Staying Medically Inspired

Current MS3. This blog used to have a lot of resources from when I was going through pre-med and applying to school (if you scroll back far enough, maybe you'll find some of it!). Nowadays, I'm using this as my sounding board as I adventure through medical school! Hearing from other medblrs around the world keeps me focused and inspired to keep on keepin' on. 

[chocolatesofamedstudent]

medblr HELP! I am about to plan my Step 1!

I have been out of touch with tumblr and all the current med students out here, and I really really need help from all of you!

ESPECIALLY those in 3rd year of med school or those who just recently gave their Step 1.

I made a schedule for myself last year but that is useless now, and I plan to make one for myself to sit the exam in exactly 6 months. Here, I need tons of help.

Any advice, suggestions, something to avoid, something to absolutely not skip, any tips and help on: planning for, studying for, scheduling my Step 1 exam. It would be VERY much appreciated!

[chocolatesofamedstudent]

Addition: I am about to buy by new First Aid (I currently use an old one), and I will subscribe to UWorld 3 months out from my exam.

I am depending highly on Pathoma and Sketchy videos, but if you have suggestions for any other resource I would love to hear it!

[stayingmedicallyinspired]

Hey! Third year here who took Step 1 a few months ago. Feel free to message with any specific questions but here's what I can come up with right now:

Resources I used were: First aid, Pathoma, UWorld, SketchyMicro and the occasional Boards and Beyond video available on YouTube. My main study method was using Anki, a really great flash card program (you've probably heard of it or used it before!). I think it worked well for me! If you have any questions about Anki let me know. It's best used earlier rather than just during dedicated study time, but 6 months is still a long time away. There's a lot of info to know, and Anki just helps you remember things you learn now so you don't have to study them in depth when it gets closer to your exam. It does require doing flash cards every day though. In the end, I'm a huge believer in the spaced repetition method that Anki uses.

My one other piece of advice would be when you use UWorld, most of the learning happens by reading the explanations for the right AND the wrong answers. It's a great resource! You could spend a lot of your study time just reviewing your UWorld question sets. I didn't start using it until my 6 week dedicated period began. I probably spent a good 3-4 hours a day on it. Personally, I think going through it once is just fine. I actually didn't finish UWorld (I feel like it's a crime to say that!). I would say it's more important that you spend time really understanding the material after you do each question set rather than setting a goal to get through it twice, but in the end do whatever works for you!

Also, I found these Step 1 guides on Reddit very useful to get an idea of how to make a study schedule: https://www.reddit.com/r/step1/wiki/

[stayingmedicallyinspired]

Third Year

Haven't really posted anything personal since first year of med school, but I'm thinking of starting to blog about some interesting cases and experiences during third year! 

I just finished my first rotation (a rural primary care rotation) and have the following rotations to go: 

Psychiatry 

Transplant surgery 

Medicine subspecialty (undecided what yet, get to do 2 weeks each in 3 different areas) 

Internal Med 

Colorectal surgery 

Neuro 

Peds 

OB/GYN 

Family Med 

Hope to post soon about a specific experience I had in psych with a resident advising me to avoid being self-sacrificing in life, advice I wasn't expecting to hear.

[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.

[aspiringdoctors-blog]

Flawless

[thedisagreeabledoctor]

It’s not your ulcer

“I am not a diabetic. Look, this morning my blood sugar was 193 and I hadn’t even eaten anything. That’s not diabetes.”

“Ma’am, that 100% is diabetes.” This conversation quickly became a stalemate between ignorance and my inability to explain her diagnosis in a way she would accept. In fact, every conversation I had with her went this way. She was perhaps the most obstinate and oblivious patient I had ever met. And she was my patient. 

She had come in with the worst foot ulcer I have ever seen. It tracked all the way down to the bone, meaning an amputation was likely in her future. According to her, the ulcer had started a couple days before and she had never had an ulcer before in her life. I used my years of medical training to quickly deduce that a) there was no way that ulcer happened in a few days and b) she most definitely had two very bad looking ulcers on the other foot. When I pointed that out she became upset, telling me they were just split calluses, not ulceration. Every attempt to diagnose and explain the diagnosis was refuted by her “intimate knowledge of her own body.” 

The next several days were some of my most frustrating. I was called to her room for numerous reasons, including refusing insulin (because she wasn’t diabetic), refusing dressing changes (because she was allergic to the dressing), complaining that the hospital food was inedible and rotted, and yelling at nurses about their inadequate care. Each time I walked to the room and took my verbal lashings. I listened. I empathized. I did everything I could to put myself in her place and see the fear she likely felt about losing her foot. 

None of that was enough.

I am not sure if I have ever truly hated a patient. But with her, I came close. Despite my ill-feelings I spent hours coordinating her care between multiple surgical specialties, all of which wanted to pass on taking a non-compliant diabetic, vasculopath to the OR. Podiatry, vascular, and orthopedics all subtly yelled, “not it.” 

Several days into her hospital stay I expressed my frustration to my attending. “They are not your ulcers,” he replied. I looked back, confused, as he continued. “They are not your ulcers. If you care for every patient’s problem as if it were your own, it will destroy you. She got herself into this and she has to bear some responsibility for getting herself out. If she refuses to take our recommendations as to her care, there is nothing we can do. There are times you have to step back and separate yourself from the patient.”  

I have thought about his words a lot since then. In some ways if feels antithetical to my nature to see medicine as a job. But I have also experienced the severe mental fatigue and frustration that comes with trying to help a patient unwilling to help themselves. At the end of the day, how far should we go? How much time should I spend on one uncooperative patient knowing it takes time away from other patients who also need my services? In the end I did step back from the case and allow myself to see my care for her as something closer to a job. I switched off service a few days later and the last I knew she was getting an amputation, though she spent time fighting with surgeons about where they could cut.     

At some point we have to protect ourselves as physicians, despite how mentally strong we believe ourselves to be. This year has taught me a lot of medicine, but it has also challenged me mentally. I am still searching for the coping skills necessary to survive life as a resident and eventually as an independent doctor. Despite the frustration this patient provided, she did allow me some excellent learning in this area. In the end, I have to appreciate her for that.  

[cranquis]

Medblr Post. Of. The. Year.

1. It’s ok to care about everyone – as long as you include yourself.

2. Look for the positive in even your most difficult patients.

[onlinecounsellingcollege]

You have to let go of what could have been, how you should have acted and what you wish you would have said differently. You have to accept that you can’t change the past experiences, opinions of others at that moment in time or outcomes from their choices or yours. When you finally recognize that truth then you will understand the true meaning of forgiveness of yourself and others. From this point you will finally be free.

Shannon L. Alder (via onlinecounsellingcollege)

Will keep reminding myself of this through third year!

[intrainingdoc]

Transitioning to the Clinical Years: Be A Duck

“Be a duck,” became my mantra throughout medical school, so much so that my mother had it printed onto a canvas and has it hanging on a wall at home in my honor. As a medical student you might think I would be more interested in having the prowess of a lioness, the elegance of an eagle, the speed of a cheetah or the energy of a dolphin. A duck, as most envision it, does not have much appeal; except, however, when swimming. The quote that led me to emulate the duck is Michael Caine’s, “Be a duck, remain calm on the surface and paddle like the dickens underneath.”

“Your short white coat is a symbol for everyone to know that you are a novice and that you are working hard to stay vertical some days, never mind become the brightest clinician you can be. Be like a duck, but don’t frazzle your feathers”

Vivienne Meljen at The Geisel School of Medicine at Dartmouth says to, “Be a duck, remain calm on the surface and paddle like the dickens underneath.”

[stayingmedicallyinspired]

Getting ready for third year!

[wayfaringmd]

Any advice for an m3 starting family medicine clerkship?

Here’s a brief little post I wrote about what to read and what to study for the shelf. 

But wait, there’s more!

Family medicine is a hard rotation, especially to have at the beginning of the year, because it covers SO much material.

Hi Yield stuff to know: 

Type 2 Diabetes management

JNC 8 hypertension guidelines 

recommendations for statins

basics of treating anxiety and depression

preventive care guidelines for adults and children

recommended immunizations

pediatric developmental milestones

newborn physical exam

basic rashes, skin disorders, and viral exanthems

asthma and COPD management

chest pain and stroke management

Think systematically. Use mnemonics to help you expand your differential diagnosis. Keep patient demographics and co-morbid conditions in mind as you make your differential.

Even if you have no interest in family medicine, you will learn something relevant to your specialty of choice on your family med rotation. Depending on your attendings, you may be able to tailor your rotation a bit toward what you are interested in (more kids! Pregnant ladies! women’s health! sports medicine for you ortho folks! office procedures for the surgeonly types! more psych for you little Freuds!).

Embrace the variety. Don’t let it overwhelm you. You will see something new every day. Write it down and read about it when you go home. Write down the medications or diagnoses that are unfamiliar to you and read on them too.

The AAFP is your friend. They have tips for doing well on your rotation too. You can make a student account and access lots of practice questions for your shelf exam. Use the online board exam prep questions.

If you have the opportunity to do your family medicine rotation in a community or rural practice rather than an academic medical center, take it. Family medicine was designed to be a community based practice, not academic, so you will find the specialty looks very different in those two settings.

[telep0rt]

I definitely second the last point on here! If you can do rural or community based FM, DO IT! 

I did a rural, community based practice for my FM and got to see a really diverse patient population with really incredible medical problems. It was much more interesting, and I think representative of FM, than people I know who stayed to do the academic center FM. 

[stayingmedicallyinspired]

Reblogging so I can remember to review this before starting my rural medicine rotation in a month!

[wayfaringmd]

Hi Wayfaring! My sister is graduating from med school on Friday. She matched into a great family medicine residency. I'm super proud. Any thoughts on what would be a good semi-useful graduation gift for the starting intern?

Ooh I like this question! I’m a pretty practical person so most of my suggestions will be practical things, but things people appreciate nonetheless. I’m purposefully not putting any medical stuff here. Her life will be full of medicine. Get her something else. Her residency program will give her an allowance for books and coats and such, so don’t waste your $$ on those. 

K, here goes:

Subscription or intro month to one of those services like Blue Apron or Hello Fresh that sends you all the stuff to make a fancy meal once a month or something. Residents don’t cook right most of the time. 

Massaaaaaahhhhge. Or Acupuncture. Whatever your flavor is. She will need a session to relax those tense muscles at some point in her intern year.

Car wash coupons. Sounds lame, I know, but a friend gave them to me for Christmas one year and it was awesome because I NEVER paid to get my car washed before. A clean car makes you feel better about your life. 

Get her car serviced. Oil change, new fluids, belts, whatever. She ain’t gone have time for it once she gets started in residency.

Starbucks gift card. Because @cranquis and I are the only doctors in America who don’t drink coffee. 

Coloring books. For real tho. They’re so relaxing. She’s going to need something to do during those times she’s stressed out and doesn’t want to use her brain.

Birchbox subscription. Bacon of the month (I got that once for like 6 months and it was AMAZEBALLS). Doggy treats of the month. Wine of the month. Dollar shave club. Something of the month. It’s nice to get a fun package every month. And she will forget about it every month and be surprised every time she gets one. 

Pay for a maid to come clean her apartment/house at some point in residency. Probably in January of intern year. January is the worst. 

Houseplants. Everyone needs something alive in their house to brighten it up. Succulents, african violets, and kitchen herbs are easy to grow in a windowsill, easy to keep alive, and are usually pet-friendly too.

A trash magazine subscription. She’s going to have to read a bunch of boring crap. Help her stay up to date on the things that really matter like who Taylor Swift’s current boyfriend is.

A really good quality pillow and a face mask or blackout curtains. Night shifts are the worst. Help her sleep better. 

Aromatherapy. Candles, spray, whatever. In calming scents. One of my friends used to spray her call room to help her de-stress on 30 hour shifts. It sounds weird, but if it makes it smell or seem a little more like home, it helps it suck a little less. 

Hope these ideas help! Medblrs, do y’all have any suggestions to add?

[uptomyeyeballs]

Yeah gonna save this and send out to family and friends when I graduate. Though I already have hellofresh and a massage membership. Highly recommend 👌🏼

[aspiringdoctors-blog]

*casually reblogs in hopes irl friends and family see*

[medicalstate]

As the popularity of smartphone of tablet computing expands, so too does the library of apps. The following is a list of iOS apps that might be of interest or use for the curious, for the learners, and for the clerks.

Laboratory

LabDx: A reference tool for common laboratory investigations.

Acid Plus: A calculator tool that helps tease out the type of acidotic or alkalotic process involved.

Lytes: A basic reference to the common electrolyte abnormalities, the causes, signs, and symptoms.

Calculators

BiliTool: An online tool that has an optimized mobile format, this tool helps calculate bilirubin levels in neonates and gives recommendations based on the risk stratification of jaundice.

Qx Calculate: A free calculator for many of the formulas and algorithms in medicine including risk calculators and unit conversions.

MedCalc Pro: A premium calculator that has a more streamlined design and more formulas than Qx Calculate. It also allows you to save patient values for use in multiple calculations.

Pharmaceutical

Lexicomp: The standard for monograph information, this subscription-based app includes routine updates to the drug database for newly added medications and warnings. It includes a drug interactions calculator.

Epocrates: For the free alternative, Epocrates continues to be a favorite among my classmates and attendings. It includes the standard dosing and regimens for medications but offers less detailed information regarding them compared to Lexicomp.

Micromedex: Another decent alternative that is updated regularly with the most recent warnings and medications. There is a basic free form with premium add-ons including the drug interactions tool.

Anatomy

Netter’s Anatomy Atlas: Netter is a household name in the world of medical illustrations and all of his anatomical plates have been compiled in this app. A good quick reference of study tool.

Pocket Anatomy/Essential Anatomy: Moving into the third dimension, these two apps despite a premium price, a useful study tool for anyone interested in medicine.

Muscle System Pro III: For the anatomical enthusiast wishing to see muscles in all their detail and intricacies. Premium.

Skeleton System Pro III: For the anatomical enthusiast wishing to see bones in all their detail and intricacies. Premium.

Brain and Nervous System Pro III: For the anatomical enthusiast wishing to see nerves in all their detail and intricacies. Premium.

Radiology

Radiology 2.0: One Night in the ED: A case-based radiological app that goes through the common presentations with a methodical approach.

Clinical

Medscape: A basic app that includes drug interaction calculator, a procedures reference and daily news in the world of medicine.

Skyscape: A free app that includes a number of resources to help with clinical decision making. Designed to be a one-stop shop, you can purchase and subscribe to more features and resources within depending on your needs.

Eponyms: For the medical student, half the battle is learning the language of medicine. Eponyms explains the common and obscure terms and signs of medicine named after their discoverers. 

Bugs and Drugs: A reference tool for antimicrobial therapy, the dosing guidelines and the sensitivity tables of all antibiotics.

PEPID: A clinical companion tool that provides summary information around conditions, include a brief explanation of the condition, the investigations, differential, and the treatment plan. Written in a concise form for the learner on the go.

UpToDate: The clinical companion tool that is a favourite among the attendings. This subscription-based app comes in both an online or offline version and mirrors the desktop counterpart. Including in-depth review of disease states and clinical pearls surrounding therapy.

DxSaurus: A differential diagnosis generator that works around your working diagnosis or the symptoms you see.

Reference

The Merck Manual: Professional Edition: A digital, pocket version of the original reference. Disease states can be searched by section or by symptom.

Toronto Notes 2012: While not exactly an app, this textbook is an excellent reference for any medical student and is one that I read during quiet moments on shift. A digital copy of this textbook stays with me in my eBooks library.

Principles and Practice of Hospital Medicine: This is also not an app but an eBook. An excellent reference for internal medicine, it offers great deal of information and clinical pearls for the hospitalist. 

Tools

Google Translate: For the moments where language is a barrier, this could be the only useful way to gather patient information.

Flashlight: For the times on call where we do not want to disturb other patients in a dark room as we make our way around.

Evernote: A note-taking tool to keep and sort out clinical pearls or to document clinical moments.

Drive/Dropbox: A cloud-based service like Drive or Dropbox offers an opportunity to store algorithms, guidelines, or textbooks that you can access anywhere. Now available on your phone or tablet.

Review

USMLE World QBank: For the medical student preparing for exams, the QBank is an important resource to have.

This list is by no means exhaustive but is a good starting point for readers out there interested in finding medical apps. What apps do you use?

[pagingmedicine]

AWESOME COMPILATION OF APPS. My only addition is the SANFORD Guide app. It’s pricy, but so handy as a medicine resident. Plus I love ID, so I am probably a bit more curious about antibiotics and stuff like that.

[stayingmedicallyinspired]

Advice on Family Med Preceptorship

Hey all,

I’ll be spending the next week with a family med doc for my required preceptorship. Our school wants us MS1s to do stuff like H&Ps and vitals a certain number of times, and write up SOAP notes. I’m actually super excited since I’m very interested in family med!

Anyone have any advice on how to prepare or helpful tips for when I head into the office tomorrow?

[tungsten-heart]

I think just having the courage to suggest a plan as an MS1 shows great initiative. Some students stop at the assessment and plan during the patient presentation because they think their A/P is wrong or not good enough.

Have fun! The primary care preceptorship was my favorite part of the pre-clinical years of med school.

[stayingmedicallyinspired]

I really appreciate that advice! My preceptor has been really big on not saying “I don’t know” and just coming up with some sort of A/P. I struggle quite a bit especially not being too familiar with pharm.

It makes me a little nervous, but it’s the first time anyone’s really forced me to think about how I’d actually take care of the patient and not just the disease process/pathophys.

I’m thankful he said really has no expectations for me other than not saying “I’m not sure”, especially seeing the way the MS4 is being constantly challenged by this tough doc!

[psychokangaroo]

I’m in a Family Med preceptorship right now as an M1! Everyone there is going to assume that you don’t know things, so don’t be afraid to ask questions - at the appropriate time of course. One of the coolest things about Family Med is that you see EVERYTHING, so if someone has something cool, ask to follow in, as long as your preceptor is okay with it. Also, no matter how many times you practice, you’re not going to be prepared for the first time you talk to a patient. It’s going to be awkward. Awkward things are going to happen. That’s okay. It’s expected because you need experience to find your footing. 

Best of all, the PATIENTS. They are just so wonderful and kind and understanding. And they probably know about the whole med student thing, and they tend to be really chill, and they are often fairly open to show you things and be a part of your education. 

One of the things I like to do (when i have the opportunity/time) is to thank the patients for being part of my education. For one, it’s completely genuine because it’s patients that teach me how to do the clinical thing. Also, some of them really like hearing that and they feel good about it. So if you can, that’s something nice to say. 

[stayingmedicallyinspired]

I agree, the patients have been the best part of this whole experience! He's basically been handing me charts and throwing me into patients rooms alone with no background on their PMH, I'll come and present, and then we go in together. I think I'm getting better at handling the awkwardness of it, and I'm hoping I get better at asking the right questions as the week (and life) goes on.

I'm definitely gonna start saying thank you to my patients! That's great advice.

[stayingmedicallyinspired]

Advice on Family Med Preceptorship

Hey all,

I’ll be spending the next week with a family med doc for my required preceptorship. Our school wants us MS1s to do stuff like H&Ps and vitals a certain number of times, and write up SOAP notes. I’m actually super excited since I’m very interested in family med!

Anyone have any advice on how to prepare or helpful tips for when I head into the office tomorrow?

[tungsten-heart]

I think just having the courage to suggest a plan as an MS1 shows great initiative. Some students stop at the assessment and plan during the patient presentation because they think their A/P is wrong or not good enough.

Have fun! The primary care preceptorship was my favorite part of the pre-clinical years of med school.

[stayingmedicallyinspired]

I really appreciate that advice! My preceptor has been really big on not saying "I don't know" and just coming up with some sort of A/P. I struggle quite a bit especially not being too familiar with pharm.

It makes me a little nervous, but it's the first time anyone's really forced me to think about how I'd actually take care of the patient and not just the disease process/pathophys.

I'm thankful he said really has no expectations for me other than not saying "I'm not sure", especially seeing the way the MS4 is being constantly challenged by this tough doc!

[ashleymd7]

You may not become the best doctor in the world, or this country, this state or city. Hell, you may not even be the best doctor on your street, at your hospital or clinic, or the best doctor on a hospital floor or in a room at a given time. But when a patient comes to you, scared the headaches, the chest pains, whatever they’ve been having for months might be something worse, at that moment, YOU are their best chance for survival. You are that patient’s best hope, and proving yourself worthy of that responsibility is the only title you should ever care about winning.

A practicing physician for 40 years, and one who still hasn’t lost sight of what truly matters in this profession: the patients. (via ashleymd7)

[stayingmedicallyinspired]

Advice on Family Med Preceptorship

Hey all, I'll be spending the next week with a family med doc for my required preceptorship. Our school wants us MS1s to do stuff like H&Ps and vitals a certain number of times, and write up SOAP notes. I'm actually super excited since I'm very interested in family med! Anyone have any advice on how to prepare or helpful tips for when I head into the office tomorrow?

[stayingmedicallyinspired]

Gift for a friend studying for Step 1

Hey guys!

I’m looking to put together a little package for my big who is studying for boards for the next 5 weeks. Was thinking of including some fun snacks, chocolate, maybe pens….not sure what else? What would you want to help get you through boards?

[miss-sassmaster]

I have a few idea!

Nice Highlighters

Cute water bottle/travel mug 

A heat pack thing for a sore neck

Starbucks gift card (or anything they like, really)

Something that reminds them to stay positive (I have hand-written sticky notes from friends with positive messages taped to my laptop)

Ask if they want their First Aid spiral rebound if it’s falling apart

[stayingmedicallyinspired]

Ahh Starbucks gift card, how could I forget! We have a Starbucks right inside the hospital. Also maybe I'll have one positive message go along with each item in the basket :) Heat pack sounds amazing...considering getting an extra one for myself. All great ideas, thanks to you and @eclipperton for helping a girl out!

[stayingmedicallyinspired]

Gift for a friend studying for Step 1

Hey guys!

I’m looking to put together a little package for my big who is studying for boards for the next 5 weeks. Was thinking of including some fun snacks, chocolate, maybe pens….not sure what else? What would you want to help get you through boards?

[eclipperton]

Chocolate for sure. Maybe a google chrome extension that could block my classmates’ completely inane social media posts about their step 1 studying (If you figure out how to make that I’d pay $$$ for it). Maybe a poster of Leo’s Oscar winning suffering in The Revenant that says “at least you’re not in The Revenant” to help remind me that even though studying can be really hard and boring that at least I’m not getting mauled by a bear. Pens and a notebook couldn’t hurt either. You’ve got fine ideas–I’m sure your friend will be very appreciative!

[stayingmedicallyinspired]

Thanks for the advice! I could definitely use some moolah so maybe I should consider working on that extension. Added "Find Revenant Poster" to my to-do list for the week haha

[stayingmedicallyinspired]

Gift for a friend studying for Step 1

Hey guys! I'm looking to put together a little package for my big who is studying for boards for the next 5 weeks. Was thinking of including some fun snacks, chocolate, maybe pens....not sure what else? What would you want to help get you through boards?

[aspiringdoctors-blog]

Basics for the Wards: How to Read EKGs

I’m on cardiology right now, and yesterday the fellow taught us some basics for interpreting EKGs. The trick is the have a thorough algorithm and do it every time so you don’t miss anything.

Disclaimer: Obviously this is just a cursory intro so folks won’t look like complete fools like me- who, when asked to interpret an EKG, went into a cold sweat and said, “Well, it looks like the heart is beating.” Attendings do NOT like that.

INTRO

This is what a normal lead II EKG one beat reading should look like. TAKE NOTE LITERALLY EVERYONE STOP CALLING YOUR SQUIGGLY LINES HEARTBEATS IT IS WRONG GAAAHHHH.

Normal EKG.

What the various leads are monitoring.

1. Rhythm: Sinus or not- aka, is the SA node talking to the AV node correctly? Check in leads V1 and II- if there is a P wave before every QRS you have sinus rhythm. If this is not the case, you do not have sinus rhythm! A whole discussion on things messing up sinus rhythm will come when I have a better grip on it myself.

2. Rate: How fast is the heart beating- aka, how fast are the ventricles depolarizing? So EKGs are little tiny boxes in bigger boxes, right? There are several methods for calculating rate using the boxes, but the one that works for my brain is to count the big boxes between R’s and divide that by 300. So, 1 big box between R = 300/1 = 300 bpm. 2 big boxes between R= 300/2= 150 bpm. And so on.

In general, any heart rate above 100 is tachycardia, and any heart rate below 60 is bradycardia. These values may vary (ex: SIRS criteria counts heart rate above 90 as tachy). Normal heart rate is around 75 (exceptions include athletes- look up athletic heart syndrome)

3. QRS Complex: Wide or narrow- aka, is the Bundle of His bossing the ventricles around? Basically, a nice narrow QRS complex generally indicates the bundle of His is intact and operating how it is supposed to. A wide QRS complex indicates something is awry with the Bundle of His- could be an organic pathology, could be a medication side effect (ex: antiarrythmics, TCAs, quinidine, to name a few), could be an electrolyte imbalance (ex: hyperkalemia), could be other things.

4. Axis: Is the heart depolarizing the way it should- aka right shoulder to left nipple. I, personally, am still sorting out the axis system, and it’s hard to do in this format. The first, most basic place to start is checking if lead I and aVF are POSITIVE, meaning their QRS complexes go ABOVE the isoelectric line. If that is the case, you are probably ok axis-wise.

Essentially, lead I’s vector goes from left to right, and aVF’s vector goes from head to toe. So the average of those vectors is the general path of depolarization of the heart. You want the axis to be between -30 and +90.  So, if aVF is positive, but lead I is negative (the QRS is below the isoelectric line) that means it is going from left to right instead and would be classified as a right shift. Likewise, if lead I is positive, but aVF is negative, that means it is going down to up and would be classified as a left shift. There is soooo much more to axis interpretation, this is just a starting point.

5. Intervals: Again with the conduction system, it’s, like, totally important that it obeys all the rules every time. PR= <.2 seconds, or one big box QRS= <.12 seconds, or 3 small boxes QT= < ½ the RR interval

6. ST segment changes: checking for CAD- aka, is the myocardium getting enough blood/oxygen?  Since the folks in the South seem to consider butter a food group and know that if it can’t be fried it’s not worth eating, CAD is a huuuuuuuuge issue here. When blood supply to the myocardium is compromised, there will usually be characteristic EKG changes. Note- not every episode of angina/MI will have EKG changes though! - Inferior leads –> right coronary artery. - lateral leads –> circumflex artery - anteroseptal leads –> left anterior descending. Disclaimer: does not apply to everyone all the time, some folks have variant coronary anatomy.

So the EKG changes to look for must be seen in two contiguous leads, aka, two inferior leads or two lateral leads. - Ischemia (low oxygen) = ST depression or T wave inversion (EXCEPT T wave inversions are ok in leads V1 and aVR)

- Injury = ST elevation

- Old infarct/dead myocardium = pathologic Q waves. Basically that first negative vector (aka, the Q of the QRS complex) should never be bigger than one tiny box.

And, that, friends, is a basic algorithm for reading EKGs! There is a lot more, but if you follow these steps every time, you will look like a rock star on wards. Good luck!

[stayingmedicallyinspired]

This is the best! In cardio right now,and we're getting introduced to EKGs...I'm really struggling and summaries like this always help.