*Crickets

Ask me anything. I mostly live here - on my smorgasbord - @flyonthewallmedstudent.tumblr.com  

[nerdgirlnarrates]

Cardiology recommending torsemide 100 mg BID in someone with an AKI

[flyonthewallmedstudent]

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.

[nerdgirlnarrates]

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

[medtumbleweeds]

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

[meg2md]

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

[flyonthewallmedstudent]

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

[meg2md]

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

[medtumbleweeds]

That sounds amazing. Do it.

[medtumbleweeds]

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. 

[theverge]

FYI: Smartphones can detect eye cancer.

[flyonthewallmedstudent]

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)

[flyonthewallmedstudent]

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

Hey, 

Ah, tricky to answer on my end. 

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. 

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.  

Hope that somewhat helps and makes sense :SAnyone else have suggestions?

[medtumbleweeds]

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. 

[medicaletymologies]

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

[flyonthewallmedstudent]

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.

[medtumbleweeds]

Make sure you take a CXR. 

[flyonthewallmedstudent]

When on Orthopaedics, every resident reminds me of the Todd..

Well. in some ways more than others. that is. 

[flyonthewallmedstudent]

Final Year so..Panic

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.

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. 

[medtumbleweeds]

Little did I know..

[flyonthewallmedstudent]

The look I’ve seen on so many residents/attendings (consultants). 

But the gunners seem to miss reading between the lines every time. 

[elkasah-md]

Confused about reading and commenting on X-rays Relax and follow the steps

[flyonthewallmedstudent]

Perfect for orthopaedic rotations! Or emergency med Everybody needs a system to read these. Or at least show the medical team you do for extra brownie points.

[flyonthewallmedstudent]

The life undramatic.

Did marathon of Grey’s anatomy over the weekend on netflix. My other half was like, how can you watch that crap?  

Well, it’s something to do.  Then I was on surgery again today and it was like.. My gawd. Surgical rotation is boring.  To begin with, there was no one dying on the table. Didn’t see no CPR.

No crazed gun man roaming the halls. 

No freak storms with buses flipping over. 

No foreign bodies where they shouldn’t be

No dinosaurs outside the building. 

And everyone was so cordial to each other in halls and in surgery. Because no one’s secretly bumping uglies and breaking up when they’re not.

Wow. is real life boring.  the most dramatic it ever got today was when the junior resident forgot to order a few units of blood prior to one surgery and got icy death stare.

[flyonthewallmedstudent]

I love looking at pictures of stationary and study material. Mostly with creepy longing and envy. 

Because, the last time I legit made notes for myself in order to study material was high school. Or all of one week in undergrad, before I gave up (and descended to apps, other people’s notes, publications using other people’s notes etc.) 

My handwriting has also degenerated to chicken scratch/doctor’s writing. Someone even commented the other day on the wards that I’m ready to be a doctor now :’(  

I don’t even own physical books anymore. they’re all digital on my smart phone so I flick through them like a mad man on rounds or during clinics. more than two attendings/consultants I’ve rotated under made me download their fave med apps too (e.g. MedScape), to look things up for them ^^;;; clerking, literally means, clerking. 

[flyonthewallmedstudent]

Take every moment; you know that you own them. It’s all up to you, to do whatever you choose. Live like you’re dying and never stop trying. It’s all you can do, use what’s been given to you.

Lenka, Live like you’re dying (Grey’s anatomy music)

[flyonthewallmedstudent]

Wow. Just when I needed to feel more de-motivated by med school: Randomly found this while googling for something else: Think medical school is right for you?  (According to an admissions officer at a medical school) Think again D::: *cue dramatic music. 

Too late for me now!!!

Highlights (if you can call it that, I wanted to type it “de-highlights” or make a shorter version.. but realized if I shortened it, it would become = “de-lights”)

“Medical students are not like other students. They are used to being the best, to being treated as if they are gifted (of course, many of them are gifted.)The thing with medical students is that most of them have never experienced failure. Not big failure, anyway. Maybe they got mono during their freshman year. Maybe they failed a test once, in the second grade. Still, they play it safe. Having achieved perfection in high school, their goal is simply not to mess it up. For this reason, they do not cope well with uncertainty. They want concrete rules that will make success a simple matter of obedience and effort.

Perhaps instinctively, medical students know that once they leave the artificial world of grades and prizes, there is nothing to separate them from their academically-less-gifted peers. Once they graduate, their ‘merit’ will no longer be judged according to familiar metrics. Their 4.0 averages will mean very little in the real world. In fact, students with poorer grades might actually outperform them. They might be better networkers, better coffee-getters, better elevator-pitchers. More importantly, they might have the real-world experience that medical students spend a lifetime in school avoiding.

…But medical school is only a deferral. Eventually, the real world catches up.”

[theroyaltenenblarghs]

[lomadia]

House is the best. I lived for these random consults he did.

[flyonthewallmedstudent]

Oh gawd.  There’s nothing worse than seeing a child present with failure to thrive, which is considered neglect/starvation and can result in significant harm, even death, which is why it is negligence and would trigger child protective services. 

[letuscare-deactivated20200901]

hello my pretty.

[flyonthewallmedstudent]

AWESOME for ophthalmology electives/rotations. Probably a bit too much information.  really just need to know about the fovea, choroid, macula. (it’s a cross section of the layers of the back of the eye, with the retina and macula, like a CT allows cross sectional views of the body, the OCT does it for the eye just using light as a beam to create the image). Tells you a number of things like..retinal detachment, macular degeneration.

[medtumbleweeds]

It’s so weird to look back and think I actually knew that much about the eye in med school. 

[flyonthewallmedstudent]

[image from wikipedia] Studying anatomy in the pre-clinical years is like having a mocha latte without the mocha. For a lot of us, it’s like bland coffee without the sugar. Boring as hell. 

And yet some people still enjoy coffee without that sugary, tasty reward. Like students who majored in anatomy prior to med school. Or even got whole graduate degrees in the stuff. 

Also, coffee can be an acquired taste (I doubt many people liked coffee as kids). It grows on some people, for others, it never does. 

During the clinical years, the context starts to hit you, particularly during surgery, where it’s all about anatomy, every day. It’s as rewarding as chocolate in your morning coffee. Where all the information they threw at you before finally makes sense. has relevance. is interesting. But also absolute torture if you didn’t pay enough attention or care to it in your pre-clinical years. :x I’ve lost track of the number of times I’ve embarrassed the hell out of myself while getting pimped on rounds or worse,..while I’m assisting during surgery.