Med School Abroad: The Early Years Matter

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By Edison Cano

Med School Abroad - The Early Years MatterTwo days after finishing my last year of medicine, the so-called internship in my country, I boarded a flight to the United States to start an observership. I wondered over and over again, what am I supposed to do there? I had heard the “rumors” about the dreaded Steps, the thorny Match, review courses, and resources, but all I knew was that I fiercely wanted a residency in the US.

Once I started my rotation and got involved in US medical education, stumbling and rolling with some good luck, I learned on the go what I needed to get a residency. No surprise, this is what happens to most IMGs who attempt to get a residency in the US. But the phrase I hear consistently is: I wish I started earlier. Here is some advice for those in the early years of med school abroad interested in a US residency.

Always ask for advice. Keep in touch with people who made it into residency or are some steps ahead. Any advice can give you a different perspective on your quest. A friend shared advice he got from one of his mentors: never hesitate to ask for advice or help, whoever made it this far never got here alone, there are always grateful people willing to pass on their knowledge. (more…)

USMLE-Rx Step 1 Qmax Challenge #3862

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Check out today’s Step 1 Qmax Question Challenge.

Know the answer? Post it below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 1 Qmax Challenge #3862A 67-year-old former landscaper is referred to the dermatologist for a lesion on his right forearm. The lesion is a flesh-colored pearly papule approximately 1.5 cm in diameter with a central telangiectasia. A biopsy is taken, and the results are shown in the image.

Which of the following is the most likely diagnosis?

A. Actinic keratosis
B. Basal cell carcinoma
C. Dermatitis herpetiformis
D. Melanoma
E. Seborrheic keratosis
F. Squamous cell carcinoma

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Baby Say What? Understanding Developmental Milestones

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By Joe Savarese

Baby Say WhatPersonally, I don’t have children. Considering my hectic schedule, that is probably a larger benefit for my future children than it is for me. However, this puts me at a distinct disadvantage in understanding what is considered normal in a baby’s development.

Developmental milestones always seem intuitive on paper, which makes them difficult to commit to memory. Ranges of what is considered normal makes diagnosing a developmental delay even more difficult. I am going to make this ridiculously easy for you and myself. In the clinic setting, scales such as the Early Language Milestone (ELM) scale-2 can be useful in evaluation of speech delays (click here for more).

Remember everything in 3’s.
3 months – Cooing
6 months – Babbling
9 months – Jargoning (more…)

Check Out First Aid Step 1 Flash Facts 2015

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Why You Should Stop Apologizing: Playing to Win in Med School

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By Luke Murray

Why You Should Stop ApologizingIn my last post, I urged medical students to stop apologizing, and I spelled out the logic from which these inappropriate apologies originate. What I didn’t do was really drive home why you should stop apologizing.

Some of those reasons could be implied by the text of the last post. For example, communicating to your peers and superiors, “I have unreasonable expectations” – in other words, “I have an inappropriate grasp of reality” – does not make you look intelligent and calibrated.

In addition to making you look unreasonable, it makes the interaction awkward. What are people supposed to say? “I accept your apology?” It’s like hanging around with someone that’s dogging on themselves completely out of context. (“Man, I’m terrible at math.” ….”Umm.. yeah man. That’s rough. Uhh…They’re ready to take our order, so do you know what you want, or should I go ahead?”). Your lack of comfort with yourself makes everyone else around you uncomfortable. (more…)

USMLE-Rx Step 2 Qmax Challenge #21566

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Check out today’s Step 1 Qmax Question Challenge.

Know the answer? Post it below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 2 Qmax Challenge #21566A 3-year-old girl is brought to the emergency department from her day care center. Over the course of the day, she has had four episodes of nonbloody nonbilious emesis. She has also been extremely lethargic and difficult to arouse. The day care center tried to reach her mother at work but was unsuccessful. She was born vaginally at 39 weeks’ gestation after a normal uncomplicated pregnancy and delivery. She is the youngest of seven children and her father has been incarcerated for the past 2 years. Her heart rate is 60/min. Her anterior fontanelle is full and her pupils are poorly reactive to light bilaterally. Cardiac examination is normal. Her lungs are clear to auscultation bilaterally with shallow breath sounds. She has bruising and tenderness over her posterior lower ribs. An image from a non-contrast head CT is shown below.

Which of the following is the most likely diagnosis?

A. Coagulation disorder
B. Glutaric aciduria type 1
C. Intracranial aneurysm
D. Meningitis
E. Shaken baby syndrome

———————–

Want to know the ‘bottom line?’ Purchase a USMLE-Rx Subscription and get many more features, more questions, and passages from First Aid, including images, references, and other facts relevant to this question.

This practice question is an actual question from the USMLE-Rx Step 2 CK test bank. Get more Step 2 CK study help at USMLE-Rx.com.

Stop Apologizing: How to Stop the Expectation of Perfection

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By Luke Murray

Stop ApologizingI can tell he’s nervous before he even opens his mouth. Poor third year.

“The patient is a 58-year-old male with a past medical history of congestive heart failure and…hold on a second…,” he flips over his ragged sheet of collected notes. Still searching, he looks up, “Sorry,” and then back down, scanning the paper back and forth.

“Coronary Artery Disease.” He almost shouts it, as the air in his lungs and the tension in his body release with the expulsion of the words.

“…who presents today with shortness of breath and chest pain since 9am today. His first troponin was .01, second was .02.”

He’s already going out of order. He hasn’t finished giving the HPI (describing the presenting symptoms) and he needs to tell me other relevant PMH and physical exam information before he starts giving lab values. I want to guide him in the proper direction without calling him out, so I interrupt with a question. (more…)

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