About US clinical experience and tips for electives

 US Clinical Experience (USCE) is one of the most important parts of our residency application.

Gerstmann's syndrome physical examination

 Gerstmann's syndrome is caused by lesions in the dominant parietal lobe (usually left).

Hoffman sign in neurology

Hello! Let's learn about the Hoffman sign.

The Hoffman sign: Involuntary flexion of the thumb and/or index finger when the fingernail of the middle finger is flicked down. 

Shingles vaccine

What do we know about the Shingrix Vaccine?

This vaccine is recommended for patients over the age of 50 years. It is a live attenuated vaccine. It is a

recombinant vaccine containing the glycoprotein E named RZV or Shingrix. Two doses are

required 2-6 months apart and can be safely given with influenza (flu) vaccine. History of chickenpox or varicella zoster doesn’t determine whether to give the vaccine or not because antibodies gained through the infection wanes with time.

Internship diaries: Perception of nipple discharge

A 60-year-old female complained of clear discharge from her right breast for one week. 

On examination, the right breast nipple was painful and there was clear fluid around the nipple. Expressing the breast produced no discharge. Incidentally, she mentioned a rash that was hurting on her right shoulder. The rash was a distinctive cluster of fluid-filled blisters with inflamed underlying skin, suggestive of shingles. 

Mechanism of action of lipid-lowering drugs

Hey everyone! 

I wanted to talk about the new lipid-lowering drug, bempedoic acid. But first, let’s just quickly go through the mechanism of action of the existing lipid-lowering drugs:

Statin reduces cholesterol synthesis by HMG-CoA Reductase inhibition.

Ezetimibe inhibits cholesterol absorption from the intestine.

Sub-specialty WhatsApp groups

 Hi everyone!

I have decided to create sub-specialty groups on WhatsApp in addition to our regular study groups. If more than 5 people are interested in it, we will create a group.

Mnemonic for cancers which have “BRAF” gain of function mutation

Hello everyone ! 

Mnemonic : 

Sodium-glucose co-transporter 2 (SGLT2) inhibitors notes and mnemonics

 A short post on SGLT2i!

Examples:
Canagliflozin (brand name Invokana)
Empagliflozin (brand name Jardiance)
Dapagliflozin (Farxiga)
Ertugliflozin (Steglatro)

Mechanism: Blocks renal glucose absorption, resulting in glycosuria.
Mnemonic: GliFlozIN makes Glucose Flow In Nephrons

In addition:
Has beneficial effects on ASCVD events, heart failure, and CKD.
Causes weight loss  (Mnemonic: SGLT2 Surely Generates Less Tummy).
No risk of hypoglycemia.

Side effects:
Genital fungal infections.
Fournier’s gangrene.
Dehydration may result.
Euglycemic diabetic ketoacidosis (should be held 24H prior to scheduled surgeries).
Canagliflozin may increase the risk of leg amputation (should be avoided in those with peripheral vascular disease).

Caution: Renal dose adjustment is required in CKD.

That's all!
-IkaN

Related posts:
Oral hypoglycemic drugs used for diabetes mellitus mnemonic
Oral hypoglycemic drugs and weight - Weight gain or weight loss mnemonic

Metformin notes and mnemonics

 A short post on Metformin!

Mechanism:
Decreases hepatic glucose output by reducing hepatic gluconeogenesis and glycogenolysis.
Enhances peripheral glucose uptake and enhances insulin sensitivity.
Decreases glucose absorption in the GI tract.
Reduces hemoglobin A1C levels by 1.5%.

In addition:
Decreases triglyceride levels.
Decreases LDL-cholesterol.
May increase HDL-cholesterol.

Side effects:
Diarrhea
Vitamin B12 deficiency may develop
Risk of lactic acidosis in renal or liver disease or CHF

Contraindicated in: GFR <30ml/min.

That's all!
-IkaN

Related posts:
Oral hypoglycemic drugs used for diabetes mellitus mnemonic: Metformin meets glucose and advises it to stay out of the blood. It asks the liver to keep glucose in the house (Inhibits hepatic glucose production) and asks the glucose in the bloodstream to go into adipose and skeletal muscle (Stimulates peripheral uptake of glucose). Metformin never met a glucose molecule and did not tell him to not stay in the blood (Illustration in the original post).

Oral hypoglycemic drugs and weight - Weight gain or weight loss mnemonic: "Metformin forms you in, makes you thin."

Virtual interview tips

Interview questions for practice

 Hi everyone! 

Here are some of the questions I was asked during my cardiology fellowship interviews. They can be useful to practice during medical school or residency interviews as well, which is why I am writing this post.

How do you answer these questions? Always attach a story (situation) to it. It only comes with practice - so please, practice a lot.

Fragmented QRS

Fun fact: Fragmented QRS can be caused by conduction around the scarred myocardium, resulting in multiple spikes within the QRS complex.

-IkaN