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  #1  
Old 09-05-2013
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Smile Step 2CK Preparation Journal

Today's Progress

Pages Read : 26 with Kaplan Vidoes
Chapters : IM - Finished Infectious Diseases, Started Nephrology

Tomorrow

Finish Nephrology & Start pulmonology
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Old 09-06-2013
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Today's Progress

Pages Read : 31 with Kaplan Vidoes
Chapters : IM - Finished Nephrology

Tomorrow

Start pulmonology
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Old 09-06-2013
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Why is there pruritis in End Stage Renal Disease? Why is it treated with UV light?
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  #4  
Old 09-07-2013
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Today's Progress

Pages Read : 21 with Kaplan Vidoes + 10 pages Kaplan Notes (Pulmonary Diagnostic tests & Radiography)
Chapters : IM - Started Pulmonology

Tomorrow

Day off
Monday: Finish Pulmonology

5 Daily Notes
  • Asthma is high yeild, make sure you know everything about it
  • Steroids decrease mortality in Sterp. pneumonia meningitis, although it is now given in all cases of meningitis
  • Steroids also decrease mortality in severe PCP penumonia
  • Important medications that cause seizures: Imipenim, Desipramine, Bupropion.... any other important ones?
  • Pneumococcal and H. Influenza vaccine is given to HIV+ patients regardless of CD4 count
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After trolling USMLE forums for 1 week, here is what I think:

IM- MTB 2CK
Pediatrics - MTB 2CK, MTB 3 & first 6 chapters Kaplan Notes
OBGY - MTB 2CK & MTB 3
Surgery - MTB 2CK & MTB 3
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  #6  
Old 09-09-2013
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Today's Progress

Pages Read : 12 with Kaplan Vidoes + 2 pages Kaplan Notes (Lung cancer)
Chapters : IM - Finished Pulmonary

Tomorrow

Finish Emergency Medicine in 2 days

5 Notes:
  • 3 more infections where steroids decrease mortality: TB pericarditis, TB meningitis & Acute exacerbation of COPD (technically not an infection but most acute exacerbations are caused by infections)
  • What is the most accurate test for Cystic Fibrosis? MTB says Cl- sweat test, but I remember Uworld for step 1 says Transnasal Potential Difference can diagnose those with partial mutations.....
  • Low Na+ can occur in pneumonia as a result of SIADH, most common in Legionella
  • Silicosis occurs in upper lung fields distorting TB CXR so PPD is done yearly
  • Lymph Node biopsy is most accurate test in Sarcoidosis, follow ACE levels for efficacy of treatment and prognosis
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  #7  
Old 09-11-2013
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Today's Progress

Pages Read : 28 with Kaplan Videos
Chapters : IM - Finished Emergency Medicine
Did not study yesterday! spent extra time and finished Emergency Medicine...

Tomorrow

Cardiac Resuscitation algorithms from Kaplan Notes & Start Neurology

5 Notes:
  • Why is there a normal Po2 in Methemoglobinemia, oxidized hemoglobin can't carry o2
  • Bicarbonate is used in TCA overdose to prevent arrhythmia
  • VF & pulse-less VTach are the only arrhythmias that get un-synchronized cardioversion
  • Defibrillation is more important than endotracheal intubation while giving basic life support
  • MCC of death in hypothermia is arrhythmia (VTach)
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  #8  
Old 09-11-2013
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Quote:
Originally Posted by kid_next_door View Post
After trolling USMLE forums for 1 week, here is what I think:

IM- MTB 2CK
Pediatrics - MTB 2CK, MTB 3 & first 6 chapters Kaplan Notes
OBGY - MTB 2CK & MTB 3
Surgery - MTB 2CK & MTB 3
with kaplan videos with all these topics?
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  #9  
Old 09-11-2013
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I think sweat chloride is the initial test for cystic fibrosis. The most accurate test is genetic analysis of CFTR gene, correct me if I am wrong
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  #10  
Old 09-12-2013
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Quote:
Originally Posted by ` Faith ` View Post
with kaplan videos with all these topics?
Yes with Kaplan Videos..
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  #11  
Old 09-12-2013
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Quote:
Originally Posted by billy View Post
I think sweat chloride is the initial test for cystic fibrosis. The most accurate test is genetic analysis of CFTR gene, correct me if I am wrong
According to MTB 2 Genotyping is not the most accurate test because there are multiple types of mutations that cause Cystic Fibrosis....

I think that Cl- sweat test on multiple occasions can establish the diagnosis even in patients with partial mutations
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Old 09-12-2013
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Today's Progress

Pages Read : 26 with Kaplan Videos
Chapters : IM - Neurology 90% finished
Didn't do cardiac resuscitation algorithms, better to do it with a study partner

Tomorrow

Finish Neurology, Ophthalmology, Radiology & Start Dermatology

5 Notes:
  • What is the best antiepileptic in pregnancy? Dr. Conrad Fisher says Carbamazepine but until now I thought it was Barbiturates
  • Aspirin is not routine prophylaxis in stroke because risk of hemorrhagic stroke, unlike MI where there is no risk of hemorrhagic MI
  • Tension Headaches are not vascular so Triptans & Ergotamine will not work
  • Oligoclonal bands in CSF - Multiple Sclerosis, Monoclonal bands - Myeloma or MGUS, ↑ Albumin with Normal Cell count - Guillain Barre Syndrome, WBC:RBC ratio 1:500 to 1:1000 - Subarachnoid hemorrhage, ↑ WBC in ratio - Meningitis
  • Meniere's disease Rx: Na+ restriction & diuretics
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  #13  
Old 09-12-2013
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Quote:
Originally Posted by kid_next_door View Post
After trolling USMLE forums for 1 week, here is what I think:

IM- MTB 2CK
Pediatrics - MTB 2CK, MTB 3 & first 6 chapters Kaplan Notes
OBGY - MTB 2CK & MTB 3
Surgery - MTB 2CK & MTB 3
I am using MTB 3 to cover anything not in MTB 2 for IM.... It is much faster than reading Kaplan Notes....
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  #14  
Old 09-12-2013
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Yes you are also right but I am confused look page 406 MTB2
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  #15  
Old 09-12-2013
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Quote:
Originally Posted by billy View Post
Yes you are also right but I am confused look page 406 MTB2
i see your point, I am confused too
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  #16  
Old 09-14-2013
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Today's Progress

Finished Neurology, Ophthalmology, Radiology & Dermatology

Didn't study yesterday, spent extra time to finish Internal Medicine and stay on schedule
IM is over....

Tomorrow

Sunday off
Next week: Pediatrics (first 6 chapters KLN, MTB 2, MTB 3 & Kaplan Videos)

5 Notes:
  • Nikolsky sign + conditions - Pemphigus Vulgaris, Toxic Epidermal Necrolysis, Staphylococcal Scald Syndrome & Toxic Shock Syndrome
  • MCC of death in Steven-Johonson Syndrome is respiratory failure, sloughing off respiratory epithelium causes blockage
  • Syphillis causes Alopecia Areata, Asprin worsens Diabetic Retinopathy
  • Break down of Blood-Brain barrier in cancer and infections of the CNS causes contrast to extravasate into lesion
  • Ring enhancing lesion in HIV- patient> biopsy, HIV+> TMP-SMX > biopsy if no recovery
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  #17  
Old 09-18-2013
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16/9/2013

Didn't study today, change in my schedule: from now on Monday is my day off
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  #18  
Old 09-18-2013
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17/9/2013
Today's Progress

Started Pediatrics, 15 pages finished with Kaplan Videos, 10 pages KLN

I decided not to do KLN, even the first 6 chapters because everything is covered in MTB 2 & 3. What ever little is missing from KLN is covered in videos.

Tomorrow

Continue Pediatrics (goal around 20 pages/day with videos)

5 Notes:
  • Omphalocele: defect in abdominal wall musculature, is covered by omentum (associated with Trisomy 18); Gastroschisis: defect in lateral to midline abdominal wall formation, not covered by omentum; Umblical hernia: congenital weakness in rectus abdominis muscle (associated with congenital hypothyroidism)
  • Parachute reflex is the only reflex that is not present at birth (develops around 6-8 months) and persists
  • Subcutaneous Fat Necrosis: associated with: difficult labor, prolonged asphyxia & prolonged hypothermia. Hypocalcemia can occour due to Ca+2 deposition in nodules
  • Galactosemia predisposes to E. coli infections, Waardenburg syndrome - white forelock of hair
  • Antenatal Betamethasone 24 hours before delivery can prevent Respiratory Distress Syndrome in premature infants.
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Old 09-18-2013
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Today's Progress

Pediatrics: 25 pages

Tomorrow

Continue Pediatrics (goal around 20 pages/day with videos)

5 Notes:
  • Human milk is deficient in Vitamin D & K, give Fe+2 supplementation at 4-6 months; no cow's milk before 1 year: high renal solute load, less Fe+2 availability; goats milk - give folate supplementation
  • Sotos syndrome: LGA, Hydrocephalus, Mental Retardation & Tall Stature
  • Steeple sign: croup; Thumb-print sign: Epiglotitis
  • G551D mutation + > give Ivacaftor
  • Staccato cough + peripheral eosinophilia = Chlamydia trachomatis pneumonia, check conjunctiva
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Old 09-18-2013
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Quote:
Originally Posted by kid_next_door View Post
Today's Progress

Pediatrics: 25 pages

Tomorrow

Continue Pediatrics (goal around 20 pages/day with videos)

5 Notes:
  • Human milk is deficient in Vitamin D & K, give Fe+2 supplementation at 4-6 months; no cow's milk before 1 year: high renal solute load, less Fe+2 availability; goats milk - give folate supplementation
  • Sotos syndrome: LGA, Hydrocephalus, Mental Retardation & Tall Stature
  • Steeple sign: croup; Thumb-print sign: Epiglotitis
  • G551D mutation + > give Ivacaftor
  • Staccato cough + peripheral eosinophilia = Chlamydia trachomatis pneumonia, check conjunctiva
what is G551D?
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  #21  
Old 09-18-2013
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Quote:
Originally Posted by target250 View Post
what is G551D?
It is a mutation that causes cystic fibrosis by inhibiting CFTR gene
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  #22  
Old 09-18-2013
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Quote:
Originally Posted by target250 View Post
what is G551D?
G551D mutation - all patients should undergo genotyping in order to reveal this mutation, because drug ivacaftor is the first FDA approved drug that can decrease sweat chloride levels in patients with G551D mutation
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  #23  
Old 09-20-2013
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19/9/2013
Today's Progress

Pediatrics: 15 pages with Kaplan videos

Studied only 4 hours, some thing came up

Tomorrow

Continue Pediatrics (goal around 20 pages/day with videos)

5 Notes:
  • Why is there no anaphylactic reaction to whole blood in Bruton Agammaglobulinemia? In selective IgA deficiency the patient should not receive blood products with IgA, Why can a patient with Bruton receive blood products with IgG, IgM?
  • Why dose A2 come before P2? Systemic vascular resistance is higher than Pulmonary vascular resistance, so shouldn't it take longer for the Left Ventricle to eject blood?
  • Cholesteoma - Complication of Otitis Media where squamous epithelium growths in ear drum.
  • Amoxicillin is drug of choice for Otitis Media, if no resloution after 2 - 3 days then consider B-Lactumase producer (Moraxella catarrhails).
  • In Congenital Heart Disease always perform corrective surgery before Irreversible Pulmonary Hypertension.
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  #24  
Old 09-20-2013
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Today's Progress

Pediatrics: 25 pages with Kaplan Videos

Tomorrow

Finish Pediatrics, 17 pages left

5 Notes:
  • Congenital Heart Disease that are high flow are more risk to develop Endocarditis. ex. VSD more risk than ASD. Although both should receive prophylaxis before dental procedures.
  • Prostaglandin E1 is used to keep Ductus Arteriosis open, generally more useful in Cyanotic Heart Disease.
  • Rotavirus is most common cause of diarrhea in children, never give antibiotics to suspected case of HUS.
  • Vomiting since birth: Deodenal Atresia & TE fistula (Deodenal Atresia - bile stained vomit); Vomiting starts at 2 weeks: Pyloric stenosis (projectile & non-bile stained).
  • Alport syndrome - X linked Dominant, although females only present with mild symptoms. They may present with mild hearing loss & very little renal problems.
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  #25  
Old 09-20-2013
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Quote:
Originally Posted by kid_next_door View Post
Today's Progress

Finished Neurology, Ophthalmology, Radiology & Dermatology

Didn't study yesterday, spent extra time to finish Internal Medicine and stay on schedule
IM is over....

Tomorrow

Sunday off
Next week: Pediatrics (first 6 chapters KLN, MTB 2, MTB 3 & Kaplan Videos)

5 Notes:
  • Nikolsky sign + conditions - Pemphigus Vulgaris, Toxic Epidermal Necrolysis, Staphylococcal Scald Syndrome & Toxic Shock Syndrome
  • MCC of death in Steven-Johonson Syndrome is respiratory failure, sloughing off respiratory epithelium causes blockage
  • Syphillis causes Alopecia Areata, Asprin worsens Diabetic Retinopathy
  • Break down of Blood-Brain barrier in cancer and infections of the CNS causes contrast to extravasate into lesion
  • Ring enhancing lesion in HIV- patient> biopsy, HIV+> TMP-SMX > biopsy if no recovery

According to my understanding, you give a full battery of treatment when suspecting toxoplasmosis as a ring enhancing lesion in HIV (+) patients, that is you give Pyrimethamine + Sulfadiazine + Folinic acid.

From Medscape LINK

"In patients in whom brain imaging shows multiple lesions, whether serologic results are negative or positive, antitoxoplasmosis therapy should be initiated. In cases of impending herniation, an open biopsy with decompression is indicated. Corticosteroid treatment may be warranted in cases of impending brain herniation. However, their use may complicate the interpretation of a response to antitoxoplasmosis therapy... "

"Standard therapy consists of pyrimethamine, sulfadiazine, and folinic acid in combination. Trimethoprim-sulfamethoxazole (TMP-SMZ) can be used as an alternative regimen.[8] A Cochrane data base review failed to find a significant difference between standard therapy and TMP-SMZ."


Eventho TMP-SMZ is considered equal in efficacy, it is not the more complete treatment.. Remember both treatments can cause Megaloblastic anemia if not correctly supplemented with folinic acid.. So I would always pick the best answer out of the 2 (that is the one that covers treatment + complications of the treatment)
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  #26  
Old 09-21-2013
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Today's Progress

Finished Pediatrics
Relived to get my permit & book date with Prometric (Dec 31)

Tomorrow

Finished 1 day ahead of schedule, so don't know what I am going to do.
First Aid cases Pediatrics? Step 2 Secrets?

5 Notes:
  • In pediatric patients, only H. Influenzae (Hib) Meningitis is treated with Dexamethasone, in adult Meningitis steroids are empirical (I am not 100% sure about this would someone please check)
  • Dactylitis is usually the first manifestation of Sickle Cell Anemia.
  • Von Willebrand Disease - Autosomal Dominant, affects females more than male.
  • No clinical bleeding with PTT & Mixing Study both prolonged - Lupus Anticoagulant.
  • Fever without a focus - < 1 week; Fever of Unknown Origin - > 3 weeks.
    Fever Without a Focus - Admit & Antibiotics to cover common causes of Neonatal Meningitis : Group B Strep., E. coli & Listeria monocytogens
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Old 09-24-2013
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Today's Progress

Obstetrics 15 pages with Kaplan Videos
Kaplan Videos are very long!

Tomorrow
Continue Obstetrics (25 pages/ day with Kaplan Videos)
My goal is to finish Obstetrics by Friday & finish Gynecology by Sunday

5 Notes:

  • Increased Progesterone in pregnancy causes decreases smooth muscle tone causing GERD, Cholelithiasis & constipation.
  • Warfarin causes Chondrodysplasia Punctata & Optic Atrophy.
  • DIC in Obstetrics is from Thromboplastin released by dead fetus or from amniotic fluid embolism.
  • Proximal tube Ectopic Pregnancy is more likely to rupture than a distal tube Ectopic Pregnancy.
  • When is Methotrexate contraindicated in Ectopic Pregnancy?: B-HCG>6000, Ectopic > 3.5cm, Fetal heart beat is present, immunodeficiency & liver disease
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Old 09-25-2013
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Today's Progress

Obstetrics 25 pages with Kaplan Videos


Tomorrow

Continue Obstetrics (25 pages/ day with Kaplan Videos)

5 Notes:
  • Most common cause of DIC in Obstetrics is Abruptio Placenta. Thromboplastin is released from a Concealed clot.
  • Twin Twin Transfusion Syndrome can occur only in Monozygotic Monochorionic Diamniotic twins. Cord entanglement is more common in Mono, Mono, Mono.
  • If Placenta is >2cm from internal os, vaginal delivery can be attempted.
  • AB blood group is more susceptible for Rh isoimmunization. AB blood group lacks Anti-A & Anti-B antibodies that would normally kill Rh+ fetal erythrocytes before they stimulate Lymphocytes.
  • PGE2 for induction of labor.
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