usmlestep1

Acid Base Mnemonic

2013-10-07T20:28:00.002-07:00

https://www.youtube.com/watch?v=rLaPJjXQvec

The Strep Family mnemonics

2013-10-07T20:27:00.003-07:00

https://www.youtube.com/watch?v=e1UPNfi5VxY

ANS Drugs : Quick 4 minute Review

2013-10-07T20:26:00.000-07:00

https://www.youtube.com/watch?v=jTuFOoFeSuY&list=WLSGE2bLTiyHEbBUBxiE9v6kt5mmlBXQjg

Musa 100 Rules For Step 3

2013-08-16T10:35:00.001-07:00

http://www.mediafire.com/view/24vn6kodlmr13nh/Musa_100_Rules_For_Step_3.pdf

List of programs that dont participate in ERAS or NRMP

2013-08-15T13:17:00.002-07:00

This is a list of programs that do not participate in the NRMP match. The data was compiled from FREIDA and tabulated based on states and specialties. I have excluded army, naval and armed forces medical programs from this list. They can be viewed in table later in the article. This list is for information only, please cross check your sources prior to application.

List of programs that do not participate in NRMP match process| from freida - 2012 (Internal medicine, Family medicine, psychiatry, pediatrics, anesthesia, radiology, PM&RS, pathology, neurology, neurosurgery, transitional, ob gynecology and general surgery)

Rest of the denotes programs that are variations on the standard ERAS and NRMP match process. These programs have declared that they do not either go through ERAS or NRMP. I am pretty sure this must not be an exclusive condition but quite a few programs are armed forces programs so they may be doing just that. Listed below are programs that do not participate in ERAS. What is the implication of this? firstly, you may have to get in touch with the programs individually to apply for residency. They may have their own criteria for selection of applicants which may be very similar to programs that do participate in ERAS. Remember, ERAS was made to streamline and facilitate application to residencies to many places. Imagine if there was no ERAS you would have to send your CV and photo and scores individually to each of the 100+ so places!. So ERAS is actually a boon for applicants but at the same time there may be places that opt for a more individualized approach.

Then there are also programs that participate in ERAS but do not participate in NRMP. This is going to a obsolete thing in the near future because as news has it, the days of prematches are soon over. But there is a caveat, a program could still in spots after the match day post scramble independent of the match, they could just be filling in for a residency spot that they lost (due to resident leaving the program for what so ever reason).

In any case, the list was complied from American medical association (AMA) FREDA website for more details about the programs and program numbers etc. check the AMA-FREIDA site here.

The programs in blue are regular programs while ones in black are armed forces programs.

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SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
OB-GYN	National Capital Consortium Program Bethesda, Maryland	No	-
	San Juan City Hospital Program San Juan, Puerto Rico	No	-
	Naval Medical Center (San Diego) Program San Diego, California	Yes	No
	Tripler Army Medical Center Program Tripler AMC, Hawaii	Yes	No
	John H Stroger Hospital of Cook County Program Chicago, Illinois	Yes	No
	Jamaica Hospital Medical Center Program Jamaica, New York	Yes	No
	Cleveland Clinic Foundation Program Cleveland, Ohio	Yes	No
	San Antonio Uniformed Services Health Education Consortium Program Lackland AFB, Texas	Yes	No
	Naval Medical Center (Portsmouth) Program Portsmouth, Virginia	Yes	No
	Madigan Healthcare System Program Tacoma, Washington	Yes	No

SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
NEUROLOGY	San Antonio Uniformed Services Health Education Consortium Program Fort Sam Houston, Texas	No	-
	National Capital Consortium Program Bethesda, Maryland	Yes	No
	Madigan Healthcare System Program Tacoma, Washington	Yes	No

SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
ANESTHESIA	Naval Medical Center (San Diego) Program San Diego, California	No	-
	National Capital Consortium Program Bethesda, Maryland	No	-
	New York Methodist Hospital Program Brooklyn, New York	No	-
	Naval Medical Center (Portsmouth) Program Portsmouth, Virginia	No	-
	Nassau University Medical Center Program East Meadow, New York	Yes	No
	San Antonio Uniformed Services Health Education Consortium Program. Fort Sam Houston, Texas	Yes	No

SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
FAMILY MED	David Grant Medical Center Program Travis AFB, California	No	-
	US Air Force Regional Hosptial/Headquarters Air Armament Center (AFMC) Program Eglin AFB, Florida	No	-
	Naval Hospital (Pensacola) Program Pensacola, Florida	No	-
	Mike O'Callaghan Federal Hospital/Nellis Air Force Base Program Nellis AFB, Nevada	No	-
	Montgomery Hospital Program Norristown, Pennsylvania	No	-
	Dr Alejandro Otero Lopez Hospital Program Manati, Puerto Rico	No	-
	Naval Hospital (Camp Pendleton) Program Camp Pendleton, California	Yes	No
	Naval Hospital (Jacksonville) Program Jacksonville, Florida	Yes	No
	Martin Army Community Hospital Program Fort Benning, Geogia	Yes	No
	Dwight David Eisenhower Army Medical Center Program Fort Gordon, Georgia	Yes	No
	Tripler Army Medical Center Program Honolulu, Hawaii	Yes	No
	Idaho State University/Madison-Rexburg Family Medicine Rural Program Pocatello, Idaho	Yes	No
	St Francis Hospital and Health Centers Program Indianapolis, Indiana	Yes	No
	Wyckoff Heights Medical Center Program Brooklyn, New York	Yes	No
	Naval Hospital (Camp Lejeune) Program Camp LeJeune, North Carolina	Yes	No
	Womack Army Medical Center Program Fort Bragg, North Carolina	Yes	No
	Bella Vista Hospital Program Mayaguez, Puerto Rico	Yes	No
	Darnall Army Medical Center Program Fort Hood, Texas	Yes	No
	National Capital Consortium (Fort Belvoir Community Hosptial) Program Fort Belvoir, Virginia	Yes	No
	Naval Hospital (Bremerton) Program Bremerton, Washington	Yes	No
	Madigan Healthcare System Program Tacoma, Washington	Yes	No

SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
MEDICINE	Keesler Medical Center Program Keesler AFB, Mississippi	No	-
	Mount Vernon Hospital Program Mount Vernon, New York	No	-
	Universidad Central del Caribe Program Bayamon, Puerto Rico	No	-
	San Juan City Hospital Program San Juan, Puerto Rico	No	-
	San Antonio Uniformed Services Health Education Consortium Program Fort Sam Houston, Texas	No	-
	University of Alabama Medical Center (Huntsville) Program Huntsville, Alabama	Yes	No
	Dwight David Eisenhower Army Medical Center Program Fort Gordon, Georgia	Yes	No
	National Capital Consortium Program Bethesda, Maryland	Yes	No
	St Barnabas Hospital Program Bronx, New York	Yes	No
	Mount Sinai School of Medicine (Bronx) Program Bronx, New York	Yes	No
	Wyckoff Heights Medical Center Program Brooklyn, New York	Yes	No
	St John's Episcopal Hospital-South Shore Program Far Rockaway, New York	Yes	No
	Ramon Betances Hospital-Mayaguez Medical Center/Ponce School of Medicine Consortium Program, Mayaguez, Puerto Rico	Yes	No
	William Beaumont Army Medical Center Program El Paso, Texas	Yes	No
	Madigan Healthcare System Program Tacoma, Washington	Yes	No

SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
PATHOLOGY	Naval Medical Center (San Diego) Program San Diego, California	No	-
	National Capital Consortium Program Springfield, Virginia	No	-
	National Institutes of Health Clinical Center Program Bethesda, Maryland	Yes	No
	San Antonio Uniformed Services Health Education Consortium Program Lackland AFB, Texas	Yes	No
	Texas Tech University (Lubbock) Program Lubbock, Texas	Yes	No
	Madigan Healthcare System Program Tacoma, Washington	Yes	No

SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
PSYCHIATRY	National Institutes of Health Clinical Center Program Bethesda, Maryland	No	-
	Naval Medical Center (San Diego) Program San Diego, California	Yes	No
	Delaware Psychiatric Center Program New Castle, Delaware	Yes	No
	Tripler Army Medical Center Program Honolulu, Hawaii	Yes	No
	National Capital Consortium Program Bethesda, Maryland	Yes	No
	Brookdale University Hospital and Medical Center Program Brooklyn, New York	Yes	No
	St John's Episcopal Hospital-South Shore Program Far Rockaway, New York	Yes	No
	Jamaica Hospital Medical Center Program Jamaica, New York	Yes	No
	Griffin Memorial Hospital Program Norman, Oklahoma	Yes	No
	Naval Medical Center (Portsmouth) Program Portsmouth, Virginia	Yes	No

SPECIALITY	NAME	PARTICIPATE IN ERAS	PARTICIPATE IN NRMP
PEDIATRICS	Children's Hospital of Orange County Program Orange, California	No	-
	San Juan City Hospital Program San Juan, Puerto Rico	No	-
	Naval Medical Center (Portsmouth) Program Portsmouth, Virginia	No	-
	University of California (Irvine) Program Orange, California	Yes	No
	Naval Medical Center (San Diego) Program San Diego, California	Yes	No
	Tripler Army Medical Center Program Tripler AMC, Hawaii	Yes	No
	National Capital Consortium Program Bethesda, Maryland	Yes	No
	Brookdale University Hospital and Medical Center Program Brooklyn, New York	Yes	No
	Nationwide Children's Hospital/Doctors Hospital Program Columbus, Ohio	Yes	No
	San Antonio Uniformed Services Health Education Consortium Program Fort Sam Houston, Texas	Yes	No
	Madigan Healthcare System Program Tacoma, Washington	Yes	No

make sure you also read up on the related article - on securing a residency even if you did not match.

H1B to green card (GC)

2013-08-15T13:15:00.000-07:00

Green card: Amazon

The best way to convert H1 visa to GC is to approach a lawyer who specializes in dealing with such issues. There are plenty of good lawyers in New York, Texas and California who have made this their expertise in dealing with medical professionals and converting their visa status.

You can file for national interest waiver category by yourself but it can be expensive and time-consuming also very tedious. Green cards are usually filed in 2 categories EB1 and EB2, to maximize the chance of being granted one.
If you chose to seek help of a lawyer, then you will be faced with an expense anywhere from $8000-$12,000 depending on your case. Good luck!

Trends in USMLE residency positions

2013-08-15T13:13:00.002-07:00

Aim

To find out the growth rate of residency positions in medical specialties over the last five years.

Methods

I compiled the data from NRMP Advance Data Tables Main Residency Match 2012. The difference in change of number of positions was calculated using the (Tn-T1)/T1 formula where T1 represents the first time point, which in this case is 2008 and Tn represents the nth time point which in this case is 2012. The formula was uniformly applied to the residency match position and the derived values growth coefficient (GC) was plotted on a linear graph.

I represented foreign medical graduate (IMG/FMG) friendly specialties (Internal medicine, Family Medicine, Pediatrics and Psychiatry) with diamonds. I gave second tier programs (Neurology, Anesthesia and Emergency Medicine), circles and surgical/semi surgical specialties (Pathology, Surgery, Obstetrics and Gyn), squares. Radiology was placed in semi-surgical group for graphical reasons.

Fig.1: Growth trends in Medical Specialties in the last five years

Interpretation:

As seen in the figure, the specialties show three distinct groups based on the growth coefficient. The ‘growth’ group comprises of Anesthesia, emergency medicine and neurology and internal medicine. These specialties have shown continued increase in number of positions each year. The more the positions are there to apply, the better the chance of being accepted into a program. Anesthesia has shown a remarkable growth in the number of positions (about 40%) while internal medicine has shown a modest growth of 8% from 2008 to 2012.

The second group called the ‘stagnation’ group has demonstrated neither an increase nor a decrease in the number of positions. This group comprises of psychiatry, pediatrics and family medicine (the three of the four pillars of IMG success). This is a worrisome trend because, if the number of positions in these do not increase the competition for the allocated positions is only going to worsen with each successive year. Pathology and General surgery (prelim) also belong to this group.

The third group of specialties is the ‘reduction’ or the ‘attrition’ group. This comprises of radiology and ob-gyn specialties. What is interesting is General surgery was trending to be a part of this group until 2011 but as can be seen an increase in number of available positions pushed it out of this group. Radiology has shown a remarkable reduction of residency positions every year. I believe that this self imposed attrition is soon going to reverse because there will be need for more radiologists. Read about the radiology staffing market, demands and trends here.

One word of caution though, these represent growth curves and do not reflect the total number of positions available for applying. Thus as an example, even though the growth of family medicine spots has remained more or less the same in the last five years compared to anesthesia, the total number of positions in FM are far more than those in anesthesia.

Implications:

For medical graduates who are undecided regarding the choice of specialty, this growth rate data provides information regarding growing versus reducing fields. Given the intense competition for the few positions, it would be important to know where the competition is going to be the fiercest. Thus applying to specialties that are growing may increase the chances of being accepted.

sample letter asking for observership

2013-08-15T13:11:00.003-07:00

As a response to my past article, On writing to the department chief, I had several folks ask me what kind of letter should one write when initiating communication with physicians. The following is an example of a letter, which you can use to ask for observership opportunities.

DON’T copy the letter verbatim because you may find that your credibility will be called into question using cookie cutter templates. The idea of showing the below example is to allow you to formulate a channel of correspondence that gets results.

This template letter may be applicable to you in most cases but if background is unique enough, the letter may be molded to support your intent. Also make sure to read the foot notes to different points that are touched in this letter paying careful attention to the topics brought forth. Also, the italics are special directions, that you can modify as needed to suit your purpose.

Name: residency applicant

two lines of your current address

can go here

phone number

Sub:

Seeking a possibility for shadowing[i] in Dept. of (your favorite field here). This line will be an explanatory heading unlike the email subject, which has to be attention grabbing.

Dear Dr. Dept. Chair[ii] (personalize by using name),

(Introduction, paragraph). The purpose of my correspondence with you is to explore opportunity to shadow in your department. As you may be aware, one of the silent requisites prior to being accepted into a US program is familiarity with the US health care system[iii]. I am determined to understand the nature and workings of health care delivery in US and for that matter would like to shadow a medical team.

(Why I chose you, paragraph). The reason I chose your department is because, it is one of the busiest programs with illustrious faculty, and a training program[iv] that seems to uphold the six core values of the ACGME curriculum[v]. The breadth of patient care issues and the depth of involvement of your physicians are worth learning from.

(Why you should choose me, paragraph). I am driven and ambitious to achieve a level of professional excellence, which I see in action at your program. The testament to that statement comes from ______ (insert your best accomplishment, or recognition, it has to be good!)[vi]. Also, I am very interested in continuing this association by applying to your program for residency starting in 20__. This engagement will allow the faculty to evaluate for themselves a potential asset for the program. I am attaching a one page resume for your perusal at this time[vii], I will be more than happy to send a detailed CV, if you wish to consider extending me the offer.

Thanks

First name

ECFMG number

[i] Avoid using and abusing the word observership. Letter should sound fresh and crisp.

[ii] Or other faculty that you have come to know, who is in a position to influence the program.

[iii] There is no mention that you are “IMG”, it is easy to deduce that, and is implicit. Thus does not look like “another IMG seeking observership opportunities”

[iv] Do some homework about the place you are writing to. Sounding superficial is just as bad as being ignorant.

[v] Familiarize your self with these and use this if you know residents or someone who is in the program.

[vi] Don’t waste a good letter with a bad reference. If you don’t have much to sell in the first place – do not attempt to sell a poor accomplishment by garnishing or inflating your achievements. Doing so will result in instant discredit and loss of any future chances of getting anything done from there.

[vii] You are doing them a favor by not attaching a bulky 8 page resume at the first pass. They will be thankful to you for not flooding their inbox with attachments they do not need. Remember to have both long and short versions of your CV.

Guidelines for a successful observership

2013-08-15T13:09:00.001-07:00

these days doing an observership has become more of a norm than anything else. IMGs strive to get an observership position with the anticipation that it will increase their chances of obtaining interviews and consecutively up the chances of matching into the residency of their choice. For tips on getting observerships . Many graduates are lucky to land an opportunity and go on to rotate through hospitals for shadowing, however if you plan to optimize your experience as an observer and ensure that you get the most out of your participation, here is a guide which will help you do just that.

DONT'S

Don't be rude

This is number one no for a reason, if you are rude to other member of your team or even patients for that matter you ARE going to burn the very same bridges that will help you secure a residency.

Don't be arrogant

This can particularly tick some junior members of your team like the intern or resident. Remember, control yourself don't look down on them, they may know less than you but they have what you don't - they are in a residency and they can help you get there. Being arrogant is going to rub people the wrong way and limit you chances

I know of a IMG from india who had come to do an observership in the medicine department. He was a good fellow but he had finished his post graduate education in medicine and there fore knew a lot more than the interns. But his knowledge was portrayed in a wrong light as he came off being arrogant and this became a big issue for the team. He was not asked to continue his observership after one month.

Don't be a know it all

This goes hand in hand with the point number 1 and 2. If you know it then keep quite till you are asked or if no one is saying anything. Don't blurt out the answer, politely interject and ask permission to answer. Remember, the rounds are NOT for your education, they are for the interns, residents and medical students. You are sadly the bottom of the educational food chain(but hopefully not long!)

Do not intrude the 'space'

American people have a high sense of personal space, do not invade it. Standing too close to someone you met can be construed as aggression or downright creepy. A safe distance is 2 to 3 feet.

Put you arms by the side hanging down and now flex your elbow keeping your shoulder straight. That is the minimum distance the other person needs to be at.

Limit the desire to get carried away with 'impressing' your residents and attending.

Realize that your goal is to 'observe' and not run the show. Though the inherent nature of the job is such that a good recommendation hinges on how much you impress the attending, this can also have a negative impact as you can over-do the 'impressing' and land in more trouble than you need.

Help not hinder

Rounds are the busiest part of the day. They can be chaotic and unexpected. Let the residents and interns do their job of collecting patient data, reviewing charts and talking to patients. The busiest time for a team is just before the rounds when everyone is running around scurrying to collect all the information they need to make a good informed clinical judgement, try and limit your interruption of this process and the team members will be thankful!

Another IMG from Egypt who was doing an observership at my institution had the uncanny and annoying ability to ask all of his questions during the pre-round times, the busiest time for a resident and his team. He would ask the interns, residents and even the medical students about the patients they were covering. It quickly became evident, he did that because he wanted to look informed on rounds with the attending. Essentially, he did sabotage his experience. Don't do that.

No need to stay all day

There is not need to hang around all day, you can excuse yourself right after the rounds are done. Before you leave though, ask the residents if there is anything they need help with. They might ask you to call a consultant or look something up related to the patient and that way you can increase your involvement in patient care!

DO'S

Do be punctual

Never, ever be late for rounds. Running in late when the rounds have started will make the attending remember you for the wrong reasons. If you are going to be late for reasons not in your control, call up the resident and tell then to inform the attending that you are being late because (did not have ride etc…)

Be committed

Getting an opportunity to do an observership is difficult, don't misuse it. If done well, it can have the power to change your fortunes as far as match is concerned. If you are not enthusiastic or appear lackadaisical or non-committed then you will get a 'satisfactory' recommendation or non at all. You don't want to have a satisfactory recommendation,

One other IMG that I worked with used to ride in with a friend who was doing residency in prelim surgery. This IMG was doing an observership in medicine, so he used to come in at 5 AM out of necessity as he did not have a ride for later on. After a first few days, he started to help the interns and residents write down vitals or lab data. He stood out overall and received a glowing commendation for his rotation.

Do be humble

Humility will go a very long way to secure personal success. Be humble, listen to everyone and speak when spoken to.

Do dress well

Unless, explicitly stated by the attending or team that days X or Y you can wear scrubs, don't wear them. Be professional and dress smartly. This includes no flashy body jewelry, bling-bling, grilles, extra chunky rings, tacky globys earrings or necklaces. Be sophisticated. wear a good deodorant. It does not matter what the resident is wearing or medical student is wearing, they are not needing a residency spot, you are. Dress well.

Do make the team feel comfortable and safe in your presence

Don't start hitting on the junior medical students or flirt with other members of the team. The minute one gets a 'creepy' vibe from you, you are done for. Look people in the eye, keep conversation safe, steer clear off controversial topics.

Do be aware of the limits of your involvement in patient care

Be involved but not passive and realize what you CAN do and what you CANNOT do. It is a good practice to outline you role in the day to day activities of the team with the upper level resident.

Help the team

Discuss medical topics with the medical students and interns. Help the team by looking up articles or answers to questions that came up during rounds. Make a list of all such questions as you round, the residents have so many other things to keep in mind, they may forget. If you write down and revisit the questions during rounds with the answers that you have looked up, you will shine. Help them find articles that they may want to person in morning report or journal club.

All in all, observership can be a very valuable or wasteful experience depending on how you conduct yourself. It can even be detrimental if not done right but can be a rewarding experience if you do well.

The above is applicable for those you end up getting the coveted observership experience. In case you dont get this typical experience, there are other ways to bag an 'observership experience

USMLE and Residency Tips

2013-08-15T13:05:00.004-07:00

20 steps to boost residency match chances

This is the first week after the match results have been declared. Already the buzz regarding September 1 for the current year has started and rightly so. For those who are planning to apply this year.

Plan your time
Coordinate with your medical schools and colleges so that your paper work is done on time
Spend a lot of time, I mean a lot, on your personal statement. You are speaking to an audience, make an impression.
Brush up on your correspondence skills, 80% of correspondence is written by email, learn to write impressive emails with appropriate subject headings and striking content
Be organized, use a filing system (in person) and on computer to sort and store important documents (scanned or original)
Be sure to upload your documents to ERAS on time and that your packet is complete by September 15.
If there are any deficiencies in getting ECFMG certified, go ahead and take care of them
Most programs will need Step 1 and Step 2 CK scores before application. Incomplete applications that do not satisfy criteria tremendously reduce chances of getting an interview.
Choose which approach you are going to take - Shotgun™ or Sniper™ and stick with it.
Shotgun strategy is applying all over in multiple specialties without restriction, while sniper strategy is to focus on one subject and hammer out the applications finely tuned to that specialty. You could be specific to the extent of applying to few chosen states but this may reduce your chances of interview.
Make a careful selection of programs - if you are indiscriminate in applying (you can increase your chances but expenses will also mount), if you are too critical in choosing places (you may not get interviews) find a balance in either strategies.
Brush up your interview skills, if you have an accent - work on it to improve it. A phenomenal impression in an interview can often overcome an inadequate resume
Keep your resume up to date. If you find there are gaps in your CV, explain them in your personal statement.
Keep your CV evolving; a static CV is not impressive. As a norm, you should add one new accomplishment to your CV every 6 months.
If you are an new graduate - fresh out of medical school, look for few volunteer or quasi research/research experiences to add to CV
If you are an old graduate but have been in clinical practice - make sure you justify why you want to change careers in your personal statement
If you are an old graduate and have not been active clinically - do everything it takes to get US clinical experience.
Policies have changed in 2011, with ‘all or none’ phenomenon for programs – either all seats are through NRMP or not. Prematches – out of match offers for positions will go down but still exist and one can get residency outside of match system.
Keep a positive attitude.
Network, network and more network. Find connections and folks to put in a word for you. Candidates who have someone vouch for them have a far greater chance than those without connections. IF you cannot get connections – make them. If you think you do not need connections – you had better have triple 99 (250+) and a stellar resume.

These are some very important steps that you should pay full attention to before applying for medical residency in US.

usmle step 1 online 4138 questions

2013-08-13T12:12:00.001-07:00

To better prepare students for the computer-based format of the USMLE, the format and options of this website have been designed to resemble that of the USMLE exams.

The page layout mimics that of the USMLE. You will see the questions appear one by one, with navigation buttons at the bottom of the screen that are identical to those on the USMLE.
A timer simulates the time constraints imposed by the USMLE.
A "Review Answers" button allows you to see all your answers, including unanswered questions, and skip to specific questions.

A notable difference between this website and the USMLE is that you have the option of showing the correct answer and feedback (if available) on each question. This may be viewed at any time.

Additionally, feedback from students prompted the addition of new features, such as:

The ability to mark questions you guessed on, with a readout of how well you did on those questions
The computer tracks changed answers and tells you how much you should trust your "gut instinct."

http://umed.med.utah.edu/testfiles/courses.cfm

Medical Pharmacology and Disease-Based Integrated

2013-08-13T12:07:00.001-07:00

www.pharmacology2000.com/learning2.htm

How to pass USMLE Step 2 CS on first attempt

2013-08-13T11:56:00.000-07:00

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.

Mnemonic Learning Aid for CML (Chronic Myelogenous Leukemia) in Pictorial format

2013-08-13T11:47:00.000-07:00

http://www.youtube.com/watch?v=Pg9-qiK-5iU

HIGH YIELD ANATOMY FOR USMLE STEP 1

2013-08-13T11:42:00.000-07:00

BACK
1. Exaggerated over-curvature of thoracic area of vertebral column Kyphosis
2. Lateral deviation of vertebral column Scoliosis
3. Major feature of cervical vertebrae Transverse foramina
4. Vertebra located at level of iliac crest L4
5. Ligament that connects internal surface of laminae of vertebrae Ligamentum flavum
6. Ligament that checks hyperextension of vertebral column Anterior longitudinal
7. Ligament affected by whiplash injury Anterior longitudinal
8. Ligament which limits skull rotation Alar
9. Defective portion of vertebra with spondylolisthesis in cervical area Pedicle
10. Defective portion of vertebra with spondylolisthesis in lumbar area Pars interarticularis,
Lamina
11. Common direction of all superior articular facets of vertebrae Posterior
12. Structure in contact with posterior surface of dens Transverse ligament of
atlas (part of cruciate)
13. Most commonly herniated intervertebral disc L4-5
14. Most common nerve compressed with herniated intervertebral disc L5
15. Spinal nerve affected by protrusion of the disc between C5/6 C6
16. Thoracic intercostal space located deep to triangle of auscultation sixth
17. Vertebral level of lumbar puncture L4
18. Innervation of suboccipital muscles Suboccipital nerve
19. Roof of suboccipital triangle Semispinalis capitis
20. Floor of suboccipital triangle Posterior arch of atlas;
posterior atlanto-occipital
membrane
21. Major vessel within suboccipital triangle Vertebral artery
22. Synonym for dorsal ramus of C2 Greater occipital nerve
23. Inferior extent of dura-arachnoid sac SV2
24. Inferior extent of spinal cord LV2
25. Location of internal vertebral plexus Epidural space
UPPER LIMB
26. Most frequently fractured bone of body Clavicle
27. Most frequently dislocated carpal bone Lunate
28. Most frequently fracture carpal bone Scaphoid
29. Name of fracture of distal radius that produces “dinner fork” appearance Colleʼs fracture
30. Nerve injured with fracture of surgical neck of humerus Axillary
31. Nerve injured with fracture of medial humeral epicondyle Ulnar
32. Nerve injured with fracture of shaft of humerus Radial
33. Nerve injured in wrist drop Radial
34. Muscle that is chief flexor and chief extensor at shoulder joint Deltoid
35. Muscles innervated by axillary nerve Deltoid and teres minor
36. Muscle that initiates abduction of arm Supraspinatus
37. Most commonly torn tendon of rotator cuff Supraspinatus
38. Two muscles that rotate scapula for full abduction of arm Trapezius and serratus
anterior
39. Tendon that courses through shoulder joint Long head of biceps
40. Chief supinator muscle of hand Biceps brachii
41. Injury to what nerve causes winged scapula Long thoracic nerve
42. Spinal levels of axillary nerve C5 and C6
43. Spinal levels to muscles of the hand C8 and T1
44. Dermatome of thumb C6
45. Nerve to thenar compartment Recurrent branch of
2
Median
46. Innervation of adductor pollicis Ulnar (deep br.)
47. Innervation to all interosseous muscles Ulnar (deep br.)
48. Region affected by upper trunk injury of brachial plexus Shoulder
49. Region affected by lower trunk injury of brachial plexus Intrinsic hand muscles
50. Nerve compressed with carpal tunnel syndrome Median
51. Nerve affected by cubital tunnel syndrome Ulnar
52. Paralysis of which muscles results in total “claw” hand Lumbricals
LOWER LIMB
53. Boundaries of femoral triangle Inguinal ligament, sartorius
and adductor longus
54. Structure immediately lateral to femoral sheath Femoral nerve
55. Structure immediately medial to femoral artery in femoral sheath Femoral vein
56. Contents of femoral canal Deep inguinal lymph
nodes
57. Medial boundary of femoral ring Lacunar ligament
58. Structures that course throughout entire length of adductor canal Femoral artery and vein
59. Structures that course through only portion of adductor canal Saphenous nerve, nerve
to vastus medialis,
descending genicular
vessels
60. Muscle that forms floor of popliteal fossa Popliteus
61. Muscle that is chief flexor at hip joint Iliopsoas
62. Muscle that prevents pelvis from tilting when walking Gluteus medius
63. Muscle that extends leg Quadriceps femoris
64. Muscle that unlocks knee joint Popliteus
65. Muscle affected with “foot slap” Tibialis anterior
66. Chief invertors of foot Tibialis anterior and
posterior
67. Chief evertors of foot Fibularis longus and brevis
68. Ligament that checks backward displacement of femur on tibia Anterior cruciate
69. Ligament laxity with positive valgus maneuver Medial collateral
70. Most commonly injured ankle ligament Anterior talofibular
71. Ligament stretched with “flat foot” Plantar calcaneonavicular
(spring)
72. Joints for movements of inversion and eversion Subtalar and transverse
Tarsal
73. Major artery to head of femur in adult Medial femoral circumflex
74. Nerve affected with fracture of head and neck of fibula Common fibular
75. Tendon affected with avulsion fracture of 5th metatarsal Fibularis brevis
76. Innervation of adductor magnus Obturator, tibial portion of
Sciatic
77. Nerve affected with tarsal tunnel syndrome Tibial
78. Cutaneous innervation to medial side of foot Saphenous (L4)
79. Cutaneous innervation to lateral side of foot Sural (S1)
80. Cutaneous innervation of heel Tibial
81. Cutaneous innervation to dorsal aspect of web between toes 1 and 2 Deep fibular
82. Cutaneous innervation of most of dorsum of foot Superficial fibular
83. Major dermatome to big toe L4
84. Dermatome to small toe S1
85. Spinal level of patellar reflex L4
86. Spinal level of Achilles reflex S1
87. Locking of knee when walking suggests Meniscus injury
88. Major injury triad with lateral impact to knee Medial collateral, medial
3
meniscus and anterior
cruciate ligament
THORAX
89. Dermatome around nipple T4
90. Vertebral level at inferior angle of scapula TV7
91. Structure that lies immediately posterior to manubrium Thymus
92. Rib related to oblique fissure of lung posteriorly 2nd
93. Rib paralleled by horizontal fissure of right lung 4th
94. Inferior extent of lung at midclavicular line 6th rib
95. Inferior extent of pleura at midclavicular line 8th rib
96. Inferior extent of lung at midaxillary line 8th rib
97. Inferior extent of pleura at midaxillary line 10th rib
98. Inferior extent of lung posteriorly 10th rib
99. Inferior extent of pleura posteriorly 12th rib
100. Innervation of costal pleura Intercostal nerve
101. Innervation of mediastinal pleura Phrenic nerve
102. Site for auscultation of pulmonary valve Left 2nd interspace
103. Site for auscultation of aortic valve Right 2nd interspace
104. Site for auscultation of tricuspid valve Xiphisternal joint
105. Site for auscultation of mitral valve Left 5th interspace,
midclavicular line
106. Heart chamber with greatest sternocostal projection Right ventricle
107. Chamber that forms apex of heart Left ventricle
108. major chamber that forms base of heart Left atrium
109. Heart chamber that contains moderator band Right ventricle
110. Artery that determines coronary dominance Posterior interventricular
111. Usual origin of SA and AV nodal arteries Right coronary artery
112. Location of SA node Cristae terminalis
113. Major vessel that drains the musculature of the heart Coronary sinus
114. Innervation of fibrous pericardium Phrenic nerve
115. Most common cause of systolic ejection murmur Aortic stenosis
116. Rib associated with sternal angle Second rib
117. Vertebral level associated with sternal angle Disc between TV4-5
118. Location of ductus arteriosus Between left pulmonary
artery and aorta
119. Nerve potentially injured with repair of patent ductus arteriosus Left recurrent laryngeal
Nerve
120. Veins that unite to form brachiocephalic Subclavian and internal
Jugular
121. Veins that unite to form superior vena cava Right and left
Brachiocephalic
122. Termination of azygos vein Superior vena cava
123. Structures that lie to right and left of thoracic duct Azygos veins, aorta
124. Spinal levels of greater splanchnic nerve T5-9
125. Spinal levels of lesser splanchnic nerve T10-11
126. Spinal levels of least splanchnic nerve T12
127. Thoracic structures that can compress the esophagus Left bronchus, aorta and
Diaphragm
128. Disease often associated with thymoma Myasthenia gravis
ABDOMEN
129. Remnant of umbilical vein Round ligament of liver
4
130. Dermatome to umbilical area T10
131. Dermatome to suprapubic area L1
132. Vertebral level associated with origin of celiac artery T12
133. Vertebral level associated with origin of SMA L1
134. Vertebral level associated with origin renal arteries L2
135. Vertebral level associated with origin of gonadal arteries L2
136. Vertebral level associated with origin of IMA L3
137. Vertebral level of umbilicus Disc L3-4
138. Vertebral level of aortic bifurcation L5
139. Vertebral level for formation of IVC L5
140. Spinal levels to muscles of anterior abdominal wall T7 – L1
141. Structure that forms superficial inguinal ring Aponeurosis of external
Oblique
142. Structure that forms deep inguinal ring Trasnversalis fasica
143. Structure that form floor of inguinal canal Inguinal ligament
144. Bony attachments of inguinal ligament ASIS and pubic tubercle
145. Structures that form conjoint tendon Internal oblique and
transversus abdominis
146. Abdominal layer continuous with external spermatic fascia External oblique
147. Abdominal continuous with cremasteric fascia Internal oblique
148. Abdominal layer continuous with internal spermatic fascia Transversalis fascia
149. Structure that lies between protrusion sites of direct and indirect hernias Inferior epigastric artery
150. Type of hernia that enters deep inguinal ring Indirect inguinal
151. Most common type of hernia Indirect inguinal
152. Most common side for indirect inguinal hernia Right
153. Type of hernia that protrudes through Hesselbachʼs triangle Direct inguinal
154. Boundaries of Hesselbachʼs triangle Inguinal ligament, rectus
abdominis, inferior
epigastric artery and vein
155. Type of hernia that traverses both deep and superficial rings Indirect inguinal
156. Fluid in processus vaginalis Hydrocele
157. Communication between greater and lesser sacs Epiploic foramen
158. Superior border of epiploic foramen Caudate lobe of liver
159. Inferior border of epiploic foramen Part one of duodenum
160. Posteiror border of epiploic foramen IVC
161. Ligament that contains portal vein, hepatic artery and bile duct Hepatoduodenal (lesser
omentum)
162. Structure that limits spread of ascitic fluid in left paracolic gutter Phrenicocolic ligament
163. Structuer that limits spread of ascitic fluid within infracolic compartment Root of mesentary
164. Superior extent of right paracolic gutter Hepatorenal recess
165. Most inferior portion of peritoneal cavity Rectouterine pouch
166. Structures supplied by celiac artery Stomach, duodenum, liver,
spleen, gallbladder,
pancreas
167. Branches of celiac artery Left gastric, common
hepatic and splenic
168. Blood supply to stomach Right and left
gastroepiploics, right, left
and short gastric
169. Major structures of bed of stomach Pancreas, spleen, left
kidney and suprarenal
gland, diaphragm
170. Ducts that join to form common bile duct Cystic and common
Hepatic
171. Structure that separates right and left lobes of liver Falciform ligament
5
172. Origin of cystic artery Right hepatic artery
173. Ribs directly related to spleen Ribs 9-11
174. Organs related to spleen Stomach, colon, left
kidney, tail of pancreas
175. Artery to small intestine SMA
176. Organs supplied by both celiac and SMA Duodenum, pancreas
177. Organs supplied by both SMA and IMA Transverse colon
178. Vessel located posterior to head of pancreas IVC
179. Vessel located posterior to neck of pancreas Portal vein
180. Veins that unite to form portal vein Splenic and SMV
181. Clinically importatnt organs for portacaval anastomoses Esophagus, rectum, liver
182. Two structures that lies posterior to SMA near its origin Left renal vein, duodenum
183. Three distinguishing features of the large intestine Tenia coli, haustra,
epiploic appendages
184. Termination of left gonadal vein Left renal vein
185. Termination of right gonadal vein Inferior vena cava
186. Location of initial pain of appendicitis Umbilical region
187. Motor innervation of diaphragm Phrenic
188. Sensory innervation of diaphragm Phrenic + intercostal
189. Spinal levels of phrenic nerve C3-5
190. Vertebral level that inferior vena cava traverses diaphragm T8
191. Vertebral level that esophagus traverses diaphragm T10
192. Structures that traverse diaphragm with esophagus Vagal trunks
193. Vertebral level that aorta traverses diaphragm T12
194. Structure that traverses diaphragm with aorta Thoracic duct
195. Structure that traverses diaphragm through crura Greater, lesser and least
splanchnic nerves
PELVIS AND PERINEUM
196. Structure that separates pelvis and perineum Pelvic diaphragm
197. Two major components of pelvic diaphragm Levator ani + coccygeus
198. Two major components of levator ani Pubococcygeus and
Iliococcygeus
199. Two muscles which close lateral pelvic wall Obturator internus and
Piriformis
200. Means by which obturator internus exits pelvis Lesser sciatic foramen
201. Means by which piriformis exits pelvis Greater sciatic foramen
202. Innervation of detrusor Pelvic splanchnics (S2-4)
203. Remnants of umbilical arteries Medial umbilical ligaments
204. Chief artery to rectal mucosa Superior rectal
205. Most common type of pelvic inlet in females Gynecoid
206. Two remnants of gubernaculum in females Ovarian and round
Ligament
207. Ligament that contains ovarian vessels Suspensory ligament of
Ovary
208. Lymph nodes for ovary and testes Lumbar
209. Normal position of uterus Anterverted, anteflexed
210. Chief uterine support Pubococcygeus
211. Ligament that contains uterine vessels Lateral cervical
212. Structure potentially injured with hysterectomy Ureter
213. Relation of ureter to uterine artery Inferior and posterior
214. Structure that separates deep and superficial perineal spaces Perineal membrane
215. Bony landmarks between anal and UG triangles Ischial tuberosities
216. Lateral wall of ischioanal fossa Fascia of obturator
Internus
6
217. Structure that forms the pudendal canal Fascia of obturator
Internus
218. Structure that separates internal and external hemorrhoids Pectinate line
219. Lymph nodes for area superior to pectinate line of anal canal Internal iliac, IM
220. Lymph nodes for area inferior to pectinate line of anal canal Superficial inguinal
221. Major structure of deep perineal space Sphincter urethrae
222. Lymph nodes for glans penis Deep inguinal
223. Muscle which compresses the bulb of penis Bulbospongiosus
224. Muscle which compresses the crus of penis Ischiocavernosus
225. Muscles which meet at the perineal body Superficial and deep
perineal, bulbospongiosus,
external anal sphincter,
pubococcygeus
HEAD AND NECK
226. Vertebral level of hyoid bone CV3
227. Vertebral level of thyroid cartilage CV4,5
228. Vertebral level of cricoid cartilage CV6
229. Muscles that are innervated by CN XI Trapezius, SCM
230. Structures that course between anterior and middle scalene Brachial plexus,
subclavian artery
231. Innervation of omohyoid, sternohyoid and sternothyroid Ansa cervicalis
232. Innervation of digastric Anterior belly = CN V
Posterior belly = CN VII
233. Innervation of carotid sinus and carotid body CN IX, CN X
234. Major structures to pass through pharyngeal wall superior to superior constrictor Auditory tube, levator veli
Palatini
235. Nerves of pharyngeal plexus CN IX, CN X,
Sympathetics
236. Only muscle innervated by CN IX Stylopharyngeus
237. Structures that pierce thyrohyoid membrane Internal laryngeal nerve,
superior laryngeal artery
238. Only muscle to abduct vocal cords Posterior cricoarytenoid
239. Innervation of cricothyroid External laryngeal nerve
240. Innervation of laryngeal muscles exclusive of cricothyroid Recurrent laryngeal
241. Muscle that increases tension on vocal cords Cricothyroid
242. Sensory nerve to larynx superior to vocal cords Internal laryngeal
243. Sensory nerve to larynx inferior to vocal cords Recurrent laryngeal
244. Site of aspirated lodged fishbone Piriform recess
245. Afferent – efferent limbs of gag reflex CN IX – CN X
246. Afferent – efferent limbs of cough reflex CN X – CN X
247. Nerve injury that causes hoarseness following thyroid surgery Recurrent laryngeal
248. Chief structures that traverse internal acoustic meatus CN VII and VIII
249. Foramen where CN VII exits skull Stylomastoid foramen
250. Major arterial supply to calvaria and supratentorial dura Middle meningeal
251. Major cutaneous nerve of face CN V
252. Major artery to internal structures of head Maxillary
253. Spinal levels of sympathetic fibers to head T1 – 2
254. Autonomic ganglia for CN III Ciliary
255. Sensory ganglia for CN VII Geniculate
256. Autonomic ganglia for CN VII PPG and submandibular
257. Autonomic ganglia for CN IX Otic
258. Muscle attached to disc of TMJ Lateral pterygoid
259. Muscle that retracts mandible Temporalis
260. Major nerve to TMJ (pain) Auriculotemporal
261. Specific nerves that elicit secretion from the parotid gland Tympanic branch of CN IX
7
and lesser petrosal
262. Branch of CN V that carries parasympathetics to parotid Auriculotemporal
263. Structure that opens into superior meatus of nasal cavity Posterior ethmoid sinus
264. Structures that open into middle meatus of nasal cavity Frontal, maxillary, anterior
and middle ethmoid
265. Structures that opens into inferior meatus of nasal cavity Nasolacrimal duct
266. Major artery to nasal cavity Sphenopalatine
267. Most common site of nose bleed Kiesselbachʼs plexus
268. Innervation of levator veli palatini CN X
269. Muscle that opens auditory tube Tensor veli palatini
270. Innervation of tensor veli palatini CN V3
271. Nerve that provides taste to anterior 2/3 of tongue Chorda tympani
272. Site of cell bodies for nerve that carries taste to anterior 2/3 of tongue Geniculate ganglion
273. Specific nerve that elicits secretion from submandibular gland Chorda tympani
274. Branch of CN V that carries parasympathetic to submandibular Lingual
275. Nerve injured when tonsilar pillars sag and uvula deviates CN X
276. Nerve potentially injured with tonsillectomy CN IX
277. Muscle that protrudes tongue Genioglossus
278. Nerve injured when deviation of protruded tongue Ipsilateral CN XII
279. Specific nerve that stimulates tear production Greater petrosal CN VII
280. Sensory nerve to cornea CN V1 (nasociliary)
281. Muscle that elevates and abducts eye Inferior oblique
282. Muscle that depresses and abducts eye Superior oblique
283. Site of preganglionic nerve cells that elicits dilation of pupil Lateral horn, T1 - 2
284. Site of postganglionic nerve cells that elicits dilation of pupil Superior cervical ganglion
285. Site of preganglionic nerve cells that elicits constriction of pupil Edinger-Westphal
286. Site of postganglionic nerve cells that elicits constriction of pupil Ciliary ganglion
287. Innervation of external surface of tympanic membrane Auriculotemporal, CN X
288. Innervation of internal surface of tympanic membrane CN IX
MIXED TOPICS
289. Level where ascending aorta is continuous with arch of aorta TV4-5
290. Level where arch of aorta is continuous with descending aorta TV4-5
291. Effect of sympathetic nerves on lungs Bronchodilation,
Vasoconstriction
292. Effect of parasympathetic nerves on lungs Bronchoconstriction,
Vasodilation
293. Rationale for aspirated small objects to go to right primary bronchus Wider diameter, shorter
and more vertical
294. Needle location for therapeutic pleural tapping Superior to 12th rib,
posteriorly
295. Name given to portion of right ventricle prior to beginning of pulmonary trunk conus arteriosum or
infundibulum
296. Name given to orientation where uterus and vagina intersect at angle of 90 degrees Anteversion
297. Name given to orientation where uterine body and cervix intersect at angle of 10-15 degrees Anteflexion
298. Ridge located between sinus venarum and right ventricle Cristae terminalis
299. Nerve at risk when performing thyroidectomy Both left and right
recurrent laryngeal nerves
300. Specific muscle that holds patella in place Vastus medialis
301. First portion of quadriceps femoris to atrophy with injury to femoral nerve Vastus medialis
302. Last portion of quadriceps femoris to recover following injury Vastus medialis
303. Innervation to nail bed of middle finger Median nerve
304. Innervation to nail bed of ring finger Ulnar and median
305. Spinal nerve affected with herniated disc at L3/L4 L4

HIV InSite Knowledge Base

2013-08-13T11:36:00.004-07:00

Comprehensive, up-to-date information on HIV/AIDS treatment,prevention, and policy

http://hivinsite.ucsf.edu/InSite

Learning Radiology

2013-08-13T11:32:00.003-07:00

http://www.learningradiology.com/

Radiology Masterclass Tutorials

2013-08-13T11:31:00.003-07:00

http://www.radiologymasterclass.co.uk/

A best website to study radiology.Personally tested and impressed !!!!!

A growing resource in medical imaging education, for medical students and junior doctors.

Radiology Masterclass is a long term education project, devised and edited by Dr Graham Lloyd-Jones (BA MBBS PCME MRCP FRCR). Graham initially studied Graphic Design at Bristol Polytechnic, graduating in 1991, before going on to study Medicine at Imperial College, graduating in 2001. Graham trained in post graduate medicine in West London and then as a Radiologist on the Wessex training scheme. He now works as a Consultant Radiologist in Salisbury. It was while working as a Specialist Registrar that this website was conceived.

High-Yield Brain Cancer for the USMLE

2013-08-12T23:03:00.001-07:00

http://www.youtube.com/watch?v=Nxes7dgOyO8

USMLE First Aid Classic Findings

2013-08-12T22:57:00.001-07:00

1Actinic keratosis: Often precedes squamous cell
carcinoma

2. Addison’s disease: 1° adrenocortical deficiency
Albright’s syndrome: Polyostotic fibrous dysplasia,
precocious puberty, café-au-lait spots, short stature,
young girls
3.
Albuminocytologic dissociation: Guillain-Barré (↑
protein in CSF with only modest ↑ in cell count)
4.
Alport’s syndrome: Hereditary nephritis with nerve
deafness
5.
Anti-double-stranded DNA antibodies (ANA
antibodies): SLE (type III hypersensitivity)
6.
7. Anti-IgG antibodies: Rheumatoid arthritis
Anti–basement membrane antibodies: Goodpasture’s
syndrome
8.
9. Anti–epithelial cell antibodies: Pemphigus vulgaris
10. Anticentromere antibodies: Scleroderma (CREST)
11. Antigliadin antibodies: Celiac disease
12. Antihistone antibodies: Drug-induced SLE
13. Antimitochondrial antibodies: 1° biliary cirrhosis
14. Antineutrophil antibodies: Vasculitis
Antiplatelet antibodies: Idiopathic thrombocytopenic
purpura
15.
16. Arachnodactyly: Marfan’s syndrome
17. Argyll Robertson pupil: Neurosyphilis
Arnold-Chiari malformation: Cerebellar tonsillar
herniation
18.
19. Aschoff bodies: Rheumatic fever
Atrophy of the mammillary bodies: Wernicke’s
encephalopathy
20.
Auer rods: Acute myelogenous leukemia (especially the
promyelocytic type)
21.
22. Autosplenectomy: Sickle cell anemia
23. “Bamboo spine” on x-ray: Ankylosing spondylitis
24. “Blue bloater”: Chronic bronchitis
“Brown tumor” of bone: Hemorrhage causes brown color
of osteolytic cysts: 1. Hyperparathyroidism 2. Osteitis
fibrosa cystica (von Recklinghausen’s disease)
25.
“Chocolate cysts”: Endometriosis (frequently involves
both ovaries)
26.
27. “Fat, female, forty, and fertile”: Acute cholecystitis
“Hair-on-end” appearance on x-ray: β-thalassemia,
sickle cell anemia (extramedullary hematopoiesis)
28.
“Lumpy-bumpy” appearance of glomeruli on
immunofluorescence: Poststreptococcal
glomerulonephritis
29.
“Orphan Annie” nuclei: Papillary carcinoma of the
thyroid
30.
“Pink puffer”: Emphysema (centroacinar [smoking],
panacinar [α1-antitrypsin deficiency])
31.
32. “Smudge cell”: CLL
33. “Strawberry tongue”: Scarlet fever
“Tram-track” appearance on LM:
Membranoproliferative glomerulonephritis
34.
35. “Wire loop” appearance on LM: Lupus nephropathy
“Worst headache of my life”: Berry
aneurysm—associated with adult polycystic kidney
disease
36.
37. Babinski’s sign: UMN lesion
38. Baker’s cyst in popliteal fossa: Rheumatoid arthritis
39. Bartter’s syndrome: Hyperreninemia
40. Basophilic stippling of RBCs: Lead poisoning
2
Becker’s muscular dystrophy: Defective dystrophin; less
severe than Duchenne’s
41.
42. Bell’s palsy: LMN CN VII palsy
Bence Jones proteins: Multiple myeloma (kappa or
lambda Ig light chains in urine), Waldenström’s
macroglobulinemia (IgM)
43.
44. Bernard-Soulier disease: Defect in platelet adhesion
45. Bilateral hilar adenopathy, uveitis: Sarcoidosis
Birbeck granules on EM: Histiocytosis X (eosinophilic
granuloma)
46.
47. Bloody tap on LP: Subarachnoid hemorrhage
48. Blue sclera: Osteogenesis imperfecta
49. Blue-domed cysts: Fibrocystic change of the breast
50. Boot-shaped heart on x-ray: Tetralogy of Fallot; RVH
Bouchard’s nodes: Osteoarthritis (PIP swelling 2° to
osteophytes)
51.
52. Boutonnière deformity: Rheumatoid arthritis
53. Branching rods in oral infection: Actinomyces israelii
54. Brushfield’s spots: Down syndrome
55. Bruton’s disease: X-linked agammaglobulinemia
56. Budd-Chiari syndrome: Posthepatic venous thrombosis
57. Buerger’s disease: Small/medium-artery vasculitis
Burkitt’s lymphoma: 8:14 translocation; associated with
EBV
58.
59. Burton’s lines: Lead poisoning
C-ANCA, P-ANCA: Wegener’s granulomatosis,
polyarteritis nodosa
60.
61. Café-au-lait spots on skin: Neurofibromatosis
62. Caisson disease: Gas emboli
63. Calf pseudohypertrophy: Duchenne’s muscular dystrophy
Call-Exner bodies: Granulosa-theca cell tumor of the
ovary
64.
65. Cardiomegaly with apical atrophy: Chagas’ disease
Cerebriform nuclei: Mycosis fungoides (cutaneous T-cell
lymphoma)
66.
67. Chagas’ disease: Trypanosome infection
68. Chancre: 1° syphilis (not painful)
69. Chancroid: Haemophilus ducreyi (painful)
Charcot-Leyden crystals: Bronchial asthma (eosinophil
membranes)
70.
Charcot’s triad: Multiple sclerosis (nystagmus, intention
tremor, scanning speech), cholangitis (jaundice, RUQ
pain, fever)
71.
72. Chédiak-Higashi disease: Phagocyte deficiency
Cheyne-Stokes respirations: Central apnea in CHF and ↑
intracranial pressure
73.
Chronic atrophic gastritis: Predisposition to gastric
carcinoma
74.
Chvostek’s sign: Hypocalcemia (facial muscle spasm upon
tapping)
75.
76. Clear cell adenocarcinoma of: DES exposure in utero
77. Clue cells: Gardnerella vaginitis
78. Codman’s triangle on x-ray: Osteosarcoma
Cold agglutinins: Mycoplasma pneumoniae, infectious
mononucleosis
79.
80. Cold intolerance: Hypothyroidism
81. Condylomata lata: 2° syphilis
82. Continuous machinery murmur: Patent ductus arteriosus
83. Cori’s disease: Debranching enzyme deficiency
84. Cotton-wool spots: Chronic hypertension
85. Cough, conjunctivitis, coryza: Measles
86. Councilman bodies: Toxic or viral hepatitis
87. Cowdry type A bodies: Herpesvirus
Crescents in Bowman’s capsule: Rapidly progressive
crescentic glomerulonephritis
88.
3
Crigler-Najjar syndrome: Congenital unconjugated
hyperbilirubinemia
89.
Curling’s ulcer: Acute gastric ulcer associated with severe
burns
90.
91. Currant-jelly sputum: Klebsiella
Curschmann’s spirals: Bronchial asthma (whorled
mucous plugs)
92.
Cushing’s ulcer: Acute gastric ulcer associated with CNS
injury
93.
94. D-dimers: DIC
Depigmentation of neurons in: Parkinson’s disease (basal
ganglia disorder––rigidity, resting tremor,
bradykinesia)
95.
Dermatitis, dementia, diarrhea: Pellagra (niacin, vitamin
B3 deficiency)
96.
Diabetes insipidus + exophthalmos +:
Hand-Schüller-Christian disease
97.
98. Dog or cat bite: Pasteurella multocida
99. Donovan bodies: Granuloma inguinale
100. Dressler’s syndrome: Post-MI fibrinous pericarditis
Duchenne’s muscular dystrophy: Deleted dystrophin
gene (X-linked recessive)
101.
Eburnation: Osteoarthritis (polished, ivory-like
appearance of bone)
102.
Edwards’ syndrome: Trisomy 18 associated with
rocker-bottom feet, low-set ears, heart disease
103.
Eisenmenger’s complex: Late cyanosis shunt (uncorrected
L → R shunt becomes R → L shunt)
104.
105. Elastic skin: Ehlers-Danlos syndrome
Erb-Duchenne palsy: Superior trunk brachial plexus
injury (“waiter’s tip”)
106.
107. Erythema chronicum migrans: Lyme disease
Fanconi’s syndrome: Proximal tubular reabsorption
defect
108.
109. Fatty liver: Alcoholism
110. Ferruginous bodies: Asbestosis
Gardner’s syndrome: Colon polyps with osteomas and
soft tissue tumors
111.
112. Gaucher’s disease: Glucocerebrosidase deficiency
113. Ghon focus: 1° TB
Gilbert’s syndrome: Benign congenital unconjugated
hyperbilirubinemia
114.
Glanzmann’s thrombasthenia: Defect in platelet
aggregation
115.
Goodpasture’s syndrome: Autoantibodies against
alveolar and glomerular basement membrane proteins
116.
Gowers’ maneuver: Duchenne’s (use of patient’s arms to
help legs pick self off the floor)
117.
118. Guillain-Barré syndrome: Idiopathic polyneuritis
Hand-Schüller-Christian disease: Chronic progressive
histiocytosis
119.
120. HbF: Thalassemia major
121. HbS: Sickle cell anemia
hCG elevated: Choriocarcinoma, hydatidiform mole
(occurs with and without embryo)
122.
Heberden’s nodes: Osteoarthritis (DIP swelling 2° to
osteophytes)
123.
124. Heinz bodies: G6PD deficiency
Henoch-Schönlein purpura: Hypersensitivity vasculitis
associated with hemorrhagic urticaria and URIs
125.
126. Heterophil antibodies: Infectious mononucleosis (EBV)
High-output cardiac failure (dilated cardiomyopathy):
Wet beriberi (thiamine, vitamin B1 deficiency)
127.
128. HLA-B27: Reiter’s syndrome, ankylosing spondylitis
HLA-DR3 or -DR4: Diabetes mellitus type 1 (caused by
autoimmune destruction of β cells)
129.
130. Homer Wright rosettes: Neuroblastoma
131. Honeycomb lung on x-ray: Interstitial fibrosis
Howell-Jolly bodies: Splenectomy (or nonfunctional
spleen)
132.
4
Huntington’s disease: Caudate degeneration (autosomal
dominant)
133.
Hyperphagia + hypersexuality + hyperorality +
hyperdocility: Klüver-Bucy syndrome (amygdala)
134.
Hyperpigmentation of skin: 1° adrenal insufficiency
(Addison’s disease)
135.
136. Hypersegmented neutrophils: Macrocytic anemia
137. Hypertension + hypokalemia: Conn’s syndrome
Hypochromic microcytosis: Iron deficiency anemia, lead
poisoning
138.
Increased α-fetoprotein in amniotic fluid/maternal
serum: Anencephaly, spina bifida (neural tube defects)
139.
Increased uric acid levels: Gout, Lesch-Nyhan syndrome,
myeloproliferative disorders, loop and thiazide
diuretics
140.
Intussusception: Adenovirus (causes hyperplasia of
Peyer’s patches)
141.
142. Berger’s disease: IgA nephropathy
Cherry-red spot on macula: Tay-Sachs, Niemann-Pick
disease, central retinal artery occlusion
143.
Dubin-Johnson syndrome: Congenital conjugated
hyperbilirubinemia (black liver)
144.
145. Horner’s syndrome: Ptosis, miosis, and anhidrosis
146. Low serum ceruloplasmin: Wilson’s disease
Philadelphia chromosome (bcr-abl ): CML (may
sometimes be associated with AML)
147.
148. Rib notching: Coarctation of aorta
149. t(8;14): Burkitt’s lymphoma (c-myc activation)
150. Janeway lesions: Endocarditis
Jarisch-Herxheimer reaction: Syphilis—overaggressive
treatment of an asymptomatic patient that causes
symptoms due to rapid lysis
151.
152. Job’s syndrome: Neutrophil chemotaxis abnormality
Kaposi’s sarcoma: AIDS in MSM (men who have sex with
men)
153.
154. Kartagener’s syndrome: Dynein defect
155. Kayser-Fleischer rings: Wilson’s disease
156. Keratin pearls: Squamous cell carcinoma
157. Kimmelstiel-Wilson nodules: Diabetic nephropathy
158. Klüver-Bucy syndrome: Bilateral amygdala lesions
159. Koilocytes: HPV
160. Koplik spots: Measles
Krukenberg tumor: Gastric adenocarcinoma with
ovarian metastases
161.
162. Kussmaul hyperpnea: Diabetic ketoacidosis
Lens dislocation + aortic dissection + joint
hyperflexibility: Marfan’s syndrome (fibrillin deficit)
163.
164. Lesch-Nyhan syndrome: HGPRT deficiency
165. Lewy bodies: Parkinson’s disease
166. Libman-Sacks disease: Endocarditis associated with SLE
167. Lines of Zahn: Arterial thrombus
Lisch nodules: Neurofibromatosis (von Recklinghausen’s
disease)
168.
169. Lucid interval: Epidural hematoma
170. Lytic bone lesions on x-ray: Multiple myeloma
171. Mallory bodies: Alcoholic liver disease
172. Mallory-Weiss syndrome: Esophagogastric lacerations
173. McArdle’s disease: Muscle phosphorylase deficiency
174. McBurney’s sign: Appendicitis
175. MLF syndrome (INO): Multiple sclerosis
Monoclonal antibody spike: Multiple myeloma (called the
M protein; usually IgG or IgA), MGUS (monoclonal
gammopathy of undetermined significance),
Waldenström’s (M protein = IgM) macroglobulinemia
176.
177. Myxedema: Hypothyroidism
5
Necrotizing vasculitis (lungs) and necrotizing
glomerulonephritis: Wegener’s and Goodpasture’s
(hemoptysis and glomerular disease)
178.
179. Needle-shaped, negatively birefringent crystals: Gout
180. Negri bodies: Rabies
181. Nephritis + cataracts + hearing loss: Alport’s syndrome
182. Neurofibrillary tangles: Alzheimer’s disease
183. Niemann-Pick disease: Sphingomyelinase deficiency
No lactation postpartum: Sheehan’s syndrome (pituitary
infarction)
184.
185. Nutmeg liver: CHF
Occupational exposure to asbestos: Malignant
mesothelioma
186.
187. Osler’s nodes: Endocarditis
188. Owl’s eye: CMV
189. Painless jaundice: Pancreatic cancer (head)
Palpable purpura on legs and buttocks:
Henoch-Schönlein purpura
190.
Pancoast’s tumor: Bronchogenic apical tumor associated
with Horner’s syndrome
191.
192. Pannus: Rheumatoid arthritis
193. Parkinson’s disease: Nigrostriatal dopamine depletion
194. Periosteal elevation on x-ray: Pyogenic osteomyelitis
195. Peutz-Jeghers syndrome: Benign polyposis
196. Peyronie’s disease: Penile fibrosis
197. Pick bodies: Pick’s disease
Pick’s disease: Progressive dementia, similar to
Alzheimer’s
198.
Plummer-Vinson syndrome: Esophageal webs with iron
deficiency anemia
199.
200. Podagra: Gout (MP joint of hallux)
201. Podocyte fusion: Minimal change disease
Polyneuropathy preceded by GI or respiratory
infection: Guillain-Barré syndrome
202.
Polyneuropathy, cardiac pathology, and edema: Dry
beriberi (thiamine, vitamin B1 deficiency)
203.
Pompe’s disease: Lysosomal glucosidase deficiency
associated with cardiomegaly
204.
205. Port-wine stain: Hemangioma
Positive anterior “drawer sign”: Anterior cruciate
ligament injury
206.
207. Pott’s disease: Vertebral tuberculosis
Pseudopalisade tumor cell arrangement: Glioblastoma
multiforme
208.
209. Pseudorosettes: Ewing’s sarcoma
Ptosis, miosis, anhidrosis: Horner’s syndrome (Pancoast’s
tumor)
210.
Rash on palms and soles: 2° syphilis, Rocky Mountain
spotted fever
211.
212. Raynaud’s syndrome: Recurrent vasospasm in extremities
213. RBC casts in urine: Acute glomerulonephritis
Recurrent pulmonary Pseudomonas and S. aureus
infections: Cystic fibrosis
214.
Red urine in the morning: Paroxysmal nocturnal
hemoglobinuria
215.
216. Reed-Sternberg cells: Hodgkin’s lymphoma
217. Reid index (increased): Chronic bronchitis
218. Reinke crystals: Leydig cell tumor
219. Reiter’s syndrome: Urethritis, conjunctivitis, arthritis
Renal cell carcinoma + cavernous hemangiomas +
adenomas: von Hippel–Lindau disease
220.
221. Renal epithelial casts in urine: Acute toxic/viral nephrosis
222. Rhomboid crystals, positively birefringent: Pseudogout
223. Roth’s spots in retina: Endocarditis
Rotor’s syndrome: Congenital conjugated
hyperbilirubinemia
224.
225. Rouleaux formation (RBCs): Multiple myeloma
226. Russell bodies: Multiple myeloma
6
S3: Left-to-right shunt (VSD, PDA, ASD), mitral
regurgitation, LV failure (CHF)
227.
228. S4: Aortic stenosis, hypertrophic subaortic stenosis
229. Sézary syndrome: Cutaneous T-cell lymphoma
230. Schiller-Duval bodies: Yolk sac tumor
231. Senile plaques: Alzheimer’s disease
232. Sheehan’s syndrome: Postpartum pituitary necrosis
233. Shwartzman reaction: Neisseria meningitidis
234. Signet-ring cells: Gastric carcinoma
235. Simian crease: Down syndrome
236. Sipple’s syndrome: MEN type IIa
237. Sjögren’s syndrome: Dry eyes, dry mouth, arthritis
238. Skip lesions: Crohn’s
239. Slapped cheeks: Erythema infectiosum (fifth disease)
240. Smith antigen: SLE
241. Soap bubble on x-ray: Giant cell tumor of bone
242. Spike and dome on EM: Membranous glomerulonephritis
243. Spitz nevus: Benign juvenile melanoma
244. Splinter hemorrhages in fingernails: Endocarditis
245. Starry-sky pattern: Burkitt’s lymphoma
246. Streaky ovaries: Turner’s syndrome
247. String sign on x-ray: Crohn’s disease
Subepithelial humps on EM: Poststreptococcal
glomerulonephritis
248.
249. Suboccipital lymphadenopathy: Rubella
250. Sulfur granules: Actinomyces israelii
Swollen gums, bruising, poor wound healing, anemia:
Scurvy (ascorbic acid, vitamin C deficiency)—vitamin C
is necessary for hydroxylation of proline and lysine in
collagen synthesis
251.
Systolic ejection murmur (crescendo-decrescendo):
Aortic valve stenosis
252.
253. t(14;18): Follicular lymphomas (bcl-2 activation)
254. t(9;22): Philadelphia chromosome, CML (bcr-abl hybrid)
255. Tabes dorsalis: 3° syphilis
Tendon xanthomas (classically Achilles): Familial
hypercholesterolemia
256.
Thumb sign on lateral x-ray: Epiglottitis (Haemophilus
influenzae)
257.
Thyroidization of kidney: Chronic bacterial
pyelonephritis
258.
259. Tophi: Gout
Trousseau’s sign: Visceral cancer, pancreatic
adenocarcinoma (migratory thrombophlebitis),
hypocalcemia (carpal spasm)
260.
Virchow’s node: Left supraclavicular node enlargement
from metastatic carcinoma of the stomach
261.
Virchow’s triad: Pulmonary embolism (triad = blood
stasis, endothelial damage, hypercoagulation)
262.
von Recklinghausen’s disease: Neurofibromatosis with
café-au-lait spots
263.
von Recklinghausen’s disease of bone: Osteitis fibrosa
cystica (“brown tumor”)
264.
265. Wallenberg’s syndrome: PICA thrombosis
Waterhouse-Friderichsen syndrome: Adrenal
hemorrhage associated with meningococcemia
266.
267. Waxy casts: Chronic end-stage renal disease
268. WBC casts in urine: Acute pyelonephritis
269. WBCs in urine: Acute cystitis
270. Wermer’s syndrome: MEN type I
Whipple’s disease: Malabsorption syndrome caused by
Tropheryma whippelii
271.
272. Wilson’s disease: Hepatolenticular degeneration
273. Xanthochromia (CSF): Subarachnoid hemorrhage
Xerostomia + arthritis + keratoconjunctivitis sicca:
Sjögren’s syndrome
274.
7
275. Zenker’s diverticulum: Upper GI diverticulum
Zollinger-Ellison syndrome: Gastrin-secreting tumor
associated with ulcers
276.

USMLE - BRS Pathology - Term List

2013-08-12T22:56:00.000-07:00

1
USMLE BRS Path terms
1. 11:22: transloc seen in ewing sarcoma
14:18: follicular lymphoma IG heavy chain on 14, bcl-2
oncogene on 18 p95
2.
15:17: acute promyelocytic leukemia PML gene on 15 and
RARa on 17 p95
3.
4. 8:14: Burkitts c::myc is on 8, IG heavy chain is on 14 p95
9:22: Philadelphia chromosome, CML bcr abl fusion c-abl
on 9, bcr on 22 p95
5.
6. Addison disease: primary adrenal failure p312
Albers SCHonberg dx: aka osteopetrosis, marble bone
dx, dense skeleton, failure of osteoclastic activity p349
7.
Alport syndrome: hereditary nephritis associated with
nerve deafness and ocular disorders, mutation in gene
for the a5 chain of type IV collagen p261
8.
ANAs in SLE: dsDNA antibodies and Sm Smith antigen =
highly specific for SLE p77
9.
Angelman syndrome: materal transmission
del(15)(q11q13), aka happy puppet syndrome, mental
retardation, ataxia, seizures, inappropriate laughter
p53
10.
APC: tumor suppressor common in familial polyposis coli
and adenoCA of colon as well as other tumors p96
11.
Arnold Chiari formation: downward displacement of
cerebellar tonsils and medulla through foramen
magnum p364
12.
Arthus reaction: seen in hyperacute rejection, = acute
inflammation, fibrinoid necrosis of small vessels, and
extensive thrombosis p72
13.
Aschoff body: area of focal interstitial myocardial
inflammation characterized by fragmented collagen and
fibrinoid material, by large cells (Anitschkow myocytes)
and occasional multinucleated giant cells (Aschoff
cells) p140
14.
15. Bax: gene product facilitates apoptosis p7
16. Bcl2: gene product inhibits apoptosis p7
Beckwith Weidemann syndrome: hemihypertrophy,
macroglossia, organomegaly, neonatal hypoglycemia,
various embryonal tumors, deleted WT 2 gene p268
17.
Bense Jones protein: seen in urine of patients with
multiple myeloma, Ig light chain either k or l p175
18.
Berger dx: aka IgA nephropathy, deposition of IgA in
mesangium, benign recurrent hematuria in kids
following infection p261
19.
Beriberi: this comes in a wet variety and a dry one, they
are both Vit B1 thiamine deficiency
20.
Bernard Soulier dx: autosomal recessive, unusually large
platelets, lack of “GPIb IX V” p191
21.
Binswanger dx: aka subcortical leukoencephalopathy,
assoc with HTN, multiple lacunar infarcts and
progressive demyelination in subcortical area 372
22.
Birbeck granule: tennis racket shaped cytoplasmic
inclusion seen in langerhans cells (so also seen in
langerhan cell histiocytosis) p68
23.
24. Bouchard nodes: osteophytes at PIP joints p355
Bowen dx: single erythematous plaque on shaft of penis or
scrotum p280
25.
Bowenoid papulosis: appears as multiple wart-like lesions
resembling condyloma accuminatum p280
26.
BRCA1: tumor suppressor mutated in breast and ovary
CA p96
27.
BRCA2: associated with breast alone (isn’t one of these
associated with prostate? Check) p96
28.
2
Brenner tumor: ovarian tumor resembling bladder
transitional epith p296
29.
Brown tumor: non::neoplastic tumor like masses, fibrous
replacement of resorbed bone p317
30.
Brushfield spots: seen in Down synd, small white spots on
periphery of iris p51
31.
Brutons Agammaglobulinemia: x linked, absence of
plasma cells and serum immunoglobulins, cell mediated
immunity still ok, no germinal centers, recurrent
bacterial infections, resistances to fungal and viral still,
btk gene defect p73
32.
Btk gene: defective in x-linked brutons
agammaglobulinemia, B-cell tyrosine kinase p73
33.
Budd Chiari: thrombotic occlusion of major hepatic veins,
abnormal pain, jaundice, hepatomegaly, acites, liver
failure, assoc with polycythemia vera, hepatocellular
CA, and other common neoplasms, may occur as a
complication of pregnancy p246
34.
Buerger dx: aka thromboangiitis obliterans, acute inflame
of small and med arteries of extremities, extending to
adjacent veins and nerves, young jewish men, painful
ischemic dx, worse with smoking p129
35.
Burkitt lymphoma: aggressive B-cell lymphoma, EBV,
starry sky appearance, c myc p179
36.
37. C ANCA: associated with Wegener granulomatosis p128
Call Exner bodies: small follicles filled with eosinophilic
secretion, diagnostic feature of granulose cell tumor
p297
38.
Charcot Bouchard aneurysm: aneurysm at small artery
bifurcations p365
39.
Charcot triad: nystagmus, intention tremor, scanning
speech, seen in MS p370
40.
Chediak Higashi syndrome: autosomal recessive,
neutropenia, albinism, cranial and peripheral
neuropathy, tendency to develop repeated infections,
abnormal WBCs (abnormal mictotubul formation and
large cytoplasmic granules = lysosomes) p25
41.
Chromosome 10: paracentric inversion or translocation
with 17 associated with papillary thyroid CA p316
42.
Churg Strauss syndrome: aka allergic granulomatous
angiitis, necrotizing vasculitis, variant of polyarteritis
nodosa, involves pulmonary vasculature, peripheral
eosinophilia, and asthma p128
43.
Clue cell: vaginal epithelial cell with stippled appearance
due to adherent coccobacilli p290
44.
Codman triangle: radiologic appearance of periostium in
bone tumors p352
45.
46. Conn syndrome: primary aldosteronism p320
Cori dx: deficient debranching enzyme
amylo-1,6-glucosidase, glycogen in liver, heart, skeletal
muscle, stunted growth, hepatomegaly, hypoglycemia
p57
47.
Councilman body: small round eosinophilic masses found
in dieing hepatocytes often containing chromatin
remnants seen in viral hepatitis p7 and p242
48.
Cri du chat syndrome: 5p chromosome deletion, severe
mental retardation, microcephaly, catlike cry, low birth
weight, round face, hypertelorism (wide eyes) p51
49.
Crigler Najjar syndrome: severe unconj
hyperbilirubinemia due to deficient glucuronyl
transferase p239
50.
Denys Drash syndrome: abnormal WT 1 gene, intersexual
disorders, nephropathy, wilms tumor p266
51.
3
DiGeorge syndrome: aka velocardiofacial syndrome and
CATCH 22 syndrome, micro deletion of 22q11, Cardiac
abnormalities, Abnormal facies, T cell deficit due to
thymic hypoplasia, Cleft palate, Hypocalcemia due to
hypoparathyroidism, from poor development of 3rd and
4th cranial arches p51 and p73
52.
Donovan bodies: seen in granuloma inguinale, multiple
organisms filling large histiocytes p291
53.
Dry beriberi: peripheral neuropathy, atrophy of muscles,
wet - high output cardiac failure, DCM, AV shunting,
hypervolemia p116
54.
Dubin Johnson syndrome: autosomal recessive, conj
hyperbilirubinemia, defect in bili transport, black color
to liver p239
55.
E4 allele of apoprotein E: chromosome 19, allele common
in alzheimers
56.
Edwards syndrome: aka trisomy 18, mental retardation,
prominent occiput, micrognathia (small jaw), low::set
ears, rocker::bottom feet, finger deformities, congenital
heart dx p51
57.
Ewing sarcoma: small round blue cell tumor of bone, long
bones, kids, 11:22 transloc p352
58.
Fabry dx: aka angiokeratoma corporis diffusum universal,
deficient a::galactosidase A, accumulate ceramide
trihexoside, skin lesions angiokeratomas, fever, burning
pain in extremities, cardiovascular and cerebrovascular
involvement, death as adult by renal failure p59
59.
Fanconi syndrome: renal tubular dysfunction, impaired
reabsorption of glucose, amino acids, phosphate, and
bicarb thus glycosuria, hyperphosphaturia,
hypophosphatemia, aminoaciduria, systemic acidosis
p264
60.
Felty syndrome: variant of rheumatoid arthritis,
splenmegally, neutropenia, RA p354
61.
Ferruginous body: asbestosis, yellow-brown, rod shaped
body with clubbed ends, stain with Prussian blue p204
62.
FGFR3: gene mutated in achondroplasia (most common
form of dwarfism), located at 4p16.3 p349
63.
Foamy histiocyte: sphingomyelin containing phagocytes
seen in Niemman::Pick dx in liver, spleen, lymph nodes
and skin p57
64.
Gardner syndrome: autosomal dominant, numerous
adenomatous polyps along with osteomas and soft
tissue tumors p230
65.
Gaucher dx: deficient glucocerebrosidase, accumulation
of glucocerebroside in cells of mononuclear phagocyte
system 3 types :: see p 56
66.
Gerstmann Straussler: Scheinker syndrome :: prion dx,
fatal familial insomnia
67.
Gilbert syndrome: modest elevated serum unconj
bilirubin, due to decreased uptake by liver cells and
reduced activity of glucuronyl transferase p239
68.
GNAS1: mutation here causes pseudohypoparathyroidism
p318
69.
Goodpasture syndrome: aka antiglomerular basement
membrane dx, antibodies against alveolar and
glomerular basement membranes, linear
immunoflorescence p261
70.
Graves dx: autoimmune thyroiditis, hyperthyroid,
exophthalmos, increased in HLA DR3 and HLA B8 pos
people p315
71.
Guillain Barre syndrome: acute inflammatory
demyelinating dx primarily involving peripheral nerves
p370
72.
Hand Schuller Christian dx: aka chronic progressive
histiocytosis, not as bad as Letterer Siwe p350
73.
Hartnup dx: impaired tubular reabsorption of tryptophan,
pellagra::like manifestations p264
74.
Hashimoto thyroiditis: autoimmune hypothyroid, hurthle
cells common p316
75.
4
Heart failure cells: intra::alveolar hemosiderin-laden
macrophages caused by RBCs from capillary rupture
2* to pulmonary HTN p35
76.
77. Heberden nodes: osteophytes at DIP joints p355
Henoch Schonlein Purpura: hemorrhagic urticaria of
extensor surgaces of arms, legs, and buttocks, with
fever, arthralgias, and GI renal involvement similar to
IgA nephropathy, associated with URIs p128 and 189
78.
HER: 2/neu :: oncogene (aka c-erbB2), in breast cancer =
poor prognosis p95
79.
Hfe gene: located on xsome 6, mutation here = hereditary
hemochromatosis p9
80.
Hirano bodies: intracytoplasmic proximal dentritic
eosinophilic inclusions consisting of actin seen in
Alzheimers p370
81.
Hirschsprung dx: aka congenital megacolon, dilation of
colon due to absence of ganglion cells p227
82.
HLA B27 antigen: associated with 90% cases of
ankylosing spondylitis, common in rheumatoid arthritis
p69 and p354
83.
Hodgkin dx: malignant lymphoma with features
resembling inflammatory disorder, young men, Reed
Sternburg cells p176
84.
Hunter syndrome: similar to Hurler, deficient L
iduronosulfate sulfatase, accumulations of heparin
sulfate and dermatan sulfate, hepatospenomegaly,
micrognathia, retinal degeneration, joint stiffness,
mental retardation, cardiac lesions p59
85.
Huntington dx: autosomal dominant, fatal, progressive
degeneration of striatum and frontal cortex with
neuronal depletion and gliosis p372
86.
Hurler syndrome: mucopolysaccharidosis, deficient a L
iduronidase, accumulations of heparin sulfate and
dermatan sulfate in heart, brain, liver, and other
organs, progressive, hepatosplenomagaly, dwarfism,
gargoyle-like facies, stubby fingers, corneal clouding,
mental retardation, death by 10 years of age p57
87.
Hurthle cell: epithelial cells with eosinophilc granular
cytoplasm seen in hashimoto p316
88.
Hutchinson freckle: aka lentigo maligna, precursor to
lentigo maligna melanoma p336
89.
90. If you’ve gotten this far, give yourself a high five: High 5
Kartagener syndrome: defective cilia, sinusitis,
bronchiectasis, situs inversus, sometimes hearing loss
and male sterility p202
91.
Kawasaki dx: aka mucocutaneous lymph node syndrome,
acute self-limited, infants and young kids, acute
necrotizing vasculitis of small and medium vessels,
fever hemorrhagic edema of conjunctivae, lips and oral
mucosa, and cervical LAD, can cause coronary artery
vasculitis with aneurysm formation p129
92.
Kayser Fleischer ring: ring of copper deposited around
iris seen in Wilson Dx p245
93.
Kimmelsteil Wilson dx: diffuse nodular diabetic
glomerulosclerosis p323
94.
Kimmelstiel Wilson nodules: mesangial matrix material
acculmulations seen in nodular glomerulosclerosis seen
in diabetic nephropathy p259
95.
Klinefelter syndrome: at least 2 X and one Y,
hypogonadism, tall, gynecomastia, low testosterone,
high pituitary gonadotropins, infertility, p51
96.
97. Koilocyte: dysplastic cell seen in HPV p293
98. Krukenberg tumor: metastatic stomach CA to ovary p224
5
Lambert Eaton syndrome: paraneoplastic synd looks like
myasthenia gravis, often small cell lung CA p347
99.
Langhans giant cell: nuclei arranged in horseshoe-shaped
pattern about periphery of cell, characteristic of but not
specific for granulomatous TB (as opposed to a foreign
body giant cell that has scattered nuclei) p26
100.
Lesch Nyhan syndrome: deficient hypoxanthine::guanine
phosphoribosyltransferase (HGPRT), low purine
metabolism, high uric acid, thus gout, mental
retardation, choreoathetosis, spasticity, self mutilation,
aggressiveness p59
101.
Letterer Siwe dx: aka acute disseminated langerhans cell
histiocytosis, aggressive, usually fatal, kids
hepatosplenomegaly, LAD, pancytopenia, pulmonary
involvement, recurrent infections p350
102.
Li Fraumeni syndrome: lots of tumors, breast CA, soft
tissue sarc, brain tumors, leukemias, has loss of p53
tumor suppressor gene p96
103.
Libman Sacks endocarditis: occurs in SLE, small
vegitations on either or both surfaces of valves p141
104.
Lisch nodule: pigmented iris hamartoma seen in
neurofibromatosis
105.
Lynch syndrome: hereditary nonpolyposis colon cancer,
DNA repair genes messed up p96
106.
Marfan syndrome: deficient fibrillin (constituent of
microfibrils), arachnodactyly, ectopia lentis, aortic
aneurysm, mitral valve prolapsed p55
107.
McArdle syndrome: deficient muscle phosphorylase,
glycogen in skeletal muscle, cramps with exertion p57
108.
McCune Albright syndrome: polyostotic fibrous
dysplasia, precocious puberty, café au lait spots, short
stature, young girls p349
109.
Mediterranean anemia or Cooley Anemia: B
Thalassemia major p163
110.
Meigs syndrome: triad of ovarian fibroma, ascites,
hydrothorax p297
111.
Munro abscesses: minute neutrophilic abscesses found
within parakeratotic stratum corneum in psoriasis p333
112.
N: myc :: neuroblastoma amplicatiion correlates inversely
with degree of differentiation p95
113.
Names of Vitamins: B1 thiamine, B2 riboflavin, B3 niacin,
B6 pyridoxine, B12 cobalamin, C ascorbic acid, D
calciferol, E a::tocopherol
114.
Negri bodies: eosinophilic intracytoplasmic inclusions in
hippocampus and purkinje cells seen in rabies infection
p368
115.
Nelson syndrome: development of large pituitary
adenomas following bilat adrenalectomy p313
116.
117. NF1: tumor suppressor mutated in Von Recklinhousen p96
Niemann Pick dx: deficient sphingomyelinase,
accumulation of sphingomyelin in phagocytes, foamy
histiocytes in liver, spleen, lymph nodes, skin,
hepatosplenomegaly, anemia fever, occasional neuro
degeneration, half have cherry red spot macula p 57
118.
119. Orphan annie nuclei: seen in papillary thyroid CA p316
Osler Weber Rendu syndrome: aka hereditary
hemorrhagic telangectasia, telangectasias in skin and
mucous membranes, epistaxis, GI bleeds p55 and p189
120.
p53: gene product facilitates apoptosis, decreases bcl::2
and increases Bax p7
121.
p53: tumor suppressor gene, pretty much the coolest one
p96
122.
Paget dx of bone: aka osteitis deformans, increased
osteoclastic and osteoblastic activity p348
123.
Paget dx of breast: eczematoid lesion of nipple areola,
large cells with clear “halo like” area, invade
epidermis, underlying ductal CA p300
124.
6
Paget dx of vulva: similar to paget breast, sometimes
related to underlying adenoCA of sweat glands p291
125.
Pancoast tumor: aka superior sulcus tumor, seen in
bronchogenic CA, often with Horner’s p 212
126.
Patau syndrome: aka trisomy 13, mental retardation,
microcephaly, micropthalmia, brain abnormalities, cleft
lip/palate, polydactyly, rockerbottom feet, congenital
heart dx p51
127.
Peutz Jeghers syndrome: hamartomatous polyps in colon
and small intest, freckles on lips, hands, genitalia,
higher incidence of adeno CA of colon and other
malignancies, stomach, breast, ovaries p230
128.
Peyronie dx: subcutaneous fibrosis of dorsum of penis
p279
129.
PIG A: mutation = paroxysmal nocturnal hemoglobinuria
p161
130.
Plummer dx: combination of hyperthyroidism, nodular
goiter, absence of exophthalmos p315
131.
Plummer Vinson syndrome: iron deficient anemia
associated with upper::esophageal web p157
132.
Pompe dx: deficient a1,4 glucosidase, accumulation of
glycogen in liver, heart, skeletal muscle, cardiomegaly,
muscle hypotonia, spelnomegaly, intractable
hypoglycemia, death from cardiorespiratory failure
before age 3 p57
133.
Potter sequence: oligohydramnios causes fetus to be
smashed p257
134.
Prader willi syndrome: paternal transmission del
(15)(q11q13), hypogonad, hypotonia, mental
retardation, behavior probs, uncrontrolled appetite p53
135.
Ras oncogenes: oncogenes that code for p21 proteins
which are membrane signalers p93
136.
Raynaud disease: different in that it is the primary
disorder, recurrent vasospasm of small arteries and
venules, pallor, cyanosis, fingers and toes, young
healthy women p129
137.
Raynaud phenomenon: vasosmasm of small vessels, most
often in fingers, seen with autoimmune dx like SLE,
scleroderma and others (R in CREST), recurrent
vasospasm, always secondary to underlying disorder
p77 and p129
138.
139. Rb gene: retinoblastoma on chromosome 13 p95 and p352
Reed Sternburg cell: binucleated or multinucleated giant
cell seen in Hodgkin dx
140.
Reidel thyroiditis: thyroid replacement by fibrous tissue,
unkown origin, mimics CA p316
141.
Reinke crystal: intracytoplasmic inclusions seen in leydig
cell tumors p283
142.
Reiter syndrome: urethritis, conjunctivitis, arthritis,
associated with venereal or intestinal infection p354
143.
ret: protooncogene mutated in medulary thyroid CA
(MENII) p96
144.
145. ret PTC: associated with papillary thyroid CA
Reye syndrome: aspirin toxicity seen in kids after acute
febrile viral dx, microvesicular fatty change in liver and
encephalopathy p108
146.
Rotor syndrome: similar to Dubin Johnson with no black
liver p239
147.
Rouleaux formation: also seen in urine of MM, stacks of
RBCs, will have high ESR p175
148.
Sheehan syndrome: pituitary insufficiency post-partum,
low TSH ACTH p298 and 312
149.
Shy Drager syndrome: parkinsonism with autonomic
dysfunction and orthostatic hypotension p373
150.
Signet ring cell: mucinous cell, characteristic of stomach
CA met to ovary (krukenberg tumor) p224
151.
7
Simmonds dx: aka pituitary cachexia, generalized
panhypopituitarism p312
152.
153. Sipple syndrome: = MEN2a
Smudge cells: seen in CLL, leukemic B-cells that are
fragile p172
154.
Starry sky appearance: on lymph node biopsy, seen with
Burkitt lymphoma p179
155.
Stein Leventhal syndrome: aka polycystic ovary
syndrome, young women, amenorrhea, infertility,
obesity, hirsutism p295
156.
Still disease: variant of rheumatoid arthritis, aka juvenile
rheumatoid arthritis p354
157.
Sturge Weber syndrome: port wine stain on face,
ipsilateral glaucoma, vascular lesions of ocular
choroidal tissue, extensive hemangiomatous
involvement of meninges p337
158.
Takayasu arteritis: aka pulseless dx, inflammation and
stenosis of medium and large sized arteries, often aortic
arch thus aortic arch syndrome p129
159.
Tay Sachs dx: deficient hexosaminidase A, GM2
ganglioside accumulation, especially in neurons, CNS
degeneration, mental/motor deterioration, blindness,
cherry red spot on macula, death by 4 years of age p56
160.
Turcot syndrome: adenomatous polyps with tumors of
CNS p230
161.
Turner syndrome: 45 XO, female hypogonadism,
hypothyroid, short, webbed neck, 1* amenorrhea p52
162.
Um… see p 94: there’s like 15 different oncogenes listed,
knock yourself out
163.
Virchow node: superclavicular lymph node identifying
metastatic stomach CA p224
164.
Von economo encephalitis: infectious disorder, caused
postencephalitic parkinsonism p373
165.
Von Gierke dx: deficient glucose-6-phosphatase,
accumulation of glycogen in liver and kidney,
hepatomegaly, hypoglycemia p57
166.
Von Hippel Lindau dx: hemangioblastoma or cavernous
hemangioma of cerebellum, brainstem or retina,
adenomas, cysts in liver, kidney, pancreas, and other
organs, increased renal cell CA, gene = short arm of
chromosome 3 p55 and p127
167.
Von Recklinhousen dx: aka neurofibromatosis,
neurofibromas in skin, schwannomas of CN VIII, café
au lait spots, lisch nodules, skeletal disorders, other
tumors, mutated NF1 tumor suppressor gene, osteolytic
lesions, brown tumors p55 and p96 and 347
168.
Waldenstrom Macroglobulinemia: manifestation of
lymphplasmocytic lymphoma, B cell neoplasm p176
169.
Waterhouse Friderichsen syndrome: catastrophic
adrenal insuff and vascular collapse, hemorrhagic
necrosis of adrenal cortex p321
170.
Wegener granulomatosis: unknown etiology, necrotizing
granulomatous vasculitis of small to medium sized
vessels of the respiratory tract, kidneys, and other
organs, circulating C-ANCAs p128
171.
Werdnig Hoffman syndrome: aka infantile progressive
spinal muscular atrophy, autosomal recessive, LMN
disease, infants p373
172.
173. Wermer syndrome: = MEN1
Wernicke Korsakoff syndrome: thiamine deficiency,
cerebral dysfunction, aka alcoholic encephalopathy,
hemorrhagic lesions in the mamillary bodies,
confusion, ataxia, ophthalmoplegia, and memory loss
plus confabulation p 105 and p115
174.
Whipple dx: malabsorption syndrome, Tropheryma
wippelii bacilli, small intestine commonly affected,
arthralgias, cardiac, and neuro symptoms p227
175.
Whipple triad: seen in insulinoma, episodic
hyperinsulinemia and hypoglycemia, CNS dysfunction,
reversal of CNS probs with administration of glucose
p324
176.
177. Wilms tumor: clear cell renal tumor seen in kids p266
8
Wilson dx: autosomal recessive, hepatitis, accumulation of
copper due to transport problem, low ceruloplasmin
seen, kayser fleischer rings in eyes p245
178.
Wiskott Aldrich syndrome: x linked, aka
immunodeficiency with thrombocytopenia and eczema,
total immunoglobulins often normal, recurrent
infections p74
179.
WT1 and WT2: tumor suppressor mutated in wilms tumor
p96
180.
Zenker diverticulum: esophageal diverticulum just above
upper esoph sphincter p221
181.

acid base mnemonic

2013-08-12T22:52:00.001-07:00

Brachial Plexus in 10 seconds! mnemonics

2013-08-12T22:49:00.001-07:00

http://www.youtube.com/watch?v=gTas7ijp0YE

THE PERSONAL STATEMENT

2013-08-12T22:45:00.002-07:00

Why is the personal statement so important? It is important because it is the only part of your application that is not based on test scores or other people’s perceptions of you. For this reason committees place a heavy emphasis on the personal statement. It is the one part of your application that you have complete control of and allows you to make a personal case for yourself. Because of these reasons, however, it is so very difficult to write.

There are some basic questions that you need to address in your personal statement. These are usually divided into three paragraphs that address: 1) what got you interested in the field that you have chosen; 2) what are you looking for in a residency program; and 3) what are your expected goals in the field you have chosen. You are always free to add other commentary that is relevant to the above topics. But, make sure you discuss these 3 topics in your essay.

Your personal statement should fit onto one page when it is printed from the ERAS system. You can test this prior to submitting your statement to residency programs.

Some helpful suggestions in getting started:

Go back to your medical school application essay. Some students find it useful to look at that as a basis for their residency statement. Specifically the introductory and final paragraphs.
Find out if your school has a writing office, which can help you with your statement.
Use a theme to structure your essay. This helps unite all aspects of your statement.
Provide concrete examples that pertain to your life, goals and experiences.
Be concise. Refrain from using a lot of unnecessary words.
Begin your essay with an attention grabber: a quote, a story, an anecdote, or a riddle.
Finish your essay with a conclusion that refers back to the beginning of your statement and restates the theme.
Have your departmental program director evaluate/critique your statement. Remember they have probably seen thousands of essays and is most likely the best authority at your institution to evaluate your work.
Don’t be afraid to start from scratch if your essay is not working.
Do write about what interests you, excites you. Your reader wants to hear a positive essay not a negative one about the profession.

Mistakes to avoid in a personal statement:

Underestimating the importance of the personal statement.
Underestimating the time and difficulty involved in developing the personal statement.
Lack of “flow”. You read the essay and have no idea what the applicant is trying to say. They jump from one tangent to another. When reading a statement like this I would rather not read the essay at all. To prevent this error you need not one, not two, but at least three people to read your essay and give you feedback. You need to revise your essay several times. Therefore, you cannot start working on the essay one week before it is due. I recommend starting to work on your personal statement in July. Remember that most attendings will ask for a copy of your personal statement in order to write a letter of recommendation. You therefore need to start early.
Spelling and Grammar mistakes. These can kill you. It says a lot about an applicant if they have not taken the time to carefully proof read their essay. Is this someone who pays attention to detail and will spend time taking care of patients in my hospital? No!
Avoid clichés.
Making the writing process a group effort. This does not work.
Being too cute. This is not an essay for college admissions where originality/strangeness is applauded. Keep it simple to the point and address the issues I have brought up before.
Procrastinating until the very end to begin your statement. You need to start months in advance.
Failing to let yourself come through. This goes back to trying to make your statement too cute. You do not want to show up to an interview and have the interviewer thinking: Am I speaking to the same person that wrote this statement?
Including topics in the statement that if asked to discuss you would not be able to answer, such as particular research points, volunteer activities, etc…

APPLYING FOR A FELLOWSHIP IN THE USA

2013-08-12T22:42:00.002-07:00

When applying for a residency (in the USA), many of us aspire to eventually pursue fellowships in different subspecialties. Getting into a fellowship can be more difficult than applying into a residency program; it is a process that starts from the time you start residency and involves more hard work and time than just giving and clearing your USMLE exams and applying through ERAS/NRMP.

I will discuss here the general principles of applying for fellowship positions in the internal medicine subspecialties. I am sure that the same principles would apply to the surgical subspecialties as well. My own experience comes from applying for a hematology-oncology fellowship, which along with cardiology and gastroenterology, is currently among the most competitive fellowships in the USA.

The basic rule is that you have to make your candidacy attractive; remember, you are competing with US medical graduates and international medical graduates (IMG’s) with prior experience (MRCP, PhD, MPH etc) for positions which are a lot fewer than the residencies you applied for. For example, according to the 2002 statistics (from the American Medical Association), there were 21,136 residents in accredited internal medicine residencies compared to 1,999, 1,058, and 991 fellows in cardiology, gastroenterology and hematology-oncology programs respectively (you can divide these numbers by three to get a rough estimate of the first year positions available every year in the respective specialties). Furthermore, for various reasons that I will not divulge into, fellowship programs are being downsized and getting more competitive to get into every year.

Start Planning Early

If you are interested in doing a fellowship, you have to start planning even before you apply for residency. As IMG’s, we are at a disadvantage; the type of training we receive in medical school cannot be verified by program directors here. Our ‘medical school transcripts’ do not have the information they are looking for, it is arduous to call and get in touch with deans/principals to verify the ‘accomplishments’ we mention in our resumes and there is no way they can verify our medical school standing (for them, AIIMS, New Delhi and Medical College, Jhumri Tilyya are usually the same). To make up for these deficiencies, the first thing that we can do is get into a good and well known residency program. People do get fellowships after doing residencies in ‘community’ programs, but it becomes easier if you are in an ivy league or a ‘university’ program where there are more opportunities for research, the faculty is ‘well known’, and there is a chance you will get absorbed into a fellowship position in the same institution. For example, this concept is similar to applying for a residency after graduating from say the ‘Harvard’ medical school versus an osteopathic medical school (for those of you not familiar with the US medical education system, these schools grant a DO (Doctor of Osteopathy) degree and are generally considered to be not as good as the regular medical schools). So study hard, get good USMLE scores and get into a good residency program (good ‘community’ or a ‘university’ program). If you choose to do residency in a ‘community’ program, as a lot of us do for various reasons (H1B visas being the most common), you can still get a good fellowship position provided you plan ahead of time. A lot of ‘community’ programs impart excellent training, have fellowships, have opportunities for research, or are affiliated with ‘university’ programs where you can do rotations or hook up with some one to do research or get recommendation letters from.

Once you start your residency, get settled and then start focusing on which fellowship you want to pursue. Fellowship applications are sent out in the beginning of your second year of residency. As most of us are here on different visas, unfortunately we don’t have the option of delaying our fellowship applications (as some US grads do – they take a year or two off after completing residency to do research before applying for a fellowship). We have to start our fellowship right after we finish our residency and usually cannot take a break (there are some options though, and I have listed them below). So, the earlier you can decide which subspecialty you want to pursue, the earlier you can start your research and identify mentors in that field.

Identify a Mentor

Unlike India where getting into MD/DM courses is strictly on the basis of merit in an entrance exam, a number of variables are looked at when you apply for a fellowship in the USA. One of the important factors is recommendation letters. So identifying a good mentor in the beginning of your residency is crucial. The mentor should be someone who is easily approachable, readily available, is willing to write a good letter of recommendation, and might make a few phone calls when the time comes for you to apply. Usually, mentors are from the same specialty as the one you are interested in (makes sense!), and often can give you guidance for research. Don’t go after somebody just because s/he has a ‘big name’; s/he may not be always available, may not have the time to get to know you well and hence may not be able to write a good letter of recommendation. Remember, an excellent letter from some one not as well known will be better that a mediocre letter from someone who is a stalwart in that specialty.

Research

Your accomplishments in research are also very important. You are not expected to be a Nobel Prize winner or have an extensive list of publications. But you should be actively doing something. Most program directors understand that the internship is too busy and short a time to complete a project and publish. They are looking for people who are motivated enough to be taking out the time and effort to pursue research despite their hectic schedules. So don’t worry if you lack extensive prior research experience, don’t have a PhD or an MPH degree – work hard during internship to set the foundation for your research which you can at least mention in your CV and talk about during the interview. Again, research does not have to be ground breaking lab research, even retrospective clinical studies, case reports etc will be appreciated.

Apply Early

Again, I cannot emphasize this enough. Fellowship programs have limited spots. Once the interview slots are filled out (most programs interview around 3-5 candidates for each position), the applications mostly start going into a pile of trash. So apply on time, the earlier the better.

Talk to Your Peers

Learn from the experiences of your seniors, both US medical grads and IMG’s. It is always better to learn from other peoples mistakes. And your seniors can tell you about the advantages and disadvantages of different programs, what to expect during interviews and who to contact for research projects and good recommendation letters.

Don’t Get Discouraged

For those who unfortunately cannot get into a fellowship during their residency, an option is to practice as an internist, settle your visa issues, and then apply for a fellowship. I know of many people who have taken this route and then come back to do a fellowship. Try to remain in touch with your residency mentors during that time period and try to keep in touch with the concerned subspecialty (attend related conferences, do research, etc).

Though the prospect of applying and getting into a fellowship is getting more formidable and competitive every year for IMG’s, one can still get into a program of one’s choice. It is imperative that you apply early and thoroughly plan the application and interview process.

All the best!