no urine output after a sore throat

A 21 year old presents to the office two weeks after a sore throat. The rapid strep test came back positive as well as cultures showing group A beta-hemolytic strepococcus. He finished his course of antibiotics and came back to the office two weeks later with the main complaint of swelling in his feet. He also noticed he's not urinating as frequently and the urine he does make is smoky-brown.  His vital signs were significant for an elevated blood pressure of 150/80. What is the most likely diagnosis?
A) Wegener's granulomatosis
B) Goodpasture's syndrome
C) Alport's syndrome
D) IgA Nephropathy
E) Postinfectious glomerulonephritis
What additional lab tests can be ordered?
A) c-ANCA
B) serum C3
C) ASO titer
D) fat pad biopsy

Answer: This patient most likely has postinfectious glomerulonephritis, an immune complex nephritic syndrome. A serum C3 would be decreased and an ASO titer would be positive.

Source:
1. Le, Tao. First Aid for the USMLE Step 2 CK. 5th. New York: McGraw-Hill, 2006.
First Aid for the USMLE Step 2 CK (First Aid for the USMLE Step 2: Clinical Knowledge)

poison signs and symptoms

Mercury - stomatitis, abdominal pain, nausea and vomiting, and explosive, bloody diarrhea.
Iron - vomitting, hematemesis, diarrhea, hypotension, and metabolic acidosis
Arsenic - skeletal muscle cramps, abdominal pain, watery diarrhea, vomiting
Lead - headache, abdominal pain, constipation, coma, convulsions
Selenium - garlic breath, hair loss, skin depigmentation, abnormal nail growth, fatigue

Source: NMS review for USMLE Step 2 Ck

Expensive efficiency in medicine

This NY Times article looks at the cost of promoting efficiency in medicine. An office of four doctors had to spend $140,000 to install electronic medical records.
Who Pays for Efficiency?

Regional differences in Medicare

The NY Times compiled an interactive graphic about regional differences in Medicare looking at reimbursements, surgery rates, and enrollees.
http://www.nytimes.com/ref/business/20070611_GAP_GRAPHIC.html

California debating universal health care

California Moves Toward Universal Health Care
The program would be funded by several sources including a cigarette tax and a 4% tax on hospital revenues.

FSB: Healer or dealer? - September 1, 2006

FSB: Healer or dealer? - September 1, 2006

Strategies to Avoid Medicare’s Big Hole - New York Times

Strategies to Avoid Medicare’s Big Hole - New York Times Technorati tags: medicare, drugs

Medicare drug benefits have a gap from $2,510 to $5,726. This has lead many patients to try generic drugs before they reach the $2,510 limit. Companies such as Wal-Mart (WMT) are offering good discounts on generic drugs, and some companies are offering free generic drugs so their employees stay healthy.

hyperpigmentation after pregnancy

Dizziness
A 29 year old female presents to your office after noticing increased skin pigmentation over the last four months in winter. She's also noticed dizzyness and a ten pound weight loss. She delivered her first baby four months ago. The delivery was complicated by excessive blood loss, and she lost consciousness for a brief period after the delivery. Review of systems is notable for decreased appetite, nausea and vomiting, and feeling thirsty. She has also been unable to breastfeed her baby since she is unable to form breast milk. Her blood pressure in the office is 100/70, while blood pressure from last year was 120/80. After ordering a basic metabolic panel, it's significant for a sodium of 130 and a potassium of 5.2.
What is the patient's most likely condition?
A) Conn's Syndrome
B) Pheochromocytoma
C) Addison's disease
D) Secondary adrenal insufficiency
E) Hashimoto's thyroiditis
What is the next immediate step?
A) IV Fluids
B) Hydrocortisone
C) CT Abdomen
D) Renal Ultrasound
E) Aspirin
What is the name of her pregnancy related condition?
A) Eclampsia
B) Preeclampsia
C) Sheehan's syndrome
D) Hemochromatosis
Answer: This recently pregnant patient with hyperpigmentation, syncope, and hypotension most likely has secondary adrenal insufficiency. Other supporting information include his hyponatremia and hyperkalemia. Addrenal insufficiency requires immediate action including IV fluids and hydrocortisone. She likely has Sheehan's syndrome from postpartum hemorrhage and hypotension. This is likely causing her inablility to breastfeed also. She should be interviewed further for endocrine abnormalities.

Sources:
1. Brochert, Adam. Crush Step 2. 2nd. Philadelphia: Hanley & Belfus, 2003.
Books for Medical Students

Dizziness

A 27 year old male presents to your office after having an episode of dizziness followed by a loss of consciousness. Over the last four months, he's noticed a ten pound weight loss. Although it's December, he has noticed increased skin pigmentation. Review of systems is notable for decreased appetite, nausea and vomiting, and feeling thirsty. His blood pressure in the office is 100/70, while his blood pressure from last year was 120/80. After ordering a basic metabolic panel, it's significant for a sodium of 128 and a potassium of 5.
What is the patient's most likely condition?
A) Conn's Syndrome
B) Pheochromocytoma
C) Addison's disease
D) Graves' disease
E) Hashimoto's thyroiditis
What is the next immediate step?
A) IV Fluids
B) Hydrocortisone
C) CT Abdomen
D) Renal Ultrasound
E) Aspirin

Answer: This patient with hyperpigmentation, syncope, and hypotension most likely has Addison's disease. Other supporting information include his hyponatremia and hyperkalemia. Addison's disease is a medical emergency which requires immediate action including IV fluids and hydrocortisone.

Sources:
1. Brochert, Adam. Crush Step 2. 2nd. Philadelphia: Hanley & Belfus, 2003.
Books for Medical Students

purulent nasal discharge

A 32 year old woman comes into the office with yellow nasal discharge for one week. She has also had a headache during this time. Physical exam shows tenderness over the frontal sinus and an inability to transilluminate the frontal sinuses. The maxillary sinuses are non-tender. CT of head shows opacification of the frontal sinus.
What pathogens can cause this condition?
A) Moraxella
B) Cocciodides
C) Respiratory Synctial Virus
D) S. pneumoniae
E) Haemophilus species
What is the first line of treatment?
A) Penicillin
B) Amoxicillin
C) Second generation Cephalosporin
D) Tetracylcine

Answer: This patient with nasal discharge and frontal sinus tenderness most likely has sinusitis. Common pathogens include Haemophilus species and S. pneumonia. Treatment can be begin with amoxicillin or second-generation cephalosporin.

Sources:1. Brochert, Adam. Crush Step 2. 2nd. Philadelphia: Hanley & Belfus, 2003.2.
Books for Medical Students

A tired farmer

A 62 year old farmer in New Mexico comes to the office with a 1 week history of malaise, fevers, cough, joint pain, and a headache. The patient denies smoking. A chest x-ray shows a 2 cm round nodule not present on prior x-rays.
What can cause this condition in this patient?
A) Histoplasmosis
B) Tuberculosis
C) Hamartoma
D) Lung cancer
E) Coccidiodes immitis
What is this condition called?
A) Death Valley Fever
B) San Joaquin Valley Fever
C) San Andreas chills
D) desert pneumonia
What can happen 1-2 weeks later?
A) diarrhea
B) vomitting
C) blurry vision
D) rash
E) erythema nodosum
F) erythema multiforme

Answer: This patient living in the southwest United States likely has an infection with Coccidiodes immitis. It is a flu like syndrome along with small nodules found on x-ray. The condition is called San Joaquin Valley Fever. Only 40% of those with the infection develop symptoms. 1-2 weeks later they can develop a rash, erythema nodosum, and erythema multiforme.

Sources:
1. Brochert, Adam. Crush Step 2. 2nd. Philadelphia: Hanley & Belfus, 2003.
2. http://www.accessmedicine.com/content.aspx?aID=2763279
Books for Medical Students

Wheezing 1 year old

In December, a 1 year old baby girl is brought into the emergency room. The mother states the baby has been wheezing for 1 day intermittently. The baby is crying and when she pauses to take a breath you can hear wheezing bilaterally. Her temperature is 101.9 degrees Fahrenheit. What can cause wheezing in this 1 year old?
A) Foreign Object
B) Asthma
C) Respiratory Synctial Virus
D) Pneumonia
What is the standard for diagnosis?
A) Chest X-ray
B) Elisa of blood
C) Elisa of nasal washings
D) Culture of nasopharyngeal secretions
What is the treatment?
A) Humidification, hydration, and ventilatory support
B) Ribavirin
C) Corticosteroids
D) Bronchodilators
E) Palivizumab

Answer: Although asthma and a foreign object can cause wheezing, respiratory synctial virus must also be considered for wheezing in patients less than 2 years old. RSV occurs during the winter and can be accompanied by a fever. The standard for diagnosis is culture of nasopharyngeal secretions. Initial treatment is humidification, hydration, and ventilatory support. The other methods listed are advanced treatments.

Source:
1. Brochert, Adam. Crush Step 2. 2nd. Philadelphia: Hanley & Belfus, 2003.
2. http://www.accessmedicine.com/content.aspx?aid=2549353
Books for Medical Students

young person with difficulty breathing

A 25 year old male comes into the office with progressive shortness of breath. He admits to a 3 year history of smoking cigarettes averaging less than 1/2 a pack per day. Physical exam shows a prolonged expiratory phase, end-expiratory wheezing, and decreased heart and breath sounds. What is a likely etiology of his current condition?
A) Pneumonia
B) Asthma
C) Asbestos
D) Alpha1 Trypsin Deficiency

Answer: This young 25 year old male appears to have emphysema. This usually develops after several years of smoking in older individuals. In this person with a short smoking history and physical findings consistent with emphysema, alpha1 Trypsin deficiency should be considered.

Source:
1. Brochert, Adam. Crush Step 2. 2nd. Philadelphia: Hanley & Belfus, 2003.
Books for Medical Students

COPD trouble breathing

A patient with COPD comes into the ER with altered mental status. An arterial blood gas is ordered and it shows CO2 of 54 and an O2 of 48. The pH was 7.25 while he was breathing room air. 2 liters oxygen is given by nasal canula yet the patient is not improving symptomatically, and his scalene muscles are contracting heavily. What is the next step?
A) Increase nasal canula to 4 L
B) Give albuterol nebulizers
C) Intubate
D) Give epinephrine

Answer:
This person has several indications for intubation including a CO2 > 50, O2 <50, pH <7.30 on room air, and lack of improvement with nasal canula. He is also starting to use his accesory muscles to breathe.

Source:
1. Brochert, Adam. Crush Step 2. 2nd. Philadelphia: Hanley & Belfus, 2003.
Books for Medical Students

Medical Residency Interview

Medical Residency Interview

Excellent tips on going for the residency interview.

Technorati tags: Interview tips

Publish medical books for free

http://studentdoctor.net/blog/2007/10/06/partner-organization-spotlight-fep-international/

Direct Link:http://www.fepint.org/. Here's the page of benefits for authors, including receiving high royalties, owning copyright, and providing extensive distribution.

Flights, suits, and organization for residency interviews

Interview season can be daunting. Once all the applications are sent, there's the interviews. You need to get organized, get dressed, and get going. Gmail is a great web based e-mail service, and it also has a great calendar with Google Calendar. Amazon.com has some great deals on interview suits for men. Ralph Lauren seperates can be found for less than $200, a few are available for $180. Several can be found for less than $240. You have to know your suit size and pant size, and your prefernce for designer stitching. Here are a couple of great suits for a $180 in size 42R. One is for $210. At Macy's, the suits are usually selling for $50 more. 

Last minute deals on flights are available for residency interviews. Look for better deals during the weekdays. Also, consider alternative airports in larger cities. Combine hotels and flights to save money.  Car rentals are also cheaper online.

Writing Personal Statements for Medical Students

Writing a personal statement for a medical student requires time and effort. Resumes and Personal Statements for Professionals was mentioned in Iserson's Getting Into A Residency.
Both of these books provide a lot of guidance from people who have helped
many medical students apply for residency.

Links for Applying to Residency

ERAS Login
Create and send application to multiple programs.
https://services.aamc.org/eras/myeras2008/index.cfm

NRMP Login
Create the rank order list of interview programs.
https://services.nrmp.org/R3/Home/Login/Login.cfm

Freida Program Search
Research residency programs.
http://www.ama-assn.org/vapp/freida/srch/

Why Become a Chest Surgeon?

Why Become a Chest Surgeon? Technorati tags: cardiothoracic surgery

Got this article from a friend, beautifully well-written article about medical students experiences and chosing a medical specialty, in this case cardiothoracic surgery.

The Profit and the Pauper - New York Times

The Profit and the Pauper - New York Times:

And they will still be able to pursue deadbeats practically into the grave, since people who file for bankruptcy have to keep paying back their student loans — an astonishing exception to the bankruptcy law that lenders lobbied for, and won, in the 1990s. The student loan business will still be, well, a business.

Technorati tags: student loans

Selling Yourself by Showing Yourself, in a Good Way - New York Times

Selling Yourself by Showing Yourself, in a Good Way - New York Times

The art of self-promotion is discussed in this NY Times article.

Technorati tags: self-promotion

Radiology Search Engine

Radiology Search Engine

Searches through radiology related websites. Includes radiology residency websites.

Technorati tags: radiology, search engine

Neuroradiologist's Web Guide 2004

Neuroradiologist's Web Guide 2004

Finding-the-Path

Finding-the-Path

Brigham Radiology department's website with cases and algorithms.

Technorati tags: brigham, radiology, cases, algorithms

Branches of the basilar artery

http://www.ib.amwaw.edu.pl/anatomy/atlas/image_12e.htm

Osteoma

Osteoma at diaphysis

Ebsein's Anomaly

Ebstein's Anomaly
-Shelf above right atrium
-Decreased pulmonary vasculature
-Cyanosis

Mitral Regurgitation

Mitral regurgitation with large left atrium and large heart.

Aortic Stenosis

Aortic Stenosis with post obstructive dilation and coarction.

Osteosarcoma

Osteosarcoma
Osteosarcoma with cartilage cap

Giant Cell Tumor

Giant Cell Tumor

Some Employers Are Offering Free Drugs

http://www.nytimes.com/2007/02/21/business/21free.html?ref=business

Employers provide free prescriptions for common, chronic medical conditions hoping to prevent more costly complications from non-compliance. Employees benefit with more access to prescription medications. Employers benefit with lower long-term healthcare costs. Medical system benefits with hopefully decreased incidences of complications from diabetes, asthma, and high cholesterol.

Doctors Who Deliver - Forbes.com

Doctors Who Deliver - Forbes.com
Doctors will visit you in your hotel room or business for $300. Compare this to the alternative of waiting in an ER for nine hours and getting a larger bill.

Bayesian Analysis - Odds Ratio Calculator

Bayesian Analysis - Odds Ratio Calculator

Technorati tags: odds ratio, calculator, bayes

Odds Ratio = (a/b)/(c/d)

"estimates relative risk in case-controlled studies"