How to apply for USMLE exams

Hello!

Many medicowesomites have asked about how to apply for their USMLE exams. Finally, here is the procedure. Sorry this took so long

I have answered all the queries in the end.

If you have any more questions, comment in the commments section below and I'll try to reply :)

Descriptive Epidemiology

Hello everyone !
Here's a video telling you a little bit of the Descriptive Epidemiology.
Let me know how you like it and I can continue to make some more to finish it up and tell you more about Epidemics!

Stigmata of infective endocarditis

Hey Awesome people!

Here is another stigmata apart from those mentioned previously by IkaN in a post here,

Stigmata of infective endocarditis:-
(Remember- It's all in the hands)

- Janeway's lesions: non- tender, erythematous macules on the palms and soles.
- Osler's nodes: ephemeral spots of painful nodular erythema on hands and feet.
- Splinter haemorrhages: seen on the nails.

Thats all!

- Jaskunwar Singh

Glaucoma

For all those who don't know what is glaucoma here is the quick review :-

There is damage to the optic nerve, etiology of glaucoma is yet to be known.

Generally, there is increase in intraocular tension , intraocular pressure above 25-30mm Hg which can cause loss of vision. In acute inflammation, WBCs and tissue debris can block exit of intraocular fluid through channel of Schlemm and in chronic conditions, especially in older individuals, fibrous occlusion of the trabecular spaces appears to be culprit!

Buerger's disease

Hey awesomites!

Here's a short post on important points in diagnosis of Buerger's disease (don't confuse the name with Berger's disease which is IgA nephropathy) also known as Thromboangiitis obliterans.

- Recurrent inflammation and thrombosis of small and medium sized vessels
- Hands and feet are affected the most
- Vasculitis and ischemia (causing blackish discoloration of skin)
- Chronic smoking (a definite predisposing/ risk factor)

Clinical features and diagnostic criteria:
            - male patient 30-40 years of age
            - history of chronic tobacco use
            - Angiography: - cock- screw appearance of arteries of wrists and ankles
                                      - tree root/ spider leg appearance due to collateral circulation
            - Exclusion of other vascular diseases ( Raynaud's phenomenon, atherosclerosis, diabetes, hypertension, endocarditis, hypercoagulable states, auto-immune disorders) is important.
            - Skin biopsy (rare)

Note: A possible Rickettsial infection (mostly Rickettsia rickettsiae) could be there which adds on to the pathology of the disease!  (usually in cases of  amputation of the affected area)

Thats all!

- Jaskunwar Singh

Supracondylar fracture of the humerus

Supracondylar fracture of the humerus

- Transverse fracture of the distal part of the humerus.
- Bruises of anterior elbow (Proximal fragments buttons through the brachialis muscle)
- Posterior fat pad sign is seen in non displaced fracture of the humerus.

IMPORTANT: Assess radial and ulnar pulses because brachial artery can be compromised.

That's all!
-IkaN

Submissions: Selenium deficiency mnemonic

"Selena Gomez and Ke$ha both are young and have big hearts."

Selenium deficiency causes Keshan disease which is cardiomyopathy in young children. Also, singers like to dye their hair (Loss of hair pigment is seen in Selenium deficiency aka Keshan disease).

Submitted by Krutika.

Interesting fact: Keshans disease is thought to be caused by Selenium deficiency and coxsackie virus. It's common in places where selenium content in soil is low (China).

That's all!
Thanks Krutika for the mnemonic =)
-IkaN

How to browse through knowledge on Medicowesome

So we have written over 1000 posts. It's absolutely crazy! :D

About me

Hey Awesomites!

Well, I am not a new author here. I am honored to write so many posts for the blog . Let me introduce myself so that all of you can know about me...

Treatment of cholesterol-induced Alzheimer's

Hey awesomites!

Pathology done! Now lets know about its pharmacology here :)

Cranial Nerve Exits Mnemonic (2 2 4 4 )

Hey guys, Jay here!

This is a very simple self explanatory image which I made.

Brain abscess notes

Brain abscess notes

Here's what I studied =)

Causes
- Direct spread (Paranasal sinusitis, otitis media, mastoiditis, dental infection)
- Head trauma or surgical procedure
- Hematogenous spread (Pneumonia, endocarditis)

Organisms:
- Streptococci
- Bacteroides
- Pseudomonas
- Hemophilus
- Enterobacteriaceae
- MRSA (Head trauma, neurosurgical procedure)

Symptoms:
- Headache > 75% patients
- Fever only in 50% patients (Important: Absence of fever should not exclude the diagnosis)
- Focal neurologic deficits > 60% patients
- Other symptoms - Papilledema, nausea, vomiting, drowsiness, confusion
Hemiparesis - Frontal lobe abscess
Dysphasia - Temporal lobe abscess
Nystagmus, ataxia - Cerebellar abscess

Neuroimaging:
- MRI is better than CT.
- Ring enhancing lesion with surrounding edema on neuro imaging studies is seen.
- Most accurate: Brain biopsy
High yield: Biopsy is essential to distinguish brain abscess from cancer and also to determine the precise organism.

Don'ts: Do NOT do a LP. CSF analysis doesn't contribute to diagnosis or therapy. Increases the risk of herniation.

Extra: Abscesses due to Listeria have blood culture positive > 85% of the time.

Differentials:
- Meningitis
- Meningoencephalitis
- Brain tumors (Cancer can give fever)

Treatment:
- Empirical antibiotics should be modified after results of gram stain and culture.
- Surgical drainage.
- Prophylactic anticonvulsant therapy (High risk [>35%] of seizures)
- Glucocorticoids are reserved for substantial periabscess edema and mass effect due to increased ICP.
- Serial MRI or CT scan monthly to document resolution of abscess.

That's all!
-IkaN

Hypercholesterolemia and the Alzheimer's disease

Hey awesomites!

All of you know that cholesterol is synthesized locally in brain as well as peripherally in liver, both separated by a line of blood-brain barrier. But what about the case of hypercholesterolemia and how it eventually leads to increased amyloid depositions. what is the ultimate link between high serum levels of cholesterol and the Alzheimer's disease?

Enteric nervous system (ENS)

Recently, while studying pharmacology, I came to know about the third system of ANS - Enteric nervous system, apart from sympathetic and parasympathetic systems .

Here is some information of ENS:

It consists of highly organized neurons situated in the wall of GI tract.

It mainly includes Auerbach's plexus and Meissner's plexus.

The most interesting point about ENS is this network receives preganglionic fibers from the parasympathetic system and from postganglionic sympathetic neurons.

ENS controls GI motility, secretions, mucosal blood flow.

ENS causes relaxation or stimulation of smooth muscles.

Non-cholinergic excitatory transmitters such as substance - P plays a modulatory role in controlling ENS!

~Ojas

What is the difference? : Meconium vs. Meconium Ileus

Hey Folks, Jay here!

Meconium is the very first stool ("poop") of a Neonate. This is mainly composed of the material that it ingested during its intrauterine life. This can include, amniotic fluid, mucus, bile, intestinal epithelium cells, lanugo and water.

Classical Findings of RDS Infant!

Hi awesomites, Jay here! This is a short description on Classical clinical findings of a Neonatal Respiratory Distress Syndrome(RDS or NRDS) infant.

Scarlet fever notes and mnemonic

Hello. How are you awesomites?

Let's talk about scarlet fever today!

Scarlet fever, also known as scarlatina, is characterize by exudative pharyngitis, fever and scarlatiniform rash.

It's caused by erythrogenic toxin producing GABHS (Group A Beta Hemolytic Streptococci)

Characterized by:
- Fever, headache
- Sore throat, circumoral pallor
- Sandpaper rash (Pinpoint, erythematous blanchable papules), erythema trunk, pastia lines
- Lymphadenopathy

Diagnosis:
- Rapid antigen detection test is specific, but not sensitive.
- If it is negative, do throat culture.
- Elevated ASO, DNAse maybe seen.

Treatment:
- Treatment as long as 9 days after the onset of symptoms prevents rheumatic fever.
- Oral penicillin, amoxicillin for 10 days.
- Cephalosporins, macrolides are alternatives. (Penicillin resistant group A staphylococcus doesn't exist.)
- If adherence problem, intramuscular benzathine penicillin G.

That's all!
The only fever I have is for Scarlett Johansson =P
-IkaN

Erythroblastosis fetalis (HDNF)

It is a condition that develops when Rh-negative women is pregnant with Rh-positive baby .
It causes phagocytosis of the fetus's RBC's (Baby inherits Rh positive antigen from father ).
As mother is Rh-negative , exposure to fetus's antigen causes development of anti-Rh agglutinins .
These agglutinins(mostly IgG antibody ) diffuse through the placenta and enters fetus blood cells and leads to phagocytosis of the RBCs ,which leads to release of hemoglobin into blood !Then fetus's macrophages converts the hemoglobin into bilirubin ,which causes baby skin to become yellow(jaundiced).Although the severe form of anemia is responsible for many deaths of infants ,many children who barely survive the anemia exhibit permanent mental impairment , because of precipitation of bilirubin in the neuronal cells  ,causing destruction of many cells , condition known as Kernicterus

It usually doesn't affect the first child ,since sensitization occurs during parturition.However ,if Rh-negative mother was sensitized earlier with Rh antigen then first child can get affected .

Treatment:
1)One treatment of HDNF is to replace the neonate's blood with Rh-negative blood .About 400ml of Rh negative blood is infused over a period of 1.5 or more  hours ,while neonate's own blood is removed,the process may be repeated several times during the first week of life ,to prevent Kernicterus .

Prevention:
Anti-D antibody is administered to the expectant mother ,starting at 28-30 weeks of gestation.The anti -D antibody is also administered to Rh-negative women who deliver Rh -positive babies to prevent sensitization of the mothers to the D antigen .This greatly reduces the risk of developing large amounts of D antibodies during second pregnancy !

~ojas

DON'T use Perfumes to test Olfactory nerve!!! But why?

Hi folks,

Our Neurology professor said not to use Perfumes to test Olfactory nerve in Cranial nerve testing. But why?

The updated Glasgow Coma Scale

Hi Awesomites,

The Glasgow coma scale or GCS as we know it has changed since its inception in 1974.

So lets go!

Main differences are 

• We no longer use the term "Pain", but "Pressure"
• We no longer recommend "Sternal Rub", but "Trapezius Pinch" or "Supraorbital notch pressure" or careful "Fingertip pressure"(Peripheral stimulation)
• "To speech" is changed to "To Sound"
• "To pain" is changed to "To pressure"
• "Inappropriate speech" is changed to "Words"
• "Incomprehensible speech" is changed to "Sounds"
• Flexion is defined two way now as "Normal flexion" and "Abnormal flexion"

The differences between 1974 and 2014 updates are as follows.

You can read more details on the update, in this link. Download the pdf in the page which is the original paper.

Thanks,

With love,

Jay :) 

Anatomy of the larynx: Cartilages

Here's an awesome video on the anatomy of the larynx by A. P. Burkholderia!

Isn't he just awesome? :D