USMLE Step 3 CCS: Rape

Hello!

These are my CCS steps for a case of rape. Lemme know if I missed out on anything!

Consent
Rape evidence kit

Complete physical examination

CBC
BMP
Vaginal fluid analysis
Vaginal, cervical, rectal cultures
BHCG
UA
Urine culture
HIV test, P24 antigen
VDRL
HbSAg
Gonococcal tests
Chlamydial tests

Emergency contraception (ulipristal / levonogestrol)
Ceftriaxone
Azithromycin
Metronidazole
Tenofovoir + emtricitabine + raltegravir
HBIG (if unvaccinated)

Psych consult
Drug screen
Colposcopy (for injuries)

That's all!
-IkaN

USMLE Step 3 CCS: Kawasaki disease

Hello, these are my hypothetical orders for KD.
Let me know if I missed something out!

Physical examination (PE)

CBC
BMP
ESR
CRP
Blood culture (to rule out infection)
Urinanlysis (to rule out infection)
Urine culture (to rule out infection)
CXR (to rule out infection)

LFT
ASO
Strep pharyngitis culture
EKG
Echocardiogram

IVIG
Aspirin

That's all!
-IkaN

Save, near miss and preventable adverse effect mnemonic

Hey!

These are for USMLE ethics.

Poor prognostic factors for schizophrenia mnemonic

Hello!

This is a mnemonic for some (not all) prognostic factors for schizophrenia.

Likelihood ratio mnemonic

Hello! :)

The likelihood ratio of a positive test result (LR+) is sensitivity divided by 1- specificity.

The likelihood ratio of a negative test result (LR-) is 1- sensitivity divided by specificity.

How I remember the formulae for LR+ and LR-

Mnemonic on viral structures

Hey guys!! Long time!

As the title suggests this post will help you remember the different viral structures in a way that is fun and easier.

Puerperal sepsis

PUERPERAL SEPSIS

Puerperal sepsis is any bacterial infection of the genital tract which occurs after the birth of a baby. It is usually more than 24 hours after delivery before the symptoms and signs appear.

Some of the most common bacteria are:
Streptococci
Staphylococci
Escherichia coli (E.coli)
Clostridium tetani
Clostridium welchii
Chlamydia
Gonococci

SYMPTOMS AND SIGNS 
Fever (temperature of 38°C or more)  Chills and general malaise
Lower abdominal pain
Tender uterus
Subinvolution of the uterus
Purulent, foul-smelling lochia.
Slight vaginal bleeding
Shock.

RISK FACTORS
Some women are more vulnerable to puerperal sepsis, including anaemia and/or malnourished, protracted labour, prolonged rupture of the membranes, frequent vaginal examinations, a traumatic delivery, caesarean section and retained placental fragments, PPH, diabetes all predispose to puerperal infection.

SITES
The most common site of infection in puerperal sepsis is the placental site.
Other sites of infection are abdominal and perineal wounds following surgery and lacerations of the genital tract, e.g. cervix, vagina and perineum.

Following delivery, puerperal sepsis may be localized in the perineum, vagina, cervix or uterus.
Infection of the uterus can spread rapidly if due to virulent organisms, or if the mother’s resistance is impaired.
It can extend beyond the uterus to involve the fallopian tubes and ovaries, to the pelvic cellular tissue causing parametritis , to the pelvic peritoneum, causing peritonitis , and into the blood stream causing septicaemia

DIFFERENTIAL DIAGNOSIS
Fever  in the puerperium can also be caused by:  urinary tract infection (acute pyelonephritis)  wound infection (e.g. scar of caesarean section)  mastitis or breast abscess  thrombo-embolic disorders, e.g. thrombophlebitis or deep vein thrombosis  respiratory tract infections.

-Md Mobarak Hussain (Maahii)

Adrenaline : Dosage

Dose of Adrenaline :

Anaphylaxis :- 0.5mg 1:1000 IM

Anaphylactic Shock :-  1mg 1:10000 IV

Cardiac Arrest :-  1:10000 IV

CPR :-  1:10000 IV/IO, if not accessible 1:1000 ET

With LA :- 1:200000 SC

-Md Mobarak Hussain (Maahii)

Flap Valve Mechanism of Inguinal Canal

Hello Everyone!

     Today lets understand the Flap Valve mechanism of Inguinal Canal:

That's all,

Thank you!

Chaitanya Inge

Cryoprecipitate constituents mnemonic

Hello!

This is a post on the constituents of Cryoprecipitate :)

Guidelines for treatment of drug-susceptible tuberculosis 2017 UPDATE

Hello Awesomites :D

This is to inform you the updated guidelines.
I was overwhelmed with the data in the book. I tried to simplify it.

1.The name given to this scheme is "99 DOTS"
99 means that 99% benefits should reach to all the people who are enrolled under this programme.

2.INTRODUCTION OF FDC (fixed dose combination)
 (Please make a correction in the following diagram :- ETHAMBUTOL=275mg)

3. FROM THRICE WEEKLY TO "DAILY DOSING"

4.Information technology is incorporated to monitor the adherence of patient to treatment regimen.

5.REGIMEN :-

6. DOSE OF THESE DRUGS :-

7. IMPLEMENTATION :-

by toll free no. 

I hope it helped. 

(Edit1:- 99DOTS) 

-Upasana Y. :)

USMLE Step 3 CCS: Asthma exacerbation

Orders to remember!

Pulse oximetery (every 1-2 hours to access response)
Oxygen
Physical examination
Albuterol nebulizer
Intravenous methylprednisone
Peak flow (every 1-2 hours to access response)
EKG (is this cardiac?)
CXR (to find out cause of asthma excerbation - infection)
CBC (to find out cause of asthma excerbation - infection)
BMP

Other stuff:
Cardiac monitor
Head elevation
Ipratropium for severe exacerbations
ABG
Admit
NSS 0.9%
NPO
Discharge on oral prednisone for 5-7 days

Uptodate:
- Use inhaled short-acting beta agonists early and frequently, and consider concomitant use of ipratropium for severe exacerbations
- Start systemic glucocorticoids if there is not an immediate and marked response to the inhaled short-acting beta agonists
- Make frequent (every one to two hours) objective assessments of the response to therapy until definite, sustained improvement is documented

-IkaN

Mapelson circuits in anaesthesia mnemonic

Hey!

So I've faced a lot of problems trying to remember the various Mapelson semiopen circuits for inhalational anaesthesia and sadly they have been asked in exams so I tried to identify them using these simple points.

Firstly, remember, the circuits are semi open so part of the gases will be exhaled and part of them will be re inhaled.

Basic parts of any circuit are
-an inlet for fresh gases
-an outlet valve for exhalation
-the patient end
-the distal end usually with a bag to control rise and fall of the chest.

1) Mapelson A
The only circuit where fresh gases come in from the distal end. The exhaling valve is near the patient. It is suitable for spontaneous ventilation so rate of flow of gases = minute volume.

2) Mapelson B
Remember, B for both. So both inlet and outlet are together at the patient end. Otherwise it's the same as A.

3) Mapelson type C
C for closed and C for corrugationless. It's a closed circuit and the only one which has no corrugations.

4) Mapelson D
It is the exact opposite of A. Inlet for fresh gases is near the pt, outlet is far away. It is suitable for controlled ventilation.

5)Mapelson E
This is a valveless circuit and also has no bag (the only one without a bag). Since the arrangement is in the form of a T, it is also called Ayre's T piece.

6) Mapelson F
It is the same as E, valveless, but it has a bag to control the rise and fall of chest. It is mainly used in infants and neonates.

Summary:

Fresh gases distally ➡A

Inlet outlet both together➡B

No corrugation➡C

Opposite of A➡D

No exhaling valve ➡ E and F

No bag ➡ E

Same as E but with bag ➡F

Submitted by Aditi