Wednesday, September 28, 2011

Tips from a friend in clinical rotations

me: cud u email me tips for starting internal medicine
i want to be smmmurt
D: lol
7:14 PM i just started internal medicine
me: how is it
D: its good
A.) Work Hard
if a patient says they were seen at another hospital for something related to their current hospitalization
call up the other hospital and get that info
7:15 PM me: nice
D: B.) follow up on info
if you know a patient is getting a culture or xray, call up xray etc and follow up
key is to be proactive
go after information
don't wait for it to come to you
7:16 PM me: werd
D: if you get assigned a patient
and they have something
look up papers on that
and maybe discuss it when talking about the patient the next day
it shows that you are interested and care
7:17 PM things like that stick out
read Step up to Medicine
know your antibiotics
just put forth a strong effort
7:18 PM me: k sweet
thx
too clutch bra
D: you mean brah
me: lulz
7:19 PM Dib: when you do things like thism the residents like you
cause you are doing stuff they don't have to do anymore and they can free up more time to teach you
it sounds silly, you are making their life easier and your better
7:20 PM me: makes sense
D: when you do stuff like that, they'll also enjoy teaching you more
and be less dickish to you
7:22 PM me: i like less dickish

Wednesday, July 27, 2011

some lists today

Drugs that can cause Leukopenia (<4000)/suppress the bone marrow
1. Chloremphenicol
2. Vinblastine
3. AZT
4. Benzene

Viral causes:
1. Parvovirus B19
2. Hep C
3. Hep E

7 Drugs that can cause Neutropenia and cause agranulocytosis*
1. Carbamazapine*
2. Colchicine
3. Clozapine*
4. Propylthiouracil
5. Methimazole
6. Dapsone
7. Ticlopidine*

The Herpes viruses
HHV1 oral
HHV2 genital
HHV3 varicella
HHV4 EBV
HHV5 CMV
HHV6 Roseola
HHV7 Pityriasis
HHV8 Kaposi

Saturday, May 28, 2011

Rinne and Weber tests

RINNE TEST: The Rinne test is performed by placing a vibrating tuning fork (512 or 256 Hz) initially on the mastoid process until sound is no longer heard, the fork is then immediately placed just outside the ear.

In a normal ear, air conduction (AC) is better than bone conduction (BC)
AC > BC, and this is called a positive Rinne.

In conductive hearing loss, bone conduction is better than air
BC > AC, a negative Rinne.

WEBER'S TEST: In the Weber test a tuning fork (either 256 or 512 Hz) is struck and the stem of the fork is placed on the top of the patient's skull - equal distance from the patient's ears, in the middle of the forehead - equal distance from the patient's ears or above the upper lip over the teeth. The patient is asked to report in which ear the sound is heard louder.
Weber without lateralization & Rinne both ears AC>BC = Normal hearing.


HOW TO USE THE TESTS:

Weber Lateralizes Left & Rinne both ears AC > BC = senorinerual loss Right ear

Weber Lateralizes Right & Rinne both ears AC > BC = sensorineural loss Left ear



Rinne Left BC>AC & Weber's lateralized to the left = conductive loss on the left

Rinne Right BC>AC & Weber's lateralized to the right = conductive loss on the right

Wednesday, March 23, 2011

tips for clinicals

squire's fundamentals of radiology robert a. novelline, md
buya self-learning EKG text book
the name of the game is to impress people in clinicals
Kochar's clinical medicine for students, it is the first step of reading for ur pt
ACP medicine volume 1 david c dale daniel d federman 3rd edition

read abt ur pt everyday
write it down in the little book and later look it up in the big book
read for understandning not for fact memorization
this is also how you will learn to do life long learning
how to get an inside track
use ur electives
choose a reasonable site
work very hard do way more than what is expected
goal: to get your attending to write a glowing assesment/recommendation
name recognition bwyour attaending and the program director is the key

avoid multiple attempts to pass usmle1
dont use illict drugs ever or stop
be very careful w alcohol a dwi can ruin your career
get along in ur clerkships be a team player you cant cover urpatient 24/7
if you have a disordered personality, hide it or switch professions now
show up, be ontime, be prepared

stop using digital social media
evenbe careful what u write in email
dont like to pts , to attending, or to collegeuas
dont write orders or write anything in the chart that you dont understand, dont be a scribe

Tuesday, March 22, 2011

IL-2, IL-3, IL-4

IL-2: Secreted by Th1 cells. Stimulates growth of helper and cytotoxic T cells. Immunosuppressant drugs inhibit production of IL-2 (cyclosporin, tacrolimus). Stimulate T cells.

IL-3: Secreted by activated T cells. Supports the growth and differentiation of bone marrow stem cells. Has fucntion similar to GM-CSF. Stimulates bone marrow.

IL-4: Secreted by Th2 cells. Promotes growth of B cells. Enhances class switching to IgE and IgG. Induces generic T-helper cell to become Th2 cell. IL-4 stimulates IgE and IgG production.

Corpus Callosum

Test your corpus callosum

I’ve just discovered a wonderfully simple finger touch procedure that can test the function of your corpus callosum, a key brain structure that connects the two cortical hemispheres.

It is called the ‘cross lateralization of fingertips test’ and was used in a 1991 study by Kazuo Satomi and colleagues.

It relies on the fact that different hemispheres are responsible for the movements and sensations from each hand.

In other words, each hand is connected to a different side of the brain, and, to allow you to co-ordinate both hands, the brain passes information between the two sides by using the corpus callosum.

The corpus callosum is the largest structure in the brain and works like a huge bundle of white matter ‘cables’, connecting different areas.

If this structure gets damaged, a patient might have trouble with coordinating their hands, preventing them from matching sensations on one hand with movement on the other, because the information doesn’t get to where it’s needed.

The test works like this: you need to ask someone to close their eyes and put their hands face up.

You then touch one of their fingertips with a pencil, and with the opposite hand the participant needs to touch the corresponding finger with thumb of the same hand.

For example, if you touched their right ring finger, they would need to touch their left ring finger with their left thumb, as shown in the diagram above.

You need to do this on both hands, with them always touching the corresponding finger on the opposite hand.

It’s important that the person keeps their eyes closed, because as soon as they look, they get information from the eyes, which goes to both hemispheres.

Patients who have damage to the corpus callosum (either because of acquired damage or because it just hasn’t developed) usually can’t do this test, because of the disruption in communication between the two hemispheres of the brain.

Of course, just to be sure its not a problem with movement or sensation in one hand only, the patient is also asked to do another quick test where they’re asked touch the exact finger you just touched.

For this part, the sensation and movement happen in the same hand, so information doesn’t need to cross the corpus callosum.

The test was shown to me by Dr Emma Barkus, who researches what neurological tests can tell us about psychosis and unusual experiences.

One Comment

Posted May 15, 2010 at 3:35 am | Permalink

The test you describe for the corpus callosum has been around since the 1970′s. It is called Tactile Localization. I have used it for 35 years as you describe it except that I make the student hold the hand behind him that I will touch so I can be sure he hasn’t seen it. I have never had it fail to pick out dyslexia. The beauty of it is that it doesn’t cost a thing and can be done by anybody. A person with poor reading, a good IQ and a few mistakes on TL is a guarantee of dyslexia.
And it is free! Dorothy van den Honert

Hyporeflexia

Hyporeflexia is the condition of below normal or absent reflexes. It can be tested for by using a reflex hammer. It is the opposite of hyperreflexia. Hyporeflexia is generally associated with a lower motor neuron deficit (at the alpha motor neurons from the spinal cord to muscle), whereas hyperreflexia is often attributed to upper motor neuron lesions (along the long motor tracts from the brain).