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Canadian Med Student

[randommomentsdevida]

MS3 resources/apps/stuff

General/all rotations:

https://onlinemeded.org/

Has a ton of free lectures on various topics. Notes and stuff, you need to pay for.

http://www.medbullets.com/

Summary of various topics. Free. 

http://radiopaedia.org/

Useful radiology source

http://www.dynamed.com/ or http://www.uptodate.com/

Useful readings that are subscription based - I would wait to buy subscriptions because the hospital or your school may give it to you for free. Also, dynamed is free for students. 

Maxwell Quick Medical Reference

A quick reference for random things

Case files / Blueprints

Books series that has books for each rotation. Choose whichever works for you, and before you buy, check out your hospital library!

http://som.uthscsa.edu/StudentAffairs/thirdyear.asp

Has review lectures for the psych, surgery, peds, and medicine shelves that are about 2 hours each.  

Qbank

Pick your fav

Medscape app Apple / Android

Useful reference and has calculators 

I don’t really recommend epocrates - has a lot of random and really stupid errors that even I caught. 

Figure1 - Apple / Android / Web

Instagram for medical people

http://www.2minutemedicine.com/

“High-Impact Reports on the Latest Medical Studies. All Curated and Written by Practicing Physicians and Health Professionals “

Medicine 

Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook) 

Gold for medicine rotation

Step Up to Medicine 

Good reading for medicine rotation. I’ve heard that the older version and the newest version are not that much different so you might consider buying an older version to save money. 

Family

http://www.fpnotebook.com/ 

Reference guide. Also has apps. Recommended by my attending. 

ER

10 second EM app - Apple / Android

Recommended by an ER resident - has quick references for everything ER

Ortho

http://www.orthobullets.com/

Medbullets for ortho.

Surgery 

Pestana’s Surgery Notes  

Overview of surgery things. I dunno, I never finished reading this but people highly recommend it.

Surgical Recall 

Good to review before your surgery for pimp questions.

For pts

GoodRX - Apple / Android

Find the cheapest prescriptions. 

Medisafe - Apple / Android

To help remember when to take medications 

Random 

Compression socks

Especially on surgery or any other rotation where you’re on your feet a lot.

Comfy shoes

For all rotations

Food/granola bars in your whitecoat

Because you never know when you’ll get hungry/hangry

Pain meds

You may consider carrying some in your white coat because there may not be time to go to your locker to get anything.

Whitecoat clipboard 

Useful to organize notes and whatever. Also has some nice reference things on the back that I always forget is there.

General advice

Be flexible. Things don’t always work out perfectly - roll with it. 

Have things to study with you, especially for when your attending invariably runs late. 

Don’t take things too personal. People will yell for the most stupidest things. Realize that it’s a problem with them and not you. 

Do what’s best for you. Sometimes attendings don’t want you to use certain resources. You’re not gonna make everyone happy and at this point, you know what works for you so do what you can and what you already know works for you. Also, sometimes, you just need sleep. Sleep. 

[finallyalyssamd-deactivated2021]

MS3 Resources

For all my wonderful rising MS3 followers, here’s the list of things I used for each shelf exam. I was completely clueless about what to study at the beginning of third year, so I hope this can be helpful! Third year is INFINITELY better than first/second year, so don’t stress. It is possible to get honors on shelf exams. Don’t let anybody tell you otherwise. 

Resources for Every Rotation:

Online Med Ed: didn’t get a chance to use all of it for internal, but used it for every other rotation. It is best to use these videos during the first few days of the rotation to get a nice foundation of knowledge.

Emma Ramahi powerpoints: just google her name and they will pop up. She has powerpoints on IM, peds, psych, and surgery. These are easy “gimme” points and are always amazingly helpful. Best to do these at the beginning and towards the end of the rotation (during the week before the shelf). Easily got me 10 extra questions on both IM and surgery shelves.

NBME practice exams: I always did at least 1-2 of these for every rotation (except family medicine…because they don’t have any for family med :( ). Best to do them the weekend or so before the shelf. Sometimes, the questions in the practice exams are eerily similar to the real shelf questions. 

Rotation-Specific Resources: 

Family Medicine: My Family medicine shelf was based off of CaseFiles…so this won’t be helpful for schools that use NBME’s version. 

CaseFiles: Literally every question from my shelf was pulled from these 43924890238 cases. So, memorize them as best you can if your shelf is set up this way.

AAFP has a set of practice questions. Just sign up for a free membership and you can access them.

Unfortunately, there are no practice shelf exams, no OME videos, and no Ramahi powerpoint :( This shelf can be tough. Focus a lot on health maintenance and screening stuff.

Internal Medicine: At my school, this rotation was SO SHORT for the amount of things you need to learn (only 6 weeks). Start studying early and stay on top of it.

I did not have time to do OME videos. At all. I don’t really regret it, but I hear they are good.

I did all the U World questions. There are like…1400? of them. It is a LOT for 6 weeks in addition to working from 6am-5pm. However, they are excellent prep.

Step Up to Medicine chapters on cardio and ambulatory medicine are da bomb and added to U World. This whole book would honestly be really great prep, but I just didn’t have enough time to read it all. I’m using it more during Step 2 study time, and I really love it.

Neurology: This was only a 3 week rotation for me, but the residents and attendings were amazing teachers and absolutely saved us for the shelf exam. 

U World questions

First Aid: around 40 pages. Good foundation along with OME.

Case Files: I thought this particular Case Files was super helpful.

OB/GYN: Gyn-Onc week was possibly the hardest week of third year as far as hours and work went, for me. Benign-Gyn and L&D were also super busy weeks. Basically, just try to plan your study schedule as best you can with the knowledge that this is an extremely busy rotation.

U World

First Aid: pretty long section (like 70 pages), but good foundational knowledge.

 APGO questions: 550 questions that are a little more “detailed.”  

Case Files if there is time.

Pediatrics: Wards and clinic weeks are super busy. Residents are amazing and very good teachers. You will learn a ton.  This shelf was a bit of a sleeper in that it was more difficult than people were expecting.

U world

First Aid: 50 pages of goodness

Case Files: honestly didn’t find this one as helpful as neuro or OB. 

Psychiatry: Residents and attendings are very nice and hours are great. Know the drugs really, really well. Supposedly, the shelf this year will now officially contain all the DSM-V diagnoses.

U World

First Aid for Psychiatry: This book is honestly all you need to get honors on the psych shelf. It is unequivocally the best study aid for this rotation. Its also pretty short and if you really want to, you can probably get through the whole thing in one weekend.

Relax during this rotation! 

Surgery: Long hours, rough days, but also very challenging and exciting cases (sometimes). 

U World

Dr. Pestana’s Surgery Notes: great review of high yield topics, but leaves out a lot of detail.

National Medical Series (NMS) – Surgery: I absolutely loved this book. It gets pretty detailed at times, but provides a more comprehensive review of shelf information.

[docinlimbo]

[bottleoftonic-blog]

Most bang-for-buck things every intern should know before starting inpatient wards

Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.

Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong

Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.

Pretty thorough review of fluid management on openanesthesia.org

2) Nausea. When to treat, how to treat and at what dose.

3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%

4) “Reflex” antibiotic choice for routine inpatient infections.

http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight

5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).

6) Initial work-up and treatment of oliguria/anuria.

7) A sensible initial approach to suspected ileus.

8) Blood. When, how, why to replace.

9) Pain. Optimal management without inducing narcosis.

Managing cancer pain: Frequently asked questions: CCJM

10) Potassium. When, why and how to shift or replace.

A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld

11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.

12) Resuscitation aka commit the ACLS algorithms to memory.

Current ACLS guidelines. https://www.acls.net/aclsalg.htm

Would love a video series, interactive cases etc.

13) Basic EKG interpretation.

Whole EKG video courses

A whole free youtube EKG video review course by meddit’s own u/ericstrong

An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/

I have to admit I haven’t used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.

EKG video cases

Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu

– If you like Dr. Mattu’s cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.

Practice EKGs with answers

Watching videos isn’t enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.

EKG blogs

I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:

http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)

http://www.ems12lead.com

http://ecg-interpretation.blogspot.is

http://jhcedecg.blogspot.is

EKG resource libraries

Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.

http://www.practicalclinicalskills.com/ekg.aspx /u/collidge

14) Know when to order ABGs and how to interpret them.

Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)

Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg

Bonus 15) Basic CXR interpretation

CXR video lecture course

Again, Dr. Eric Strong has an excellent video course for free on youtube

Step-by-step guides to basic CXR interpretation

The Radiology Assistant: Chest X-ray - Basic interpretation

Radiology Masterclass step-by-step basic CXR

University of Virginia’s step-by-step basic CXR

All inclusive resources

The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.

UPenns CXR learning website

Loyola Universities excellent CXR Atlas Most outdated look but amazing content.

Checklist approach to CXR

Bonus 16) Overnight o-shit-what’s-that Head CT interpretation

Midnight radiology: Emergency CT of the head

University of Virginia’s guide to the Head CT

[sothisisnursingschool]

Hey, self: review before NCLEX. Xo, me.

[md-admissions]

Oh hell yes

[populationpensive]

For future reference.

[doctorkintsugi]

Must. Study.

[telep0rt]

Reblogging again to read ASAP.

[toho-medblr]

Deffo reblogged before but must remember to review this stuff in the next 8 weeks. Final year has loads of general med, ward based stuff and prescribing.

[mdintraining]

Today I taught myself about reading EKG’s and where they actually line up with things going on in the heart with regards to MIs. Basically you have 3 coronary arteries that get occluded in most MIs: Left Anterior Descending (LAD), Left CircumfleX (LCX), and Right Coronary Artery (RCA). LAD feeds the anterior heart and the septum. LCX feeds the lateral and some posterior heart. RCA feeds the right ventricle and some posterior heart, as wells as the SA node in 60% of people.

Now EKGs are confusing and complicated, but it gets easier if you remember where they measure relative to the anatomy. This little diagram helps me get started:

I’ve overlaid the heart over this in the diagram up top. Now remember, those arrows are vectors which is reflected in an EKG read by the upstrokes and downstrokes of the read. (I’m oversimplifying things, but physics makes my brain hurt, and this has worked for me so far.) Practically, what it means is that if the arrow is pointing towards the damage you get ST elevations. For example, in an inferior infarct, you get ST elevations in II, III and aVF, which point towards the inferior part of the heart.

You also have leads V1-V6 which are arranged like so:

(Image from wikipedia)

Notice their vectors point anteriorly. So an anterior infarct shows up at ST elevations in some or all of V1-V6. Meanwhile a posterior infarct will show up as ST depression in V1-V3 which point away from the posterior part of the heart.

To take it one step further you can figure out which artery is blocked. But that’s just a matter of knowing the blood supply, which is basically just what’s nearby. When I’m trying to figure it out on a test, sometimes I draw out this 5 second diagram (aka artistic masterpiece):

[magicmedic]

[genuinecowboy]

Frank H. Netter (1906-1991)

Netter is the Norman Rockwell of Medical Illustration.

“Dr. Netter’s contribution to the study of human anatomy is epochal. He has advanced our understanding of anatomy more than any other medical illustrator since the 16th century, when Vesalius introduced drawings based on cadaveric dissections.” - Dr Michael Debakey

Unlike most sterile medical illustration, Netter aimed to include the human element in his pictures. His characters are real, they cry and they sweat and show emotion through the blood and disfigurement. Netter was as much about the psychology of the human condition as he was about accurate anatomy. 

[tobedoctorly]

How to Draw the Brachial Plexus in 10 Seconds!

Probably one of the most useful resources for memorizing the brachial plexus for the upper limb exam. I drew this on the back both of my both practical and written exams, and listed the nerve fibers for each branch and the muscles innervated. Well, as many as possible. The video helped me get the foundation and visual very quickly. Learning the innervations and the paths and which fibers are found in each nerve? That’s a different story. Here is a rundown of all of the branches:

Remember To Drink Cold Beer - Roots Trunks Divisions Cords (Terminal) Branches

Branches from the Roots:

Lateral Thoracic Nerve (C5-7) travels with Long Thoracic Artery to innervate and supply the Serratus Anterior (and breasts)–L travels with L

Part of the phrenic nerve comes from C5 (remember this one?)

Dorsal Scapular Nerve (C5) goes around the back (dorsal side) of the scapular to innervate the levator scapulae and rhomboids

Branches from the Trunks:

Suprascapular Nerve (C5-6) goes through the suprascapular notch (on the superior aspect of the scapular), under the superior transverse scapular ligament to innervate the supraspinatus and infraspinatus muscles (or as I just remember, the spinatus muscles). Note about this: there is also a suprascapular artery that goes over the same ligament–you can remember “Army over Navy” in that the artery (army) goes over the ligament (a bridge), whereas the nerve (navy) travels below and under.

Nerve to Subclavius (C5-6) is self-explanatory

Branches from Divisions - NONE

Branches from the Lateral Cord (C5-7 with the exception of lateral root of median n. (C6-7)):

Lateral Pectoral Nerve to pectoralis major–p. major is bigger than p. minor, receives nerve fibers from two sources

Lateral root of Median Nerve to hand and anterior forearm–median n. innervates the anterior forearm and goes through the carpal tunnel and plays a role in carpal tunnel syndrome

Musculocutaneous Nerve provides motor to anterior arm (pierces the coracobrachialis m. before traveling between biceps brachii and brachialis mm.) and sensory to forearm (this is the cutaneous part of the name)

Branches from the Median Cord (ALL C8, T1):

Medial Pectoral Nerve to pectoralis major and minor muscles–p. major is bigger than p. minor so it gets innervated by both lateral and medial pectoral nn while p. minor only gets innervated by medial pectoral n.

Medial Brachial Cutaneous Nerve–Brachial = Arm, Cutaneous = Skin; ergo sensory to arm

Medial Antebrachial Cutaneous Nerve–Antebrachial = forearm, Cutaneous = Skin; ergo, sensory to forearm

Medial Root of Median Nerve (see above @ Lat root of Median Nerve)–C6-7 from lateral root, C8-T1 from medial root

Ulnar Nerve–motor to portion of forearm and hand (flexor carpi ulnaris can’t be innervated by anything else…)

Branches from the Posterior Cord (C5-6 with exception of radial n. (all) and thoracodorsal n. (C6-8)):

Upper Subscapular Nerve innervates the subscapular muscle.

Lower Subscapular Nerve innervates the subscapular muscle and teres major muscle (minor over major–these muscles are named major and minor based on their size, but it just so happens that the minor muscle is located superior to the major muscle)

Thoracodorsal Nerve (middle subscapular n.) innervates the back (dorsal) muscle of the trunk (thorax), the latissimus dorsi

Axillary Nerve goes through the quadrangular space (see here) that is bordered by the humerus, what muscles inserts on the humerus? Deltoids. And then there’s also teres minor (I can’t remember how I remembered this).

Radial Nerve, as my labmates says, is a beast of a nerve. It gives motor fibers to posterior arm and forearm and throws out cutaneous sensory nerves left and right–which is why it gets motor fibers from all roots C5 through T1.

I wish I made this post earlier (although this tumblr had yet to exist when I was studying this material), as I would’ve remembered it better. I don’t doubt that this will be helpful recalling the brachial plexus come time to study for the boards. Nevertheless, I hope this will be helpful and useful for anyone learning/reviewing/anticipating! To my fellow peers, please feel free to add anything or make corrections (I admit I’m a bit rusty with brachial plexus now!), and as always my askbox is open for questions!

[medxclusive]

[medxclusive]

Know your Heart Sounds.

*HOCM = Hypertrophic Obstructive Cardiomyopathy

[docinlimbo]

Hey, how did your step 2ck go? Can you share your experience please?

So I actually just found out the results Thursday evening and I’m happy to report that despite the massive nervous breakdown I had prior to the exam it was unfounded….I passed!!!!!!

I’m also happy to say that I did sooooooo much better than I did on step 1. Not super fantastic I’m going to match in dermatology awesome, but enough that I’m not so worried about not matching next year (though I suppose that will always be in the back of my head a little).

I don’t really know what to say about the exam or prep. I was working 60+ hours a week so my prep could have been much better. Count this as a disclaimer not to use the docinlimbo study method- it was dumb luck I did as well as I did (especially when I studied 100x harder for step 1 and didn’t do so hot).

 As far as reading, I used step up to medicine and first aid step 2ck (though I only finished about 1/3 of each). I also did the majority of uworld, but only did it once during my designated study time. I did however use it to study for my shelf exams during 3rd and 4th year so I guess I technically did it twice. I also did two practice exams the uworld one when I first started my studying to gague my current status and one of the newer practice NBME’s. There was a 40 point discrepancy between the two. AKA I bombed the uworld exam which I took 4 weeks before the real thing. I’ve been told by lots of people after the fact that it’s harder and to do it last. The NBME was also a bit lower than my real score. 

I came out of the exam feeling so much worse than I did for step 1. Over the past few weeks I’ve actually sat down and tried to read step up to medicine in preparation to retake it. I’m so happy that it’s over. 

Or at least I hope it is! CS scores haven’t been released yet. 

[awesomedude777ar]

I'm happy for you :)

[strangebiology]

A three-year-old girl had a hemispherectomy to treat Rasmussen syndrome. This MRI scan was taken in 2002 after she had turned seven. The right hemisphere of her brain, which was completely removed, contained the language center and motor control for the left side of her body, and today she has very minor issues controlling her left arm and leg. However, she is fully bilingual in Turkish and Dutch and leads an otherwise normal life. 

[shencomix]

A vs. B

image | twitter | facebook

[jewsee-medicalstudent]

Caul birth.

A caul or cowl birth (from Latin: Caput galeatum, literally, “helmeted head”) is a delivery with a piece of membrane that can cover a newborn’s head and face. The “en-caul” birth, not to be confused with the “caul” birth, occurs when the infant is born inside the entire amniotic sac. The sac balloons out at birth, with the amniotic fluid and child remaining inside the unbroken or partially broken membrane. Birth with a caul is rare, occurring in fewer than 1 in 80,000 births. The caul is harmless and is immediately removed by the physician or midwife upon delivery of the child.

There are two types of caul membranes, and there are four ways such cauls can appear. The most common caul type is a piece of the thin, translucent inner lining of the amnion which breaks away and forms tightly against the head during the birthing process. The lesser common (unknown) type of caul tissue is adhered to the face and head by attachment points and is looped behind the ears, making the removal process more complex. In extremely rare cases, the thicker caul encases the infant’s entire body, resembling a cocoon. The rarest caul type is a thick, soft membrane of unknown tissue type, which presumably forms against the infant’s head during gestation.

In medieval times the appearance of a caul on a newborn baby was seen as a sign of good luck. It was considered an omen that the child was destined for greatness. Some Early Modern European traditions linked caul birth to the ability to defend fertility and the harvest against the forces of evil, particularly witches and sorcerers. Cauls were therefore highly prized by sailors. Medieval women often sold these cauls to sailors for large sums of money; a caul was regarded as a valuable talisman. In Romanian folklore, babies born with a caul are said to become vampires upon death.

[doctordconline-blog]

Let’s remember this … And share this with friends, tag them..

#xray #radiology #radiologist #sunday #neck #anatomy #physiology #usmle #university #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #premed #nurse #nursing #hospital #patient #diagnosis #medicine #medlife #plab #amc #medstudent @doctordconline

[medicine-and-coffee-deactivated]

Pretty much me everyday

[generalistherbalist]

Currently cycling through this on a multiple times per day basis.

[studyspire]

tips on choosing your study spot for the day

[emt-monster]

Compartment syndrome (or “muscular claustrophobia”) is a swelling of the tissue inside a compartment, resulting in compromised circulation. Treatment is to relieve pressure, in this case by fasciotomy.

Source: lifeinthefastlane