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Today's schedule

Day 01

Opthalomology

. management of corneal ulcer

. Anterior uveitits

Ent

. Acute suppurative otitis media

. Chronic suppurative otitis media

Wishing me luck

Any tips on how to study while feeling sleepy?

I am on Cetrizine due to dermatitis and I am super sleepy. Caffeine is not helping much

Any tips. ....

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Hola

I will be starting 100 days productivity challenge from today. My exams (internals) are one week away and I am super stressed. Hence I am putting all my stress on this community. Hope you will help me through this journey.

Don't mind me ranting in next week as I I'll be super stressed.

Hopefully I'll succeed.....

Send me wishes guys...

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ECG: quick and dirty

I’ve had countless sessions and lectures on ECGs. I don’t know how many websites I have bookmarked, or how many times my eyes glazed over reading Dubin. I’m also terrible at cardiology. I was on my way to accepting my fate of being horrible at ECGs forever, until I had a life changing session on ECGs taught by a great ER doc. I want to post it here because it was probably the most useful thing I learned in med school, and it will stick with me for the rest of my career. 

WHEN LOOKING AT ECGs FOR THE FIRST TIME:

1. One ECG is never enough. Always get old ones for comparison. If none available, do another one. Because. One ECG is never enough. 

2. RATE. Look at the number on top of the printed ECG. It’s stupid not to use that number. Yes, you should know the rule, 300-150-100-75-60-50. People say you shouldn’t trust the machine because… well, it’s a machine, and it can make mistakes. This is true. I don’t like to look at their “diagnosis” until I have gone through it myself. But the rate is just a number. Plus you should be able to eyeball it and be able to tell if it’s tachy, brady, etc. If the machine is telling you it’s 200 and if it looks tachy, then it’s probably the right number. 

3. RHYTHM. Is there a p-wave for every QRS and a QRS for every p-wave? Is the p-wave upright in lead II and down in aVR? Good. Done. BOOM. It’s sinus rhythm. ***if you cannot clearly see the p-waves then you cannot call sinus. move on.

4. AXIS. Again, look at the number at the top of the page. If it’s between 0 and +90, then it’s normal axis. If the number isn’t provided, or if your preceptor doesn’t believe in the convenience of machines/technology, look at the QRS complex of lead I and lead II. 

up in lead I, up in lead II: normal axis

up in lead I, down in lead II: left axis deviation (most common causes are left anterior hemi block and left ventricular hypertrophy)

down in lead I, up in lead II: right axis deviation (most common causes are right ventricular hypertrophy…PE)

5. did someone say HYPERTROPHY?

look at V1

is the R wave tall? (greater than 7mm?) right ventricular hypertrophy.

is the S wave tall? (greater than 11mm?) left ventricular hypertrophy.

  6. P-waves

look at lead II

is it wide? left atrial enlargement.

is it tall? right atrial enlargement.

7. PR interval

should be between 0.12 sec and 0.2 sec (3-5 small boxes). I used to always get this interval and QRS complex (less than 0.12 sec) mixed up. Think: atria depolarizing + shit getting to ventricles is gonna take longer than ventricles depolarizing. [2 things happening] versus [1 thing happening]. [0.12 sec-0.2 sec] versus [<0.12 sec].

long PR interval means there’s some sort of block at the AV node. 

1st deg block. PR interval is long. everything else is normal. cool. 

2nd deg block

type I: PR interval progressively gets long. eventually a dropped QRS.

type II: PR interval is constant, but randomly dropped QRS. 

3rd deg block “complete block”

there is no association between P waves and QRS. they run separately. **QRS does NOT have to be wide. Just look for P wave/QRS complex disassociation. I sometimes get this and 2nd deg type II mixed up. The only difference I try to remember is that PR interval is constant in 2nd deg type II, but is variable in 3rd deg. 

8. QRS complex

narrow or wide? 

narrow: good. signal coming from somewhere above ventricles. 

wide: think BBB (bundle branch block)

LOOK AT V1 ONLY.

if the last deflection of QRS is DOWN, then it’s a left BBB

if the last deflection of QRS is UP, then it’s a right BBB. super easy. no more of this bunny ears crap. 

9. ST segment

always look from J point, and compare with the isoelectric line of T-P segment (NOT PR interval). 

elevated/depressed… STEMI… duh. indicates ACUTE ischemic changes. 

look for reciprocal changes of the heart. if ST elevation in lateral leads, could see ST depression in the septal leads. PAILS:

posterior up, anterior down

anterior up, inferior down

inferior up, lateral down

lateral up, septal down.  

LBBB can look like STEMI. How to tell?

disconcordant changes is normal. (QRS and STEMI on opposite sides of the isoelectric line.)

concordant changes is abnormal. 

massive discordance is abnormal. (STEMI is greater than 5mm)

this isn’t that important. Moving on. 

Inferior STEMI. Could right ventricle be involved? 

DO NOT GIVE NITRO DO NOT GIVE NITRO DO NOT GIVE NITRO.

order a 15 lead

is STE in lead III > lead II? likely RV involvement

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

10. T waves

is it inverted? indicates recent ischemic changes. 

11. Q waves

is it significant? indicates old ischemic changes. will likely be present if followed rule number 1 of reading ECGs. (1 ECG is never enough= look at old ECGs). 

I literally go through this list of 11 points in my head when I’m reading an ECG, regardless of whether or not I have an atrial flutter jumping at my face or if I see a massive anterolateral STEMI. Obviously I needed background knowledge on ECGs and the physiology of the heart before constructing this list, but this basic checklist has been very, very useful to me so far. It might look lengthy, but it doesn’t take a lot of time at all- a patient is not likely going to have all these issues with their heart. 

  Anyway. I still don’t love ECGs, but it feels pretty wonderful to be able to be able to evaluate it in a systematic manner, and get the theory behind interpreting the scribbles of an ECG reading. I don’t get these moments as much as I would like to, but it’s that crosspoint where my classroom learning actually meets real-life applications that gives me happy brain-gasms for days. I love knowing things and more importantly, knowing why.

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05-11-18 bio notes! i tried out a new background and i think it looks really pretty!! i hope you guys like it :). i had my first test for my dissection lab and my group ended up getting 100%! the next few tests are harder, but i think we’ll all do gr8. i hope you all had a great week!

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Bored of being told to listen to classical music? Here is a list of great study music from your favorite video games, movies and more. 

aesthetics and smooth

lofi hip hop radio 

anime vibes

dozing off *

soft piano

nostalgic *

synthwave

video games

compilation

animal crossing *

final fantasy 

fez

pokemon

zelda

nintendo 

assassins creed 

mario bros

ambient sounds

hufflepuff common room *

slytherin common room

ravenclaw common room

gryffindor common room

hagrids hut

diagon alley

the hall of faces (game of thrones)

the green dragon inn (lotr)

spaceship bedroom

medival towns

fireplace

from the screen

the hobbit

harry potter

disney

studio ghibli 

the grand budapest hotel *

amelie

pirates of the caribbean

narnia

how to train your dragon

clockwork orange

moonrise kingdom

twin peaks

acoustics / bands (with lyrics)

the paper kites

gregory alan isakov

soley

crywolf

mogwai

* personal favorites 

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What are the most popular reference books for doctors?

I mostly use various apps and websites, but I have a few good reference books too. Which books a doc has will vary a lot based on their specialty and their individual interests, but I have:

Fracture Management for Primary Care

A Practical Guide to Joint and Soft Tissue Injections

Pfenninger and Fowler’s Procedures for Primary Care

The Sports Medicine Patient Advisor

Harriet Lane

Nelson’s Textbook of Pediatrics

Zheng’s handbook of Obstetrics and Gynecology

Harrison’s Principles of Internal Medicine (the mini version)

Pocket Medicine

Netter’s Anatomy Coloring Book

Oxford Handbook of Tropical Medicine

Lecture Notes in Tropical Medicine

Fitzpatrick’s Clinical Dermatology

Kaplan and Sadock’s Textbook of Psychiatry

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Revise the Pearl Types of abortions and features on MARROW! -

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7 study tips from someone who rides the struggle bus to school everyday

Because I struggle bussed too hard to come up with a solid 10. Regardless, I made it this far, so I must have done something right(ish), or not completely wrong. 

Set the scene. Not necessarily in the Tumblr studying aesthetic kinda way. They’re definitely #deskgoals, but let me tell you, my desk never looked like any of the pictures you see here. What I mean, make your space a productive place to study for you. I preferred my study space to be separate from my sleep place, so my desk wasn’t in my bedroom. Not being locked up in a cave was important to me, so I put my desk by a window. Light a candle, Bath and Body Works got all my loan money. Get a natural sunlight lamp. Play some music, preferably without lyrics – classical, EDM, whatever keeps you focused without being distracting. Just make an optimal space for you. 

Stay hydrated (and caffeinated). I’m 100% a coffee addict, but water is so incredibly important. It helps you to not feel like shit, both physically and mentally, or look like shit #skincare.  Drink your morning coffee, but chug water throughout the day. Your mind and body will love you. I discovered flavoring packets that contained caffeine (Crystal Light, Mio, etc) at the beginning of MS2, and let me tell you, life-changing for those mid-afternoon slumps. And all those pee breaks you have to take? Much needed and well-deserved! You don’t want a DVT from studying all day. 

Sleep! I honestly cannot stress this enough. I don’t know how I ever pulled all nighters in college and I don’t know how my friends did it in medical school. It’s important for your mental health and physical health. Studies have shown sleep enhances memory retention and you’ll study more productively. I became a “my brain doesn’t function after 10pm” person in medical school, so I went to sleep early-ish and woke up early, but if you’re a night owl, then let yourself sleep in! You’re not taking away precious study time if you’re sleeping, I promise. And for that night before the test, that extra hour of sleep is way better than staying up an extra hour to read your notes one more time, I pinky promise. 

Move, stretch, dance, anything not hunched over a desk. Sitting for 12 hours straight is simply not sustainable. Take a couple minute break every hour to give your brain a rest. A lot of people use the Pomodoro technique with success but I never got into it. I downloaded the Forest app and timed myself for an hour, then took a 5-10 minute break between study sessions. You’ll feel refreshed and rejuvenated for another round of studying! 

Repetition, repetition, repetition. Repetition is key when it comes to learning and memorizing. Figure out your best way of learning and stick with it. Whether it be reading, re-writing notes, listening or watching lectures, recording yourself reading the notes, flashcards, etc. Find it and stick with it. Repeat it until you can do it in your sleep. I would literally wake up sometimes reciting notes in my head and I it was annoying, but it meant I had studied effectively. 

Questions. Always reinforce your knowledge with questions. You can memorize every page of a textbook but it doesn’t mean much unless you can apply it. And the more questions you do, the faster you get at test-taking, which is key once you get into 8 hour board exams. But I digress. Take practice tests, buy review books, invest in question banks. Some professors provide old exam questions for review. Do as many as you can. And if explanations are provided, read them! They’re just as much of a learning tool as any other resource! As I reviewed the questions, I’d take notes, simple one-liner facts, for review later. 

One pagers. This one may not be for everyone, but they came in clutch for me. My study method was a combination of re-writing notes and reciting things out loud as if I’m teaching it to a class. I talk to myself a lot. The more comfortable I got with the material, the more I condensed my notes until I had whole lectures or topics down to one page. This page would contain things that I thought were super important that I needed to make sure I knew, or those pesky facts that would not commit themselves to my memory. Because I’m a firm believe in not re-reading something you know you already know. This also held me accountable to always be actively studying. Then I would review these pages the day before and the morning of exams. 

Above all else, remember to trust yourself. Don’t panic. You put in the time and work, you will do great. If you have anxiety issues, don’t be afraid to seek help so you can learn how to get your anxiety under control because school is hard enough without that added obstacle. 

Study, take that test, go home and pass out, then melt into the couch and watch Netflix for the rest of the day. You deserve it.