Rhomboids

Physician Assitant preparing for PANCE

[drdessertfox]

hey, do you know if someone can change their specialty years after working it? like, i really want to be an ER doc or a surgeon but i feel like those jobs won't be as "easy" when you're like 50... (high stress, having to be in surgery for hours at a time, etc.) so would it be possible to switch to something more fitting once you get older? or do you have to quit if you don't want your specialty anymore?

If you end up wanting to leave your specialty or change how much of a toll it takes on your life, there are a variety of options. If you went into ER, you can always go into the calmer setting of Urgent Care. Not everyone wants to work in a Level 1 trauma center. There’s also the option of going back and doing a residency or fellowship in something else. Lastly there is always the option of going into education. You definitely don’t have to quit being a doctor if you’re not in love with your specialty anymore. 

[cranquis]

COME TO URGENT CARE

[wayfaringmd]

Or you could be a PA instead. They have the freedom to switch specialties a lot easier than Doctors do.

[drdessertfox]

Reblogging @wayfaringmd’s advice because I completely forgot about the option of becoming a PA when answering this question

[simplysupergirl]

Preceptor asking if I wanna do [insert procedure here]

[nv245]

Secondary Amenorrhea workup

1. Pregnancy test

2. Review Medications (dopamine antagonists cause increase prolactin which cause amenorrhea)

3. TSH: increase = hypothyroidism

4. Prolactin: increase = prolactinoma (think pituitary adenoma and order MRI)

5. Progesterone challenge test for 10 days (if bleeding induced = anovulation; no bleeding? do #6)

6. Progesterone and Estrogen challenge test (bleeding induced = measure FSH and LH; No bleeding = Asherman Syndrome)

*Asherman syndrome: outflow problem, fibrosis, after D&C

7. Other causes: female athlete (anorexia, osteoporosis), stress, hyperandrogenism (chect testosterone/DHEAS), Sheehan Syndrome (pituitary necrosis, post partum bleed, could not breast feed, no menses 6-12 months post partum, do MRI), increase exercise. 

[cwote]

believe in yourself and everything you can accomplish.

[populationpensive]

Listed here are verified interview questions that PAblrs received during their application cycle. If you are a PA-S or PA-C and would like to add to this, feel free. Please avoid duplication. What is the difference between a PA, a MD, and a NP? What is a PA’s role on a care team? Imagine you h...

ATTN PAblr: after having 2 PAblr chats on Slack, it seems pretty clear that pre-PAs are looking for what interviews questions are ACTUALLY asked.

I’ve created a google doc in a new “PA Apps/Interviews folder” for interview questions. No sign in is necessary. As long as you have the link, you can edit.

Please try to avoid the “typical” questions. We all know the “what’s your greatest strength, weakness” get asked. We’re looking for specific things that don’t always show up in the interview books. Sometimes schools ask WEIRD stuff.

If you’ve got anything to add, help a PAblr out and add it to the sheet.

[slinted]

I am STRONG. I am SMART. I am HARDWORKING. I am CAPABLE. I am WORTHY. I will SUCCEED.

[brooklynpa-c]

SCRUBBING IN WITH A SURGEON WHO’S 6′11″

[fuckyeah-tonedandfit-deactivate]

[thewellnessresolution-deactivat]

This made me chuckle.

[medicowesome]

COPD: Tips for step 2 CK and rounds

Hello! I have a pulmonary rotation going on and I thought I’d shed light on management of COPD :D During rotations, you may be asked what you want to do for the patient. I have written “Plan” for what you might want to answer to impress your attending. I’ve included a few common brand names too :) Inhalers: Remember inhalers only improve symptoms and have no mortality benefit and do not affect the progression of the disease. For all patients with COPD: A short-acting bronchodilator (eg, beta-agonist, anticholinergic agent) is prescribed for use as-needed for relief of intermittent increases in dyspnea. Plan: Albuterol PRN COPDers in whom intermittent short-acting bronchodilators are insufficient to control symptoms or two or more exacerbations in the previous year: Add a regularly scheduled long-acting inhaled bronchodilator. The long-acting inhaled anticholinergic (muscarinic) agent (LAMA) is preferred to the twice daily long-acting beta agonists (LABAs). Plan: Albuterol PRN Tiotropium OD (Spiriva) Important for step 2 CK: Inhaled anti-cholinergics are the most effective in COPD. (Contrary to asthma, where you start Inhaled steroids if symptoms aren’t controlled by short acting bronchodilator like albuterol alone.) Mnemonic: antiCholinergics are the Coolest in COPD. For patients who continue to have respiratory symptoms or exercise limitations when using long-acting inhaled bronchodilator monotherapy, add a second long-acting bronchodilator from another class (LAMA or LABA), rather than adding an inhaled glucocorticoid. For patients who continue to have symptoms or have repeated exacerbations despite an optimal long-acting inhaled bronchodilator regimen, add an inhaled glucocorticoid (ICS). An inhaled glucocorticoid may be warranted earlier (ie, at the same time that the long-acting inhaled bronchodilator is initiated) if there are signs of inflammation or an asthmatic component to the COPD. Personally, I have seen them prescribed together in clinical practice rather than one after the other. Plan: Albuterol PRN Tiotropium OD Fluticasone / Salmeterol BD (Adavir) Or Budesonide / Formoterol BD (Symbicort) Stuff that has a  mortality benefit: Oxygen therapy Smoking cessation Vaccination (Influenza, pneumococcal) Clinical pearl: Always ask your COPD patient when was their last flu shot. If your attending asks, you’ll know it like a boss B) When do you start O2? Start O2 when pO2 < 55, sat < 88% (Silly question that I asked and answered myself: Why don’t we start O2 right away if it’s so awesomee? Because carrying an O2 cylinder around isn’t always feasible lol.) Other things to shine on rounds: Know that COPD is a systemic disease, not just a lung disease - Depression, osteoporosis, weight loss, etc are also a part of the disease. Read about BODE index. Know about the anti-inflammatory effects of macrolides in COPD exacerbations. That’s all! We rise by lifting others :) -IkaN

[deeplifequotes]

Never forget the people who take time out of their day to check up on you.

(via deeplifequotes)

[mynotes4usmle]

ANTIBIOTICS CHEAT SHEET :)

Also, REMEMBER!!!!

* Sulfonamides compete for albumin with:

Bilirrubin: given in 2°,3°T, high risk or indirect hyperBb and kernicterus in premies

Warfarin: increases toxicity: bleeding

* Beta-lactamase (penicinillase) Suceptible:

Natural Penicillins (G, V, F, K)

Aminopenicillins (Amoxicillin, Ampicillin)

Antipseudomonal Penicillins (Ticarcillin, Piperacillin)

* Beta-lactamase (penicinillase) Resistant:

Oxacillin, Nafcillin, Dicloxacillin

3°G, 4°G Cephalosporins

Carbapenems 

Monobactams

Beta-lactamase inhibitors

* Penicillins enhanced with:

Clavulanic acid & Sulbactam (both are suicide inhibitors, they inhibit beta-lactamase)

Aminoglycosides (against enterococcus and psedomonas)

* Aminoglycosides enhanced with Aztreonam

* Penicillins: renal clearance EXCEPT Oxacillin & Nafcillin (bile)

* Cephalosporines: renal clearance EXCEPT Cefoperazone & Cefrtriaxone (bile)

* Both inhibited by Probenecid during tubular secretion.

* 2°G Cephalosporines: none cross BBB except Cefuroxime

* 3°G Cephalosporines: all cross BBB except Cefoperazone bc is highly highly lipid soluble, so is protein bound in plasma, therefore it doesn’t cross BBB.

* Cephalosporines are "LAME“ bc they  do not cover this organisms 

L  isteria monocytogenes

A  typicals (Mycoplasma, Chlamydia)

M RSA (except Ceftaroline, 5°G)

E  nterococci

* Disulfiram-like effect: Cefotetan & Cefoperazone (mnemonic)

* Cefoperanzone: all the exceptions!!!

All 3°G cephalosporins cross the BBB except Cefoperazone.

All cephalosporins are renal cleared, except Cefoperazone.

Disulfiram-like effect

* Against Pseudomonas:

3°G Cef taz idime (taz taz taz taz)

4°G Cefepime, Cefpirome (not available in the USA)

Antipseudomonal penicillins

Aminoglycosides (synergy with beta-lactams)

Aztreonam (pseudomonal sepsis)

* Covers MRSA: Ceftaroline (rhymes w/ Caroline, Caroline the 5°G Ceph), Vancomycin, Daptomycin, Linezolid, Tigecycline.

* Covers VRSA: Linezolid, Dalfopristin/Quinupristin

* Aminoglycosides: decrease release of ACh in synapse and act as a Neuromuscular blocker, this is why it enhances effects of muscle relaxants.

* DEMECLOCYCLINE: tetracycline that’s not used as an AB, it is used as tx of SIADH to cause Nephrogenic Diabetes Insipidus (inhibits the V2 receptor in collecting ducts)

* Phototoxicity: Q ue S T  ion?

Q uinolones

Sulfonamides

T etracyclines

* p450 inhibitors: Cloramphenicol, Macrolides (except Azithromycin), Sulfonamides

* Macrolides SE: Motilin stimulation, QT prolongation, reversible deafness, eosinophilia, cholestatic hepatitis

* Bactericidal: beta-lactams (penicillins, cephalosporins, monobactams, carbapenems), aminoglycosides, fluorquinolones, metronidazole.

* Baceriostatic: tetracyclins, streptogramins, chloramphenicol, lincosamides, oxazolidonones, macrolides, sulfonamides, DHFR inhibitors.

* Pseudomembranous colitis: Ampicillin, Amoxicillin, Clindamycin, Lincomycin.

* QT prolongation: macrolides, sometimes fluoroquinolones

[mynotes4usmle]

Reblogging for the 100th time!!!! (sorry)

I’ve made some corrections and added ABs that didn’t include before!!! Here’s the link if you want to download the corrected chart:  [Antibiotics doc]

Also, I’m gonna add a couple of things that didn’t mention before:

* MRSA: Ceftaroline, Telavancin, Dalbavancin, Oritavancin, Vancomycin, Linezolid, Tidezolid, Daptomycin, Tigecyclin.

* Skin MRSA: TMP/SMX, Clindamycin, Doxycycline, Linezolid

* FQ: Gemi, Levo, Ciprofloxacin cover Pseudomona but do NOT cover anaerobes. Moxifloxacin covers anaerobes but do NOT cover Pseudomona.

* Ertapenem DOES NOT cover Pseudomona

* mAcrolides DO NOT cover stAph.

* ciPRofloxacin DOES NOT cover stReP

* Cefoxitin, Cefotetan: the only 2°G cephalosporins that cover anaerobes. Also deplete prothombin, so there’s increase risk of bleeding. 

* VRE: Tigecycline, Linezolid, Quinupristin/Dalfopristin, Daptomycin

* ESBL: (BLEE en español)  carbapenems, beta lactam+beta lactamase inhibitors

Dear @md-admissions (I’m mentioning you, since you and I share a passion for ID) & Medblr fam: Are there any corrections and/or additions that you would like to mention? Thanks :) 

[populationpensive]

PAblr: the Physician Assistant hashtag

Are you a pre-PA, pa-s, pa-c, or someone who is interested in learning more about the profession? I highly recommend that you check out our Masterlist of pablrs on Tumblr! We officially organized in March 2014 and have grown a nice little community! We branch off from medblr simply so it is easier for ya’ll to find PA people. If you need convincing, here are some reasons why we are awesome:

1. Community Support! If you’re down, we’re around!

2. We feature a community member each month! PAblr of the Month allows community members to select people to feature! This is a great way to make friends and learn about personal stories that lead people to choose PA.

3. K N O W L E D G E ! Our peeps have great resources that they share and advice that they give. I’ve learned so much from the PAblr peeps.

So, check us out, reblog this, and see what our profession is all about!

[anatomyandphysiology101-deactiv]

If you’re in the health science field and haven’t already, eventually you will have to know how to give injections. This is a very common practice and there are plenty of people that cant stand the thought of needles especially inserting it into a person. Its very important you get it right or else it could lead to damages. Here are some tips on inserting needles the right way.

www.learninghumananatomy.com

[rhomboids]

[tobeagenius]

We have a lot to owe to neurotransmitters, they are the driving force behind every chemical process that occurs in your body. This infographic shows the most common, and the roles they have.

[neuronursejess-deactivated20171]

Differnt type of hematomas and hemorrhages