UCSF Students

March 9, 2010

Thoracic outlet syndrome for USMLE Step 1 USMLE Step 2 CK USMLE Step 2 CS and the ABSITE

Link: http://www.brianthemountainram.com/2010/03/09/thoracic-outlet-syndrome/

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March 8, 2010

Anatomy of the Small Intestine, Colon, and Rectum

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Anatomy of the Small Intestine, Colon, and Rectum

Dr. Goodman’s Lecture on the Anatomy of the Small Intestine, Colon, and Rectum pt. 1.mp4

Dr. Goodman’s Lecture on the Anatomy of the Small Intestine, Colon, and Rectum pt. 2.

Dr. Goodman’s Lecture on the Anatomy of the Small Intestine, Colon, and Rectum pt. 3.mp4

Dr. Goodman’s Lecture on the Anatomy of the Small Intestine, Colon, and Rectum pt. 4.mp4

Dr. Goodman’s Lecture on the Anatomy of the Small Intestine, Colon, and Rectum pt. 5.mp4

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March 5, 2010

Diverticulitis flashcards

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Term Definition
Diagnosis:  Diverticulitis (Lower Quadrant Pain)
Diverticulitis

Pathophysiology:


History

ID: incidence of diverticulitis increases with age

CC:

HPI: Patient with abdominal pain, usually in the LLQ.

Associated symptoms: nausea, vomiting; constipation or diarrhea


Physical Exam


WORKUP

Assessment:

The diagnosis of diverticulitis is usually a clinical diagnosis. p.6PN

Exam:

Stool exam

(heme-positive stool in 50% of cases (gross blood is rare.) p.6PN

Labs:

WBC

(is of little value; elevated in 31% to 69% of patients.) p. 6PN

Imaging:

Abdominal CT with oral contrast

(will reveal pericolonic inflammation/stranding and possible abscess formation or free air.) p. 6PN

Abdominal X-ray

(useful to check for free air if considering perforation) p. 6PN


source:

Pocket Notebook, p. 6

Gastrointestinal: Diverticulitis


Diagnosis

Common Pathogens Drug(s) of First Choice1 Alternative Drug(s)1 Comments
DIVERTICULITIS
No signs of bowel perforation.  If bowel perforation, see Peritonitis on Inpatient Antibiotic Guidelines EnterobacteriaceaeBacteroides fragilisEnterococci Amoxicillin/clavulanate 875mg/125mg PO BID Or Moxifloxacin5,6 400mg PO daily Duration of treatment should be until patient is afebrile for 3-5 days For PCN allergic patients3:Metronidazole 500mg po TID+[Ciprofloxacin5 500mg PO BIDor Levofloxacin5 500mg PO daily]  Duration of treatment should be until patient is afebrile for 3-5 days Surgical evaluation and follow up is advised.
References

source:

ucsf.edu/idmp

Diverticulitis: History Diverticulitis: History
- Age – occurs in 20% of patients >40 years of age with diverticulosis

- Classic triad of left lower quadrant pain, fever, and leukocytosis

- Pain is most common symptom, usually in left lower quadrant, but may be anywhere in lower abdomen due to the redundancy of the sigmoid colon (or right sided diverticulitis).
- The pain is typically dull and achy but may be crampy and associated with tenesmus.
- Fever, malaise, anorexia, nausea with/without emesis

- Change in bowel habits: diarrhea, constipation, alternating diarrhea and constipation, change in stool caliber, obstipation, tenesmus

- Urinary symptoms:  frequency, nocturia, and/or dysuria due to pericystic inflammation; pneumaturia (presenting symptoms in 3-5%) and/or polymicrobial urinary tract infection in noncatheterized patients are seen with colovesical fistulas.
MOnt reid p.429


Sample case:

68 y/o M complains of dull, achy left lower quadrant abdominal pain with fevers, chills, and malaise of 3 days duration.

He also complains of recent alternating diarrhea and constipation and increased urinary frequency. He is a chain smoker and consumes a low-fiber, high-fat diet.

UCV surgery, p.11

Diverticulitis: Physical Exam Diverticulitis: Physical Exam
Diverticulitis:  Physical Exam
a. Tenderness and guarding
b. Distention due to ileus or mechanical bowel obstruction
c. palpable tender mass especially on pelvic or rectal exam
d. Hypoactive or absent bowel sounds with peritonitis
e. Hyperactive high-pitched bowel sounds with obstruction
f. Guaiac -positive stools
Mont reid p.429


Sample patient:

VS:

- tachycardia (HR 1001); normal BP

- fever (38.3C)

- mild dehydration

- mild abdominal distention with left lower quadrant tenderness

- localized voluntary muscle guarding

- discrete oblong mass in left lower quadrant

- bowel sounds diminished

- rectal exam reveals hemorrhoids; heme-positive stool

UCV surgery p.11

Diverticulitis: Workup Diverticulitis: Workup


Initial diagnosis is made on clinical assessment– diagnostic studies are performed for confirmation of clinical suspicion.

10-20% of patients diagnosed with diverticuitis on clinical rounds subsequently are found to have carcinoma of the colon; therefore, it is necessary to rule out carcinoma following resolution of the acute attack.


Diverticulitis: Workup
a. Mild to moderate leukocytosis, often with a shift to immature forms
b. Urinalysis — leukocytes may be present as a result of inflammation around the ureters and bladders

Imaging
CT scan

- study of choice

- therapeutic advantage of percutaneous abscess drainage

- superior to contrast enemas for defining pericolic inflammation and evaluating complications of diverticulitis

- 90-95% sensitivity, 72% specificity, and false-negative rate of 7-21%

Contrast enema

- barium enema deferred until peritoneal signs subside (usually 2-4 weeks) due to risk of perforation and resulting barium peritonitis

- water-soluble contrast enema has 94% sensitivity and accuracy of 77%

Ultrasonography

- low cost

- reasonable sensitivity (84-93%), but higher operator dependent

Flexible sigmoidoscopy (with minimal insufflation)

- can be used to rule out a perforated colon cancer

Colonoscopy

- mandatory once acute process has resolved (6-8 weeks) in the case of bleeding or the possibility of cancer based on radiographic studies

MOnt reid p.429


Sample patient

CBC: decreased hemoglobin (10mg/dL)

- leukocytosis (16,3000) with neutrophilia (78%) and 18% bands (Left shift)

UA/Lytes: normal

UCV surgery, p.11

Diverticulitis: Imaging Diverticulitis: Imaging

CXR

- free intraperitoneal subdiaphragmatic air (perforation of hollow viscus [sigmoid colon] walled off)

KUB

- small bowel loop dilatation; increased radiodensity in the left lower quadrant

CT

- blurring of pericolic fat

- mass in the wall of the sigmoid colon

Barium enemas

- Barium enemas are contraindicated in acute diverticulitis because of the risk of leakage and severe peritonitis.

UCV surgery p.11

Diverticulitis: Pathogenesis, Pathophysiology Diverticulitis: Pathogenesis, Pathophysiology

Pathophysiology
- Inspissated stool lodges in the diverticulum, producing increased intraluminal pressure with impairment of venous return.
- Venous hypertension with impaired capillary filling results in ischemia and mucosal injury with subsequent inflammation
- Ischemia usually leads to a “microperforation,” a contained perforation into the mesentery or pericolic fat, causing focal inflammation and localized peritonitis
- 10-15% of patients with diverticulitis have free perforation, producing generalized peritonitis. This is more common in immunosuppressed, debilitated and steroid-dependent patients.
Mont reid p.428

- diverticula are herniations of the mucosa and submucosa through the muscular layers of the bowel wall (FALSE DIVERTICULUM) and result from high intraluminal pressures.

- These herniations usually arise at sites where arterioles traverse the colonic wall and thus are prone to bleed.

- These outpouchings may also be obstructed, permitting unabated growth of bacteria and consequent inflammation (DIVERTICULITIS).

- Diverticulitis has a higher incidence in the left colon (rectosigmoid region) than elsewhere in the GI tract and is most common in the sigmoid, where intraluminal pressures are highest.

- Diverticulitis classically presents as “left-sided appendicitis.”

UCV surgery p.11

Diverticulitis: Epidemiology Diverticulitis: Epidemiology

- Colonic diverticula occur predominantly in those older than 70 years.

- Risk factors include a low-fiber diet, as seen in developed countries. Perforation and consequent generalized peritonitis occur in 10% to 15% of patients.

Epidemiology
- Age – occurs in 20% of patients >40 years of age with diverticulosis
mont reid p.428

UCV surgery case #11

Diverticulitis:  Management Diverticulitis:  Management

- Treat with IV fluids, NPO, and antibiotics effectiev against gram-positive, gram-negative, and anaerobic organisms (eg. ciprofloxacin plus metronidazole)

- After an acute episode, a colonic evaluation is needed (one-third of patients have a colonic tumor).

- Long-term management involves increased dietary fiber intake and regular excercise.

- In cases of recurrent diverticulitis (10% after a single uncomplicated episode and >30% otherwise), patients should consider sigmoidectomy.

- Surgery is indicated in the presence of an abscess (that cannot be drained percutaneously), generalized peritonitis, a fistula, an obstruction, or failure of medical therapy.

UCV surgery case #11

Diverticulitis: Complications Diverticulitis: Complications

- Infection may cause necrosis of the colonic wall with perforation (microscopically or macroscopically), abscess formation, or peritonitis. Other complications include obstruction and fistula.


- Abscess

CT guided drainage

- effective drainage of an abscess can allow the performance of an elective procedure when the acute process has subsided, with lower morbidity and mortality than an emergent one, and can avoid the need for a colostomy.

- One stage operation is possibe in 50-90% of patients after effective percutaneous drainag.

Hartmann’s operation is usually indicated during a celiotomy in the setting of an undrained abscess


Fistulas

Fistulas occurs in 2-4% of patients with diverticular disease and in 20% of patients undergoing surgery for diverticular disease.

Colovesical fistula

- accounts for 65% of fistulas secondary to diverticulitis

- See colovesical fistula CARD for history,physical,diagnosis, and treatment

Colovaginal fistula

- see colovaginal fistula CARD for history, physical, diagnosis, and treatment


Perforation

- Associated with generalized peritonitis

- Sepsis must be controlled

- Primary resection should be performed whenever possible (lower mortality rate compared to simple diversion)

UCV surgery case #11

mont reid p.431-432

Diverticular disease: surgery resident handbook Diverticular disease: surgery resident handbook

DIVERTICULAR DISEASE

Diverticulosis

5-10% of people >45 have tics

80% of those older than 85

Diverticulitis

all are microperforations.  Hence “perforated diverticulitis” strictly speaking is redundant.  It connotes, however, an uncontained perforation mandating exploration (Hinchey III or IV) but the term probably should not be used because of this confusion.

Classify by Hinchey:

stage I: small confined pericolic or mesenteric abcess

stage II: walled off pelvic abscess

stage III: rupture with generalized peritonitis (ruptured abscess or free perforation from colon, 6% mortality)

stage IV: fecal peritonitis (35% mortality)

Pathogenesis:  increased intraluminal pressure and weakness of bowel wall.

Assoc with low fiber, high carbohydrate diet.

Occlusion of neck->bacterial growth->pressure->ischemic mucosa->rupture.

Natural History

if diverticulosis, 10-25% lifetime risk of diverticulitis

if first diverticulitis, 5% risk of recurrent attack within 2 years requiring readmission, probably 20-30% within 10 years.

85% of first attacks are uncomplicated and will resolve with medical therapy.

if second diverticulitis, 60% risk of recurrent attack à traditional indication for sigmoidectomy

probablility of success with medical therapy

first attack:  75-80%

third attack:  6%

Diagnosis

periumbilical ->LLQ pain, diarrhea, dysuria, frequency, LLQ tenderness, trace blood in stool.  occasionally present with colon obstruction.

85% occur in descending / sigmoid.  DDx = IBD, ischemic colitis, tumors.

right sided->in Asians, confused with appendicitis, more benign prognosis than left sided.  Rx antibiotics.

Imaging: CT is diagnostic. false negative rate of 2-21%.  carcinoma cannot be ruled out by CT. Some authors advocate US.  Colonoscopy contraindicated in the inflammatory phase..

Management of uncomplicated diverticulitis:

mild case–outpatient cipro/flagyl x7-10d.  After attack, use high fiber diet.  Screening colonoscopy in 6-8 weeks to rule out perforated cancer as cause of inflammation (as opposed to diveritcular disease).   5% will have second attack within next 2 years.  If cannot take po’s: admit, IVF, NPO, zosyn or cipro/flagyl.

Complicated diveritculitis:

Defined as diverticulitis with concomitant obstruction, abscess, fistula.  Most of these patients will require operation either emergently or electively.

Indications for emergent OR are

diffuse peritonitis

uncontrolled sepsis

acute clinical deterioration

free air on plain film

complex abcess or phlegmon

necrotic bowel

complete obstruction

stool in percutaneous drain.

Do a Hartman’s procedure with resection of diseased sigmoid (lower mortality 7% than just proximal diversion 26%).  If localized inflammation present, healthy ends, and low patient risk, a primary anastomosis may be contemplated (some argue Hartman takedown has 30-40% complication rate, and even Hinchey 3 and 4 patients have similar M&M vs. Hartman’s (Schilling DisColRec 2001).  About 20-25% of patients will require surgery during their initial hospitalization.

ABSCESS

If abcess >5cm, drain in IR.  Smaller abcesses will remit with antibiotics to allow single stage resection.  If IR drains stool, go to OR for washout (drain will not control disease).  If resolves do sigmoidectomy in 6-8 weeks (even for first episode) because recurrent complications will occur in 85%.  Consider ureteral stent placement.

FISTULA

generally are colovesicular.  SSx: recurrent UTIs, pneumaturia.  Dx: barium enema, cystoscopy. Rx: sigmoidectomy.  Generally the bladder does not need to be repaired formally. Just leave Foley x7-14d.

ELECTIVE

When to resect electively?  After second episode of itis (58% risk of subsequent complications with subsequent atacks), fistula formation, or recurrent diverticular bleeding.  Do sigmoidectomy.  Some data to support elective sig in patients under 40 years of age and immunosuppressed patients after the FIRST attack (Ambrosetti JACS 1994), but others say 2/3 will not have another attack within 10 years.  ASCRS does not recommend this practice.

BLEEDING

5-15% of patients with tics will bleed.  In 5% of these, bleeding is massive.  Generally right sided.  80% stop bleeding spontaneously.

Bleeding patient: CVP, T&C 6U, NGtube with 500cc lavage to r/o upper source (need to see bile), Foley, anoscopy/rigid proctoscopy to r/o anorectal source.  If bleeding stops, bowel prep and colonoscopy.  If doesn’t stop, to NM for tagged RBC scan to localize.  Then if still not stopped, to IR for embo.  Monitor after for bowel ischemia (10-15% of cases).

When to operate?

Hemodynamically unstable after initial resuscitation, transfusion requirement >6U, unable to stop bleeding with IR or colonoscopy.

Operation to perform?

If localized preop->segmental.  If not localized->subtotal.  Primary anastomosis?  Small series show is safe (generally speaking), but if patient unstable, on pressors, frail ->end ileostomy + Hartman’s pouch.

Weak data on elective resections for recurrent bleeds.

FISTULAS

occur in 2% of diverticulitis.  Most commonly colovesical fistulas.  SSx of pneumaturia, fecaluria, abd pain, UTIs, f,c.

Preop eval is CT, colonoscopy r/o malig.  For vaginal, contrast enema with tampon followed by XR of tampon can be helpful.

Wait for inflammation to resolve, then do elective takedown.

surgery.ucsf.edu/res

Diverticulitis: Differential Diagnosis Diverticulitis: Differential Diagnosis

Diverticulitis: Differential diagnosis
a. acute appendicitis
b. Crohn’s disease
c. Carcinoma
d. Colitis — pseudomembranous, infectious, and ischemic
e. Gynecologic – ruptured ovarian cysts, ovarian torsion, ectopic pregnancy, and pelvic inflammatory disease
MOnt reid p.429

Cecal diverticulitis: Multiple choice questions! Cecal diverticulitis: Multiple choice questions!

A 28 year old previously healthy woman arrives in the emergency room complaining of 24 hour of anorexia, nausea, and lower abdominal pain that is more intense in the right lower quadrant than elsewhere. On examination, she has peritoneal signs of the right lower quadrant and a rectal temperature of 3.8C (101.8F). At exploration through incision of the right lower quadrant, she is found to have a small, contained perforation of a cecal diverticulum. Which of the following statements regarding this situation is true?

a. Cecal diverticula are acquired disorders

b. Cecal diverticula are usually multiple

c. Cecal diverticula are mucosal herniations through the muscularis propria

d. Diverticulectomy, closure of the cecal defect, and appendectomy may be indicated

e. An ileocolectomy is indicated even with well-localized inflammation

The answer is d. (Brunicardi, p.1084)

Cecal diverticula must be differentiated from the more common variety of diverticula that are usually found in the left colon.

Cecal diverticula are thought to be congenital.

The cecal diverticulum is often solitary and involves all layers of the bowel wall; therefore, cecal diverticula are true diverticula.

Diverticula elsewhere in the colon are almost always multiple and are throught to be an acquired disorder.

These acquired diverticula are really herniations of mucosa through weakened areas of the muscularis propria of the colon wall.

The preoperative diagnosis in the case of cecal diverticulitis is acute appendicitis about 80% of the time.

If there is extensive inflammation involving much of the cecum, an ileocolectomy is indicated.

If the inflammation is well localized to the area of the diverticulum, a simple diverticulectomy with closure of the defect is the procedure of choice.

To avoid diagnostic confusion in th future, the appendix should be removed whenever an incision is made in the right lower quadrant, unless operatively contraindicated.

pretest p. 232, 262

Diverticulitis: Treatment: Nonoperative management: Outpatient Diverticulitis: Treatment: Nonoperative management: Outpatient

Oral antibiotics

- appropriate for mild tenderness and low-grade fever

- coverage should last 7-10 days and should include anaerobes and gram-negative rods

- Amoxicillin plus clavulanic acid

- Sulfamethoxazole-trimethoprim and metronidazole

- Quinolone and metronidazole

Low-residue diet once symptoms improve

Admission criteria include high fever, increasing abdominal pain, inability to tolerate enteral nutrition, and/or failure to improve on oral antibiotics

mont reid p.430

Diverticulitis: Treatment: Nonoperative management: Inpatient Diverticulitis: Treatment: Nonoperative management: Inpatient

- NPO

- IV hydration

- Nasogastric suction (if ileus or small bowel obstruction is present)

- Parenteral antibiotics

- gram-negative and anaerobic coverage

- continue for 7-10 days, or until afebrile with normal white blood cell count and nontender exam

- Pain control with meperidine

- Serial abdominal exams to detect worsening or complicated disease

- Oral antibiotics

- Continue for 1-2 weeks after discontinuation of parenteral antibiotics for severe attacks

- Diet

- clear liquids once symptoms have improved

- low-residue diet for 2-4 weeks after an acute attack

- patients are then placed on a high-fiber diet including psyllium

- this may decrease the rate of further symptoms but probably does not decrease the incidence of complications

mont reid p.430

Diverticulitis: Treatment: Surgical management: Indications for operation Diverticulitis: Treatment: Surgical management: Indications for operation

Repeated attacks (two or more)

- In patients >50 y/o, response rate to conservative therapy is 70% after the second attack and only 6% after the third attack

- The rate of complications is <20% with the first occurrence but increases to 60% with subsequent attacks

Complications

- abscess, obstruction, fistula, stricture

Failure to improve with conservative management after 3-4 days

First episode in patients <40 y/o (controversial)

Inability to exclude carcinoma

Right sided diverticulitis

mont reid p.431

Diverticulitis: Prognosis Diverticulitis: Prognosis

50-70% of all patients admitted to the hospital resolve their diverticulitis with conservative therapy.

Only 25% return with a subsequent attack (half within 1 year, 90% within 5 years)

Of the patients who do not respond during initial hospitalization

- 60% do not resolve (or recur) after discontinuation of antibiotics

- 30% have free perforation, requiring immediate surgery

- 9% have urinary fistulas

- 1% have a solitary right-sided diverticulum

mont reid p.430-431

Diverticulitis: Multiple choice case Multiple choice question

A 52 year old woman undergoes a sigmoid resection with primary anastomosis for recurrent diverticulitis. She returns to the emergency room 10 days later with left flank pain and decreased urine output; laboratory examination is significant for a white blood cell (WBC) count of 20,000/mm3. She undergoes a CT scan that demonstrates new left hydronephrosis, but no evidence of an intraabdominal abscess. Which of the following is the most appropriate next step in management?

a. Intravenous pyelogram

b. Intravenous antibiotics and repeat CT in one week

c. Administration of intravenous methylene blue

d. No further management if urinalysis is negative for hematuria

e. Immediate reexploration

The answer is a. (Brunicardi, pp 175, 1606)

The patient should undergo an intravenous pyelogram for a suspected ureteral injury.

After gynecologic surgeries, colorectal surgery is the most common cause of iatrogenic ureteral injuries.

Intraoperatively, intravenous administration of methylene blue or indigocyanine green may facilitate identification of an injury.

However, delay in diagnosis is common, and patients may present with flank pain, fevers, and signs of sepsis, ileus, or decreased urine output.

CT scan may demonstrate hydronephrosis or a fluid collection (urinoma).

Initial diagnosis and management should include urinalysis, although hematuria may not always be present; percutaneous nephrostomy tube or retrograde ureteral catheterization; percutaneous drainage of fluid collections; and identification of the location of ureteral injury.

Surgical management should be delayed if diagnosis is late (10 to 14 days), and operative strategy is dependent on the location of the injury.

Diagnostic imaging such as a pyelogram or nuclear medicine scan may be helpful to identify the site of injury.

pretest surgery p.10, 29,question #30

Diverticulitis treatment: Multiple choice question
[copy and paste]
Multiple chioce question

A 53 year old man presents to the emergency room with left lower quadrant pain, fever, and vomiting. CT scan of the abdomen and pelvis reveals a thickened sigmoid colon with inflammed divertiula and a 7-cm by 8-cm rim-enhancing fluid collection in the pelvis.  After percutaneous drainage and treatment with antibiotics, the pain and fluid collection resolve. He returns as an outpatient to clinic one month later. He undergoes a colonoscopy, which demonstrates only diverticula in the sigmoid colon. Which of the following is the most appropriate next step in this patients mangement?

a. Expectant management with sigmoid resection if symptoms recur

b. cystoscopy to evaluate for a fistula

c. Sigmoid resection with end colostomy and rectal pouch (Hartmnan’s procedure)

d. Sigmoid resection with primary anastomosis

e. Long-term suppressive antibiotic therapy

The answer is d. (Brunicardi, pp1081-1084)

The indications for surgical intervention for diverticular disease include hemorrhage secondary to diverticulosis, recurrent episodes of diverticulitis, intractability to medical therapy, and complicated diverticulitis.

The latter includes perforated divertiulitis with or without abscess nand fistulous disease.

Diverticular abscesses are treated with percutaneous drainage initially followed by definitive resectional therapy.

Initial percutaneous drainage allows for a one-stage procedure that consists of resection of the affected colon with primary anastomosis.

Perforated diverticulitis is typicaly treated with either the Hartmann’s procedure (sigmoid resection with end colostomy and rectal stump) or sigmoid resection, anastomosis, and diverting loop ileostomy.

pretest  surgery p.210; questoin 312

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March 4, 2010

Physical exam of the abdomen

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Physical exam of the abdomen

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March 3, 2010

Peritonitis

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Peritonitis

Peritonitis from bowel perforation, gross

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February 27, 2010

Neurology topics for USMLE Step 2 CK

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Neurology topics for USMLE Step 2 CK

Diseases of the Nervous System and Special Senses

Health and Health Maintenance

  • Cerebrovascular disease, cerebral infarction
  • Nutritional deficiencies, toxic injuries, and occupational disorders including lead, carbon monoxide, and organophosphate poisoning
  • Infection involving the nervous system, eyes, or ears
  • Degenerative and demyelinating disorders, including Alzheimer disease and multiple sclerosis

Mechanisms of Disease

  • Localizing anatomy:
    • brain and special senses
    • brain stem
    • spinal cord
    • neuromuscular system
  • Anatomy of cerebral circulation
  • Increased intracranial pressure and altered state of consciousness
  • Infection
  • Degenerative/developmental and metabolic disorders

Diagnosis

  • Disorders of the eye (eg, blindness; glaucoma; infection; papilledema; optic atrophy; retinal disorders; diabetic retinopathy; diplopia; cataract; neoplasms; vascular disorders; uveitis; iridocyclitis; traumatic, toxic injury; toxoplasmosis)
  • Disorders of the ear, olfaction, and taste (eg, deafness, hearing loss, otitis, mastoiditis; vertigo, tinnitus, Meniere disease; acoustic neuroma; traumatic, toxic injury)
  • Disorders of the nervous system:
    • paroxysmal disorders (eg, headache; trigeminal neuralgia; seizure disorders; syncope)
    • cerebrovascular disease (eg, intracerebral hemorrhage; ischemic disorders; aneurysm, subarachnoid hemorrhage; cavernous sinus thrombosis)
    • traumatic, toxic injury; including lead, carbon monoxide, and organophosphate poisoning
    • infections (eg, bacterial, fungal, viral, opportunistic infection in immunocompromised patients; Lyme disease; abscess; neurosyphilis; Guillain-Barré syndrome)
    • neoplasms (eg, primary; metastatic; neurofibromatosis)
    • metabolic disorders (eg, metabolic encephalopathy, vitamin B12 [cobalamin] deficiency, vitamin B1 [thiamine] deficiency; coma, confusion, delirium, dementia)
    • degenerative and developmental disorders (eg, Alzheimer disease; Huntington disease; parkinsonism; amyotrophic lateral sclerosis; Tay-Sachs disease; multiple sclerosis; cerebral palsy; dyslexia)
    • neuromuscular disorders, gait abnormalities, and disorders relating to the spine and spinal nerve roots (eg, myasthenia gravis; muscular dystrophy; peripheral neuropathy; neck pain; cervical radiculopathy; lumbosacral radiculopathy; spinal stenosis)
    • sleep disorders (eg, narcolepsy, idiopathic hypersomnolence, restless legs syndrome, REM sleep behavior disorder, circadian rhythm sleep disorder, sleep apnea)

Principles of Management
(With emphasis on topics covered in Diagnosis)

  • Pharmacotherapy only
  • Management decision (treatment/diagnosis steps)
  • Treatment only

source: usmle.org

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Death and dying topics on USMLE Step 2 CK

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Death and dying topics on USMLE Step 2 CK

Medical Ethics and Jurisprudence

  • Death and dying (eg, diagnosing death, organ donation, euthanasia, physician-assisted suicide) and palliative care (eg, hospice, pain management, family counseling, psychosocial and spiritual issues, fear and loneliness)

source: usmle.org

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Statistics

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Statistics

coming soon.

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Biliary Tract

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Biliary Tract

coming soon…

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Otolaryngology

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Otolaryngology

coming soon

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Eye Anatomy

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Eye Anatomy

How The Human Eye Works

Human Body : Pushing The Limits – Sight ( Part 1 of 4 )

Human Body : Pushing The Limits – Sight ( Part 2 of 4 )

Human Body : Pushing The Limits – Sight ( Part 3 of 4 )

Human Body : Pushing The Limits – Sight ( Part 4 of 4 )

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February 26, 2010

Normal Development

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Normal Development

Normal Development
Infancy/Childhood (eg, normal growth and development)
Adolescence (eg, sexuality, physical changes of puberty)
Adult (eg, normal physical findings and lifestyle issues)
Senescence (eg, normal physical and mental changes of aging)

Normal Development

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USMLE Step 3 Content Introduction

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USMLE Step 3 Content Introduction

Step 3 Content Description
Step 3 Problem/Disease List

The design of the Step 3 Content Outline has been influenced by the review of empirical data drawn from several sources, including, for example, the National Ambulatory Medical Care Survey and the National Hospital Discharge Survey. The diseases noted in the outline do not represent an all-inclusive registry of disorders about which questions may be asked. Questions are generally, but not exclusively, focused on the listed disorders. In addition, not all listed topics are included on each examination.

source: http://www.usmle.org/Examinations/step3/content/disease.html
USMLE Step 3 Content Introduction

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February 24, 2010

Advice for first year medical students

Advice for first year medical students

1. Thank you for filling out this questionnaire. Now that you’ve completed the first year of medical school, what advice would you give the incoming MS1s who are about to start this year? You can fill out this survey as many times as you wish, so come back often to share your piece of advice!

I would really recommend trying out a few different styles of studying early on in the year to find the style that works best for you. The style that got you through undergrad might still work best but you’ll have to adjust to the way courses are taught. For example, lecturers will cover most of the required/testable material in their lectures but may skip over some things which are in the syllabus and that you’re still required to know. As such you might not be able to rely only on lecture as your source of information. The syllabus will usually contain everything you need to know, and the objectives, though often broad and vague, are meant to cover the testable, take-home points of each lecture. Try early on to establish a stable routine that allows for you to have a dedicated block of time studying as well as time for yourself. The exams are not so difficult that you need to know every last detail so if you find yourself too busy to take a night off to relax and have fun with friends then you are probably studying too hard.

2. What is your Myers-Briggs personality type? Extroverted vs Introverted Sensing vs Intuitive Thinking vs Feeling Judging vs Perceiving Ex. ENFP

INTJ

3. What equipment did you purchase? Eg. stethoscope, sphygmamometer, tuning fork, etc.

stethoscope(cardio 3) BP cuff tuning fork (128) reflex hammer (queens) penlight

4. What do you wish someone had told you when you first started your first year? What would you do differently if you could do it all over again?

No Response

5. Please comment on each topic below:

Whom to go to if you need help – advisory college mentors, 2nd year students

6. How did you study for small group? What’s the best way to prepare for small group and to do well in small group?

This kind of depends on your small group and what style ends up working well for your group. The facilitators also dictate this a bit too. In the beginning I would recommend coming to each session prepared which means having read over the material and answered all the questions as best you can in a reasonable amount of time. Later on in the year you might find that your facilitator/group works better if you just read over the case/questions and come ready to share your knowledge without having necessarily gone through each question in detail. Again, this depends on your group’s dynamics and what pace you go through the cases.

7. What resources (books, websites, etc) did you use for:

Anatomy – Netters, however I didn’t use it nearly as much as I thought I would and it would probably have sufficed to only rely on syllabus figured and powerpoints from anatomy lecture. This is a personal preference because some people need the extra material to study. Personally I found Netters to contain way more detail than we actually needed to know and as such the diagrams had overly labeled figures which appeared more confusing than the lecture versions of the same figures.

Pathology – Robbins basic pathology- Dr. Abbas really recommends buying this book because the boards pull a lot of questions form here. I think this book is a good resource to have if you are interested in learning more detail but in general I felt the info we needed to know was easily found in path lectures and labs and that this book covers way more than we’ll ever need to know as medical students. I got through most of the year without it and once I got it I only needed it a couple more times.

Neurology – Blumenfeld- This book is highly touted by the BMB faculty and I think it’s quite a shame. The BMB facullty will not put Blumenfeld figures in your sylllabus and will reference them because they assume you will buy it. Honestly every figure you need from blumenfeld can be found in lecture powerpoints.

Advice for first year medical students

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February 22, 2010

Advice for first year medical students

Advice for first year medical students

1. Thank you for filling out this questionnaire. Now that you’ve completed the first year of medical school, what advice would you give the incoming MS1s who are about to start this year? You can fill out this survey as many times as you wish, so come back often to share your piece of advice!

-Avoid signing up for lots of things or thinking you should take on lots of roles. You shouldn’t do anything because of a “should”—those days are over. -Taste every specialty, elective, or talk at least once. Go to plenty of lunchtime talks and see what people have to say. Don’t go just for the food and then leave. That’s not classy. Keep San Francisco classy.

2. What is your Myers-Briggs personality type? Extroverted vs Introverted Sensing vs Intuitive Thinking vs Feeling Judging vs Perceiving Ex. ENFP

ENTJ

3. What equipment did you purchase? Eg. stethoscope, sphygmamometer, tuning fork, etc.

stethoscope. sphygmomanometer. reflex hammer (a nice one). didn’t get a tuning fork. comfortable flat dress shoes…heels don’t cut it when you’re standing a long time on clinical interlude and at preceptorship.

4. What do you wish someone had told you when you first started your first year? What would you do differently if you could do it all over again?

Wish someone had told me that Robbin’s Pathology and Wheater’s are OK and you should get them if you’re into and interested in path. I really liked path lab and probably would’ve enjoyed having them around.

5. Please comment on each topic below:

Scholarships you applied to – None. Should have! There are tons of these that come across the list and are available via easy googling!

Whom to go to if you need help - Sharad Jain. Beth Wilson. FPC Leaders. Anyone you even pseudo-create a relationship with—if you like them, go to them. Email them. Get coffee with them even when you don’t have a problem. Just to talk about life. They will most likely say yes. And they will love it because they love mentoring.

Managing extracurricular activities and academics – Don’t worry about doing ANYTHING unless you really enjoy it or really want to do it. There is no more “resume,” no more “how many clubs you’re in,” none of that matters. Make your life exactly what you want: if that involves lots of coffee sipping and pilates-class-taking, PLEASE DO IT. Just be happy.

Research in medical school – Didn’t do any.

Summer activities – Went to Thailand on OIP Grant for half the summer. Had a blast and was stress-free. Visited family. Went to a wedding. Took a road trip.

6. How did you study for small group? What’s the best way to prepare for small group and to do well in small group?

Give yourself 30min where you don’t do anything but small group. Google a few things you don’t understand—the next day, you may offer up an interesting factoid to the group and look good doing it, too! Reflect on your role in the group throughout first year—if you like the role, great. Reflect on it. When you have “a really great small group,” Think about why that was—did you talk a lot? Did you get up and draw on the board? Did you sit back and listen to others’ opinions more than you usually do? Reflect!

7. What resources (books, websites, etc) did you use for:

Anatomy – Netter’s and Grant’s checked out from the library

Physiology – classmates

Pathology – online modules

Histology – online modules

Biochemistry – classmates, tracy fulton office hours

Pharmacology – memorizing with dry erase markers and repetition

Neurology – classmates, repetition, the book everyone gets (Get it!)

Respiratory system – nothing extra

Cardiovascular system – nothing extra; studied Dave Morgan lecture notes a lot (ppts)

Gastrointestinal system – McQuaid review lecture

Muskuloskeletal system – practiced extra in the anatomy lab; made up a dermatome dance

Advice for first year medical students

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Tachycardia

Tachycardia

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February 4, 2010

Advice for 2nd year medical students

Advice for 2nd year medical students

I asked UCSF medical students to give advice to students who are about to start their second year of medical school. Below were their responses.

Remember, these are submissions from your classmates. They are based on their personal experiences. Take what is helpful and leave the rest.

Student#1. ADVICE FOR STEP 1 OF THE BOARDS

I. Goals dictate advice interpretation. Whenever you hear advice for the boards, try to assess what the advisor’s boards goals were and how they align with your own goals. Whether it’s a classmate or an upper classmen, if you aren’t sure of their goals you can always ask if they were aiming to pass or if they were aiming to crush it. For those of you still reading, you should know that my goal was to pass comfortably while giving up as little of my soul as possible to a silly exam that won’t exist in 5 years. I wanted to feel enough pressure that I wouldn’t procrastinate or be inefficient with my study time, but I also wanted to have some time to relax after a long day of studying. II. Study schedules

A) General advice Don’t blow off Life Cycle. A lot of stuff from the course is on the boards, from peds to OB to geriatrics. I had a hard time deciding what to focus on when I started juggling my time between boards review and LC. I felt much less anxiety when I decided to focus on LC stuff first and then spend extra time on non-LC boards review. Also, throughout your studying I recommend listening to the Goljan Path lectures on mp3 while you’re walking around and while you’re working out. Your class reps will set you all up with this resource.

B) Goal: “destroy the exam” Start hitting up the library every afternoon by January 1st. After the last Life Cycle exam study 12-14 hour days for a maximum of 3 weeks. Sarting as early as January you should subscribe to a Qbank and start taking at least a test a day. By the end of LC, if you’ve been studying efficiently all along, you won’t need much more time to feel confident and raring to pulverize the test. Most of my super-high-aiming friends were glad (or wish that) they had taken 2 weeks post LC, and a very small handful felt like 3 weeks was helpful for their piece of mind back when they scheduled the test (even if they wanted to take it earlier in the end). If you want to crush the test but don’t study efficiently then you might consider taking more time. C) Goal: “just pass” Take your time studying for this test. A handful of my classmates took option B, which means they start rotations one block late. They either took a short vacation after LC before buckling down or they studied steadily for over a month, slowly soaking info up. If you are most concerned about failing then the mind game is a huge component for you and you need to study as long as it takes to feel confident. As with every goal and study style, take lots and lots of practice questions. If you really just want to pass I recommend buying a 2 or 3 month Qbank, finishing all the questions and then going back and re-answering all of the questions you got wrong on the first pass until you know them cold. You will end up doing way better than just passing.

D) Goal: “pass comfortably and maintain a semblance of normal life” Here is where my advice gets more personal and specific, but hopefully still useful. Where to start: I started reading a physiology review book over winter break. As my housemate described it, it was like Discovery Channel studying: it was surprisingly fun to review basic physiology principles without worrying about testing myself. I didn’t take notes in the book because I felt like that would slow me down and not add much in the way of retention through Jan, Feb and most of March. If I could do it again I would have finished reading the physiology book by January 1st instead of dragging on through week 4 of LC. Ideally, right after new year I would have transitioned to reviewing a pathology text at the pace of about a 5 chapters/week. Again, I feel like it was the right decision for me not to take notes in the path book either (a feeling reinforced when my housemates who were taking notes ditched that strategy after a few chapters). When to start taking practice tests: Just like the way we slowly integrate palliative care into our dialogue with really sick patients in the hospital (remember the two triangle diagram from FPC?), it’s a good idea to start doing practice questions about two months before the actual test. I didn’t because I was bent on finishing the path text (which took forever even without taking notes) and because I was worried about retention. If I could do it over I would have taped into the huge number of free question banks out there, starting two months out. One month before your test day is a good time to fork out some cash for an official Qbank that you can try to get all the way through (and periodically review wrong answers throughout). I’m not going to go into details about how best to use the Qbanks or which to use since you will get a lot of that information from friends and the 4th year mentors. The only other thing I’ll mention in this schedule part is that you should start memorizing drugs at a casual pace very early on. Drugs, including interactions and side effects, make up a big chunk of the exam and the best way for most of us to learn them is by repetition. The rest of my thoughts on content are below.

III. What do I need to know? One classmate explained the test to his mom like this: “basically I need to know everything about how the human body works, everything that can go wrong with it, the drugs we use to treat those things that can go wrong and the side effects and interactions of those drugs.” And that’s pretty much what it feels like to study for this test. But in hindsight I think you could break it down like this:

A) 190’s (185 is passing): Basic physiology, 80% of Susan Masters’ drug flashcards, bacteriology (including drugs) and biochemistry. Really, that’s all you need to pass this huge exam. What about the rest of pathology beyond micro and biochem? By studying the above you will cover the basics, and assuming you have at least reviewed pathology you will be able to recall answers for reasonable questions and just have to shrug your shoulders for the ridiculous questions. In one section I was asked about the molecular make-up of surfactant (shrug) and a few sections later about it’s mechanism (score). The point is that they ask a baseline of reasonable questions that you can get right and pass just knowing the stuff I listed above. Beyond that basic info there are rapidly diminishing returns on the time you spend studying (an extra month wouldn’t have led me to learn the molecular make-up of surfactant). To be clear, in no way do I recommend studying only what I wrote above. That’s just there to highlight the fact that you CAN pass knowing just that, which is not to say anything of peace of mind/confidence.

B) 220’s: All of the above plus the rest of micro (basic virology – not including the structures of the viruses, funguses and protazoa plus drugs) and knowing all of susan’s drug cards down cold. To get this score you should also be ‘pretty comfortable’ with pathology but don’t need to know obscure minutia. Remember that they ask a baseline of reasonable questions that you can answer without a jeopardy-worthy fund of knowledge.

C) 250’s and up: All of the above plus whatever else it takes to know 95% of the details in first aid, cold, and maybe additional anatomy review to be safe. Even if you want to get above 260 you don’t need to know anything beyond what is in First Aid. That isn’t because first aid covers everything that could be on the test, but because you could spend a month studying stuff beyond first aid and only add one or two points (all the while forgetting what you’ve already worked so hard to memorize). Big time diminishing returns. Sat, 9/20/08 2:48 PM

===========================================

USMLE STEP 1 RESOURCES

First Aid for the USMLE Step 1 (2010)

High-Yield Behavioral Science by Barbara Fadem

High-Yield Embryology by Ronald W Dudek

BRS Physiology by Linda S Costanzo

Clinical Microbiology Made Ridiculously Simple by Mark Gladwin

BRS Cell Biology and Histology

High-yield Behavioral Science

MedEssentials: High-Yield USMLE Step 1 Review

First Aid QAndA for the USMLE Step 1

USMLE Step 1 Secrets by Brown

——————————————————————

Student #2. -study hard for I3, it will be very useful for boards. -enjoy your winter break and start studying for boards in january. -start flipping through first aid to become familiar with it Mon, 9/1/08 9:59 AM

———————————————————————

3. I3: all you need to study off of are MicroCards. You don’t really even need to focus on the syllabus. Know I3 well, as it will save you tremendous amount of time from boards studying on the subject. BOARDS STUDYING: You honestly don’t need to start studying until January. Kaplan QBank is not representative of the actual question style, go with UWorld. First Aid and Goljan should be the main study books with supplemental subject books to fill in the gaps. The only biochem you need to know is in First Aid. Don’t take the test on the VERY last day possible. Give yourself at least a 5 days before starting class again and take a well deserved vacation. Trust me, you’ll need it!! Sun, 8/24/08 6:10 PM

4. I3: Get the microcards and start using them early. You can even take notes on them and use that as your primary study source. Pay attention in lab, you learn good stuff that comes up over and over again. Micro is something that you end up running into in every rotation and it’s best to learn it well the first time through. Clinical Micro Made Ridiculously Simple is a fabulous, information, fun to read book if you want a supplement. Cancer: Ended up being more epidemiology and than I had anticipated. Look forward to finally really understanding sensitity and specificity – be sure to go to Rebecca Jacnkson’s lectures on screening tests, etc. They’re good and the material comes up all the time on the wards. Lifecycle: DO NOT quit and just start studying for the boards mid-block. Try and use Lifecycle as the time to study ob/gyn-related topics for Step 1. The ob part of lifecycle is particularly strong and has great small groups that came in handy for review before my ob/gyn rotation. Boards: Goljan! Goljan! Goljan! Buy this man’s book, listen to his lectures and forget about the BRS pathology book. I am still annoyed I spent money on it. Wed, 8/20/08 11:23 AM

5. Do what works for you. If you are a visual learner, forget the syllabus and buy books that explain things in lots of color and images–these books tend to be more clinically relevant anyway. I can honestly say that I didn’t read the syllabus and I think I have a good–if not great–understanding of the material because I learned in a way that worked for me. In the end, you will toss the syllabus and end up using the books in your third year. If you are in a student organization that offers mentors, make sure they hook you up with a fourth year mentor. Wed, 8/20/08 9:13 AM

6. Please do NOT start studying for boards until the earliest January ‘09 Thu, 8/7/08 6:41 PM

7. board exams are hard, just study and don’t worry. Take many many practice tests as they are the most high yield. At a certain point midway through or more, just take practce tests. It will show you what you don’t know and need to study. Thu, 8/7/08 10:05 AM

8. 1) Try not to get involved with too many things. Choose based on how much time you need to study for school. By Dec, you need to either and gotten out of your committments or have a tangible plan about how to do so within reasonable amount of time. 2) When do you want to take your boards? Early or late? 3) What kind of studier are you? Long term vs Short term because this should affect when you start studying for your boards 4) Even if you dont start studying until Jan, Be sure you have your books ready sooner than that. Because the worst thing that can happen to you is start studying later and then realise that First Aid is not your ideal book. tiv 5) Dont flow with the over hypes Q bank. USMLE world is an excellent and much cheaper choice. I used both and i can tell you this for sure. 6) Be careful about who you hang out with. If you are not the stressful kind of person, then stay away from stressful people that will make you start to freak out. 7) Are you an auditory learner? then get Golgen. He is an amusing but sometimes annoying old man but those emotions make you listen to him while walking, at the gym, etc. You dont have to wait till January to make Golgen your friend. Start now as you go along with I3 and you would have listened to him about 2 or 3 times before your exam. he is kind of addictive. Good luck, if you start to freak out, email and talk to an upperclassman that you trust, dont be shy to say “i am starting to freak out”. And dont forget. FRIENDS MAKE THE PROCESS A WHOLE LOT BEARABLE. Thu, 8/7/08 9:06 AM

9. for the first two weeks of I3 you learn immunology. Abbas’ basic immunology textbook they recommend is small and extremely helpful. for the rest of I3, it’s all about memorization. I had heard this from students in 2009, but it didn’t sink in until the end of the block so I ended up “studying” a lot with low yield. come up with a system (group or individual) and memorize bugs and drugs like crazy. Micro Made Ridiculously Simple is a good study aid for coming up with memory tricks. Cancer block is a ton of reading, so try not to fall behind. Life Cycle is about the time that many of you will start (or start thinking about) studying for boards. I was stressed for the first two weeks of LC trying to decide whether to study from the Syllabus or my Step1 materials. Once I realized that LC stuff IS on the boards I made that my priority and with my left over time (which you will have during LC since you Friday’s dedicated to boards/wards is huge) I would study for Step1 in general. I felt a lot better after getting my priorities straight, and sure enough I didn’t have to do too much review of the LC material for the boards and ended up getting a lot of questions from menstrual cycle to geriatric care. Oh, and in that vein, do your best to follow the embryology lectures/demos in LC because getting it straight in your mind in class will make it stick at least long enough for some of the questions on Step1 and is way easier than memorizing a list about embryology in First Aid. Thu, 8/7/08 6:43 AM

10. Enjoy your summer. Enjoy your winter break. Enjoy every day and continue that plan into 3rd year and beyond. As for boards, trust in how you’ve studied for every previous tests you’ve taken before. It’s not that different, just longer. That said, expect to feel overwhelmed and like you “aren’t doing enough” starting sometime in January and lasting into April. Enjoy the material. Practice your oral presentations for 3rd year by going to homeless clinic or the like if you get a chance. Wed, 8/6/08 11:59 PM

11. just make a study schedule for boards and don;t start till january Wed, 8/6/08 10:28 PM

12. study I3 WELL. Know that stuff. Only study I3. Nov 1st = START OF BOARDS SEASON. I mean this. Forget Cancer and Lifecycle blocks. Every point over 70% that you get on any one of those tests equals time you shoulda spent studying for the boards. You should be proud of 70%’s and ashamed of 71% and double ashamed for 72%, and so on.. EXCEPT-> study heme/onc well (the second half of Cancer block), but as you study, go over the relevent sections in BRS Path and take notes into that. Then use that to study for your final and then you’ll be golden for that portion of the boards. Go through EVERY question on Kaplan’s QBank. EVERY ONE. When you’re done, review the ones you’ve missed. Start in late Jan after you’ve gone through BRS Phys-> BRS Path -> First Aid (in that order). Then review ALL of them again, then path again, then First Aid again, then path again. (then w/ the QBank fine tune your reading w/ a few other books.. micro, biochem, anatomy, etc) But know BRS Path so well.. that you don’t just know about Crohns Disease, you know exactly what part of the page it’s on. I’m serious. This is top gun stuff, but will get you that 260+. Wed, 8/6/08 7:35 PM

13. Keep up in I3- the micro exams require learning a lot of facts. Micro is a big part of Step 1, and the more you can retain by spreading out your studying during I3, the more you will retain in March. The Essential Core prepares us well for Step 1, especially the Organs, BMB, and I3 blocks. You will definitely have to learn some new material related to the musculoskeletal system, genetic disorders, nutritional disorders, and cancers- you will find this as you look through First Aid or other review books. Don’t blow off Life Cycle- a lot of what you learn there is key for pediatrics and obgyn, and even internal medicine, during the third year. Wed, 8/6/08 7:24 PM

14. Don’t get bogged down and intimidated with trying to read through 10 boards review books. Use First Aid, a Q-bank (Kaplan or USMLE World) and listen to the Gulyan lectures. If you need to flush out concepts use the internet or another reference book like BRS phys but don’t try to read through a separate book for each subject. Take it little by little. And give yourself AT LEAST a week of vacation! Wed, 8/6/08 7:12 PM

15. 1. Make your own or buy a set of microbiology cards early on and use them. Learn all the ID stuff really well as it REALLY helps with Step 1. 2. Try not to let your classmates stress you out too much during boards. Really, you will pass. And if at all possible, study as far away as possible from UCSF and Parnassus. Wed, 8/6/08 7:10 PM

16. Prioritize your schedule with one or two key goals in mind, and be open to most everything else being different than what you expect. Wed, 8/6/08 6:48 PM

17. For I3 buy Clinical Microbiology Made Ridiculously Simple and the immunology book by Dr. Abbas, and don’t read the syllabus at all–it’s really confusing and both these books are great. Wed, 8/6/08 6:36 PM

18. Some of your classmates (hopefully a small minority) will already be working on step 1 study schedules and planning to start studying this fall. I strongly encourage you all to simply focus on (and enjoy!) your current courses, invest yourselves in learning this new material and don’t worry about boards until January (…maybe start thinking about it over X-mas break, if you must.) There REALLY is plenty of time to review it all, and I found that acquiring a solid understanding of the material the first time around was the most valuable part of doing well. Wed, 8/6/08 6:33 PM

19. Please make sure to enjoy yourself! Take time to spend time with your friends, explore the city, etc. The blocks are much more integrative during second year, so you will find yourself drawing on all kinds of knowledge from Prologue, Organs, and BMB. Study groups can be really helpful this year, especially in I3. Get MicroCards for I3. They are a lifesaver. You will be busier, but it’s all a transition into third year. Don’t stress out too much about the lottery; it will work itself out. Do go talk to Maureen Mitchell once spring rolls around if you’re really having a crisis. And please don’t worry about Step 1 until after Christmas break. There is a diminishing return on the quality of your study time after a certain number of weeks, and you will only stress yourself out more if you are in the library for months on end before your test day. Don’t neglect Life Cycle too much; the material is really useful, interesting and all over Step 1 AND Step 2. Wed, 8/6/08 5:44 PM

20. When it comes to boards (which you should feel NO pressure to think about until after winter break), check in with yourself. I really think that getting sleep, taking breaks, eating well, and all that common sense stuff will help you perform way better!

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January 31, 2010

USMLE Step 2 CK Books

USMLE Step 2 CK BOOKS

First Aid for the USMLE Step 2 CK
USMLE Step 2 Secrets
Crush Step 2: The Ultimate USMLE Step 2 Review
Kaplan Medical USMLE Step 2 CK Qbook
Deja Review USMLE Step 2 CK
Step-Up to USMLE Step 2
Kaplan Usmle Step 2 Ck Lecture Notes
NMS Review for USMLE Step 2 CK
First Aid Cases for the USMLE Step 2 CK
USMLE Step 2 Recall
Lange Q&A USMLE Step 2 CK

USMLE Step 2 CK Books

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January 9, 2010

USMLE Step 1 Books

USMLE Step 1 Books

The hard part about studying for Step 1  is deciding which books to use to study for each section of the USMLE. Below is an (almost) complete list of resources.

To help you decide, click on the links to any of the books to read student reviews.

COMPREHENSIVE

First Aid for the USMLE Step 1 2010 .
First Aid for the USMLE Step 1 2009 .
First Aid Q&A for the USMLE Step 1 .
First Aid Cases for the USMLE Step 1 .
Pathophysiology for the Boards and Wards .
medEssentials: High-Yield USMLE Step 1 Review (Kaplan Medessenitals for the USMLE Step 1
Kaplan Medical USMLE Examination Flashcards: The 200 “Most Likely Diagnosis” Questions You Will See on the Exam for Steps 2 & 3

Kaplan Medical USMLE Step 1 Qbook
Step-Up to USMLE Step 1
Step-Up to USMLE Step 1: A High-Yield, Systems-Based Review for the USMLE Step 1
Underground Clinical Vignettes Step 1 Bundle
Underground Clinical Vignettes Step 1: Pathophysiology II: GI, Neurology, Rheumatology, Endocrinology
Underground Clinical Vignettes Step 1: Pathophysiology I: Pulmonary, Ob/Gyn, ENT, Hem/Onc
Underground Clinical Vignettes Step 1: Pathophysiology III: CV, Dermatology, GU, Orthopedics, General Surgery, Peds
Underground Clinical Vignettes Step 1: Microbiology I: Virology, Immunology, Parasitology, Mycology
Underground Clinical Vignettes Step 1: Microbiology II: Bacteriology
Blueprints Q&A Step 1
Appleton & Lange Practice Tests for the USMLE Step 1
Appleton & Lange Review for the USMLE Step 1
Clinical Vignettes for the USMLE Step 1: PreTest Self-Assessment and Review

ANATOMY

Underground Clinical Vignettes Step 1: Anatomy
USMLE Road Map: Gross Anatomy
Rapid Review: Anatomy Reference Guide
Rapid Review Gross and Developmental Anatomy: With STUDENT CONSULT Online Access

BEHAVIORAL SCIENCES
High-Yield Behavioral Science by Fadem .
Rapid Review Behavioral Science: With STUDENT CONSULT Online Access
Underground Clinical Vignettes Step 1: Behavioral Science

BIOCHEMISTRY
Underground Clinical Vignettes Step 1: Biochemistry
Rapid Review Biochemistry: With STUDENT CONSULT Online Access

CELL BIOLOGY
Rapid Review Histology and Cell Biology: With STUDENT CONSULT Online Access

EMBRYOLOGY
High-Yield Embryology by Dudek .

EPIDEMIOLOGY AND BIOSTATISTICS
Appleton and Lange’s Review of Epidemiology and Biostatistics for the USMLE

HISTOLOGY
Rapid Review Histology and Cell Biology: With STUDENT CONSULT Online Access

LABORATORY MEDICINE
Rapid Review Laboratory Testing in Clinical Medicine: with STUDENT CONSULT Access

MICROBIOLOGY
Clinical Microbiology Made Ridiculously Simple .
Blackwell’s Underground Clinical Vignettes: Microbiology, Volume 2, Step 1
Rapid Review Microbiology and Immunology: With STUDENT CONSULT Online Access

NEUROLOGY
Rapid Review Neuroscience

PATHOLOGY
USMLE Road Map Pathology
Rapid Review Pathology: With STUDENT CONSULT Online Access

PHARMACOLOGY
Kaplan Medical USMLE Pharmacology and Treatment Flashcards: The 200 Questions You’re Most Likely to See on the Exam For Steps 1, 2 & 3
Underground Clinical Vignettes Step 1: Pharmacology
USMLE Road Map: Pharmacology
Rapid Review Pharmacology: With STUDENT CONSULT Online Access

PHYSIOLOGY
BRS Physiology by Costanzo .
USMLE Road Map: Physiology .
Rapid Review Physiology: With STUDENT CONSULT Online Access .

 

PICTURES! YOU CAN CLICK ON THEM IF YOU WANT TO READ STUDENT REVIEWS.


As more resources become available, I will add them here.

USMLE Step 1 Books

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

keywords

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January 8, 2010

The ABSITE Review by Steven Fiser

Filed under: Uncategorized — admin @ 8:07 am

The ABSITE Review by Steven Fiser
Click on the link above to read student reviews

 
As far as the little mistakes go, I think that Fiser has less than most study resources. Also, most of the mistakes are really just outdated recommendations. Since expert opinions vary, and the ABSITE tends to lag a few years behind the literature, I’m not sure if such corrections would be much help.

The ABSITE Review by Steven Fiser
Click on the link above to read student reviews

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Significance of your ABSITE score

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Significance of your ABSITE score

The ABSITE score is used by program directors to determine your progression in residency.

Doing poorly on the exam can have negative effects. One student writes: “theres been at least one example of a resident in my program who scored decently on the junior exam and below 20th percentile on the senior test. and disciplinary action was taken against them.”

Significance of your ABSITE score

source: studentdoctor.net

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How to study for the Senior ABSITE

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How to study for the Senior ABSITE

The Senior ABSITE is significantly different from the Junior ABSITE and students struggles to reconcile those differences.

One student writes: “All those above me have that skimming through Fiser and doing the usual minimal things that i do for the absite and get by will not work.”

Resources that students use include:
- Sesap
- Fiser books
- MSU

How to study for the Senior ABSITE

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How to study for the ABSITE

Filed under: Uncategorized — admin @ 8:06 am

How to study for the ABSITE

“Reading and preparing for your cases and conferences is an excellent way to retain information than just trying to read a text cover to cover. If you can then supplement this with reading from the Fiser absite review, you will do well on the absite. Good luck.”

 ”Reading Schwart/Sabistan are not productive ways of studying for the ABSITE in my opinion. There’s just too much filler in those kind of textbooks.”

How to study for the ABSITE

Source: studentdoctor.net

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December 22, 2009

Instrument tie suture technique

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Instrument tie suture technique

 

INSTRUMENT TIE – at 1:50 of video

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How to put on a surgical gown

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How to put on a surgical gown

 

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Foley Catheter Insertion

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Foley Catheter Insertion

Note: Please be advised that these manniquins show male and female parts.

 VIDEO #1 – INSERTING FOLEY CATHETER IN A MALE

 
FOLEY CATHETER INSERTION IN FEMALE

FOLEY CATHETER INSERTION IN FEMALE

 

FOLEY INSERTION IN FEMALE

FOLEY INSERTION IN FEMALE

IF YOU FOUND THIS ARTICLE HELPFUL, PLEASE SUBSCRIBE! (ABOVE)

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Thoracentesis

Filed under: Uncategorized — Tags: — admin @ 4:27 am

Below is a series of videos and flashcards demonstrating the thoracentesis procedure.

Flashcards: Thoracentesis procedure
http://www.flashcardmachine.com/601249/4×7i

Flashcards: Pleural effusion and lab interpretation
http://www.flashcardmachine.com/480154/8y5g

THORACENTESIS VIDEO FROM THE NEJM

 

THORACENTESIS VIDEO

 

THORACENTESIS VIDEO

 

IF YOU FOUND THIS HELPFUL, PLEASE CLICK SUBSCRIBE!

IF YOU WOULD LIKE ME TO CREATE A SUMMARY OF A SPECIFIC  SURGERY OR PROCEDURE , EMAIL ME AT akpeneatexaminer@gmail.com and I’ll put one together for you.

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December 12, 2009

Paracentesis

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Paracentesis

Below are videos and flashcards on paracentesis.

Paracentesis flashcards

http://www.flashcardmachine.com/368164/7ee4

PARACENTESIS VIDEO

IF YOU FOUND THIS ARTICLE HELPFUL, PLEASE SUBSCRIBE! (ABOVE)

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December 9, 2009

Mesenteric Ischemia

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Mesenteric Ischemia

Below are some videos and flashcards on mesenteric ischemia.

Mesenteric Ischemia Flashcards

http://www.flashcardmachine.com/480272/b56k

MDCT/CTA Acute Mesenteric Ischemia Part 1 by Johns Hopkins

MDCT/CTA Acute Mesenteric Ischemia Part 2 by Johns Hopkins

MDCT/CTA Chronic Mesenteric Ischemia (Part 3 of mesenteric ischemia series) by Johns Hopkins

IF YOU FOUND THIS INFORMATION HELPFUL, PLEASE SUBSCRIBE (ABOVE!) AND RECEIVE PERIOD UPDATES ON MEDICAL TOPICS FOR HEALTHCARE PROFESSIONALS!

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December 8, 2009

Hernias

Filed under: Uncategorized — Tags: — admin @ 2:01 pm

Below is information on hernias.

Hernias: General information and history and physical exam flashcards
http://www.flashcardmachine.com/476369/9te3

Inguinal anatomy flashcards
http://www.flashcardmachine.com/417265/q86k

Types of hernias flashcards
http://www.flashcardmachine.com/564050/x6j9

Hernia repair flashcards
http://www.flashcardmachine.com/564054/6ig3

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October 10, 2009

Flying Fish

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It’s not every day that one asks for an Amazon Kindle. It’s not eery day I I want a television, or the moon, or the stars. The music above is enticing, well written. I want to dance and sing. I want to get up and move my body like flowers in the wind. The music is intoxicating, like wild lfowers mixed with poppy seeds laced with sugar. The beat is uplifting, incredible, unforgiving, addictive. It’s surreal, almost. Up and down I flow, like surface of a river gone awry in a flood, during a storm, as it thunders, surrounded by a whirlwind. I need music to keep me going.

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testing

Filed under: Uncategorized — admin @ 10:02 am

attempting

epndomainepndomain

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October 8, 2009

Kaplan MCAT Test Prep

Kaplan MCAT Test Prep

The Kaplan MCAT Test Prep is a great course for premedical students. You can find out more about their online or live courses and read student reviews here.

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October 7, 2009

Finance

Filed under: Uncategorized — Tags: , , — admin @ 4:50 am

Finance

Prepaid, but Not Prepared for Debit Card Fees
This article discusses the hidden fees in prepaid debit cards. Do not buy or ues these cards.

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October 4, 2009

International Medical Graduates

Filed under: Uncategorized — Tags: , , , — admin @ 11:12 am

International Medical Graduates

USMLE STEP 1
International Medical Graduates: Significance of your USMLE score

USMLE STEP 2 CS
USMLE Step 2 CS For The IMG

BOOK REVIEWS
The International Medical Graduate’s Best Hope
The International Medical Graduate’s Guide to Us Medicine and Residency Training
First Aid for the International Medical Graduate

The Successful IMG: Obtaining a US Residency
The IMG’s Guide to Mastering the USMLE and Residency

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Residency Applications

Filed under: Uncategorized — admin @ 7:16 am

Residency Applications

GENERAL ADVICE
Residency Match Success: Lessons Learned
.
What residency programs are looking for in an applicant
.
Making a Successful Match
.
The Successful Match: Interview with Dr. Roy Ziegelstein
.
The Successful Match: Interview with Dr. Marianne Green

ERAS APPLICATION
How to fill out the Account section of ERAS.

PERSONAL STATEMENT
Residency Personal Statement .

RESUME AND CURRICULUM VITAE
How to set up a medical school resume to match the ERAS residency application
.

MATCH DAY
Match Day
.

THE SCRAMBLE
The Scramble: How It Works and How It Can Be Improved

ARTICLES
Impact of Resident Work-Hour Restrictions
.

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Second year medical students

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Second year medical students

GENERAL ADVICE
Advice for 2nd year medical students

MEDICAL TOPIC REVIEW – coming soon…
Anatomy
Behavioral Sciences
Biochemistry
Cardiovascular Disease
Cardiovascular System
Endocrinology
Epidemiology
Gastrointestinal System
Genitourinary System
Molecular and Cell Biology
Musculoskeletal System
Neurology
Pathology
Pulmonary System
Statistics

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First year medical students

First year medical students

GENERAL ADVICE
Advice for first year medical students.
Equipments that first year medical students should buy.

How to set up a medical school resume to match the ERAS residency application  .
What to do if you fail a course  .
The importance of class attendance  .
Study strategies: Wasting time and less efficient practices  .
Balancing the need to study for the boards and your need to study for your class  .
Striking a balance between school, personal life, and professional obligations  .

 



MEDICAL STUDENT TOPIC REVIEW
Coming soon…

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October 1, 2009

Other articles

Filed under: Uncategorized — Tags: — admin @ 2:47 pm

Other articles

Conferences

  

Anatomy
Behavioral Sciences
Biochemistry
Cardiovascular Disease
Cardiovascular System
Endocrinology
Epidemiology
Gastrointestinal System
Genitourinary System
Molecular and Cell Biology
Musculoskeletal System
Neurology
Pathology
Pulmonary System
Statistics

  
How to study for USMLE Step 1



=========================================
RESIDENCY APPLICATIONS

Applying into General Surgery
General Surgery Residency
General Surgery Residency: The hardest part of going into it
General Surgery Residency: Preliminary vs Categorical spots
General Surgery Residency: How to survive the application process

How to study for USMLE Step 3
Advice for IMGs
How to apply to general surgery as an IMG

Other Residencies and Alternate careers
The Successful Match: Getting into Ophthalmology

20 Questions: Gary Flashner, MD [Family Medicine]

Opportunities in Medical Writing

Medical Student Book Reviews
International Medical Graduates (IMGs)
The International Medical Graduate’s Best Hope
The International Medical Graduate’s Guide to Us Medicine and Residency Training
First Aid for the International Medical Graduate

The Successful IMG: Obtaining a US Residency
The IMG’s Guide to Mastering the USMLE and Residency

==============================================
MORE TOPICS…

USMLE Step 1
USMLE Step 1 Topics
USMLE Step 2 CK
USMLE Step 2 CS
USMLE Step 3


College Students

High School Students

Summer programs for highschool students

OTHER STUDENTS
Accounting
Comedy
COMLEX
DAT
GRE
NAPLEX
OAT
PCAT

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the

A television cameraman takes a nap at the U.S. Capitol in Washington, D.C.

Poetry Response to A Look at Who Naps

MEDICAL STUDENT MENTORING LINKS BELOW

Portrait of Isabella D’Este http://artsbeat.blogs.nytimes.com/2009/07/29/louvre-online-to-open-database-in-english/

Le Jeune Homme et la Mort  – Baryshinikov

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Clinical Rotations

Filed under: Uncategorized — Tags: , , — admin @ 2:23 pm

Clinical Rotations

Coming soon..

Anesthesia Rotation.
Emergency Medicine.
Family Medicine Rotation.
Medicine Rotation.
Neurology Rotation.
OBGYN Rotation.

Orthopedic Surgery .
Pediatrics Rotation.
Psychiatry Rotation.
Radiology Rotation .
Surgery Rotation .
Urology Rotation .

Articles
Frequently Asked Questions Regarding Clinical Rotations

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UCSF medical student articles

Filed under: Uncategorized — Tags: — admin @ 1:39 pm

UCSF medical student articles

UCSF Student Housing Exchange
UCSF Student Book Exchange

UCSF Medical Students on YouTube
Medical student rap videos on youtube

UCSF Medical School Curriculum
UCSF PRIME Program

Transportation around UCSF: MUNI and nextmuni.com

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USMLE Step 3

Filed under: Uncategorized — Tags: — admin @ 1:21 pm

USMLE Step 3

USMLE STEP 3
Cardiovascular system for USMLE Step 3

Skin and connective tissue disorders for USMLE Step 3
Endocrine system for USMLE Step 3

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USMLE Step 2 CK

Filed under: Uncategorized — Tags: — admin @ 1:16 pm

USMLE STEP 2 CK

USMLE WORLD
USMLE World  scores and Step 2 scores
USMLE World self assessment
 

KAPLAN
Kaplan Step 2 CK test prep

NBME
NBME step 2 CK self assessments

How to study for the USMLE Step 2 CK

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USMLE Step 1

USMLE Step 1

USMLE STEP 1

Step 1 USMLE Flashcards.
Predictors of USMLE Step 1 Score
.
Significance of your USMLE Step 1 score
.
USMLE Step 1 Pharmacology Books For Intuitive Personality Type
.
People with Difficulties with USMLE exams

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Zhu Zhu Pets

Filed under: Uncategorized — admin @ 12:30 pm

Zhu Zhu Pets

Zhu zhu pets are interactive hamsters and anticipated to be one of the more popular toys this Christmas season.

List of  Items  (click for reviews)

Zhu Zhu Pets Hamster Mr. Squiggles – Light Brown

Zhu Zhu Pets Hamster Num Nums

Zhu Zhu Pets Hamster Funhouse

Zhu Zhu Pets Hamster Pipsqueek – Yellow

Zhu Zhu Pets Hamster Chunk – White

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Zombieland

Filed under: Uncategorized — admin @ 7:38 am

Zombieland

Below is a list of Zombieland items.

POSTERS
Zombieland Double Sided Original Movie Poster 27X40 ~ MoviePosterBest

TOYS

Zombie Kit “Shannon” – LEGO Compatible Minifigure Pieces ~ The Big Toy Hut

Zombie Kit Set #1 – LEGO Compatible Minifigure Pieces ~ The Big Toy Hut

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The Chronicles of Narnia

The Chronicles of Narnia

The Chronicles of Narnia is a great book for adults and children alike.

Here are a list of books and items from this book.

The Chronicles of Narnia Box Set: Full-Color Collector’s Edition ~ C. S. Lewis

The Lion, the Witch and the Wardrobe (Chronicles of Narnia) ~ C. S. Lewis

I will add more to this list soon.

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August 6, 2009

July 31, 2009

Adwords

Filed under: Uncategorized — Tags: — admin @ 7:29 am

Adwords

Great resources on how to use adwords

http://www.adwords-marketing-tool.com/blog/

http://advertising.suite101.com/article.cfm/creating_great_google_adwords_ads

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July 30, 2009

A Look At Who Naps

Filed under: Uncategorized — Tags: , , — admin @ 7:31 am

A Look At Who Naps by Sam Roberts

 

This is my poetry response to an article in the NYTimes, “A Look At Who Naps” by Sam Roberts. 

 

Napper’s Delight

Guilty as sin! A napper is told
National survey release was today doled

Sleep deprived people from all walks of life admit
All I need is a little nap, as I sit, just a bit

Race and sex again related
The unemployed have also been spotted

Nap if you will, as the poor do often
Article reading with eyes resting on a swaying train in Brooklyn

Do you nap because you are ill?
Are you indeed just too lazy with no real skill?

Many are said to take the nappers thrill
Einstein, Edison, Reagan, Clinton, and Churchill

So nap if you can, no need for shame
Nap is the new exercise! You should thus claim

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July 29, 2009

Anatomy Videos

Filed under: Uncategorized — Tags: — admin @ 11:46 pm

Anatomy Videos

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The ACLS Pocket Survival Guide

The ACLS Pocket Survival Guide (Emergency Medicine Pocket Survival Guides) by Thomas Masterson

Click on the link or image below to learn more about this book.

     

The ACLS Pocket Survival Guide (Emergency Medicine Pocket Survival Guides) by Thomas Masterson

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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July 28, 2009

Success in ACLS Tips and Tricks for Passing the ACLS Course by Shaun Fix

Success! in ACLS Tips and Tricks for Passing the ACLS Course by Shaun Fix

Click on the link or imge below to learn more about this book.

     

Success! in ACLS Tips and Tricks for Passing the ACLS Course by Shaun Fix

 

 

 

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Rapid ACLS by Barbara Aehlert

Filed under: Uncategorized — Tags: , , — admin @ 7:21 pm

Rapid ACLS by Barbara Aehlert

Rapid ACLS by Barbara J Aehlert

Click on the link or image below to learn more about this book.

       

Rapid ACLS by Barbara J Aehlert

 

 

 

 

 

 

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Abuse Flashcards

Filed under: Uncategorized — Tags: , — admin @ 7:14 pm

Abuse Flashcards

Click on the link below to access the flashcards on abuse, including domestic violence, child abuse, and elderly abuse.

access makes your cards available via a direct URL that doesn’t require registration.

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July 27, 2009

Black Eyed Peas

Filed under: Uncategorized — Tags: , — admin @ 5:48 am

Black Eyed Peas

Click on the images below to watch the videos

Black Eyed Peas “Boom Boom Pow”

Channel Icon

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July 26, 2009

ACLS Study Guide by Barbara Aehlert

Filed under: Uncategorized — Tags: — admin @ 3:06 pm

ACLS Study Guide by Barbara J Aehlert

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ACLS Review Made Incredibly Easy! (Incredibly Easy! Series) by Springhouse

ACLS Review Made Incredibly Easy! (Incredibly Easy! Series) by Springhouse

Click on the link or image below to learn more about this book.

ACLS Review Made Incredibly Easy! (Incredibly Easy! Series) by Springhouse

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ACLS Basics and More w/Student CD And DVD by Kim McKenna

ACLS Basics and More w/Student CD And DVD by Kim McKenna

Click on the links and images below to learn more about this book.

ACLS Basics and More w/Student CD And DVD by Kim McKenna

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3M Littmann Lightweight Stethoscope

Filed under: Uncategorized — Tags: — admin @ 8:56 am

3M Littmann Lightweight Stethoscope

3M Littmann Lightweight 11 SE Stethoscope, 28″, Black, #L2450 by Littmann

Click on the link or image below to learn more about this stethoscope.

3M Littmann Lightweight 11 SE Stethoscope, 28″, Black, #L2450 by Littmann

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ACLS (Advanced Cardiac Life Support) Review: Pearls of Wisdom, Third Edition (Pearls of Wisdom Medicine) by Michael Zevitz

ACLS (Advanced Cardiac Life Support) Review: Pearls of Wisdom, Third Edition (Pearls of Wisdom Medicine) by Michael Zevitz

Click on the link or image below to learn more about this book.

ACLS (Advanced Cardiac Life Support) Review: Pearls of Wisdom, Third Edition (Pearls of Wisdom Medicine) by Michael Zevitz

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2009 Comlex Experiences

Filed under: Uncategorized — Tags: — admin @ 8:13 am

2009 Comlex Experiences

Click here to read the posts on student doctor.

The specific link is: http://forums.studentdoctor.net/showthread.php?t=624057

Good luck.

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July 25, 2009

Homepage

Filed under: Uncategorized — admin @ 7:41 am

We’re currently having some technical difficulties with the website. Here are some important links.

  • UCSF Medical School Curriculum
  • UCSF Student Mentoring Website
  • UCSF Medical Student Blogs
  • UCSF Student Book Exchange
  • UCSF Student Housing Exchange
  • UCSF Medical Students on YouTube
  • UCSF PRIME Program
  • Scholarships
  • Conferences
  • Articles For Medical Students
  • Advice for first year medical students
  • Advice for 2nd year medical students
  • Advice For Clinical Rotations
  • 4th Year Schedules
  • Books For Medical Students
  • EKG References
  • How to be an effective lecturer
  • Personality Types
  • USMLE Step 1
  • USMLE Step 1 Topics
  • USMLE Step 2 CK
  • USMLE Step 2 CS
  • USMLE Step 3
  • Emergency Medicine
  • Family Medicine Rotation
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    testing

    Filed under: Uncategorized — admin @ 7:29 am

    testing

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    USMLE Step 2 CS For The IMG

    Filed under: Uncategorized — Tags: — admin @ 5:36 am

    USMLE Step 2 CS For The IMG

     

    USMLE Step 2 CS For The IMG

    USMLE Step 2 CS For The IMG

    USMLE Step 2 CS For The IMG

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    Emergency Medicine SubI – Top 10 Most Common Chief Complaints

    Emergency Medicine SubI – Top 10 Most Common  Chief Complaints

    source: http://www.fresno.ucsf.edu/em/medical_students.htm

    Top 9-10 most common chief complaints

    - Lacerations

    - Abdominal pain

    - Problems of pregnancy

    - Chest pain

    - Urinar

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    July 24, 2009

    Twilight Zone The Complete Definitive Collection

    Filed under: Uncategorized — Tags: , , , , — admin @ 4:59 pm

    Twilight Zone: The Complete Definitive Collection

    Click on the link or image below to read reviews.

            

    Twilight Zone: The Complete Definitive Collection

     

     

    Description

    Product Description
    For the first time ever, find all 156 complete episodes of Rod Serling’s groundbreaking series in one box set, packed with exciting extras! Travel to another dimension of sight and sound again and again through these stellar remastered high-definition film transfers. Extras include the fascinating Serling bio-documentary Submitted for Your Approval, compelling interviews with the show’s writers, the series’ unaired pilot, audio commentaries with Martin Landau, Leonard Nimoy, Cliff Robertson and much, much more! – amazon
    Review
    Giving this set a bad rating because you already bought an earlier set is doing any potential buyers of this set a grave injustice.

    It is, simply, astonishing. Why? Start with digital transfers from the original camera negatives and magnetic tracks. Add commentaries for the majority of episodes. And multiple commentaries for several episodes. Add Rod Serling’s college lectures used for commentaries. Add interviews with cast and crew members. Add isolated msic scores. Add intros and outros. Add network promo spots. Add the TWILIGHT ZONE radio dramas and comic books…I could go on but why bother? If you are a TWILIGHT ZONE FAN, you won’t be disappointed.  – D. Alan

    Twilight Zone: The Complete Definitive Collection

    Click on the link or image below to read reviews.

            

    Twilight Zone: The Complete Definitive Collection

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    Acne Pro

    Filed under: Uncategorized — Tags: , — admin @ 9:38 am

    Acne Pro

    How to use Acne Pro

    Acne Pro is a website that teenagers go to to find information about acne. They offer information about the various acne treatments that are available, their individual ingredients, and user reviews.

    First, review the acne products on their site. Information can be found about products such as Acnezine, ClearPores, and Zyporex.

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    July 23, 2009

    Acute Coronary Syndrome

    Filed under: Uncategorized — Tags: , — admin @ 4:58 pm
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    Equipments that first year medical students should buy

    Equipments that first year medical students should buy

    I asked UCSF medical students what equipments they thought were necessary for the first year. Here is the response I received from one student.

     

    ON EQUIPMENTS

     

    1. Stethoscope – yes, absolutely. A penlight is also important. The tuning fork is definitely useful and inexpensive, and you’ll need a reflex hammer, although you won’t use them until BMB. As far as the reflex hammer is concerned, lots of students this past year were disappointed that they bought the cheap, small, tomahawk-style hammers. They’re easier to carry but much harder to elicit a reflex with. I recommend the long hammer with the flat circular thingamabob at the end. All of the other equipment is optional – I borrowed some of it – but remember, the point of having the equipment is to PRACTICE using it. Using the equipment, and feeling competent when taking someone’s blood pressure, for example, is MUCH harder than it looks. It’s better to do it over and over again with someone you know than to look/feel like a novice with your first 50 patients. Although I haven’t bought the opthalmoscope, I’ve thought about it. Opthalmoscopes are extremely hard to use; apparently it takes ages to feel competent at it. You don’t want to miss your patient’s only sign of high intracranial pressure because you never got the chance to practice using an opthalmoscope, so if you don’t buy one, make sure you volunteer somewhere where you can practice using one as much as possible. Sun, 8/31/08 10:36 PM

     

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    Healer’s Art Mini-Retreat at Commonweal

    Filed under: Uncategorized — admin @ 12:17 pm

    Healer’s Art Mini-Retreat at Commonweal

    Saturday, May 2, 2009

    For Third and Fourth Year UCSF Students

    You are invited to a special one-day retreat on May 2nd at Commonweal, a beautiful oceanside retreat center in Bolinas, CA (about one hour north of San Francisco). It is being offered because many students in the past have asked to open the Healer’s Art to students in the clinical years. The retreat will be led by UCSF’s Michael Rabow, MD, and Dianne Duchesne, RN, CPHN, a former hospice nurse who works closely with Dr. Rachel Remen.
    This unique event will be an opportunity to personally examine the nature of your intent to serve, renew your own commitment to service, reconnect with your calling to medicine, experience symbolic sand tray work, and write a personal mission statement. This retreat will be a chance to prepare for transition into fourth year and residency with other classmates.

    All students in the third and fourth year classes are invited and attendance is free. Lunch will be provided. Please email me by April 27th to reserve a space.

    Michael W. Rabow, MD
    mrabow@medicine.ucsf.edu

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    The Shack by William Young

    Filed under: Uncategorized — admin @ 9:07 am

    The Shack by William Young

    Click on the link or image below to read reviews.

    The Shack by William Young

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    USMLE Step 2 CK Advice

    Filed under: Uncategorized — Tags: — admin @ 9:02 am

    NMS Review for USMLE Step 2 CK (National Medical Series for Independent Study) by Kenneth Ibsen

    ==================================

    First Aid for the USMLE Step 2 CK (First Aid USMLE)

    Kaplan Medical USMLE Step 2 CK Qbook

    Deja Review USMLE Step 2 CK (Total Recall Series)

    First Aid Cases for the USMLE Step 2 CK

    First Aid Q&A for the USMLE Step 2 CK (First Aid Series)

    NMS Review for USMLE Step 2 CK (National Medical Series for Independent Study)

    —————————

    Here’s a good website:
    http://www.medschoolhell.com/2007/03/27/five-usmle-step-2-study-methods-that-work/

    Another good website with Step 2 CK advice:
    http://www.prep4usmle.com/forum/thread/65880/

    More from prep4usmle on Step 2 CK: http://www.prep4usmle.com/forum/thread/69396

    http://www.usmleforum.com/forum/index.php?forum=2

    Good advice from students who just recently took step 2 CK. Nice forum too.

    http://www.usmleforum.com/files/forum/2007/2/248274.php

    Download step 2 CK audio prep for free

    http://ucsfstudents.wordpress.com

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    3 Comments »

    1. ucsfstudents said

    Here is a great site

    http://usmlemd.wordpress.com/2008/07/04/usmle-step-2-ck-preparation-how-to-get-a-good-score/

  • ucsfstudents said

    Scores from random students who took Step 2, including a list of resources the used

    http://www.prep4usmle.com/forum/thread/12074/17/

  • ucsfstudents said

    Website for Step2 CK content and expectations

    http://www.usmle.org/Examinations/step2/step2ck_content.html

    PDF file
    http://download.usmle.org/2008step2.pdf

    Step 2 CK Content: short version (scroll down to the middle of the webpage for step 2)
    http://www.usmle.org/General_Information/bulletin/2008/content.html#step2ck

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    Clinical Microbiology Made Ridiculously Simple

    Clinical Microbiology Made Ridiculously Simple

    Click on the link or image below to read reviews or get this book.

            

    Clinical Microbiology Made Ridiculously Simple

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    High-Yield Embryology by Dudek

    High-Yield Embryology by Dudek

    Click on the link or image below to read student reviews or get this book

            

    High-Yield Embryology by Dudek

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    High-Yield Behavioral Science by Fadem

    High-Yield Behavioral Science by Fadem

    Click on the link or image below to read reviews or get this book.

            

    High-Yield Behavioral Science by Fadem

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    First Aid for the USMLE Step 1 2010

    First Aid for the USMLE Step 1 2010

    Click on the link or image below to read student reviews or get this book.

            

    First Aid for the USMLE Step 1 2010

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    USMLE Step 1 Books

    USMLE Step 1 Books

    Click on any of the images below to read reviews or get the book.


     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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    Neuroanatomy Through Clinical Cases by Blumenfeld

    Neuroanatomy Through Clinical Cases by Blumenfeld

    Click on the link or image below to read student reviews or get this book.

            

    Neuroanatomy Through Clinical Cases by Blumenfeld

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    Managing Surgical Oncology Patients

    Managing Surgical Oncology Patients

    The patients on the White or surgical oncology team have certain presentations that you should read about either before starting your rotation, or during.

    Common diseases you will come across on this rotation are:

    - gastric adenocarcinoma

    - Resection of sections of small bowel

    - GIST gastrointestinal stromal tumor

     

    Common management issues:

    - pain

    - fluids

    - low UOP / rising Crt

    - emesis

    - SBO vs ileus

    - Drain management/ tube checks

    - Cdiff/loose stol

    - electrolyte repletion

    - the distended abdomen

    - Wound erythema/infection

    - What to do before discharge

    - When to advance diet

    Common imaging modalities

    - CXR, AXR

    - CT

    - MRI

    - Abd series

    - esophogram

     

    Presenting

    When presenting fluids, what you should pay attention to is the rate. For example, you would say,  I/O’s  1538/48945, IVF @ 125.

    I plan to add more to this page and to organize it to.

    Share with us what YOU’VE learned by leaving a comment below.

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    Melanoma clinic with Dr. Leong

    Filed under: Uncategorized — Tags: , , — admin @ 6:36 am

    Melanoma clinic with Dr. Leong

    Melanoma clinic with Dr. Leong is awesome. You will learn a lot and he is an amazing physician and surgeon.

    So this is the information you want to gather from the patient’s chart and HPI before presenting to Dr. Leong.

    - age

    -cancer

    - any operations, dates

    - pathology

    - chemotherapy (name, how many times)

    - why patient is here

    - LN involvement

    - why pt was referred to melanoma clinic

    - any imaging

    - PE: make sure you do a good skin exam and know how to describe skin lesions; relate the location to anatomical landmarks

    - labs

    - assessment & plan

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    Surgical Oncology SubI

    Surgical Oncology Sub-I

    As I prepare for my surgery subI experience, I will keep a list of wonderful resources and things I learn along the way.

    I came across AccessSurgery today. I didn’t even know it existed. It seems like a good resource. I came across it while looking for some free online atlases for surgery. They even have a board review/questions section.

    http://www.accesssurgery.com/index.aspx

    http://medicalpblukm.blogspot.com/2008/08/ethicon-suture-manuals.html This website has the link to downloadable suture manuals and knot tying document.

    Below are links to SDN sites

    http://forums.studentdoctor.net/archive/index.php/t-189749.html

    http://forums.studentdoctor.net/archive/index.php/t-302514.html

    http://forums.studentdoctor.net/showthread.php?t=534606

    Ethicon Knot Tying Manual

    http://www.mcg-2008.com/knot_tying_manual.pdf

    You can call 1-800-255-2500 (Ethicon) and ask for the following:Ethicon Knot Tying Board
    Ethicon Knot Tying Manual
    Ethicon Knot Tying Rope
    They will ship these to you for free. This is the board that is shown in the above manual.

     

    Other surgical skills sites:

    http://www.edu.rcsed.ac.uk/video_album_clips_menu_basicskills.htm

    If you have any advice for me, leave it below. Thanks!

     

    Admit Orders

    - Admit to level of care: Acute care (if after regular operation)

    - Service: obvious

    - Attending: attending on the operation

    - First call provider/pager:  service pager, usually held by the intern

    - Diagnosis/Operation performed: obvious

    - Condition: Good, fair, or poor

    - Code status: Most all of the patients are full code

    - Allergies: Check their preop notes, or recently filled out forms for any listed allergies. This is very important.

    - Check vital signs:  For acute or transitional care, you can check the vitals Q4H

    - Call house officer for: 

    HR >110, <55

    BP > 180, <95

    RR > 26, <10

    T > 38.5, <36

    O2 sat < 93%

    UO < 30 ml/hour

    Continuous cardiac monitoring: Do you need it?

    Activity: Usually Walk TID is a good option.

    Special precautions: Are there any? (seizure, neutropenic, aspiration, fall risk, respiratory, organism)

    Smoking cessation counseling: Do they smoke?

    Bedside care: Usually AM weights on admit, and daily if clinically indicated

    Intake and Output: usually Q8H to start off

    Bedside Care:  foley (if the patient is using an epidural, you need to keep the foley in; otherwise you can D/C the foley at midnight after the operation, and have the nurses call HO if patient has not urinated within 6 hours after the foley is removed), NGT, JP drains, chest tubes, compression stockings, blood glucose checks, wound care/dressing orders, other.

    Oxygen: 0-6L adjust oxygen to keep > 92%

    ICS

    Does the patient need continous pulse oximetry? CPAP? BIPAP (IPAP, EPAP?), Other respiratory orders?

    Intravenous fluids:

    - Can start with D5 NS @ 125 ml/hr or D5LR @ 175ml/hr; but there are many different ways people start the fluids

    Diet: Can the patient start off with a regular diet? Or do they need a special type of diet?

    List of diet types:  regular, diabetic carb control  (1800,2000,2400 calories/day); renal, CRI/neutropenic, ice chips/sips for comfort not to exceed 100ml/8hrs; enteral tube feeding form, advance diet as tolerated, begin with…., patient may have food from home/outside; full liquid, soft, pureed, dysphagia, NPO except medications, TPN forms, clear liquid, low fiber, 2g sodium (cardiac), post-surgical, strict NPO.  (wow, what a long list!)

    More to come…

    —————————

    Pre-rounding

    - the morning after surgery, you should know what the patient’s urine output has been within the past 3-6 hours. Talk to the nurse to get the information on how they are doing fluid wise.

    - know how much the patient’s drain has put out. Look at the drains yourself and add the volume you see to the volume that has already been recorded by the nurses. Is the JP drain to bulb suction or continuous suction?

    - know what your patient is getting for prophylasis: ICS, SQH, TEDS, etcs.

    - Know what your patient is getting for pain management: epidural, PCA, pain meds, etc.

    - Know why the patient is having pain. Is it due to the incision or due to something else?

    - know what antibiotic and abx day and the reason for the abx and the length of time you plan to give it to the patient

    - Know if labs are pending, if they were ordered for this am, if you have to recheck them this afternoon, and if you have to write for labs for tomorrow am

    - Know the patient’s labs and cultures

     

    Rounds/Presentations/Orders

    - Know the post operative date, and importantly, know what operation the patient had done

    - replete electrolytes

    - decrease their IVF if you’re advancing their diet and increasing their PO intake

    - Is the patient hyponatremic? Consider fluid restriction (for example, to 1.5L/day) if clinically indicated

    Progress Notes

    - Only write the pertinent labs and abnormal labs; Other labs can be looked up by anyone

    - Know what part of the body the drain is coming out of, why you have the drain there, and under what conditions you will pull the drain

    - know when you should get a tube check for the drain

    - check the patient’s wound, check to see if it’s infected, send it for culture if you have to, start abx if you suspect infection

    - change dressings

    - Are you doing wet to dry dressings? removing staples? etc. etc.

    - Ins and outs

    - does the patient have nausea? emesis? do they need NGT?

    - IVF TKO or SLIV, etc. i.e. when to stop the IVF?

    - follow up with any consult notes

    - Do you need to do a 24 hour urine collection to determine the nitrogen balance of your patient?

    - Have you calculated the total caloric needs of your patient and whether or not you are supplying them with that?

    - Talk to the nurses and ask for their opinion, advice

    - Who needs to be discharged today? You’ll have to fill out the discharge orders and medications; You’ll need a script for controlled medications.

    - When should you take out the wound bag? When you do though, make sure to put guaze over it and tape around the circumference of the guaze

     

    Random Notes

    - always check the patient chart for admission forms

    - If the patient has an abdominal infection after an abdominal surgery, the primary goal is to control the infection

    - Most fistulas that develop after abdominal surgery will resolved on their own if they can’t see it.

    - Enteral nutrition is preferable

    - You should replete lytes on all patients.

     

    Discharge

    - Don’t D/C a patient’s PCA the day you plan to send them home. You should d/c it the day before so that you can they’re pain is managed well with oral medications.

    Topics to review

    - wide local excision

    - right axillary sentinel node dissection

    - inguinal lymph node dissection

    - Abdominal partial gastrectomy

    - calculation of caloric needs; Harris-Bennedict equation, using usual body weight

    - abdominal liver wedge biopsy

     

    What I learned from different folks

    - The personality of surgeons is: They like to get things done; they like to cut.

    Common Medications

    Norco 10/325 1-2 po q6h prn pain #40

    Colace 250mg #30 BID X 2 weeks

    Vicodin 1-2 tabs po Q4h prn pain #50

     

    How to help in the operating room

    - Write the orders

    - What exactly are you doing to include in your op note? You’re going to include the patient’s diagnosis, type of surgery, and specimens collected. You’re going to also need to know the names of the people who helped with the surgery.  You should also include whether the patient is being sent to the PACU, Ward, discharge from hospital, ICU, NICU, or other.

    - You should know all of the patients home meds, including prn meds

     

    Books I used for this rotation:

    Hospitalist handbook by Shah

    The Mont Reid Surgical Handbook 5th ed by Fisher and Kelly

    The MD Anderson Surgical Oncology Handbook by Feig, Berger, Fuhrman  You should get the newest edition b/c recommendations change

    Essentials of Surgical Oncology by Kaiser, Sabel, Sondak, Sussman. Very helpful.  ISBN 0-8151-4385-0

    An Atlas of Surgical Oncology; Fundamental Procedures, volume 1 and 2. by Sugarbaker.  Very old book, but also helpful in helping you visualize what will happen in the OR

    Color Atlas of Anatomy: A photographic study of the human body: 5th edition. By Rohen, Yokochi, Lutjen-Drecoll.  ISBN 0-7817-3194-1   (priceless book. It pretty much used this to review anatomy before each case. One of the best anatomy books I’ve come across.

    Surgical Recall 4th edition by Blackbourne. This was a great quick read before each operation. It’s definitely wort it.

    Surgery. 6th edition. Current Clinical Strateries; By Wilson. Also very good, short read.

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    July 22, 2009

    Rapid Interpretation of EKGs Sixth Edition Dubin

    Rapid Interpretation of EKGs Sixth Edition Dubin

    Click on the link or image below to read reviews or get this book.

            

    Rapid Interpretation of EKGs Sixth Edition Dubin

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    Rapid Review Pathology With STUDENT CONSULT Online Access Goljan

    Rapid Review Pathology With STUDENT CONSULT Online Access Goljan

    Click on the link or image below to read reviews or get the book.

             

     Rapid Review Pathology With STUDENT CONSULT Online Access Goljan

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    July 12, 2009

    Michael Jackson Memorial T-Shirt – King of Pop

    Filed under: Uncategorized — Tags: — admin @ 8:54 am

    Michael Jackson Memorial T-Shirt – King of Pop

    Click on the link or image below to get this T-Shirt.

        

    Michael Jackson Memorial T-Shirt – King of Pop

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    Michael Jackson King of Pop Memorial T shirt (Mens, Womens, Juniors)

    Filed under: Uncategorized — Tags: , , — admin @ 8:41 am

    Michael Jackson King of Pop Memorial T shirt (Mens, Womens, Juniors)

    Click on the link or image below to get an MJ T-Shirt.

         

    Michael Jackson King of Pop Memorial T shirt (Mens, Womens, Juniors)

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    Michael Jackson Glove Womens T-Shirt

    Filed under: Uncategorized — admin @ 8:30 am

    Michael Jackson Glove Womens T-Shirt

    Click on the link or image below to get this T-Shirt.

            

    Michael Jackson Glove Womens T-Shirt

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    Unmasked: The Final Years of Michael Jackson Ian Halperin

    Filed under: Uncategorized — admin @ 8:12 am

    Unmasked: The Final Years of Michael Jackson  Ian Halperin

    Click on the link or image below to learn about this book.

         

    Unmasked: The Final Years of Michael Jackson  Ian Halperin

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    Life Commemorative: Michael Jackson Life Magazine

    Filed under: Uncategorized — admin @ 8:03 am

    Life Commemorative: Michael Jackson Life Magazine

    Click on the link or image below to read this.

            

    Life Commemorative: Michael Jackson Life Magazine

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    July 10, 2009

    First Aid for the USMLE Step 2 CK Vikas Bhushan

    Filed under: Uncategorized — Tags: — admin @ 1:16 pm

    First Aid for the USMLE Step 2 CK Vikas Bhushan

    Click on the link or image below to read student reviews.

               

    First Aid for the USMLE Step 2 CK Vikas Bhushan

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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    July 9, 2009

    Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook Series) Marc S Sabatine

    Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook Series)  ~ Marc S Sabatine

    Click on the link or image below to read student reviews.

            

    Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook Series)  ~ Marc S Sabatine

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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    July 8, 2009

    The Official SAT Study Guide ~ The College Board

    The Official SAT Study Guide  ~ The College Board

    Click on the link or image below to read student reviews.

            

    The Official SAT Study Guide  ~ The College Board

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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    The Official Guide for GMAT Review, 12th Edition ~ Graduate Management Admission Council (GMAC)

    The Official Guide for GMAT Review, 12th Edition  ~ Graduate Management Admission Council (GMAC)

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    The Official Guide for GMAT Review, 12th Edition  ~ Graduate Management Admission Council (GMAC)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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    July 7, 2009

    Garmin nüvi 760 4.3-Inch Widescreen Bluetooth Portable GPS Automobile Navigator ~ Garmin

    Filed under: Uncategorized — admin @ 5:10 pm

    Garmin nüvi 760 4.3-Inch Widescreen Bluetooth Portable GPS Automobile Navigator  ~ Garmin

    Click on the link or image below to learn more about this item.

         

    Garmin nüvi 760 4.3-Inch Widescreen Bluetooth Portable GPS Automobile Navigator  ~ Garmin

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    Zinwell ZAT-970A Digital to Analog TV Converter Box ~ Zinwell

    Filed under: Uncategorized — admin @ 5:07 pm

    Zinwell ZAT-970A Digital to Analog TV Converter Box  ~ Zinwell

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    Zinwell ZAT-970A Digital to Analog TV Converter Box  ~ Zinwell

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    Hoover F5914-900 SteamVac with Clean Surge ~ Hoover

    Filed under: Uncategorized — Tags: — admin @ 4:53 pm

    Hoover F5914-900 SteamVac with Clean Surge  ~ Hoover

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    Hoover F5914-900 SteamVac with Clean Surge  ~ Hoover

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    Hoover U5140-900 Tempo Widepath Bagged Upright Vacuum ~ Hoover

    Hoover U5140-900 Tempo Widepath Bagged Upright Vacuum  ~ Hoover

    Click on the link or image below to learn more about this item and read reviews.

                    

    Hoover U5140-900 Tempo Widepath Bagged Upright Vacuum  ~ Hoover

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    Off The Wall by Michael Jackson

    Filed under: Uncategorized — admin @ 4:41 pm

    Off The Wall by Michael Jackson

    RIP Michael Jackson

    Click on any of the images below to listen to the album.

                                                               

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    Michael Jackson 25th Anniversary of Thriller

    Filed under: Uncategorized — admin @ 4:39 pm

    Michael Jackson 25th Anniversary of Thriller

    RIP Michael Jackson

    Click on any of the images below to listen to the album.

                                                               

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    MICHAEL JACKSON T-SHIRTS – MICHAEL JACKSON TRIBUTE TEES – MICHAEL JACKSON AUTHENTIC TRIBUTE SHIRTS

    Filed under: Uncategorized — admin @ 4:04 pm

    MICHAEL JACKSON T-SHIRTS – MICHAEL JACKSON TRIBUTE TEES – MICHAEL JACKSON AUTHENTIC TRIBUTE SHIRTS

    Click on the link or image below to get MJ T-shirts.

            

    MICHAEL JACKSON T-SHIRTS – MICHAEL JACKSON TRIBUTE TEES – MICHAEL JACKSON AUTHENTIC TRIBUTE SHIRTS

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