Thursday, June 18, 2020
Pediatric Residency Series: Preparing for Fellowships
Wednesday, June 17, 2020
Topics to read before PG entrance exams!
The aim is to help the students who want to give upcoming NEET PG Exam and are clueless about how to plan and prepare ?
I know my friend struggling day in and out for life in Covid wards. Exams doesn't matter now.
When they will have time in hand I want to help them out with plan beforehand. They are already brilliant enough to have been through all the challenges. :)
I know you can't predict what is important for this or next exams. Atleast with time in hand you can glance through some topics that contribute 70% of any exam. I am sharing the list 1st year subject I made during my preparation.
1.ANATOMY
- Embryology
- Pharyngeal arches
- Neural crest derivatives
- Oogenesis and spermatogenesis
- Notochord and remnants
- Extraembryonic mesoderm
- Diaphragm
- Cardiovascular system ( Abnormal subclavian artery)
- Urogenital system
- Histology
- Cerebellum
- Osteoblasts
- Urinary bladder epithelium
- Cell junctions
- Collagen types
- cartilage
- Tonsil,Lymph nodes, spleen,thymus
- Stomach glands
- Skin with sebaceous glands
- Connective tissue types
- Retina
- Salivary gland
- NEUROLOGY
- Fornix
- Corpus callosum
- Cranial nerves and its lesion
- Brainstem syndromes (lateral medullary )
- Foramen of skull
- Facial nerve and trigeminal nerve
- blood brain barrier
- Functional area and functional columns
- Parasympathetic ganglion
- Phrenic nerve and vagus
- GROSS
- Compartments of lower limb with nerve and blood supply
- Blood supply of thyroid,oesophagus,ureter,Anal canal
- Waldeyer ring
- External carotid artery
- Circle of willis
- Muscle of eye
- Brachial plexus (Sensory and motor supply of upper limb)
- Perineum
- Cruciate ligaments
- Vocal cords
- Mediastinum
- IVC tributaries
- Cavernous sinus and superior orbital fissure
- Splanchanic plexus
- Inborn error of metabolism (Types,Enzyme deficient,hallmark feature,Investigation of choice and treatment)
- Rate limiting step
- Carbohydrate metabolism (Glycolysis,Glycogen storage disease,Glucogenesis,glycogenolysis,PFK-1)
- Lipid metabolism ( Hyperlipoproteinemia and hypolipoproteinemia)
- Vitamin (Coenzyme)
- Electron transport chain inhibitor
- Heme metabolism and Porphyria
- Ketone body formation
- Urea cycle disorder
- Competitive, non competitive and allosteric inhibitors
- Mitochondrial disorders
- Amino acid disorder
- Lead poisoning
- Translation process
- Receptors
- Neurotransmitter and functions
- Second messenger
- Reflexes
- Baroreceptors and chemorecptors
- JVP
- ECG And EEG
- Spirometry
- RAAS
- Counter current exchanger and multiplier
- Factors affecting compliance of lung
- Action potential
- Smooth muscle and cardiac muscle
- Channels and types
- GIT hormones
- Tracts and lesions(brown sequerd syndrome)
- LH,FSH,GH and insulin glucagon
1.FORENSIC MEDICINE
- Ballistics (Bullet ranges)
- Identification (female male, blood sample)
- Recent amendments in acts (POCSO act, MTP Act)
- Application of IPC,CrPC sections
- Postmortem changes
- Dentition And Xray of wrist elbow and pelvis to determine age
- Injuries -fracture of skull, RTA, Bruise
- Toxicology- Plant based image, Preservation of viscera, Snakes,Arsenic, OP poisoning,Mercury,cadmium,Cardiac poison
- Consent
- Grievous hurt and murder vs culpable homicide
- Seminal stains
- Dowry death and Rape
- Battered baby syndrome
- Plant Toxicology (castor,abrus,strychnine,Dhatura,Aconite,Oleander,Calotropis,Opium,Cannabis)
- Breast cancer, Lung cancer and Ovarian and testicular cancer
- CD markers
- Hemolytic anemia
- Vasculitis
- Endocarditis And MI
- Types of hypersensitivity reaction
- Platelet and coagulation disorder(ITP,TTP,hemophilias,vWD)
- Stains And vacutainers
- Transfusion reaction
- Graft rejction
- Crohns vs Ulcerative colitis
- Necrosis, apoptosis and its variant
- Mode of inheritance
- Leukemia and lymphoma prognostic markers
- Renal histology and gross
- Liver histology and gross
- CNS tumors
- Antimicrobial Drug of choice and mechanism of action
- Classification - aminoglycoside , MRSA And drugs for cystic fibrosis
- Hypolipidemic Agents
- Asthma ( New drugs and guidelines)
- Arthritis (RA and gout)
- General pharmacology ( Pharmacokinetics,clinical trial,Pharmacodynamics)
- Concentration dependent kinetics and time dependent kinetics and post antibiotic effect
- Anti TB drugs
- Anti viral and anti HIV (anti hep B and C)
- Anti fungal
- CVS- MI ,HF, angina managment
- Endocrine- DM,Osteoporosis,SERM,SERD,Gnrh agonist
- GIT-Constipation (opioid induced,IBS related) ,Diarrhea,peptic ulcer
- CNS-Anti epileptic, Sedative,lithium toxicity,neurodegenerative disorder, side effect
- ANS- Emergency medicines,anaphylaxis, receptors ,poisoning
- Chemotherapy-Anticancer,monoclonal antibody,small molecules,kinase inhibitors
- Prostaglandins
- Insulin
- Sterilisation and disinfection (Indicator)
- Immunology (Antibody,complement deficiency,Primary immunodeficiency)
- Latest outbreaks (Zika,Congohemorrhagic fever,Ebola,Corona)
- Sexually transmitted infections
- Vectors
- Parasitology -Eggs
- Congenital infections-Toxoplasmosis,congenital syphillis,rubella,herpes,varicella
- HPV infection,HHV-8
- Bioterrorism
- Larva migrans,larva currens (cutaneous and visceral)
- CD4 counts and Opportunistic infection
- HIV and TB
- Food poisoning
- Atypical bacteria treatment and infection
- Dimorphic fungi
- Actinomycosis,Botryomycosis and eumycetoma
- Meningitis
- Exanthematous disease
- Neisseria,diphtheria,Listeria,bacillus anthrax,legionella,campylobacter jejuni
- Bacterial virulence factors,growth factors
- Rickettsial disease, spirochetes(weils ds)
- Drug resistance mechanism
Following is the list of 3rd year topics.
1.COMMUNITY MEDICINE-
- Surveillance programs
- Sensitivity, specificity,PPV and NPV (Screening of disease)
- Types of studies
- Odds ratio and relative risk ratio
- Bias
- Sampling
- Biostatistics- central tendency (Box and whisker plot )
- Level of prevention
- Vaccine and types (Toxoid and live attenuated)
- Demography and family planning
- Biomedical waste
- Health programmes ( RNTCP, HIV)
- Communication
- Nutrition and related programmes
- Disaster
- Null hypothesis,P value and alpha value
- Confidence limit
- Refractive errors (Astigmatism)
- Surgery and post op complication(Glaucoma,cataract,squint)
- Conjuctivitis
- Corneal ulcer (Bacterial,fungal and herpetic) (Stains)
- ROP and systemic retinopathy (Hypertensive and diabetic retinopathy)
- Retinitis pigmentosa and syndromes
- Retinal detachment and cause
- Retinoblastoma
- Strabismus
- Optic neuritis
- Visual field defect
- Blow out fracture and trauma to eye
- Glaucoma and drugs(Contraindication and indication)
- Managment of ptosis
- Light reflex and accomodation reflex and pupil
- 3,4,6 Cranial nerve
- OCT ,Fluorescein angiograhy,tonometers,charts,
- Sudden loss of vision and gradual loss of vision differentials
- Appearance of tympanic membrane in various disease
- Surgery (Tonsillectomy,Adenoidectomy,Mastoidectomy)
- Paranasal sinus
- CSF rhinorrhea
- Laryngeal disease (Papilloma,vocal cord paralysis, laryngeal muscles action, laryngeal cancers)
- Tracheostomy
- Abscess
- Nasopharyngeal carcinoma
- Juvenile angiofibroma
- Test of hearing and vertigo
- Otosclerosis
- Cochlear implants
- Oral cavity cancers
- cervical Lymph node and neck dissections
1.OBSTETRIC AND GYNECOLOGY-
- Pre-eclampsia (Definitions)
- HELLP
- PPH (prophylaxis and treatment)
- Perineal tear (Types and managment)
- Diabetes and anomalies scan
- Shoulder dystocia maneuvers
- Molar pregnancy (High risk and low risk for GTN)
- Ectopic (Diagnosis, Investigation and managment)
- Abortions
- Recurrent pregnancy loss (Investigations and causes)
- Cervical incompetence
- MTP
- Diagnosis and physiological changes of pregnancy
- Abruptio vs placenta previa vs Vasa previa
- Heart disease
- MgSO4 and drug
- Fetal monitoring -NST,BPP,doppler
- Twins and complications
- Labor-stages,partogram
- Placenta types and associated pathology
- Rh incompatibility
- Amenorrhea (primary and secondary)
- Mullerian anomalies (Class)
- Asherman, AIS,Gonadectomy indication
- Puberty and precocious puberty
- Menopause (Hormone replacement therapy guidelines)
- Postmenopausal bleeding and premature ovarian failure (Levels of FSH)
- Semen analysis (Evaluation and IUI and TESE)
- PCOS -Diagnosis,drugs
- Endometriosis
- Cervical,vulval,ovarian,endometrial cancer,Fibroid
- Krukenberg
- PID
- Prolapse
- Emergency contaceptives
- IUD
- Absolute contraindications in whole subject
- Female sterilisation
- Developmental milestones
- Neonatal reflexes
- Neonatal resuscitation
- Jaudice,sepsis,Hyaline membrane disease
- Congenital infections-TORCH
- Vaccines(IAP and NIS)
- Diarrhea,pneumonia,dehydration managment
- Pediatric epilepsy
- Febrile seizure (Risk factors,recurrent risk,prohylaxis)
- Severe acute malnutrition
- Rickets
- meningitis
- Neuro-Cerebral palsy and neurocutaneous syndrome
- Pediatric vasculitis-HSP and Kawasaki Disease
- Nephrotic syndrome
- Congenital heart disease( VSD,TOF,TGA and ductus dependent CHD)
- Trisomies
- Hypoxic Ischemic encephalopathy VS Periventricular leukomalacia
- Fluid managment including shock managment in children
- Childhood pneumonia, Epiglottitis, Acute laryngotracheobronchitis
- Microcephaly and macrocephaly
- Hydrocephalus and Neural tube defect
- Fetal alcohol syndrome,warfarin syndrome
- IV anesthetic agents (Propofol)
- Day care surgery (Drug of choice)
- Venous air embolism
- Local anesthetic (Remember concentration also)
- Vaporisers color
- Inhalational agents
- Monitoring (Capnography)
- Color coding of cylinder
- Circuits
- Mallampati and ASA grading
- Premedication duration of stoppage and continuation
- Muscle relaxant
- Airway devices
- Endotracheal tube (formula)
- Epidural vs spinal anesthesia (Level of blocks)
- Modes of ventilation
- Pigmentation Diseases
- Hyperpigmentation
- Nevus (Nevus of ota/mongolian spot/CMN/AMN)
- Melasma
- Acanthosis nigricans
- Becker nevus
- Hypopigmentation -PKDL/Pityriasis versicolor/alba/Hansens
- Depigmentation-Vitiligo/Contact leukoderma
- Signs (Auspitz,nikolsky,bulla spread sign)
- Histopathology of psoriasis and lichen planus
- Mast cell disorder-Urticaria pigmentosa image
- Papulosquamous disease - Psoriasis ,lichen planus
- Treatment of Psoriasis
- STD (Syphillis,chancroid,donovanosis,Herpes genitalis,syndromic approach)
- Microbiology of STD organism( Dark ground,school of fish,Tzanck smear,Donovan body,Gonococcus)
- Drug Reaction -Fixed drug eruption, erythema multiforme,SJS/TEN
- Blistering disease
- Pemphigus(clinical treatment)
- Bullos pemphigoid
- dermatitis herpetiformis
- Histopathology of blister level and Direct immunofluorescence image
- Infections
- Fungal (Tinea /pityriasis versicolor)
- Hansens
- TB
- Viral (HPV/HHV/Molluscum contagiosum)
- Hair disease-Alopecia images,DLE,trichotillomania
- Acne,Rosacea
- cutaneous markers of internal malignancy
- Emergency radiology-RTA,splenic injury,FAST,Perforation
- Radiological anatomy especially applied aspect
- CNS tumor
- Bone tumor
- BIRADS
- TIRADS
- Radiation physics and acute radiation syndrome
- Radiotherapy basics
- Contrast in various studies
- USG and doppler
- Doppler waveforms
- Knee joint (Everything)
- Shoulder dislocation
- Bone (Oncology+radiological picture)
- Pediatric Hip(Rdaiology +managment)
- Infections(TB,Osteomyelitis)
- CTEV
- AVN
- Tennis elbow and dequeverian
- Eponyms and test
- Blood supply of femur
- Pseudoarthrosis
- Genu varum/valgus,cubitus varus/valgus
- malunion
- Instruments
- Glasgow coma scale (Changes)
- Burn
- Cannula color coding
- Triage
- Trauma
- Incisions,suture,foleys,NG tube,Knots,Scores
- Latest updates in breast cancer,thyroid and hepatobiliary cancers,Pancreatic cancer,stomach,colorectal cancer
- Bed sores staging
- Renal stones managment
- Gall stone managment and surgical complication
- Bariatric surgery
- Acute pancreatitis managment
- Upper GI and lower GI bleed management and causes
- Aortic aneurysm
- Meckel diverticulum
- Wound classification
- Cancer-(Breast,rectum,stomach,oesophagus,HCC,prostate,thyroid)
- Cancer follow up duration
- Carcinoid and GIST and gastrinoma
- ECG visuals
- Cardiac emergencies-Arrest,Unstable angina,MI,Arrhythmia,Dissection
- Respiratory emergency-Pulmonary embolism,pneumothorax,Asthma
- Stroke
- Meningitis (Bacterial,viral,aseptic)
- Approach to patient in Coma
- Seizure
- Electrolyte imbalance
- ABG
- Hypertension and its emergency and management
- Murmurs and valvular lesions
- Pericardial d/o
- hepatitis(Viral,autoimmune)
- Non alcoholic and alcoholic liver disease
- Glomerular disease
- UTI
- CKD
- DM (management of different complications)
- Neurodegenerative d/o ,neuropathy,myopathy
- Septic shock guidelines
- GBS
- Poisoning
- New asthma guidelines
- RTA and Inherited channelopathies
- MEN syndrome
- SIADH, DI,Pheochromocytoma
- AIDS defining illness
- Connective tissue disorder
- Infective endocarditis and rheumatic heart disease
- Prakinson and alzheimers
- IBS,UC ,Crohns
- Cardiomyopathy
- Jones and dukes criteria
- dyslipidemia management
- General psychiatry (terms and its meaning )
- MMSE
- Psychotic disorders
- Schizophrenia
- Delusional d/o- Named syndromes (Capgras,Fregoli,Othello,Ekbom)
- Mood disorder (Treatment is very important)
- Mania
- Depression
- Bipolar
- Neurotic disorder
- Anxiety disorder
- OCD related disorder
- Dissociative disorder
- Trauma and stress related disorder
- Somatoform disorder
- Substance abuse and deaddiction
- Organic mental disorder(dementia)
- Sleep disorder
- Eating disorder
- Sexual disorder
- Personality types and disorder
- Drugs (SSRI and its sideeffect)
- Psychotherapy types and choice
- Defence mechanism
Monday, June 15, 2020
MY IELTS Experience
- Appeared on 19.03.20
- Score = 8.0; Max = 8.5 on Speaking
- Resources = IELTS Charlie + e2Cademy + IELTSAdvantage (all free)
- Time = 07 days (inconsistent)
- Writing - Practiced 3 -5 a day. Completed short essay in under 10 minutes and long essay in under 25 minutes. Spent the rest of the time trying to read the question repeatedly to ensure that I never went off topic
- Listening - Practiced 3 a day
- Speaking - 2 a day because I feel I am fluent. Use IELTS Charlie to learn some grammar. It helps. Familiarize yourself with topics that you feel you have NEVER read or don't have an idea of the global scenario about. STICK TO THE TOPIC.
- Reading - practiced 4 in all. I didn't find that I have any difficulty in writing while I listen except for the occasional errors
- Make sure you have your resources compiled. I wasted a fair amount of time trying to assess what is best in the middle of my prep.
- Ensure that you know what you need to work on by listening to others who have appeared for the exam
- Buzz me for queries and links to material.
- Read this - http://www.howtocrackplab.com/search/label/IELTS
- Realise that this is not a test of how proficient you are with the language, these are their standards to assess you because well.. somebody had to set some standards.
- Make sure you have a clear goal as to when you wish to appear for PLAB 1 (if you do wanna appear for it).
- You may appear for a pen and paper version or a computerised version. Play to your strengths. This is most important to know.
- Read the prospectus more than once. Their information tables are more than sufficient to help you avoid silly mistakes that reduce your band score.
- The types of sentences you use in the written test.
- WORD LIMIT - Going over is good. Going under is just going under the bus,
- CONCENTRATION - Listening test audio will be played only once. Ensure that you focus. If you lose touch you may land into a 6.5 band score and goof up your chances of appearing for PLAB 1.
- OPINIONS - On both the speaking and writing tests, unless asked for state a fact rather than your opinion.
Plan your preparation
Let us begin with journey for upcoming NEET PG and AIIMS PG.
Today I will share with you the tips on "How to plan your preparation for NEET PG?"
"An hour of planning can save you from hours of doing nothing."
Essentials:-
1.Google calendar or Print out of calendar -->Get printable calender here
2.Pen
3.Blank paper
I) Google calendar:-
I started my preparation in March. I had schedule of the rotations beforehand.
Lesson 1:- "Do you have 9 months for Jan NEET PG ?"
"No"
It seems so we have months for prep but we have only days .
So make realistic plan by counting out the days you will be busy with TND and grand tests.
To see how your whole year going to look like make a virtual plan.
I color coded each event I had for the entire year.
Purple-The posting in the given month
Green-The days I am free
Blue-The test and discussion day
Orange-The test and discussion I missed
Red-Grand test
II) Take out print or write on paper specifying 19 subjects :-
After every Grand test I list out the topics I am weak at.
Lesson 2:- You are not weak at subject, you are weak at topics in that subject.
III) Stick to one resource.
IV) Make separate and single notebook for test and discussion . Do not add everything in notes in one go.
V) Take breaks.
VI) Do passive studying when you are exhausted .
- I recorded the nerve injuries and certain ADR of drugs in my phone and used to listen it whenever I was unable to carry notes.
- I used to call my friends and discuss the topic after we are done with targets for the day.
VII) Don't be hard on yourself.Give some time to things you love.
Hope this will help.
-Upasana Y.
Sunday, June 14, 2020
Pediatric Residency Series: Research
In addition to its valuable role in helping humanity, research is one of the most important aspects of the fellowship application.
In this post, I will mention some points that will help in getting more research and in having a more systematic approach towards this field.
1-Start early
Time in residency flies very fast. If you know which specialty you are targeting, start doing research as early as you can. This will expose you to more ideas, allow you to have more possible publications and may also strengthen your clinical grasp on that specialty.
2-Mentors
A mentor can be a current senior or an attending in your program or in any other program. Mentors have more experience and will shine a light on things that you may not consider. They will also give you research ideas and inform you about the conferences specific to your field of interest. The fellowship world is smaller than the residency one and mentors can write you letters of recommendation, put a good word for you and direct you to fellowship programs that best suit you.
Do not forget to check the: AAP Mentorship Program. As an AAP member, you have free access to this mentorship program which links you to mentors through its algorithm based on your preferences. This AAP feature is a hidden jewel that everyone should use.
3-Finding Research:
“How can I find research opportunities?” This is the-million-dollar-question and one of the most frequent ones I get.
I like to divide the answer into two main parts:
*Research at your program
This varies a lot based on your residency program but options include and are not limited to:
A- Case reports and case series
Do you have an interesting case on the Pediatric ward, PICU or NICU? Ask your attending if it is reportable, decide which journal or conference to target and start writing!
AAP has an amazing summary about this here.
B- Retrospective studies
Is your NICU big and with a high patient turnover? Come up with a research hypothesis or let your seniors and attendings aid you in this. These days and especially with the ICD code system, you can think about any research idea and find the research objects within seconds!
C- QI projects
Have you noticed anything in your program that can be improved? Is it an order set that can be added to your EMR? Do you feel a teaching module for residents or students would help? Create your own QI project, compare pre and post intervention results and present the findings at a regional conference or wherever you deem appropriate.
D- Surveys
Surveys are usually easy to do. Come up with the survey questions (search and ask while doing so) and run it by your mentor. You may do a pilot survey on a smaller amount of people before sending your official survey to your target group. The downside is possible low response rates which can make the survey hard to be published.
Do not forget to obtain the needed IRB approval in your program before doing anything :D
*Research outside your program
A- Meta-analysis / Systematic reviews / Review articles
The above mentioned types of research can be done anywhere and anytime. They are usually carried out in teams including a statistician (or anyone who knows statistics) needed for meta-analysis. They may be time consuming so keep that in mind.
B- Global projects
Collaborative research is a type of research that is recently getting more publicity. There are infinite projects out there that you can join. You just have to know about them. An example is the Covidsurg collaborative project.
C- Databases
Databases are incredible - and sometimes costly- sources for retrospective research. The hardest part is formulating the research question. After you have your idea, search online to see if it has been done before. An example is the famous Healthcare Cost and Utilization Project (HCUP) database. This database has many sub-databases with gigantic amounts of info that can be used for research purposes. Every disease you can think of is there with its corresponding ICD code. KID (Kids Inpatient Database) and NIS (National Inpatient Sample) are two subsets that include Pediatric patients.
D- Twitter
Yes, as you have read! Some research projects can be posted on Twitter and you can directly contact whoever posted them and start.
4-Conferences
Conferences are very vital when it comes to research. Not only that attending conferences gives you the chance to meet people who share your interest, socialize and make new connections, find mentors, look for possible away electives and present your work. It also excites you, gives you new ideas and allows you to discover new places which will help in breaking the “stressful” residency routine.
Always know when the conferences are held, the early vs late registration fee, abstract submission opening date and deadlines so you can plan your traveling, accommodation and schedule changes.
Stay tuned for a list for conferences that you can attend/present at whether for general Pediatrics or Pediatric sub-specialties.
This post mainly applies to those in Pediatrics but same principles apply to most other specialties.
-Murad :)
Saturday, June 13, 2020
Clinical correlates: Epinephrine vs Norepinephrine reversal
This post is about variation in the effects of epi- and norepinephrine depending on its dose.
Monday, June 8, 2020
Topical Drug Absorption.
Hello everyone!
This is the brief mention about the extent of topical absorption of drugs.
In decreasing order-
Posterior auricular
Scrotal
Scalp
Dorsum of hand
Plantar area.
Absorption mainly depends on the thickness of the skin and is inversely proportional to it.
Hope this was helpful!
Let's learn Together!
Dr. Medha Vyas
Tympanogram.
Hello Everybody!
Let us quickly review the different curves of a tympanogram.
The following are the yypes of curves in you'll see on a tympanogram:
Type A – Normal pressure and normal compliance in normal ear.
Type As – Reduced compliance (‘s’ means stiffness leading to reduced compliance) and normal pressure.
- Seen in
- Otosclerosis or other ossicular fixation
- Tympanosclerosis
- Seen in
- Ossicular discontinuity
- Thin and lax TM
Type B – Flat or dome shaped graph i.e. reduced compliance.
Seen in case of:Serous otitis media.
Thick tympanic membrane.
Type C – Normal compliance but negative pressure due to eustachian tube obstruction.
- Seen in case of:
- Retracted tympanic membrane,
- Early stages before collection of fluid in middle ear.
Tuesday, June 2, 2020
Tuesday, May 26, 2020
Sunday, May 24, 2020
Two components of Sulfasalazine : Indications
Sulfasalazine has two components:
- 5-ASA
- Sulfapyridine (SP)
Tuesday, May 19, 2020
High-yield : Risk of stroke with cardioversion
Electrical/chemical cardioversion performed in a case of atrial fibrillation may carry a high-risk of stroke, especially if >48 hours of time has passed (thrombus formation takes about 48 hours).