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nerdgirlnarrates:

flyonthewallmedstudent:

nerdgirlnarrates:

Cardiology recommending torsemide 100 mg BID in someone with an AKI

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If the AKI is caused by heart failure diuresis with loop diuretics is actually correct. Rookie mistake is withholding it. Which many interns fall into.

It’s to do with RAAS.

As long as they can make urine, throw diuretics at it. The AKI in heart failure will improve with diuresis.

The AKI wasn’t from heart failure. We only gave the patient 50 mg torsemide x1 instead, and their creatinine jumped quite a bit.

Ah I see. how many folds did it go up? and what were cardiology consulting for (out of curiosity)?

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Dec 20, 2021

meg2md:

flyonthewallmedstudent:

meg2md:

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Not even sure what day #/25 I’m on right now cuz I was so bummed about my IM shelf that I took a day to mope, and then I visited my BF and we got very brunch-drunk so no studying got done yesterday! On my mopey-day at least I was able to do 2 blocks, half a Divine Intervention peds shelf review, and some Anki. And I listened to DIP on the 1.75 hr drive to see him, so there’s that.

I think I needed yesterday off, anyway. I took ONE day off after my shelf before I jumped into 4 blocks/day and it was rough. The downside is I am now 6 blocks behind (200 questions), but I was probably gonna slow down and not finished UWorld anyway, especially if I want to take even one day off per week. I guess I could always rebalance my questions, but the thought of doing more than 4 blocks…. ugh. Pass. I’d rather focus on DIP and Anki because it’s still studying but it makes my head hurt less. We’ll see.

Tomorrow it’s right back at it: 4 UW blocks + review, DIP Anki, Anki incorrects, and finishing some DIP episodes if I have the time and willpower.

Normally I’d watch The Handmaid’s Tale as I wind down for the night but I am just so exhausted from being social all day yesterday so I’m probably gonna go straight to bed. I’m impressed at myself for studying and getting everything done but it does always suck when you study right through to bedtime. Hopefully I won’t sleep in/nap tomorrow and I’ll get done a little earlier, but I only have to keep this up for like 3 more weeks

“only” :P

I would kill for a bloody mary right now. that looks delish.

In the midst of Step 2 CK hell, it was definitely needed. I’m looking forward to the 2 weeks I get off between the USMLE and the start of M4 because it will feature me sitting by the pool drinking bloody marys and mimosas the whole goddamn time

That sounds amazing. Do it.

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May 28, 2021

jen-writes-a-little-bit asked:

As someone who knows she wants to be a doctor but is super scared of the process (I’m in high school right now and looking for undergrad colleges) can you describe the process of becoming a doctor? Is med school really that completely selective? Does where I go to undergrad matter? Should I take a BS/MD program? I’m so lost... also for that matter how was your experience with getting into med school?

It’s so dependent on where you are in the world. 
I gather you’re in the US or Canada?

I’m not. 

I can give you general advice. 

And that would be to live in the moment. 
Study something you’d enjoy in undergrad if you have to do undergrad. Your time is short. When you start work, you may never have that same amount of time devoted to learning what you love. 

In addition to that, you should study some of sciences as it will make some of the basic principles behind medicine (and human physiology) easier to grasp later. Some med schools have pre-requisites, make sure you do those. 

There is no right or wrong path to medicine. 

Many of us (non-traditional students) didn’t go from undergrad to med school. I went to grad school, realized it wasn’t for me. Then took a leap of faith and tried med school. 

Irony is.. med school is not like residency. It’s not like being a doctor (sure it is somewhat). So it’s a huge leap of faith. I wasn’t ever sure if I’d hate it or love it until started working. And even now. It’s a love hate relationship. Like any other job. 

Work experience will also help you. 
So long as it’s not a distraction. You could take a summer casual job. 
Clinical medicine has a lot in common with customer service. It’s a people related job. 

Apart from that. With just getting into med school, keep track of the pre-reqs you need, the entrance exams you have to take and what GPA cut off’s you need to meet. 

Many med schools don’t care where you went to undergrad, that’s almost universal. They care that you met minimum requirements. It’s a bit of a numbers of game. 

At interviews (and I’ve sat on these), we’re interested in hearing stories about you. Not basic generic answers. What I’m getting at, is that we want to hear how your life experiences (especially the tough ones) shaped who you are. They give us an insight into how you’ll tackle challenges on the job and how you’ll cope on a team. 

Some of the time you need knowledge and need to care about your patients. A lot of the time, you’re sorting out logistics and simple management issues. And it’s always a dumpster fire. 

The candidates I remember either interviewed really badly or really well. I don’t really remember the ones in between - at least not all of them. 

Sep 19, 2020
flyonthewallmedstudent: “ theverge: “ FYI: Smartphones can detect eye cancer. ” White opacities, or leukocoria (seeing the white eye shine instead of the normal orange, as is normal with glare in photos). Could also be cataracts, melanoma (can get...

flyonthewallmedstudent:

theverge:

FYI: Smartphones can detect eye cancer.

White opacities, or leukocoria (seeing the white eye shine instead of the normal orange, as is normal with glare in photos). Could also be cataracts, melanoma (can get that in the eye but rarely) and other diseases in adults and kids. Cataracts are far more common. 

For medblrs - Red reflex is for this or leukocoria, in general. Always done with the ophthalmoscope. The red reflex is used in routine screening in neonates, to detect retinoblastoma. Rare disease, but its quick, painless and potentially life or sight saving, which makes it a good screen (worth doing)

(via flyonthewallmedstudent)

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Apr 02, 2019

Anonymous asked:

Hi! Can you recommend any biochemistry text books? Thank you :)

flyonthewallmedstudent Answer:

Hey, 

Ah, tricky to answer on my end. 

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It also depends on what you need the biochem texts for - undergrad course v.s. med school v.s. beyond med school even.

I took biochem as a course in undergrad - and it’s far, far more knowledge than needed in med school. During that course - I relied on Lehninger’s Principles of Biochemistry to get through. That was it. It was the one I found easiest to understand, and it was on the lecturer’s recommended list. It is massive though. 

If in doubt - trips to the library never hurt. Borrowing books cost nothing. 

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In the pre-clinical years in med, I still used Lehninger’s as a reference. i.e. if I couldn’t understand the concepts mentioned in lecture, I’d go back to that book to refresh my memory. Or just used it to relearn the steps to glucose metabolism, Krebs cycle etc. at my own pace. Med school lectures tend to hurry through a lot of concepts or have presumed knowledge. While in undergrad we’d spend months on biochem as a course, during med you might get 2-4 weeks of a condensed version. 

In the clinical years on the wards, I’ve almost never touched the hard sciences again. Simply because..no one will ever ask me to draw out the glycolysis cycle - there’s no clinical reason to. If anything, they’ll ask the medically relevant items that concern a patient we’re rounding on - e.g. what are the signs and symptoms of vitamin deficiency ‘X’? What’s the treatment? Is it water soluble? etc. What does this vitamin normally do? 

The exception to this general trend: ICU physicians. They’re possibly the only clinicians really keen to test knowledge on biochemistry, physiology or pharmacology. The stuff you learn (and then forget) in first year. Versus the surgeons, who are big on anatomy. Or paediatricians - they might ask us about congenital diseases or embryology (if they’re paediatric surgeons).   

I’ve yet to find a great clinically relevant biochem text for students. Not that they don’t exist, but there’s none that I’ve liked or stuck with. I can’t even remember their titles anymore. 

Most of the time now, I resort to the usual stuff - First Aid, Kaplan etc (It’s quick, straight to the point, millions of students worldwide still use ‘em, whether or not they take the USMLEs, they’re just great concise student notes). If I’m desperate, then Harrison’s Internal Medicine. It covers some of the underlying biochemical aspects to some diseases. Probably offers more detail than needed sometimes. 

I found Life in the Fast Lane’s Critical Care Compendium helpful as something that’s practical when actually seeing patients. But it’s a largely Australian resource, written by critical care Australian doctors. E.g. if I need a refresher on how to quickly interpret acid-base or anion gap. I don’t always have time necessarily to flip through a textbook or need to know the full background to what an acid or base is, I just need to know how to determine if my patient has an acid or base imbalance and what could have caused it.

More and more doctors I’ve known have started recommending the site, usually for the ECG stuff. Site entries are written by doctors for doctors.  

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Hope that somewhat helps and makes sense :S

Anyone else have suggestions?

Welp. As an update. 
Uptodate.com is the more widely used reference. 
It’s not bed time reading or something to read cover-to-cover. 

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Apr 01, 2019
flyonthewallmedstudent: “ medicaletymologies: “ From Ancient Greek ἀν- (negative prefix) and ἱδρώς (sweat, perspiration, moisture) ” Sweating - controlled by the sympathetic nervous system. Absence of it means dysfunction. Classically, anhidrosis is...

flyonthewallmedstudent:

medicaletymologies:

From Ancient Greek ἀν- (negative prefix) and  ἱδρώς (sweat, perspiration, moisture)

Sweating - controlled by the sympathetic nervous system. Absence of it means dysfunction.

Classically, anhidrosis is part of the triad of symptoms in Horner’s - miosis (constricted pupil), anhidriosis, ptosis (drooping eyelid). It indicates damage or pressure on the sympathetic trunk from a pancoast/lung tumour or other pathologies.

Make sure you take a CXR. 

(via flyonthewallmedstudent)

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Mar 31, 2019

Final Year so..Panic

flyonthewallmedstudent:

I spent most of med school looking up to the final year students. They were so close to being doctors and knew so much. I envied them, dreamt of being in their shoes. Nearly done. 

Now I’m there and there’s that feeling of be careful what you wish for. Because it might come true.  

I’m nearing the end. But rather than feeling the elation I was expecting, it’s more a mixture of I’m-so-over med school coupled with feeling absolutely terrified.

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It’s the beginning of something so much bigger and scarier than med school. Actually being a doctor. And realizing, amg, I really don’t know that much. There’s still so much more to learn. And do I really know how to do a cannula? Maybe I’ll do another 10 just in case. Am I anxious? Maybe I am.

The last 4 years used to seem like forever. Now they seem like a drop in a massive, gargantuan bucket. Every day, it’s ‘yay’ I’m closer to getting paid. But also. holy shit *$&#&@. People are going to give me responsibility next year. They’re going to expect me to prescribe actual medicine. They’re going to expect me to know stuff. 

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Little did I know..

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Mar 29, 2019

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