to differentiate between C. Albicans and other Candida is called germ tube test or Reynolds Braude phenomenon.
-C. Albicans when placed at 37°C in human serum forms germ cell tubes within 2 hours.
5)Candida albicans is the most common cause of mucosal candidiasis.
6) Candidiasis is the most common systemic mycosis. It is also the most common fungal infection in neutropenic and immunocompetent patients.
7) It causes oral thrush, oesophageal candidasis, cerebral candidasis and pulmonary candidiasis.

Extra information:

Their is one test which I learned online and some people consider it as diagnosis of candida infections.

The Spittle Test:
When you get up in the morning, and before you brush your teeth, eat or drink anything, fill a glass with bottled water at room temperature.
Spit some saliva gently into the glass.
Come back every 20 minutes for the next hour and check for some of these signs.

1) Strings coming down through the water from the saliva at the top.
2) Cloudy saliva sitting at the bottom of the glass.
3) Opaque specks of saliva.

Also, in above question we deducted that the given pathogenic organism is gram stain so we get to learn about stains as well.
Normally, fungi are stained by PAS and methenamine silver but some fungi are stained by special stains like :-

Candida is stained by gram stain.
Cryptococcus is stained by mucicarmine, India ink.
Histoplasma is stained by Giemsa stain.

Thanks for reading!
Ojas Gite.

.

Schizophrenia: Types and Prognosis mnemonic

Schizophrenia: Types and Prognosis mnemonic.

So to begin with, Schizophrenia is a psychiatric disorder classified under psychosis.
Psychosis is a mental state involving loss of contact with reality, causing deterioration of normal social functioning. 

Features of psychosis are:
Loss of insight.
Marked disturbance in personality and behaviour.
Loss of contact with reality.
Impairment in judgement.
Presence of delusions and hallucinations.

A quick recap : Psychosis is classified as   -

• Organic e.g. Substance related psychosis, head trauma
• Major e.g. Schizophrenia, mood disorders
• Third psychosis e.g. delusional disorder, acute and transient psychotic disorders.

There are 7 types of schizophrenia and the mnemonic goes like
PHC (primary health centre) U R SO far

1. Paranoid: The commonest type and good prognosis. The onset is later in life 3-4th decade. Major symptoms are delusion of persecution and grandeur.

2. Hebephrenic: 2nd most common and the worst prognosis. Disorganisation of thought, speech, affect and personality is more prominent than other types. Also there is marked emotional impairment.

3. Catatonic: The best prognosis (especially reactive catatonia). Characterised by marked disturbance in motor activity. Further divided into 3 forms i.e. Excited, Stuporous, and one alternating between the two.

4. Undifferentiated: Where symptoms do not fit in any subtypes.

5. Residual: Chronic type where the positive symptoms vanish and patient is left with 'residual' negative symptoms

6. Simple: only negative symptoms from onset (no positive symptoms at all)

7. Others (f): 
Schizophrenia + mental retardation = Pfropf syndrome
Schizophrenia + self-mutilation = Van-Gogh syndrome

Now let us see what exactly we mean by positive and negative symptoms.
Positive symptoms are those psychotic symptoms not seen in normal individuals (of course, haa!) but are “actively expressed” in the patients (something is added extra and so called positive).

Negative symptoms are normally expected behaviours like emotions like feelings thoughts and drives that a normal person experiences are absent in the patient (Normal things are being taken away and so called negative).

That’s all for now,
Stay awesome!
Keep calm and keep studying!
-Ashish G. Gokhale

Thursday, April 12, 2018

USMLEowesome: Basics about the Step 1 exam

This video is for those who have no idea about the Step 1 exam.



Things I forgot to cover in this video:
You can not retake the exam, if you pass or fail, you score stays forever!
How the score is reported and what is a good score.

It'll be covered in the next video.

Download the slides from here:
https://drive.google.com/open?id=1cETyEFg4kJS8uXYTF8twPg22CLqPCfiE

That's all!
-IkaN

Being street-smart during interviews: Flights!

During the hectic interview season and when you wanna travel from the east coast to the west coast, you will need flights for sure :D

Below are some tips about tickets and flights:

1- buying tickets:

> It is almost always cheaper to buy tickets online, check: Expedia, Kayak, Google flights and Cheapoair websites and compare the prices.

> Check Southwest (recommended) website too, its flights won’t show in the websites mentioned above.
What is special about Southwest is that it allows you to have 2 checked bags (up to 23 kgs each) for free! Also, you can change your flight one-time without paying anything or pay the difference between the 2nd ticket but without losing the original one.
Southwest has some nice offers too and tickets sometimes go as low as 49$ :O

> There is an app called “Hopper” on smartphones, it gives you the prices of different flights and notify you if the prices go up or drop. It also shows you which days are more expensive and which are cheap.
It sometimes shows you a bit more expensive price than the websites mentioned above so you can use it to have a general idea about cheaper days then buy the ticket from the internet.

2- When to buy the ticket?

> In general, the earlier you buy the ticket, the cheaper it will be. Be careful, sometimes this doesn’t happen and you suddenly find that the price of a certain flight has dropped so keep looking.

> Some airlines may have some offers on Black Friday and Cyber Monday so stick to your laptop these 2 days and save some money :D

> Avoid buying tickets during the Christmas season. Prices become crazy skyhigh!

3- Which airlines to choose?

I will talk about the ones I tried only:
American Airlines and United: pretty much the same (at least in my experience), the price of any checked bag is not included in the ticket so you need to pay for it (25$ or 35$). They also charge you 100$ if you have an overweight bag ( >23 kgs / 50 pounds ).

They have a rule that you have to check your “checked bag” 30 and sometimes 45 minutes before your flight, so even if you arrive 30 minutes before your flight and you have a bag to check, you will miss the flight and automatically rescheduled to the next one.

Spirit: Although some people had bad experiences with it, it still has one of the cheapest ticket prices, but put in mind that you ll pay for everything in your flight including the water you drink. (Interestingly, my experience with them was so smooth though)

Other airlines include but are not limited to: Delta and Frontier.

Some important tips:

> If you travelling to a small city, don't fly there directly. Instead, book your flights to the city with a bigger airport (mostly the capital of each state) then take a bus from their to your desired destination. This can also be done to states that are near each other (Fly to a state near to your final destination then take a bus from that state). This may help in saving a lot of money but will need more time.

> Don't forget to check the weather forecast, snow storms result in many cancellations.

> For international travelers to US, if your airport doesn't allow you to board the plane except if you have a return ticket, you can simply buy a return ticket within 24 hrs of your departure flight and cancel it after your check in. This is better than buying a round-trip ticket or paying a fee to change the date of the return flight especially if you are not sure of this date.

===
Update: 6/2/2018...Thanks to Hyndavi:
copied:

I used Delta airlines for most of the part.
1. They allow you a free carry-on bag which is good for carrying interview stuff. Compare prices with other airlines adding the baggage cost and make a purchase.

2. In December and January, there might be a lot of delays and flight cancellations. Make sure you call them after your trip and ask for compensation. They usually credit in miles which you can use at later stage. There are incidences where I claimed even after a month. Email or lodge a complaint.They are pretty responsive. American airlines is good too.

3. Whenever there is a delay or cancellation request them for an immediate rescheduling. For interviews during December and January, try to take the earliest flights possible to avoid missing an interview.

4.Try to carry a snack whenever possible as food in the airports repeatedly can cause unwanted expenditure.

5. Never check-in a carryon bag because a luggage missing or any delay can affect your interview. Sometimes, they just collect if before boarding and give it back after landing, which is ok.

6. Regarding Southwest, if you cancel a ticket, you get a credit into your Southwest account which you can use at a later stage. .
========
Comment below for any other tips you feel may be helpful :D Happy flying everyone :)

-Murad

Wednesday, April 11, 2018

The USMLE journey cost

Hello!

This blog covers the finances of the journey.

I know you are reading this because you are wondering if you can afford it, if it is all worth it.

For knowledge, I believe, destiny creates a way. Remember, to NOT quit your dreams because of green pieces of paper.

Medicowesome dentistry study group on Whatsapp


Hello everybody!

Inspired by the medical students study group, we decided to create a dentistry Whatsapp study group for dental students and we are really excited!

This idea is by one of our dentistry authors, Anisha and she'll be handling the group.

What's the study group for?
A bunch of dental students from all over the world, discussing study related concepts!
You may share your experiences, what you studied today, ask interesting questions to help other people learn or simply revise, ask doubts about things you don't understand, answer other people or just tell a fact you learnt that fascinates you.
We learn something new on a daily basis <3

How do I sign up for the group?

USMLEowesome: Introduction

Hello!

What is USMLEowesome about?
A video series for those thinking or aiming for a residency in the United States.

Who is the intended audience?
Those who are new to the USMLE journey.

This video will also cover a little bit about me (IkaN) & an overview of the USMLE journey with my timeline.


Tuesday, April 10, 2018

How to use Anki Flashcards for studying

Hello!

Since many of you guys requested it - A video demonstration on how to use AnkiDroid for studying during premed and med school!



Monday, April 9, 2018

Sample CV for electives

Hello,

Since many of you guys have been asking for my CV for electives, I thought of uploading it for you to refer.

ECG changes seen in hyperkalemia and hypokalemia mnemonic

Here's a mnemonic by Shohrat Arazov!

When it seems out of your reach, should you try?

Here's an email I got from an awesomite who was extremely confused on whether or not to pursue something out of her reach (In this case, post graduate training in the US). Since it was an extremely personal email, I haven't posted the entire email here (just bits and pieces). Her email is in italics.

Sunday, April 8, 2018

Features of DNA replication: Semiconservative replication

Hello everyone!

Here is a feature of DNA replication that we don't think much about - the semiconservative replication!

Features of DNA replication: Unidirectionality and bidirectionality

Hello everyone!

DNA replication can be unidirectional or bidirectional, depending upon whether the replication from the point of origin proceeds only in one direction or proceeds in both the directions.

Medicowesome Anki flashcards

Hello everyone!

Here are the flashcards I used for step 2 CK and Step 3 -

Saturday, April 7, 2018

Some antibiotics in the US and their trade names

When you start your rotations, you'll hear many drug names that will sound new to you and since the drug names written in qbanks and books are the scientific ones, here is a brief list of some antibiotics and their trade names in the US:


Scientific name
Trade name
Cephalexin
Keflex
Ceftriaxone
Rocephin
Cefdinir
Omnicef
Cefadroxil
Duracef
Azithromycin
Zithromax
Ampicillin - Sulbactam
Unasyn
Piperacillin - Tazobactam
Zosyn ( also called Piptazo)
Levofloxacin
levaquin
Linezolid
Zyvox
Nitrofurantion
Macrobid
Dalfopristin - Quinupristin
Synercid


Comment below for more “commonly used” antibiotics (or drugs in general) that may be added to this table.


-Murad

Wednesday, April 4, 2018

Spanish learning tips for USMLErs

Speaking Spanish is a nice addition to your CV if you are planning to specialize in the US. Spanish is the 2nd most commonly spoken language in the US and some states especially southern ones like Texas and Florida have a huge Spanish-speaking population. Moreover, learning Spanish is fun :D

Here are some tips/methods that can help with that:

1- Language learning apps:

Memrise
www.memrise.com
One of the best apps out there, it works on any device. Just make a free account and practice a bit every day to find out that you learned several thousand words without knowing.
In addition to the main “deck” offered by the smartphone app, you can study many other decks just by going to the website on a laptop and search for the language you want. The only pitfall is that the main deck doesn’t teach you grammar so you have to find other decks or sources.

Duolingo
Another great app which is similar to Memrise. I haven’t used it but I have heard great reviews about it.

Spanish Verbs Lite
A nice smartphone app that has a selective set of verbs with their conjugation in all tenses.
===
2- Social apps for languages:

Tandem and Hellotalk

Consider these apps like a Facebook/Tinder but for languages.
You enter your language and choose the language you wanna learn. These apps will match you with people who speak the language you wanna learn and you will be speaking the language that they wanna learn. Nice platforms to make “language learning friends” especially that you write about your interests so you can befriend others who have the same ones.
===
3- Youtube channels:

Butterfly Spanish
https://www.youtube.com/user/ButterflySpanishola
ِA very useful channel to boost your Spanish. I ll leave you with what Anna wrote about her channel:
“Learn Spanish for free with Spanish lessons that cover grammar, pronunciation, vocabulary, tips & tricks, and cultural aspects. My Spanish lessons are for all Spanish levels and are based on my passion for Spanish culture, language, and teaching.

123dialogues
https://www.youtube.com/watch?v=JFINwW5qL1w&list=PLzRf-4Z5tJuQvis4oLgmkfG83Lrkjj_DA
A great channel which has many dialogues in both Spanish and English.

You can always search Youtube to find more stuff. This is one of the playlists when I searched for Medical Spanish:
https://www.youtube.com/watch?v=MyzgZbZnUik&list=PL5o-4-kgVLgivtGLZy6iTV-x6EqPSUDUI
===
4- Immersion:

Immerse yourself in Spanish. Use your Facebook in Spanish and maybe your smartphone too. You will automatically memorize words without even trying. You ll know that “me gusta, comentar and compartir” are the Spanish words for “like, comment and share”. After a while, you ll be amazed that you are picking more and more passively.
==
5- songs

Songs can stick in our minds in a magical way. Look for Spanish songs and read both the Spanish and English lyrics.
==
6- Friends

No matter how many progs and apps we use, nothing is like having a real conversation with a human being. The MATCH journey will let you meet people from Puerto Rico, Dominican Republic and many many others Spanish speaking countries. Practice with your friends and ask them to correct you.
==
7-Podcasts:

A treasure to learn languages. Many podcasts are there, among the best is: coffee break Spanish.
https://radiolingua.com/coffeebreakspanish/
Listen to the audio file, learn the accent, repeat. They also provide transcripts for the audio file in PDF form.
Coffee break podcasts are available for other languages including Italian and French.
==
8- Time Time Time

Specify a fixed period of your day to learn/talk in Spanish. This may be as short as 5 minutes up to a few hours. It may be when you wake up or before you sleep. Just develop a habit of learning new words and practicing your Spanish daily.



=>Updates<=
Some suggestions from the readers:

> Meetup
https://www.meetup.com/
As the name suggests, this is a website through which you can meet people.
Create a free account, then choose your interests and discover groups of people who share your interests and hang out with them. Language learning is among the things you can choose and especially in the US, you ll meet many people who wanna learn Spanish.

>" Spouse - induced"learning
Some friends stated that having a spouse is one of the biggest motives to learn a new language :D


Comment below if you know any more tips/programs/apps/books that can help in mastering Español  :)

-Murad

Neonatal Resuscitation Protocol

Here is a short (may be not very short) but concise flowchart on the neonatal resuscitation protocol by the American Academy of Pediatrics.




If I have forgotten to add any point, let me know.

Written by our Medicowesome Student Guest Author,
Devi Bavishi

Being street-smart during interviews: Banks!

Although many of the non-US IMG MATCH applicants will have a bank account during their rotations ahead of the MATCH, let’s talk about banks and IMGs in general!

The post may be updated if more banks join the list :D

below are some banks in which IMGs can open an account without having a Green Card:

Bank of America:

Pros:
1- Available nearly everywhere
2- It gives you a temporary card that you can use for 30 days until your permanent card arrives
3- It has a nice mobile app (better than other banks in my opinion) that can basically do anything, easier than calling them or going to the bank.

Cons:
1- To avoid the monthly fee of 12 dollars, you have to maintain your balance above 1500$ at any point during the month or you have to deposit 250$ per month.
2- For IMGs, they require 2 forms of identification (compared to one in most of the other banks). These 2 can be your passport and international driving license.
3- If you wanna travel outside the US, it is preferable to activate the “travel notice” feature (via visiting the bank or the app or calling them) because they may temporarily block your debit card if you are using it from a different country.

Don’t forget to go paperless (either using your mobile app or by asking them in the bank) to avoid having infinite unnecessary papers mailed to you especially if you are staying temporarily at a friend’s place!

====

Citizens Bank:

Pros:
1- They require 1 form of identification.
2- To avoid their monthly fee of 10$, you can either deposit or let any friend deposit in your account each month even if a dollar OR simply you can open another account for free and auto-circulate a dollar monthly between the 2 accounts and voila, no fees at all.

Cons:
1- They are less available in some states like Ohio and NY where you will find ATMs only and hardly any branches.
2- They don’t give you a temporary card when you open your account, so you should leave some cash with you till the debit card arrives.
3- YOU HAVE TO TELL THEM YOU WANNA GO PAPERLESS, or else they ll charge you 2 dollars monthly for bank statements that are mailed to your physical mailing address.

When you call Citizens Bank and it asks you for a Social Security Number (SSN) to let you talk to an employee, just wait and say nothing. You ll be asked about the SSN 3 times then you ll be auto-transferred to a human employee.

Good banking everyone :D and don’t forget to comment if you know more "IMG-friendly banks"

And that’s it
===
Update 4/8/2018

Some friends mentioned: CHASE and Wells Fargo so you may try them too
(Wells Fargo pros and cons are very similar to Bank of America)

-Murad

Tuesday, April 3, 2018

Euthanasia

Hello Awesomites!
Here's a quick review on the topic Euthanasia, a collection of asked MCQs on euthanasia.

EUTHANASIA

Mercy killing or Assisted suicide
Physician assisted suicide is legal in some States of the US
Painless killing of a person who is suffering from incurable disease, senility, permanent damage to the brain which cannot be repaired or cured
Legally permitted in: USA, Uruguay, Poland, Australia, Switzerland, Nether lands
Not legalized in India

Types-

Active (Positive)euthanasia-
Act of commission
Death induced by direct/indirect action
legal in Netherlands and Belgium
E.g. giving large dose of a drug that hastens death

Passive (Negative)euthanasia-
Act of omission
No specific medicine or life supporting measures given
Death induced by discontinuation of life sustaining measures
legal in India
E.g. stopping heart lung machines in a severely defective new born, disconnecting ventilator in a brain dead patient

Voluntary euthanasia-
Euthanasia induced at the will of an individual by his request
A patient suffering from an incurable disease requesting the doctor to terminate his life

In/Non voluntary euthanasia-
Induced in patients who are unable to express their wishes
E.g. a person with irreversible coma or a severely defective infant
Paternalism - abuse of medical knowledge so as to distort the doctor-patient relationship in such a way that the patient is deprived of his ability to take rational choice.

Thank you!
MD Mobarak Hussain (Maahii)

About me

Hey Medicowesomites :D 

I have been posting here since some time and I would like to introduce myself

I am Murad Almasri from Palestine, I finished my med school in Egypt then did my USMLEs (step 3 left though) and will start my residency in Pediatrics in the US soon  :)

I am a positive person and I always like to know more and more ...it's just like eating information 
I believe in sth called "encyclopedial knowledge"..try to know everything about everything.

 I love making mnemonics and collecting them, I think I've been doing that since high school maybe even before that and this helped me tremendously in the USMLEs.

 I like reading books especially novels - I am a big Harry Potter fan ^_^ .
I also like video games ( I sometimes ask myself who doesn’t :D ?) and of course moviesssss 

 Learning new languages is a passion for me too, I already know a few.

 Good luck Medicowesomites and enjoy this amaaaaaazing website :)

 -Murad

Sunday, April 1, 2018

Neural Crest Cells : Mnemonic

Hi everyone !
Here's a short mnemonic post !

Neural Crest Cells are very special cells that form at around 2-3 weeks of gestation.
They're right next to the Neural folds of the Neural tube to begin with and then eventually come to lie lateral to the tube, after which they migrate to various parts of the body giving rise to a bunch of things.

It's kind of SUPER IMPORTANT to memories what structures arise out of the Crest cells.
One of the reasons for it is that neural crest cell tumors will express certain neuroendocrine markers and that will make it easier to detect them on histopathology.
The other reason is that it's literally the most favorite embryology question - whether it's  NEET PG or Step1!

So here goes :

Mnemonic - LAMAS BABy

L - Lepto meninges (Pia + Arachnoid)
A - Adrenal Medulla
M - Melanocytes
A - ANS Ganglia
S - Schwann Cells

B - Branchial Arches
A - Aortopulmonary windows + Endocardial Cushions
B - Bronchogenic cells - Pneumocytes
Y - Yo

This will also help you understand why Melanomas , Bronchogenic Carcinoma , Schwannoma, Pheochromocytoma and even Neuroblastoma are all positive for similar markers and have similar appearances at times along with similar histopathological fetaures.

Hope this list covers them all!
Happy Studying!
Stay Awesome!

~ A.P. Burkholderia

Friday, March 30, 2018

Tennis in medicine

This post is compiled by Devi :)

Tennis Racquet Appearance
o A descriptor for the tennis racquet-like thickening of the mesangium seen by light microscopy in glomeruli affected by Kimmelstiel-Wilson disease

Tennis Racquet Appearance on Xray Teeth
o odontogenic keratocyst, ameloblastoma, central giant cell granuloma and odontogenic myxoma

Tennis Racquet Spore
o classical shape of Clostridium tetani bacterium containing a terminal spore.

Tennis Racquet Cell
o A tennis-racquet-shaped variant of rhabdomyoblast seen in sarcoma botryoides, a form of rhabdomyosarcoma affecting children

Tennis Racquet Granule
o A subcellular particle seen by electron microscopy in Langerhans’ cell histiocytosis.

Tennis Racquet Sign
o finding in a blighted ovum in which the ultrasonically empty gestational sac is compressed—the racquet’s ‘handle’—and adjacent to a surrounding deciduoid reaction—the ‘paddle’

Tennis Elbow
o chronic inflammation at the origin of the extensor muscles of the forearm from the lateral epicondyle of the humerus, as a result of unusual or repetitive strain (not necessarily from playing tennis).

Tennis Leg
o a rupture of the gastrocnemius muscle at the musculotendinous junction, resulting from forcible contractions of the calf muscles; often seen in tennis players as the result of frequent quick stopping and starting movements.

Tennis Thumb
o tendinitis with calcification in the tendon of the long flexor of the thumb (flexor pollicis longus) caused by friction and strain as in tennis playing, but also occurring in other exercises in which the thumb is subject to repeated pressure or strain.

Tennis Toe
o Subungual hematoma of the great toe which may follow any vigorous exercise—e.g., tennis-in shoes with hardened toe protectors

Tennis Wrist
o Tenosynovitis of wrist which may occur in tennis players.

Tennis Racquet cavity
o Seen in TB
o When tuberculous process is virtually confined to the bronchus, resulting in narrowing or occlusion with dilatation beyond, or in local wall destruction with weakening and dilatation, the ring shadow is in fact a dilated bronchus, and the wall of the ‘cavity’ has the histological feature of bronchial wall with or without tuberculosis foci in it. The rest of the bronchus, extending proximally towards the hilum, is often dilated as well, and its wall thickened by tuberculous involvement, so that a so called ‘tennis racket’ shadow. The draining bronchus of the most of the tuberculous cavities, whatever the type, is either concurrently or secondarily infected, leading to tennis racket appearance

Written by Devi Bavishi 

Age of Gestation and Estimated Date of Delivery (EDD)

Hello,

This is a nice video explanation by Jay!

Tuesday, March 27, 2018

Pyruvate Carboxylase Vs Pyruvate Dehydrogenase (a mnemonic)

Biochemistry has a lot of enzymes and equations which may make it hard to memorize!
Mnemonics come in handy and make our lives easier :D

I used to mix the function of these two enzymes: PC (Pyruvate Carboxylase) and PD ( Pyruvate Dehydrogenase)
so let’s first write the “simplified equations" with their main outcomes then talk about the mnemonic:

Pyruvate ---Pyruvate Carboxylase → OXloacetate

Pyruvate --Pyruvate DehydrogenaseAcetyl-CoA

A good way to remember that PC gives Oxaloacetate is just saying: PC and Xbox ( 2 platforms used for gaming) with the X in Xbox referring to the X in oXaloacetate.

To remember that PD gives Acetyl-CoA, put in mind that we become DEHYRATED in HOT weather so we use AIR CONDITIONERS  (ACs).
Dehydrogenase in Pyruvate dehydrogenase will remind you of dehydration and the need of ACs, consider AC the acronym of Acetyl-CoA ;)

A friend drew this to help simplifying it:


And that’s it :)

-Murad


Monday, March 26, 2018

Depression: A Summary

Hey guys! Here’s a review of Major Depressive Disorder using a whiteboard as help.

Depression is a type of mood disorder with primary disturbance in internal emotional state causing subjective distress and socio-occupational dysfunction.



Learned helplessness is when the individual learns that he/she is helpless in situations where there is a presence of aversive stimuli, has accepted that there’s no control over it, and thus gives up trying.

CLINICAL FEATURES:
The classic mnemonic goes as-
  • Depressed mood: Can show diurnal variation. Patient reported. Essential for diagnosis.
  • Sleep disturbance: Patients have decreased slow wave sleep duration and R.E.M. latency while having increased total R.E.M. duration with early R.E.M. onset in sleep cycle.
  • Interest loss or anhedonia: Inability to attain pleasure from almost any activity. Patient reported. Essential for diagnosis.
  • Guilty: Patients have feelings of worthlessness or sin for events they have little or no role in/ control of.
  • Energy loss or fatigue
  • Concentration difficulties: Usually accompanied with indecisiveness.
  • Appetite and weight changes: Can increases or decrease. Usually, there’s a loss of body weight by 5% or more, associated with GI complaints of constipation, dyspepsia etc.
  • Psychomotor changes: Retardation or agitation.
  • Suicidal ideations: Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.

MANAGEMENT:

1st line-
Psychotherapy: Cognitive Behavioural Therapy, Problem Solving Therapy, Emotions Focused Therapy and Behavioural Activation etc.

Selective Serotonin Reuptake Inhibitors: Fluoxetine, Paroxetine, Fluvoxamine, Escitalopram and Sertraline.

2nd line-
Serotonin/ Norepinephrine Reuptake Inhibitors: Duloxetine, Venlafaxine, Desvenlafaxine.

Tricyclic Antidepressants: Amitriptyline, Nortriptyline, Clomipramine, Desipramine and Imipramine.

Monoamine Oxidase Inhibitors: Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline.

Atypical antidepressants: Bupropion, Trazodone, Mirtazapine.

Last line-
Electroconvulsive therapy is reserved for:
-Need for a rapid antidepressant reponse
-Failure of drug therapies
-History of good response to ECT
-High risk of suicide
-High risk of medical morbidity and mortality

Further reading:
Normal vs. abnormal grief reaction
Cyclothymia vs Dysthymia
Types of psychotherapy


Hope this helps. Happy studying!
--Ashish Singh

USMLE Mentorship

Hey there. How's it going? So I had this idea of compartmentalizing mentorship for different phases of USMLE.

Normally, what happens is a person asks questions which aren't very specific to a particular phase, and ends up annoying the opposite person.

So what if we divide usmle into 3 steps as they already are, also about paper work, electives, observerships, lodging boarding in different parts of USA, and make a list of people  specific to each step who want to help and provide mentorship. This way many people who are looking to give back to this process, have a chance of passing on the kindness.

So if you are done with any of the steps or want to provide mentorship for any of the things listed above, or have a thing that should be added to the list, send us your name and which part of the process you would like to help with. This way there can be more focused distribution of knowledge and mentorship.

People willing to help, send us your details. If we have enough people willing to volunteer, we can grow this thing into something really helpful. Depending on the number of  responses of volunteers, we will take this thing forward.

Leave your ideas and suggestions, if you have any. Thanks for reading.

If you are willing to help - email me at medicowesome@gmail.com with "USMLE Mentor" in the subject.

If you have IkaNs number on Whatsapp, contact her.

Varicose Veins : Overview

Varicose Vein

Hello Awesomites!
Through this post I'm trying to share the high yielding points on Varicose Veins.

VARICOSE VEINS
Primary:
Congenital absence or incompetence of valves
Inheritance with FOXC2 gene
Klippel-Trenuanay syndrome
Congenital AV fistula
Cutaneous hemangiomas
Hypertrophy of involved limb
Absence of deep venous system

Secondary:
Recurrent thrombophlebitis
Occupational – prolonged standing
Obstruction to venous return –abdominal tumors, retroperitoneal mass, Pregnancy.
Iliac vein thrombosis

Clinical features

Lipodermatosclerosis (brawny induration), pigmentation, thickening, chronic inflammation and induration of skin in calf muscle and around ankle.

Brodie-Trendelenburg test
To assess the competence of SFJ
Patient lies flat, elevate the leg and gently empty the veins, palpate the SFJ and ask the patient to stand whilst maintaining pressure. If the veins do not refill- SFJ is incompetent. If the veins do refill SFJ may or may not be incompetent, presence of distal incompetent perforators.

Cough impulse (Morrisey's test)
Locate the saphenofemoral junction(2-4 cm inferolateral to pubic tubercle) and ask the patient to cough. Impulse or fluid thrill felt indicates saphenofemoral incompetence.

Modified Perthes Test:Ask the patient to stand and tourniquet is applied at SF junction and ask to walk. Superficial veins become prominent – indicate deep vein thrombosis.

Three tourniquet test - To find the site of incompetent perforator
Tourniquets at SFJ, above knee level, below knee level.

Fegan's test:Detect the perforators

Investigations:
Duplex Ultrasound imaging – gold standard
Doppler examination – only when duplex is not available
Phlebography – not needed in primary venous insufficiency. Only performed as preoperative adjuncts when deep venous reconstruction is being planned
Ascending phlebography – differentiates primary from secondary insufficiency
Descending phlebography - identifies specific valvular incompetence suspected on B mode scanning.

Medical treatment:
Calcium dobesilate
Diosmin
Hesperidin
Toxerutin

Surgical management:
Trendelenburg's operation (juxta femoral flush ligation + stripping the varicose vein) for SFJ incompetency

Subfacial ligation of Cockett and Dodd :perforator incompetence with SF competency

VNUS closure(ablation catheter introduced into the SF junction and slowly withdrawn)

TRIVEX – veins identified by subcutaneous illumination; injection of fluid & superficial veins are sucked

Endo venous laser ablation (EVLA)

Sclerotherapy



That's all. Thank you.

-MD Mobarak Hussain (Maahii)

Hutchinson in Medicine

Here's a summary of the important Hutchinson's in medicine!

1. Hutchinson Teeth 
Seen in -  Congenital Syphilis
Feature -  Peg shaped Incisors , Widely spaced and smaller teeth.
Associations - Mulberry Molars : Multi-cusped Molars.

2. Hutchinson Sign of the Nail
Seen in -  Subungual Melanoma
Feature -  Melano-nychia ( Black colored nail) , feature of a melanoma below the nail plate.

3. Pseudo Hutchinson Sign of the Nail
Seen in -  Melanocytic be of nail bed
Feature -  Melano-nychia like appearance.

4. Hutchinson sign
Seen in -  Varicella Zoster infection
Feature -  Vesicle at the tip of the nose - indicative of Zoster infection. May precede Herpes Zoster Ophthalmicus.

5. Hutchinson Triad
Seen in -  Congenital Syphilis
Feature -  Hutchinson teeth + Interstitial keratitis + Sensorineural Hearing loss.

6. Hutchinson Patch
Seen in -  Syphilitic Keratitis
Feature -  Salmon patch on the cornea

7. Hutchinson Mask
Seen in -  Tabes Dorsalis, Neurosyphilis
Feature -  Mask like sensation over the face due to involvement of trigeminal.

8. Hutchinson  Pupil
Seen in -  Raised Intracranial tension especially due to a mass.
Feature -  Pupil dilated and unreactive to light due to 3rd cranial nerve compression.

Those are all the Hutchinson I can think of !
Let me know if you got any more.
Happy Studying!
Stay Awesome !

Growth Rates in Dermatology

Hi everyone. My skin Lecturer just taught me this so I thought let's post this =)

So growth rates !
We need to know 3 of them - Hair , Finger nails and Toe Nails.

Hair is the fastest growing.
So remember just one number for it - 0.37 mm/day.

Now , next fastest is finger nails.
For this divide by 3.
0.12 so 0.1 mm / day is finger nails.

Now divide this by 3 to get the value for Toe nails.
So 0.03 mm/ day is for Toe nails !

That's all for this post !
Stay awesome !
Happy Studying !
~ A.P.Burkholderia

Sunday, March 25, 2018

MIL : Tinea (Dermatophytosis)

Hi everyone ! 
This is my 2nd MIL! Hope it's illustrative and informative ! 

(Click on the image to see it in Full View). 

Description
This is an Image of Tinea Corporis (Ringworm) infection of the skin. 

Notice - the lesion is annular in shape , has a ring like appearance. 

The lesion seems to be erythematous and  elevated (papular) towards its outside, and shows central area of clearing. 

This is classic of Tinea! 
Tinea is actually a fungal infection caused by Dermatophytes
____________________________
Clinical Features -
- Include such a lesion over different body parts which are severely itchy. 
- Occur particularly in summers.

Tinea Corporis = Tinea infection occuring over the body. 

Some common forms are - 

Tinea Cruris = Tinea Infection in the groin area (Jock itch).

Tinea Glutealis = Tinea along the natal cleft and towards the Gluteal regions. 

Tinea Pedis = Athelete's foot, occuring in the feet. 

Tinea Capitis = Scalp and hair. 

- Predisposed to get this in areas of constant sweat and moisture. 
Hence dryness is very important to maintain. 
____________________________ 
Ix
Usually a clinical diagnosis. 

Differentiate from Psoriasis : Lesions are not clear centrally ; there are plaques with Scales in Psoriasis and there maybe history of pin point bleeders.

Can confirm using Biopsy / Analysis of skin scraping and obtaining a species specific diagnosis. 
____________________________

Rx

A. Topical Anti fungals 
- Resistance is rampant. 
- Most promising ones are Luliconazole and Terbinafine creams.
- Can try Clotrimazole and Ketoconazole Shampoo for the site of lesion.

B. Oral Anti fungals 
- Itraconazole is a wonderful drug , dose being 5mg/kg / day. Roughly 100 mg twice a day is good enough. 
- Griseofulvin was an option but resistance seen now.

C. Anti histaminic for allergy. 

D. Duration of Rx is almost 2-3 months. It's a hard fungus to kill..

E. Steroids not to be used strictly. ( I've seen some horrendous results where the whole body was covered with Tinea when the patient stopped applying the steroids. Best to avoid them as per clinical as well as literature review). 

Hope this was helpful! 
Happy studying ! 
Stay Awesome ! 

~ A.P.Burkholderia 


Being street-smart during interviews: Buses!

Match season is a a really unique life-time experience. You will travel for interviews, meet new friends, visit states you have never visited before and of course, spend some money.

Although flights in general are the fastest most-convenient way to travel, you may try “bus inter-state travelling” which is much cheaper than taking a flight.

I will briefly write about some bus companies that are there and their pros and cons:

Greyhound:

Pros:
> It covers most of the states in the US.
> they have stations where you can sit and wait in (which is very important especially during Winter when it is freezing and snow is everywhere!).
> Starting from late 2017, you can use an E-ticket (emailed to you) instead of a printed ticket.
> They have nice discounts up to 50% sometimes, be sure to sign in and check their website for promo codes especially on Thanksgiving, Black Friday, New Year’s Eve.
(If you are planning to travel in January, don’t rush and buy the ticket early)

Cons:
> in general, their prices are more expensive than other bus companies.
> slow wifi (sometimes non-existent :D).
> Be careful around the stations especially at night, stay indoors!
> If you buy the ticket using a visa card with a different card-holder name than your’s, they will charge you an extra 18 dollars :( .
> Some passengers may be really weird.

If you miss your trip, you will be charged 20$ to issue a new ticket and catch the next one.

Megabus:

Pros:
> Cheaper and can be as cheap as 1 dollar! Check their website regularly.
> E-tickets are available too.
> Buses are newer and more comfortable.
> Passengers are “less weird”.

Cons:
> less state coverage than Greyhound.
> No stations, you have to wait in the street which can be very bard especially if it is raining heavily or snowing.

You can change your trip (if more than 3 hours left till departure) after paying a fee of 20 dollars. This is good to avoid losing your money if you had to cancel your scheduled trip for any reason.


Bustogo:
Less state coverage but they have a nice feature which is using the ticket within a year of purchasing it.

This is based on a personal experience, so you are welcome to try anything you want and put in mind that delays may occur here or there especially with bad weather.


Before you travel to any state, check this website: http://www.smartmedtravel.com/
It will show you names of buses and trains that are available in that state in addition to airports and car rental options.

Wishing y’all a successful Match/interview season and safe travels :D

-Murad