BlindFuckingEye

last week, I made a list of all words i didn’t understand in the biology section of the MCAT. All the words in the passage, like “GTPase”. Today, I learned “lysate”. 

So when I came across ATPase today in my bio section of practice MCAT, I was happy. Biology section was my SCARY section. And now i’m trying to decipher all the hard parts. The scary part is not knowing what’s going on around you. So all I have to do is KNOW what the words mean! Even if i don’t know how to answer questions, I will know that all I have to do is read. 

Hello! I have written some tips for GP placement here.

ANTIBIOTICS CHEAT SHEET :)

Also, REMEMBER!!!!

* Sulfonamides compete for albumin with:

Bilirrubin: given in 2°,3°T, high risk or indirect hyperBb and kernicterus in premies

Warfarin: increases toxicity: bleeding

* Beta-lactamase (penicinillase) Suceptible:

Natural Penicillins (G, V, F, K)

Aminopenicillins (Amoxicillin, Ampicillin)

Antipseudomonal Penicillins (Ticarcillin, Piperacillin)

* Beta-lactamase (penicinillase) Resistant:

Oxacillin, Nafcillin, Dicloxacillin

3°G, 4°G Cephalosporins

Carbapenems 

Monobactams

Beta-lactamase inhibitors

* Penicillins enhanced with:

Clavulanic acid & Sulbactam (both are suicide inhibitors, they inhibit beta-lactamase)

Aminoglycosides (against enterococcus and psedomonas)

* Aminoglycosides enhanced with Aztreonam

* Penicillins: renal clearance EXCEPT Oxacillin & Nafcillin (bile)

* Cephalosporines: renal clearance EXCEPT Cefoperazone & Cefrtriaxone (bile)

* Both inhibited by Probenecid during tubular secretion.

* 2°G Cephalosporines: none cross BBB except Cefuroxime

* 3°G Cephalosporines: all cross BBB except Cefoperazone bc is highly highly lipid soluble, so is protein bound in plasma, therefore it doesn’t cross BBB.

* Cephalosporines are "LAME“ bc they  do not cover this organisms 

L  isteria monocytogenes

A  typicals (Mycoplasma, Chlamydia)

M RSA (except Ceftaroline, 5°G)

E  nterococci

* Disulfiram-like effect: Cefotetan & Cefoperazone (mnemonic)

* Cefoperanzone: all the exceptions!!!

All 3°G cephalosporins cross the BBB except Cefoperazone.

All cephalosporins are renal cleared, except Cefoperazone.

Disulfiram-like effect

* Against Pseudomonas:

3°G Cef taz idime (taz taz taz taz)

4°G Cefepime, Cefpirome (not available in the USA)

Antipseudomonal penicillins

Aminoglycosides (synergy with beta-lactams)

Aztreonam (pseudomonal sepsis)

* Covers MRSA: Ceftaroline (rhymes w/ Caroline, Caroline the 5°G Ceph), Vancomycin, Daptomycin, Linezolid, Tigecycline.

* Covers VRSA: Linezolid, Dalfopristin/Quinupristin

* Aminoglycosides: decrease release of ACh in synapse and act as a Neuromuscular blocker, this is why it enhances effects of muscle relaxants.

* DEMECLOCYCLINE: tetracycline that’s not used as an AB, it is used as tx of SIADH to cause Nephrogenic Diabetes Insipidus (inhibits the V2 receptor in collecting ducts)

* Phototoxicity: Q ue S T  ion?

Q uinolones

Sulfonamides

T etracyclines

* p450 inhibitors: Cloramphenicol, Macrolides (except Azithromycin), Sulfonamides

* Macrolides SE: Motilin stimulation, QT prolongation, reversible deafness, eosinophilia, cholestatic hepatitis

* Bactericidal: beta-lactams (penicillins, cephalosporins, monobactams, carbapenems), aminoglycosides, fluorquinolones, metronidazole.

* Baceriostatic: tetracyclins, streptogramins, chloramphenicol, lincosamides, oxazolidonones, macrolides, sulfonamides, DHFR inhibitors.

* Pseudomembranous colitis: Ampicillin, Amoxicillin, Clindamycin, Lincomycin.

DRSABCD is a familiar acronym for those who have undertaken First Aid/Basic Life Support courses. Now DRSABCDE can used as a simple, yet comprehensive, approach to CXR interpretation.

Normal CXR 

D – Details: 

Patient name, age / DOB, sex

Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series

Date and time of study

R – RIPE (assessing the image quality)

Rotation – medial clavicle ends equidistant from spinous process

Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded?

Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane)

Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.

S – Soft tissues and bones (it is common to leave it until the end)

Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density

Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses

Breast shadows

Calcification – great vessels, carotids

A – Airway & mediastinum

Trachea – central or slightly to right lung as crosses aortic arch

Paratracheal/mediastinal masses or adenopathy

Carina & RMB/LMB

Mediastinal width <8cm on PA film

Aortic knob

Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.

Check vessels, calcification.

B – Breathing

Lung fields

Pleura: reflections, thickenning

Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices

Pneumothorax – don’t forget apices

Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae

Horizontal fissure on Right Lung

Pulmonary infiltrates – interstitial vs alveolar pattern

Coin lesions

Cavitary lesions

C – Circulation

Heart position –⅔ to left, ⅓ to right

Heart size – measure cardiothoracic ratio on PA film (normal <0.5)

Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium

Heart shape

Aortic stripe

D – Diaphragm

Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)

Diaphragm shape/contour

Cardiophrenic and costophrenic angles – clear and sharp

Gastric bubble / colonic air

Subdiaphragmatic air (pneumoperitoneum)

E – Extras

CVP line, NG tube, PA catheters, ECG electrodes, etc

2017 ACP Updated Guidelines for Type 2 Diabetes Care

Science-backed tips to destroy distractions and stay productive in the digital age.

Studies indicate that most of us have incredibly short attention spans (in fact, some have found that we have shorter attention spans than goldfish), and it’s only getting worse.

So, in today’s world of constant digital bombardment and work demands, how do you actually stay focused?