Pituitary-
Ant pit Physiology- Pituitary hormones ( ACTH, TSH, FSH, LH, GH and Prolactin ) these trophic hormones. They act on specific target organs to release target hormones.
Adrenal - cortisol Thyroid- T4 and T3 Gonads- estradiol / testosterone.
Pathology- Some rules to remember
1) in primary pathology of pituitary trophic hormone should not be looked first as they will be in normal reference range. 2) so look for target hormone level to make the diagnosis. 3) prolactin and ACTH are only two hormones which can be suppressed by medicine. 4) so medical Rx should be tried first in case of prolactinoma and adenoma secreting ACTH.
1- Hyperprolactinemia - >; 10
Clinical- Macroadenoma -pressure symptoms-headache, visual field defects(patient hit by a car coming from side which he could not see). Macro and micro adenoma both- galactorrhea(uni or bilateral) amenorrhea, loss of libido and impotence(is like amenorrhea in female)in male.
D/D -
1) rule out pregnancy. 2) Drugs affecting dopamine level. ( dopamine secreted from hypothalamus and inhibit prolactin; So drugs inhibiting dopamine increase prolactin like antipsychotic and antiemetic.) 3) primary hypothyroidism - high TRH increases prolactin. 4) Prolactinoma - prolactin secreting adenoma. 5) non functional adenoma compressing the stalk of pituitary so decrease dopamine to reach pituitary. So leads to high prolactin. So never make diagnosis prolactinoma Just seeing high prolactin. Rule out other more common causes first.
So what is next step - urine beta hcG
Next - TSH If normal. Then think of prolactinoma.
Next - MRI brain.
Now what if it is non functional adenoma compressing stalk. How to differentiate?
Prolactin will still be high because of block of dopamine pathway in stalk. But other ant pituitary hormone will also be low. So MRI can tell whether tumor is from pituitary or stalk. Now you have diagnosis.
What to do next? Other tests or treatment?
Go for treatment. But if asked about any other test then do visual field charting if not done before.
Treatment- what is best initial Rx ?
Always Dopamine agonist. Bromocritine. Other newer drugs like (CPR) cabergolin, premipixol, ropenirol.
Why not surgery? Two reasons 1) recurrence is very high after surgery.2) only two pituitary hormone can be blocked by medical Rx; Prolectin and ACTH. None other.
So now patient is on bromocryptine. 1) Patient is responding. First symptoms to go is clinical problems like amenorrhea, impotence and visual field defects. MRI should be done to check the decrease in size at 5-6 week after Rx.
2) if patient is not responding to Rx .then think of surgery. If after surgery patient has recurrence then put him on bromocryptine.
3) if patient reproductive age female is responding. What else to do? Contraception.
4) patient is old then?
Tuesday, November 27, 2012
Friday, September 14, 2012
Best chance to get residency match in ERAS and NRMP 2013
First of all I welcome to all you guys who are struggling and working hard to get matched this 2013 residency match. I wish all you get matched the residency of your choice.
But I would like to share some Do' s and Dont points while preparing your application for match.
First of all feel positive about all this luck dependent process. So called MATCH.
If you had perfect scores then you would have not been visiting this page. I think.
So score matters a lot but not the only thing which can help you.
If your score is above 200 I think you still have chance to get match. There are so many programs whose cutoff is 200. Even for very competitive residency like Radiology. Believe me.
All you need to find and reach that right place at the right time.
So look for these programs.
Hint from me - go around north east area like new York, Philadelphia, new jersey and other near by areas. Here is the best chance you ll find what u are looking for.
Next question is how many programs you need to apply?
Well it's a tough one. Some time 100 applications are enough but it is totally waste of time and money to go above this number. Because if you have chance to get match then you get the calls enough to make you match.
So hint is search for the right programs for your application. Number not gona help you.
But how?
If you are in USA right now then you have far batter chance because you can search around and even go to the HR section of that program and drop your resume directly. You must be thinking it is a lot investment. Trust me many people I know who got lucky by this way.
I will storngly suggest you to take this step and go to the program directly. Specially if your scores are not good enough to get you calls. Because you never know it might be your lucky time. Hope!
Second points is how to enhance your chance to get in even with bad scores?
Do the thing I told you above.
Then prepare your application very cautiously and smartly. Get some weight to your CV so called SOP?
SOP- it the most important document which ll decide your fate during this application season.
How to prepare it. Well if you have money then I ll suggest you to get some expert person wrting it.
Because a well written SOP can get you many calls as a good score.
If you don't have enough funds to do that then you can write it yourself. I am not expert at this thing but I can suggest you few points how to write it.
Before you start writing SOP . Keep one thing in your mind that you are going to make a product which you have to sell . You are wrting about this product (I mean you) so mention things in such a way that PDs must find something unique in this product with out wasting his precious time.
SOP should be written in at least 4-5 paragraphs not more then that.
1) paragraph - introduction- about you. Who you are?
2) academics- write about your medical school how good that college and education is? What you have achieved that make you a right person for this job. Also write work experiences that you had after college.write those which is relevant for this program. If you are applying for IM then it's batter to mention medicine related work not OBGYN. M not saying not mention it. But do it later . Write about IM in details.once you done write other fields as well. That will enhance your versatility .
3) what makes you the right person for this job?
4) last conclude and thank for giving the precious time to to go over your SOP. You will do your best at this program. And you can be counted upon for this job.
I think that should full fill the purpose of your SOP.
Other things - like LOR, USC exp.
They all depends upon you. Batter if get US LOR and C exp. they matter at some programs but not every program need that.
So start Searching the right place this season. Have faith in GOD. He helps everyone. HE ll help us too. Just have positive attitude. just do it. No feelings of failure.
Think it this way you already lost enough, so nothing left to loose.
So this is the time to get something.
All the best.
But I would like to share some Do' s and Dont points while preparing your application for match.
First of all feel positive about all this luck dependent process. So called MATCH.
If you had perfect scores then you would have not been visiting this page. I think.
So score matters a lot but not the only thing which can help you.
If your score is above 200 I think you still have chance to get match. There are so many programs whose cutoff is 200. Even for very competitive residency like Radiology. Believe me.
All you need to find and reach that right place at the right time.
So look for these programs.
Hint from me - go around north east area like new York, Philadelphia, new jersey and other near by areas. Here is the best chance you ll find what u are looking for.
Next question is how many programs you need to apply?
Well it's a tough one. Some time 100 applications are enough but it is totally waste of time and money to go above this number. Because if you have chance to get match then you get the calls enough to make you match.
So hint is search for the right programs for your application. Number not gona help you.
But how?
If you are in USA right now then you have far batter chance because you can search around and even go to the HR section of that program and drop your resume directly. You must be thinking it is a lot investment. Trust me many people I know who got lucky by this way.
I will storngly suggest you to take this step and go to the program directly. Specially if your scores are not good enough to get you calls. Because you never know it might be your lucky time. Hope!
Second points is how to enhance your chance to get in even with bad scores?
Do the thing I told you above.
Then prepare your application very cautiously and smartly. Get some weight to your CV so called SOP?
SOP- it the most important document which ll decide your fate during this application season.
How to prepare it. Well if you have money then I ll suggest you to get some expert person wrting it.
Because a well written SOP can get you many calls as a good score.
If you don't have enough funds to do that then you can write it yourself. I am not expert at this thing but I can suggest you few points how to write it.
Before you start writing SOP . Keep one thing in your mind that you are going to make a product which you have to sell . You are wrting about this product (I mean you) so mention things in such a way that PDs must find something unique in this product with out wasting his precious time.
SOP should be written in at least 4-5 paragraphs not more then that.
1) paragraph - introduction- about you. Who you are?
2) academics- write about your medical school how good that college and education is? What you have achieved that make you a right person for this job. Also write work experiences that you had after college.write those which is relevant for this program. If you are applying for IM then it's batter to mention medicine related work not OBGYN. M not saying not mention it. But do it later . Write about IM in details.once you done write other fields as well. That will enhance your versatility .
3) what makes you the right person for this job?
4) last conclude and thank for giving the precious time to to go over your SOP. You will do your best at this program. And you can be counted upon for this job.
I think that should full fill the purpose of your SOP.
Other things - like LOR, USC exp.
They all depends upon you. Batter if get US LOR and C exp. they matter at some programs but not every program need that.
So start Searching the right place this season. Have faith in GOD. He helps everyone. HE ll help us too. Just have positive attitude. just do it. No feelings of failure.
Think it this way you already lost enough, so nothing left to loose.
So this is the time to get something.
All the best.
Tuesday, September 20, 2011
How to pass USMLE Step 2 CS on first attempt
it getting tougher day by day to pass CS on first attempt.i want to discuss few important aspect of this exam. which could help you some way to get your goal.
what to study?
well there are not so many books for CS but most of the people read First Aid and i think thats a great book but not alone.
you should read the USMLE WORLD get it print out every page make a folder. read all the topic starting from history taking, physical exam and all the cases given into it.
reading alone is of no use for this exam even if you study for years. ok so try to practice with somebody again and again.
every case should be on your tips literally.
you will be given 12 Standardized patients. they are not real patients. but keep in mind they are real examiner they will mark your performance. so be nice to them.
every case will be given 25 mins
15 mis for history and physical.
10 mins for writing the history, physical, 3-5 possible D/D and diagnostic work up.
mostly people think thats is the work we need to do and will.
but do u think 15 is enough for history and physical.
try to practice a complete case just like the real exam situation. you will find its not easy.i know.
few advice-
1- feel confident and calm yourself.
2- read the information given at the door. try to make a picture what is case all about. think about the chief
comp and try to make 3-4 D/D BEFORE KNOCKING THE DOOR.
3- now knock the door.
4-give a good smile. m serious.
5- introduce yourself. try to speak with confidence.
ex- hello mr. douglous good morn, myself dr. k i am a physician here. nice to meet you. how you doing today?
ans- fine.
6- so what i can do for you?/ what brings you in today?-open ended q?
ans-tell chief comp
7-then you need to make eye contact and ask mr. dos would you mind if write down some notes while m talking to you? this cast a impression that u really care about him.
8-then you start the case- ask the relevant q? according to the case.
can use pnemonic-PAIN
L- OCATION
I-NTANSITY
Q-UALITY
O-NSET
R-RADIATION.
A-GGREVATING FACS
A-LLEVIATING FCAS
A-SSOCIATED COMPLAINS.- according to the system involved.
fever, chills, night sweats and et. al.
+
PAM HUG FOSS-
PAST
ALLERGY
MEDICATION
H
URINE
GENITAL
FAMILY
OBS
SEXUAL
SOCIAL
few other points
1-if pat starts coughing.
give him a tissue and ask would u like a glass of water mr.....
if he say no.
again- are u sure?
always take every encounter as real clinical situation.
2-if patient is angry bcoz he think you are late.
dont think he does not like you.
try to console him. say i am really sorry mr...for making u wait so long. actually i encounter unexpected
delay with one of my patient.
to be conti...
3- always speak very clearly and slowly. dont rush things because it makes you look that you are not interested in patient problem.
4-lets the pt tell you whatever he want to.
5-once you are done taking history. dont forget to recap every point in front of patient. ask him if want to add something that i might have missed.
6-after taking history tell him that u are done with history and now i need to examine you. say like will u excuse me mr.... while i wash my hands. you can wash your hands while talking to him but make sure you dont loose the eye contacts.
7- wash hands- look what you have at wash basin. is soap available or not ? if not try to use gloves and also tell the patient and ask if he has some kind of allergy to latex.
8-before you start exam- keep few things in your mind.
consent - what ever u do always ask the permission and reason why u doing it. like mr.... i need to examine your chest, may i go for that?
mr... i need to untie your gown to examine your chest if you dont mind.
wait until he nods yes. then start untying.
try to expose as less part as possible to examine.
once you are done tie the gown up.
be gentle dont be too rough while examination. if patient is in pain be very very careful. and if pt complaints
pain always say sorry.
you can check all the top ranked books for Step 2 CS at this link.......
what to study?
well there are not so many books for CS but most of the people read First Aid and i think thats a great book but not alone.
you should read the USMLE WORLD get it print out every page make a folder. read all the topic starting from history taking, physical exam and all the cases given into it.
reading alone is of no use for this exam even if you study for years. ok so try to practice with somebody again and again.
every case should be on your tips literally.
you will be given 12 Standardized patients. they are not real patients. but keep in mind they are real examiner they will mark your performance. so be nice to them.
every case will be given 25 mins
15 mis for history and physical.
10 mins for writing the history, physical, 3-5 possible D/D and diagnostic work up.
mostly people think thats is the work we need to do and will.
but do u think 15 is enough for history and physical.
try to practice a complete case just like the real exam situation. you will find its not easy.i know.
few advice-
1- feel confident and calm yourself.
2- read the information given at the door. try to make a picture what is case all about. think about the chief
comp and try to make 3-4 D/D BEFORE KNOCKING THE DOOR.
3- now knock the door.
4-give a good smile. m serious.
5- introduce yourself. try to speak with confidence.
ex- hello mr. douglous good morn, myself dr. k i am a physician here. nice to meet you. how you doing today?
ans- fine.
6- so what i can do for you?/ what brings you in today?-open ended q?
ans-tell chief comp
7-then you need to make eye contact and ask mr. dos would you mind if write down some notes while m talking to you? this cast a impression that u really care about him.
8-then you start the case- ask the relevant q? according to the case.
can use pnemonic-PAIN
L- OCATION
I-NTANSITY
Q-UALITY
O-NSET
R-RADIATION.
A-GGREVATING FACS
A-LLEVIATING FCAS
A-SSOCIATED COMPLAINS.- according to the system involved.
fever, chills, night sweats and et. al.
+
PAM HUG FOSS-
PAST
ALLERGY
MEDICATION
H
URINE
GENITAL
FAMILY
OBS
SEXUAL
SOCIAL
few other points
1-if pat starts coughing.
give him a tissue and ask would u like a glass of water mr.....
if he say no.
again- are u sure?
always take every encounter as real clinical situation.
2-if patient is angry bcoz he think you are late.
dont think he does not like you.
try to console him. say i am really sorry mr...for making u wait so long. actually i encounter unexpected
delay with one of my patient.
to be conti...
3- always speak very clearly and slowly. dont rush things because it makes you look that you are not interested in patient problem.
4-lets the pt tell you whatever he want to.
5-once you are done taking history. dont forget to recap every point in front of patient. ask him if want to add something that i might have missed.
6-after taking history tell him that u are done with history and now i need to examine you. say like will u excuse me mr.... while i wash my hands. you can wash your hands while talking to him but make sure you dont loose the eye contacts.
7- wash hands- look what you have at wash basin. is soap available or not ? if not try to use gloves and also tell the patient and ask if he has some kind of allergy to latex.
8-before you start exam- keep few things in your mind.
consent - what ever u do always ask the permission and reason why u doing it. like mr.... i need to examine your chest, may i go for that?
mr... i need to untie your gown to examine your chest if you dont mind.
wait until he nods yes. then start untying.
try to expose as less part as possible to examine.
once you are done tie the gown up.
be gentle dont be too rough while examination. if patient is in pain be very very careful. and if pt complaints
pain always say sorry.
you can check all the top ranked books for Step 2 CS at this link.......
Sunday, January 30, 2011
FREE MEDICAL BOOKS
FREE MEDICAL BOOKS -
MCMINNS ATLAS-
DOWNLOAD THEM ALL THEN COMBINE
MCMINNS ATLAS-
DOWNLOAD THEM ALL THEN COMBINE
CLINICAL ANATOMY BY SNELL
http://www.mediafire.com/?jn2mmcpqhft (PART 10)
BIOCHEMISTRY BY HARPER
PHYSIOLOGY BY GYTON-
GANONG-
ROBINS AND COTRAN PATHOLOGY-
http://hotfile.com/dl/10519583/6a8b208/Robbins__Cotran_Pathologic_Basis_of_Disease_-_8th_Ed.zip.html
PHARMACOLOGY-
LIPPINCOTT-
WILL BE AVAILABLE SOON.
KATZUNG-
PRINCIPAL OF PHARMACOLOGY
Friday, January 28, 2011
Sending Documents to ECFMG..................
hi folks,
I am writing this post about what are the documents needed to take dates for Usmle exams and
participating into Match.
there may be two cases-
1) you may be a medical student. means you have not completed your internship yet.
2) you are a medical graduate. done with internship.
Student- if you are a student then you dont need any extra document to take date for Step 1,Step 2CK
and Step 2cs. you just to send the print out which you will get at the end of online application. this is
either form 183 aka Certification statement of identification is paper certification required by ECFMG
for applicants who r students enrolled in medical school that do not participate in ECFMG Medical
School Web Portal.
doc- Certification Statement (Form 183) only.
doc- 1) Certification of Identification Form (Form 186)
2) two copies of medical diploma
3) one passport size photo
4) ECFMG Medical Education Credentials Submission Form (Form 344).
5) Medical School Release Request (Form 345) to release your medical school transcript.
plz review ths guide line for photocopies-
Reference Guide for Medical Education Credentials
what ever the case you have to sent all these documents to the given address by the ECFMG.
if you student then you will receive the email cofirmation that we have received your application
and after apprx 3 weeks you might get your confirmation of schedule which you had chosen
during application.
if you are graduate then it will take bit longer time. because once ECFMG receives your application along with all five docs then they will send your diploma to your medical college for verification and also the request for release form 345 to release your Medical school transcript.
well if you are lucky your college might do all the steps correctly but if they are not accustom to these stuff then here is a trick.
you try to contact your college and tell them that they gona receive a package with my name. and once they receive it you go there if possible get everything done under ur vision. and you might take all the documents and send them to advised address under college name as the sender.
so that is hectic step but you have to go through it. it just the beginning man.......... you have long way to go.
Thursday, August 19, 2010
READY FOR STEP 2 CK
if you are planning to take step 2ck, i have few suggestions
, i would be as brief as possible.
what this is test all about?
it covers 5 subjects- internal medicine, surgery, ob-gyn, pediatrics and psychiatry.
where u can take it?
wherever you want.
if u don't know how to take date that i will cover in next post.
what to read?
you need to read Kaplan for step 2ck and if you have dvd do watch them.
try to read first then watch the video of that topic and add to the notes if
you found some thing extra.
here again you need to avoid Psychiatry from Kaplan. use BRS Psychiatry
by Barbara fathem.
try to read at-least twice.
don't forget to do questions.
usmle world is the best but try it when u ready to go.
last thing never study on the last day before exam. have fun.
one more thing i would not advice you to read "first aid " its upto you.
if you have any query and suggestion, do write to me.
Tuesday, August 17, 2010
how to score high at usmle step 1
guidance is the kea to score high a steps of usmle.
step 1 is more about the knowing the physiology of body how it affected in pathologic conditions.
pattern of questions at step 1 still clinical based like you will encounter in real life.
so what to learn and what to leave is very crucial to know before you take the exam.
what material is right-
1) kaplan is good. but dont read pathology and behav science from it.
2) goljan pathology
3) BRS behavioral science by barbara fathem
try to study in detail these topics
diabetes
hypertension
obesity
heart disease
stroke
anti hypertensive drug
anti depressant
anti psychotic
anti hiv
their indications, contraindications and interactions.
three p's need special attention
physio
patho
pharma.
try to familiarize yourself with the pattern of questions .
do Usmle world at least for one month and try to score at least 70 % consistently.
have faith in God and you.
all the best.
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