Forever a Student

IMGM0063-2-600x340 As a doctor, lectures and exams do not stop at med school graduation. Nor does it stop after end of residency. Getting state-licensed and board-certified is never a one-time done deal. In order for me to maintain my legal ability to practice medicine, I will be required to earn CME (continuing medical education) credit. CME comes in many shapes and forms. It can…

End of Residency

Sometime between the first and last day, I decided to ditch the white coat... I was never good at ironing that thing anyway... So that’s that, the end of residency. There’s no one word that can describe the last three years. Residency had been challenging, no doubt, with a steep learning curve, long work hours, and long board exams to study for. Throw two kids in the mix, balancing work and family life has made the experience a little more interesting. However, there…

Staying Fit in Medical School

2017-03-20 15.49.30 A few months back, I received a question from a blog reader concerning staying fit during medical school. Jonathan writes: “Benji, I have some questions regarding maintaining overall health and fitness during medical school, something which you obviously appear to have done. What did you personally do and what advice would you give to incoming students? Was there a specific training…

Happy to Announce…

Our first photo together as a family of four A little over a week ago, I wanted to give yall an update that I have just been granted my full license to practice medicine in Georgia by the Georgia Composite Medical Board. I was going to talk about how licensure was a lengthy process that requires successful completion of all three United States Medical Licensing Exams (USMLE), as well as…

About the USMLE

Prometric Center where I took the USMLE Step 3 What is the USMLE? In order to apply for licensure to practice medicine in the states, one must complete the United States Medical Licensing Exam, also known as the USMLE. The USMLE is not one exam, but several, taken as a series of exams over the course of med school and residency.  There are four exams, divided into…

Beginning of the End

Ho Family And just like that, there goes another year of residency. Every July 1, all around the US, hospitals start seeing a new set of faces taking care of patients, working with the rest of the staff. They are the new doctors, the interns. That same day, the previous interns also take their role as the new second-year residents, and the…

An Exciting Day

AUC Benji_0244 Do you remember when you were a kid and wondered what you will be when you grew up? Well, today is that special day when many of my medical colleagues find out. It’s Match Day! Congratulations to all those who matched this year. I am truly impressed by the matches AUC graduates have placed this year. Going through my Facebook, I…

Lice and Scabies

Typical scabies rash Typical scabies rash Lice (Head, Body, and Genital)
  • Dx – must see the lice. Seeing nits alone does NOT diagnose, and is not an excuse for the kid to be out of school.
  • Rx – Permethrin 1% Shampoo. Leave on 10 min, then rinse. Repeat in 1 week to kill off any hatched eggs. Wash all clothes, bedsheets, towels
  • Acne

    Cotopaxi, Ecuador Some Tid-Bits
  • Four factors lead to acne formation: increased sebum production, hyperkeratinization, propionibacterium acnes colonization, and inflammatory reaction.
  • Treatment Steps (from mild to severe)
    1. Comedones – Rx Topical Retinoids (Tretinoin, Adapalene, Tazarotene) – generally works about the same. For the following additional symptoms:
    2. Inflammation – Add Topical Non-Abx (Benzoyl Peroxide, Azelaic Acid) +/- Topical Abx (Clindamycin,

    Insomnia

    woman with yellow hair Woman with yellow hair, 1931, Picasso Some Facts:
  • Insomnia (ICSD-3 Definition) – Difficulty falling asleep, difficulty staying asleep, early awakening, daytime impairment (i.e. fatigue, poor concentration, moody, increased errors, social dysfunction, worry). Occurs at least 3x per week x1 month. Chronic if >3 months.
  • Comorbid Conditions – OSA/breathing disorders, circadian rhythm disorders, GI issues, pruritus, heart failure, pain, restless legs
  • Erectile Dysfunction

    Viagra Viagra H&P
  • Check for psych factors, medications that may cause ED, and possible medical contributions to ED (DM2, obesity, CAD). Do physical exam to check for hypogonadism, peyronie’s disease, or other possible causes of ED.
  • Labs
  • Total testosterone level (deficient if <300), TSH, lipid panel, A1C. Remember, ED can be a sentinel marker for CAD.
  • First-Line Treatment
  • Phosphodiesterase-5 Inhibitors
  • Scoliosis

    Cobb Angle Scoliometer – have patient bend over and place on patient’s back to measure angle of incline. There are also scoliometer apps you can download on your smart phone.  Background
  • Definition: >10° lateral curve to spine with vertebral rotation
  • Types: classified as congenital, neuromuscular, or idiopathic. Idiopathic scoliosis is further classified by age: Infantile (0-2 yo), Juvenile (3-9 yo), Adolescent (>10
  • Osteoporosis

    ostoeporosis Screening
  • USPSTF recommends all women 65 years and older get screened for osteoporosis with a DEXA scan to measure bone density.
  • You can also screen for osteoporosis in women younger than 65 who score high on the FRAX WHO Fracture Risk Assessment Tool.
  • USPSTF does not recommend routine screening in men unless they are older than 50 and have a history
  • Non-Insulin Meds for DM2

    Galega Officinalis, from which Metformin was derived First Line – Start with this.
  • Biguanide (Metformin)
  • MOA: inhibits gluconeogenesis
  • Weight loss, decreased mortality, decreased CV events. Because of this, continue even when insulin-dependent.
  • AE: GI. Take with meals.
  • CI in men with Cr >1.5 or women with Cr >1.4, or GFR<30.
  • Cheapest ($4/month)
  • Second Line – Add to Metformin if no improvement in A1C in 3 months. Can add…

    Anticoagulation

    hqdefault Risk Classifications Schemes
  • Caprini Risk Assessment – estimates venous thromboembolism risk for non-orthopedic surgeries. Low risk use SCDs. Mod risk use meds or SCDs. High risk use meds+SCDs. If risk of bleeding, use SCDs only.
  • CHADS2 – estimates stroke risk in Afib patients. Easiest one to use. Recommends aspirin, anticoagulant, or both, depending on risk.
  • CHA2DS2-VASc – a more accurate
  • Onychomycosis

    490px-Oncymycosis Facts about Onychomycosis
  • Onychomycosis is very common. 50% of patients older than 70 years old have it.
  • Onychomycosis is most often caused by dermatophytes of the genus Trichophyton. Non-dermatophyte molds are less common.
  • Treating onychomycosis is more than just about cosmetics. It can lead to cellulitis in the elderly, and foot ulcers in diabetics.
  • Onychomycosis is hard to treat, since
  • Supraventricular Tachycardia Management

    SVT.jpg Types of SVT:
  • AVNRT – caused by a slow and fast pathway in the node, causing reentry.
  • AVRT – caused by an accessory pathway between the atrium and ventricle, not in the node. If there is delta wave and tachycardia, it is WPW.
  • Atrial Tachycardia – caused by focal area of automaticity in atrium.
  • Acute Treatment
  • Vagal Maneuvers – Valsalva x15 sec.
  • Botanical Medicine

    Echinacea Purpurea Botanical (Herbal) medicine has been used all over the world, and in different ways. In a 2005 CDC survey, 19% of adult Americans take dietary supplements and most use them without medical advice. Because many of your patients may be taking botanicals at home, as a medical practitioner, it is important to at least be familiar with them, and even consider integrating some of…

    Treatment for Allergic Rhinitis

    Misc_pollen When treating allergic rhinitis, you should take into account the severity of symptoms, patient’s age, whether they are pregnant or not, price, and other factors. For asthmatics, allergic rhinitis is especially important to be treated as it can lead to asthma exacerbation. And of course, one should try to avoid known allergens as well. For Mild Intermittent Symptoms:
  • Second Generation
  • Nausea and Antiemetic Medications

    3205_-_Milano,_Duomo_-_Giorgio_Bonola_-_Miracolo_di_Marco_Spagnolo_(1681)_-_Foto_Giovanni_Dall'Orto,_6-Dec-2007-cropped Nausea and vomiting happens when the Vomiting Center in the medulla is stimulated by one of three different neurotransmitter pathways:
  • Visceral Stimulation (of intestines, stomach) – i.e. nausea from gastroenteritis
  • mediated by dopamine and serotonin
  • Chemoreceptor Trigger Zone (in medulla oblongata) – i.e. nausea from chemotherapy
  • mediated by dopamine and serotonin
  • Vestibular Stimulation (in inner ear) – i.e. nausea from motion sickness
  • mediated
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