Stool Osmotic Gap Calculator

Stool Osmotic Gap Calculator


Stool Osmotic Gap Formula = Stool Osmolality - 2 * (Na +K). The stool osmotic gap is used to determine the etiology of diarrhea. If the stool osmotic gap is greater than 100, the diarrhea is osmolar. If the stool osmotic gap is less than 100, the diarrhea is secretory.

200,000 visitors

Got to 200,000 visitors, a good last year. Building more and redesigning.

Quit Smoking Calculator

Quit Smoking Calculator

Quit Smoking Calculator calculates the total amount saved based on how much money is spent daily on smoking cigarettes. Enter the average paid per day for smoking for the year. Then, enter the average return in an investment. The default value is 5%, a good mutual fund's return. Then, put in the total years saved. For example, if a 30 year old quits smoking, enter 35 for the number of years till retirement. The yearly savings will be calculated, and that will be added to the investment every year. The interest will be compounded till the final savings is calculated.

Diagnostic Paracentesis

Diagnostic paracentesis is a simple bed side procedure. The basic items needed are a 60 cc syringe, 10 cc syringe, chloraprep, 18 gauge needle, 22 gauge needle, sterile gloves, ultrasound, lidocaine bottle, cap, and mask. Find a safe area to draw peritoneal fluid on the abdomen. The left lower quadrant or right lower quadrant can be used. The largest risk of a diagnostic paracentesis is bowel perforation with the sharp needles. The left lower quadrant is preferred by some since the cecum is prominent in the right lower quadrant. After finding an appropriate area with the ultrasound, sterilize the area and inject with lidocaine. Inject a wheal superficially with a 10 cc syringe and 22 gauge needle. Then inject perpendicularly deeper into the tissue beyond the muscle layers. Always apply negative pressure before injecting to avoid hitting a vein. The needle should advance into the peritoneum and ascites should be aspirated. Inject the lidocaine into the peritoneal area and inject along the pathway as the needle is pulled out. Use the 18 gauge and 60 cc syringe to aspirate the ascites along the anesthetized pathway. Obtain 60 ccs of fluid. Diagnostic paracentesis fluid should be sent for the following tests: cell count and differential, culture, albumin, and total protein. The most important initial test is cell count and differential. If the product of WBC count and segment percentage is greater than 250, then the patient has spontaneous bacterial peritonitis and needs to be treated with intravenous antibiotics. One option is Ceftriaxone. Cultures will provide specific microbe identification and antibiotic sensitivity. Albumin and protein can also help to identify the etiology of ascites, usually differentiating cardiac from hepatic sources. A diagnostic paracentesis is often important and mandatory for all patients admitted with ascites. 

FE Urea Calculator

FE Urea Calculator

Fractional Excretion of Urea =

((Urine Urea/Plasma Urea)*100
---------------------------------------
(Urine Creatinine/Plasma Creatinine))

FE Urea is used to determine the type of renal failure in patients using diuretics, since the FeNa calculation can be inaccurate. Fractional excretion of urine less than 35% is consistent with a pre-renal acute renal failure.

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92,714 visitors in 2010

180,000 visitors

180,000 visitors

Corrected Sodium Calculator

Corrected Sodium Calculator

 

Corrects sodium based on glucose. The formula is Corrected Sodium = 0.016 * (Glucose - 100) + Sodium.

Corrected Calcium Calculator

Corrected Calcium Calculator

 

Calculates corrected calcium based on albumin.

 

Built for mobile screens.

MELD Score Calcuator

MELD Score

The MELD score determines the severity of liver disease. It is used for organ allocation for liver transplantation. Laboratory values less than 1.0 should be set to 1.0, and the maximum creatinine should be set to 4. If the patient has had CVVHD or dialysis twice in the last week, set the creatinine to 4.

140,000

140,000 visitors

Glucose Corrected Sodium Calculator

Glucose Corrected Sodium Calculator

Corrects sodium based on hyperglycemia according to the formula: Corrected Sodium = 0.016*(Glucose - 100) + Sodium.

100,000 Visitors

100,097 Visitors

Multiplication Teacher

Similar to multiplication flash cards, this will create two random numbers and ask for the answer.

Online Multiplication Flash Cards

Gastroenterology Search Engine

Gastroenterology Search Engine - Searches through ACG , several gastroenterology journals, and medical websites. The page works well from the iPhone and other mobile devices.

6,000 visitors in one month

November 2009

80,000 Visitors

80,269

Serum Osmolality Gap Calculator

Calculates Serum Osmolality and then Calculates Gap from Measured Osmolality

Calculated Osmolality = 2*Na + (Urea/2.8) + (Glucose/8) + (Ethanol/4.6)
Osmolal Gap = Measured Osmolality - Calculated Osmolality

Serum Osmolality Calculator

5,000 visitors in a month

5,127 visitors in September 2009

100,000 page views

100,483 total page views today.

70,000 visitors

70,289 visitors today

History Note Writer

Created for Vista, Epic, and other EHRs, this page will create standard notes for office visits or daily progress notes. It will automatically fill in the subjective, objective, assessment, and plan. Hit the HPI and it will ask for age, chief complaint, duration, and associated symptoms. Press the physical button to enter the standard exam.

 

Note Writer  

Healthcare Reform 2009

New York Times coverage:

 

History of Healthcare Reform in America

 

Medicare has 45 million members and Medicaid has 59 million members.

Healthcare costs increased significantly after the passage of Medicare and Medicaid in 1965.

Healthcare spending reached $2 Trillion in 2006.

 

Health Care Reform Topic Page

 

iPhone Development Links

Metrics 

http://developer.apple.com/safari/library/documentation/InternetWeb/Conceptual/iPhoneWebAppHIG/MetricsLayout/MetricsLayout.html

 

Meta Tags

http://developer.apple.com/safari/library/documentation/AppleApplications/Reference/SafariHTMLRef/Articles/MetaTags.html

 

Forms

http://developer.apple.com/safari/library/documentation/AppleApplications/Reference/SafariWebContent/DesigningForms/DesigningForms.html#//apple_ref/doc/uid/TP40006512

 

60,000 visitors

60,413 today

Predicted Height Calculator

Calculates child's height based on parent's height in inches: Predicted Height Calculator.

Google search results for ipod touch

Searching for "ipod touch" on Google (GOOG) showed some recent changes in advertising strategy. Amazon is no longer allowing associates to directly link from Google to an affiliate landing page. Instead, affiliates have to place a Google advertisement for their own web page with an Amazon link. After this change, the first spot on the advertising panel on the right belongs to Amazon and links directly to their page. Another interesting point is that Microsoft's (MSFT) Bing is advertising it's cash back program for the "ipod touch" on Bing. Recently, there has been a spike in the bid price for these advertisments, and this may have been due to Microsoft and Amazon entering the bidding war for placement. I am not sure how many product advertisments Microsoft is placing on Google, but they're sending  cash to their competitor with every click. 

Gastroenterology Vignettes

American Journal of Gastroenterology Vignettes

Ipod Touch Applications

Free Applications

Best Medical:

Epocrates

MedCalc

Skyscape 

Best Finance:

AOL Finance

with Real Time Quotes

Best Phone:

Skype 

Apple iPods Comparison Chart

FeNa Calculator

Calculates the fractional excretion of sodium based on urine sodium, plasma sodium, urine creatinine, and serum creatinine. Determines the cause of acute renal failure.

FeNa Calculator

 

FeNa < 1 % - prerenal failure: dehydration more than chf

FeNa > 2 % - intrinsic disease: acute tubular necrosis, vasculitis, interstitial nephritis

 

Sources:

1. Le, Tao, Vikas Bhushan, Robert W. Grow, and Veronique Tache.First Aid for the USMLE Step 3. 2nd ed. New York: McGraw Hill, 2008. Print.

 

2. Up to Date
http://www.utdol.com/online/content/topic.do?topicKey=renlfail/11711&selectedTitle=1~32&source=search_result#

 

Citation Sources

Citation Sources

 

AMA Citation Style

 

Son of Citation Machine

Diabetes

Personally, I feel like a majority of inpatients have diabetes. Optimal blood sugar control has been proven to help recovery from multiple diseases including heart disease. Understanding how to initiate insulin and its adjustment is a skill which can be used daily. An endocrine consult month would help to learn insulin management as well as deal with more esoteric concepts as dealing with panhypopituitarism. 

chf and copd

Knowing how to deal with chf and copd hospital admissions should help you carry through 60% of intern year.

A new personal record for sleep

Got home from a 30 hour overnight call shift at 1 PM. Went to sleep around 3 PM. Got out of bed at 8:30 AM the next day with a few interruptions in between. That's 17.5 hours. I should write a little more about internship.

40,000

40,000 visitors

Parkland Burn Formula for the iPhone

Parkland Burn Formula for iPhone
For burn victims, fluid resucitation is critical within the first 24 hours. The amount of fluid resucitation can be determined from the percentage of body surface area (%BSA) involved. "Rule of 9's" can estimate the %BSA.

The Parkland Formula is as follows.
Fluid for first 24 hours (ml) = 4 * Patient's weight in kg * %BSA
Afterwards, the first half of this amount is delivered in the first 8 hours, and the remaining half is delivered in the remaining 16 hours.

The "Rule of 9's" is as follows.
Head and each arm = 9%
Back and chest each = 18%
Each leg = 18%
Perineum = 1%

Medicine Web Calculators for the iPhone

Medicine Calculators
Insulin NPH Calculator
Calculates morning and night time insulin dose based on weight in pounds. The conversion factor requires clinical judgement depending on the type of diabetes, body weight, and insulin resistance. The conversion factor can range from 0.3 to 0.8. Also calculates daily insulin glargine, ie Lantus, dose based on total NPH dose. Conversion factor requires clinical judgement.

Seek the advice of a licensed physician. Patients should not adjust their own insulin regimen. Hypoglycemia, also known as low blood sugar, can be fatal.

BMI Calculator for iPhone
Fill in your height and weight, either in inches and pounds or meters and kilograms, and this BMI (Body Mass Index) calculator will show your BMI. It will also show an ideal body weight range for the height.
A normal BMI is between 18.5 and 24.9. A BMI less than 18.5 indicates a low weight for a specific height, while a BMI greater than 24.9 indicates a high weight for a specific height. The safest and healthiest way to lose weight is to slightly decrease calorie consumption and to excercise. A 3500 calorie deficit per week should decrease weight by 1 pound per week. Eating more lean meats and fish as well as eating more vegetables can help with weight loss. Consult a physician before starting a diet and excercise program

Simple design for small screens: iPhone, gPhone, Bold.
Mobile Home

30,000 visitors

30,000 visitors

Fick's Formula Calculator for Cardiac Output

Cardiac output is calculated based on arterial and venous oxygen levels and oxygen uptake.
Fick Cardiac Output Calculator

Visit 25,000 - Nagel's Rule

Aids in Africa

Startling information displayed on Google Maps about the AIDS crisis in Africa.
Aids in Africa

aortic stenosis in the elderly

"Valvular Aortic Stenosis in the Elderly"

Wilbert S. Aronow, MD. Cardiology in Review, Volume 15, Number 5, September/October 2007

1.      Etiology and Prevalence

a.       Calcification of aortic valve increases with age: 28% in 55-71, 48% in 75-76, 75% in 85-86

b.      Reduction in aortic valve area 0.11-0.12cm²/y

c.       Risk Factors for progression: smoking and hypercholesterolemia

d.      Aortic stenosis in elderly(average age 80-81): 15% men, 17% women

SOAP Note Creator

Medicine : Saved SOAP Notes

Saved SOAP Notes

If similar SOAP notes are written for each visit, this SOAP note software will save prior SOAP notes. It also has the ability to print the notes with defined left and top margins.

Create SOAP notes below and save them to the fields provided.
Press "Create SOAP" button to make a SOAP note. Answer the question prompts and the SOAP note will be created below. Copy the created SOAP note to the other SOAP note fields to save them.

This page uses Javascript code to save the text in these forms into a cookie. When you come back to this page, the text in the forms will be saved. Be wary of putting this information in a public computer and make sure to log on and off from your account. It is the user's responsibility to protect data. Void where prohibited.

History Taker

History Taker

History Taker A free electronic personal electronic health record. Hit the HPI then PMH buttons to answer questions. Questions: HPI Button - History of Present Illness: How old is this patient? What is the sex of this patient? What is this patient's chief compaint? What is the duration? What are the associated symptoms? PMH Button - Past Medical History, Past Surgical History, Medications, Allergies: What is this patient's past medical history? What is the patient's past surgical history? What medications does this patient take? What are this patient's allergies? Please make any corrections below and then press "Generate Final" to get a personal health record page in the new window. To save the file, select "File&gt;Save As&gt;" and save as an HTML file.

Winter's Formula for Expected CO2

Winter's Formula Calculator

Calculates expected CO2 based on HCO3, bicarbonate.

Expected CO2 = HCO3 * 1.56 + 8.36

SOAP Note Software

Medicine : Saved SOAP Notes

Online SOAP software creates SOAP notes and saves them for later retrieval. This can save small changes made daily to the notes. The notes can be copied into other electronic record systems. If the notes have to be printed, the top and left margins can be defined to place the note within the correct area of the paper.

Complete Step 2 CK Study Guide

"Crush Step 2" is an easy book to read. I read this twice before taking the test. I would say it has more detail than "First Aid for Step 2 CK", yet I read both of them. I thought they complemented each other well.

"NMS Review for USMLE Step 2 CK" provided a 1000 practice questions. I was able to finish the entire book. Its explanations provide a lot of background. Sometimes explanations repeat key points several times over different questions. I did all the questions once and I think it would be pretty hard to do the questions multiple times. Reading and underlining the explanations was probably where I learned the most for Step 2 CK.

"Boards and Wards" is a good pocketbook for clinical rotations as a medical student. It's also a thorough review book for Step 2 CK. I would say it's more detailed than "Crush Step 2" or "First Aid for Step 2 CK". I was able to read this 1-2 times.

"First Aid for Step 2 CK" provided good tables for the test. I read this book twice, yet I thought sometimes it provided too little detail in some areas. Reading multiple books will help the most.

I still think you need access to at least a good medical textbook, either "Harrison's" or "CMDT". Access to Access Medicine is great also. Sometimes the explanations on practice questions will need more background information.

USMLEWorld.com - Although many people found USMLE World to be helpful for Step 2 CK, I couldn't use it for more than 100 questions. Maybe it was because I was early in my studying or I thought the questions were too esoteric. The explanations are very detailed, and reading that much on a computer screen is not a good way for me to learn. There's about 2000 questions available.

NBME Practice Tests - The practice tests are worth the money spent on them, around $40 each. The analysis of your performance on different test areas is helpful early or even late in your studying. Their projected score was pretty accurate also.

Other Methods:
Creating your own questions helps a lot. Group studying works.

FDA Hears Lasik Complaints

Witnesses Tell of Suffering After Lasik - New York Times

Warning on Storage of Health Records - New York Times

Apparently, HIPAA does not apply to web based health information storage. Microsoft (MSFT) and Google (GOOG) have started to offer storage.

Warning on Storage of Health Records - New York Times

Diesel Savings Calculator

Diesel engines have become more efficient, decreased their noise, and become an alternative to gas engine cars. They can provide mileage similar to a hybrid car. Here's a calculator that will take into account the price difference between gas and diesel along with the miles per gallon difference between the two fuels. This can also be used as a Flex-Fuel Calculator to account for the lower price of ethanol fuel and difference in miles per gallon.

Diesel Savings Calculator

Hybrid Savings Calculator

Hybrid
Savings Calculator
Calculates the
gas money saved by buying a hybrid based on hybrid miles per gallon,
standard miles per gallon, miles driven, and gas price.

For example, a hybrid averaging 40 miles per gallon versus
a standard car with 25 miles per gallon will save $9,300 over
200,000 miles when the price of gas is $3.10.

Hybrid Gallons = 5000

Standard Gallons = 8000

Hybrid Gas Price = 15500

Standard Gas Price = 24800

Savings = 9300

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2009 Federal Budget Spending on Health Care

http://www.whitehouse.gov/omb/budget/fy2009/pdf/budget/hhs.pdf

The 2009 federal budget includes $736 billion dollars to be spent on health care including Medicare and Medicaid out of the total $3.1 trillion dollar budget.

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Crush Step 2 CK Review

Crush Step 2 CK was a basic review for the USMLE Step 2 CK. It's a good book to read several times over before taking the boards. Although if you need help understanding a topic, it would be better to go to a more thorough source such as a textbook. The topics are organized into small paragraphs which basically list important facts. Practicing questions with a book like NMS Review for Step 2 CK is necessary to grasp concepts. I think First Aid for Step 2 CK is probably more well written although it will take longer to read.

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NMS Review for Step 2 CK Book Review

NMS Review for Step 2 CK has been an excellent resource. The test questions focus on large topics that will be tested on the boards. The questions do tend to repeat several concepts but this is a good way to learn. The explanations provide adequate depth, and sometimes even provide anecdotal stories that will help you remember key points. It's well written. Questions based on pictures are limited, but the board media questions are hard to replicate. The book has about 1000 questions and it will take about 1 month to finish.

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USMLE World For Step 2 CK Review

I used USMLE World for Step 2 CK for about four weeks. Although many people do highly suggest it, this product didn't work for me. I thought the questions were too detail oriented and the explanations were even more detailed. The explanations can easily fill the entire computer screen with each answer taking up to 300 words. I really stopped using the product after about 1 week of solid use. I switched to books afterwards - mainly NMS review and Crush.

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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"

Iodinizing Salt and global health

In Raising the WorldÂ’s I.Q., the SecretÂ’s in the Salt - New York Times

This article looks at the progress in iodinizing salt in developing countries and what is left to do. Iodinizing salt is one of the most cost effective public health initiatives.

Technorati tags: health, iq, salt, iodine

electronic health record - Google Patents

electronic health record - Google Patents
Search results for "electronic health record" in the patent database at the US Patent Office.

Five big firms to promote electronic health files - U.S. Business - MSNBC.com

Five big firms to promote electronic health files - U.S. Business - MSNBC.com
Walmart, BP, and Intel are promoting a centralized electronic health record system for its employers.

Lure of Great Wealth Affects Career Choices - New York Times

Lure of Great Wealth Affects Career Choices - New York Times
Physicians are switching from their practices to other fields such as finance.

dry patches

Subjective

34 year old white male presents with dry patches on his scalp, back of his elbows, and the front of his knees. They have been present for several months. No itching.

Objective

Vital signs stable. Skin - dry, scaling plaques, well-circumscribed, silver present on scalp, extensor surfaces of elbow and knee

Assessment and Plan

A- Psoriasis P- topical corticosteroids, other options include ultraviolet light (sunlight), lubricants, and keratolytics

Created with SOAP Note

ulcers in the mouth

Subjective

75 year old male presents with ulcers in his mouth. Started five months ago. Ulcers have progressed to around his mouth and on his forearms.

Objective

Vitals signs stable. Oral- multiple bullae in mucosa Skin - multiple bullae Labs - biopsy shows antibody pattern in fish-net immunofluorescence pattern

Assessment and Plan

A- Pemphigus P- corticosteroids

Created with SOAP Note

SOAP Note

SOAP note: "SOAP Note will create a standard patient encounter document. Please comment with any suggestions."

painful red nodules

Subjective

45 year old female presents with painful, red nodules on her shins. Started 1 month ago. Patient was recently diagnosed with ulcerative colitis.

Objective

Vital signs stable Extremities - pretibial, tender, erythematous nodules

Assessment and Plan

DDX - sarcoidosis, coccidiomycosis, ulcerative colitis, streptococcal infection, idiopathic A - erythema nodosum due to ulcerative colitis P - treat ulcerative colitis

Created with SOAP Note

Growth on forehead

Subjective

25 year old patient notes a growth on her forehead which is the color of her skin. It started about 2 months ago and has stopped growing.

Objective

Vital signs stable. Skin - flesh colored lesion on forehead with central crater, crater contains keratinous material

Assessment and Plan

A - Keratocanthoma P - Lesion will likely resolve in a few months, observation for few months, biopsy if needed.

Created with SOAP Note

One for the Ages: A Prescription That May Extend Life - New York Times

One for the Ages: A Prescription That May Extend Life - New York Times
Calorie restriction diet in rhesus monkeys shows health advantages, however other scientists believe the research may not translate to humans as well.

Growing Debate as Doctors Train on New Devices - New York Times

Growing Debate as Doctors Train on New Devices - New York Times