Step 2 CK/ step3/ step 1- Endocrinology

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?

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.