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.