My Journey

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.

I think Staying Focused is one of the most difficult things about studying, especially when you need to study for a long time, for big exams, etc. Here’s some ways I’ve found helpful and seen other people use. 

Set a Goal 

This was one for the first techniques I used and it still helps me to this day.  Setting a big or goal of what you want to achieve, long time or short time. 

Setting Bigger Goals Setting a big, long-term goal, like getting into college or achieving a really good result on something that you struggle with. For these kind of goals you need to plan out how exactly you’re going to achieve what you want. To do this, it’s best to set yourself smaller goals, which will lead up to you achieving the bigger goal. 

Setting Smaller Goals You need to make smaller goals easy to reach. These could be like going up a grade, getting a certain grade on an assignment,  spending a certain amount of time studying.You need to make sure these goals have a good mix of attainable and challenging. This way they’ll benefit you by keeping you motivated. 

Rewards.  Achieving big goals is usually a reward in but to keep you motivated you  may need rewards to do keep trying to yourself wanting to achieve your goals. Set yourself up some little goals along the way. Perhaps buying something, going to see a movie, watching tv, etc. There’s numerous amounts. 

Use an App

Apps are so helpful, here are some of my favourites:

Pomodoro This app is so amazing for helping to stay focused. It’s a timer with breaks after each time slot with a break after 4 Rounds. It also has a goal of what you want to achieve that day.  It helps because although you may b looking forward to getting a break, you’ll also be working. It also has a ticking noise which can aid you to keep focused or you can turn it off it annoys you. 

Focus Timer If you find yourself always picking up your phone, this app is perfect because it keeps you off your phone while timing your study. It also lets you keep a chart so you can track how much you study.  

30/30 This is app is a To-Do List and Timer all in one and is super useful to help you if you want to specifically time what you have to do. It works really well with a lot of alerts to keep you working. 

Focus Now This app is the free version of Forest, which I’ve seen a lot of people use in the community. It keeps you off of your phone because if you exit off you’ll kill the plant that grows while you’re not on your phone. 

Listen to Music

This is not for everyone but it can work well for a lot of people! Try out different genres and stick to ones without lyrics as these are generally the best for keeping you focused. 

Classical Music - popular choice with studyblrs

Instrumentals - another popular choice, very focusing and soothing

Video Game Soundtracks - these are literally made for keeping you focused so these are great!!

Instrumental Movie Soundtracks - some of these are also made to keep you focused and drawn in. (The Theory of Everything one is so good!!)

Electric Sounds - works well if you dislike classical! 

Natural Noises - keeps your mind from getting distracted by blocking out silence

Coffee Shop Noise - proven to help you be more creative and keep focused

Some good masterposts with lists for study sounds:

Melodic Studying 

Study Sounds

Study Music

Study Order

Study order is something we usually forget about but it’s actually super important! 

Do a quick/creative or subject that you like first. It will get you focused and in the mood to start with.

Move into a difficult subject or one you find hard to focus during. You’ll still be focused and motivated from the first task but not tired or bored. 

Finish on an easy or quick task. It’ll leave you feeling satisfied with the work you completed and even though you’ll be tired/less focused from previous tasks you’ll be able to do it efficiently if it’s and easy topic for you!

Have Something that Reminds You to Study

Very often we get sidetracked by something else which can break our focus. Instead have something that will constantly remind you to study or why you’re studying.

An Cheerful Alert on your Phone. It may sound cheesy but it can help you keep your phone down and get your work done. 

A Inspirational Quote/Picture that reminds your why or what you’re studying for. It’ll keep you motivated as well as focused. 

A To-List. Placed in a visible spot so you can keep in mind what you have done and what you still have to do. 

A Bullet Journal. It works well for keeping you focused on your study as it’s an analog system and you’ll have to force yourself to mark the work as completed/uncompleted therefore keeping you more motivated and focused on the work you have to do! 

A Planner - works well for informing you of what you have to study, if you would prefer more structure than a bullet journal ,a planner will work well for organising your days. @passionplanner​ has free planner printables, if you’d prefer not to invest in a planner fully yet!

*Other Posts

Guide to Studying

Guide to Mind-Maps

Getting Involved in Studyblr

Subject  Resource List

Staying Healthy While Studying

Note-Taking

Organisation Masterpost

Study Tips

Anti-Procrastination Masterpost

Motivation Masterpost

Back to School Necessities

How to Get an Internship

How to Take Notes From a Textbook +More

Google has many ‘search operators’ you can use to make your specific searches more successful. 

Fluid and electrolyte USA- Serum Osmolality = (2 x (Na + K)) + (BUN / 2.8) + (glucose / 18) UK-  Serum Osmolality = (2 x (Na + K)) + Urea + Glucose Normal range:  285 - 295

Corrected Na UK- Corrected serum Na= (RBS-5.5)/5.5 x 1.6 + measured Na- for the first 22mmol/L Corrected serum Na= (RBS-22)/5.5 x 2.4 + measured Na- for value after 22mmol/L USA- Corrected serum Na= (RBS-100)/100 x 1.6 + measured Na- for the first 400mg/dL Corrected serum Na= (RBS-400)/100 x 2.4 + measured Na- for value after 400mg/dL Corrected Ca UK- Corrected serum Ca = 0.02(40-Albumin (g/L)) + measured Ca USA-  Corrected serum Ca = 0.8 (4- Albumin (g/dL) + measured Ca

Cockroft Gault formula UK- eGFR= [(140- Age) x body weight x constant] / serum creatinine ( umol/L) constant- 1.23 for male and 1.05 for female 

Urine output Urine output (/kg/hr) = total output / IBW / Hours

Smoking pack years Smoking pack years  = (Cigarettes per day x years)/ 20

Ideal body weight  Inches and foot (in US) Male: 106 lbs for 5 ft tall;  Add 6 lbs/in above 5 ft Female: 100 lbs for 5 ft tall;  Add 5 lbs/in above 5 ftThis is easy. Cm and Kg (outside US) Male: Wt [kg] = 50.0 + 0.91 (Ht [cm] - 152.4) Female: Wt [kg] = 45.5 + 0.91 (Ht [cm] - 152.4)

Mean Arterial Pressure  MAP= Diastolic BP + (1/3)(Systolic BP- Diastolic BP)         =  [2 Diastolic BP + 1 Systolic BP]/3

Acid base Henderson Hasselbalch formula  pH= 6.1 + lg [HCO3/0.03PCO2]

Prediction of compensation Met acidosis- Winter formula  CO2 = 1.5 x HCO3 + 8 +- 2 Met alkalosis = increase in CO2 = increase in HCO3 x 0.7  Respiratory acidosis -Acute= 1 HCO3 for 10 CO2 increase -Chronic= 3 HCO3 for 10 CO2 increase Respiratory alkalosis -Acute= 2 HCO3 for 10 CO2 decrease -Chronic= 4 HCO3 for 10 CO2 decrease 

JIKA ISLAM DI TUDUH TERORIS? BANTAHAN MUALAF INI BIKIN BUNGKAM PENUDUH

Ulama muda Jerman, Pierre Vogel, punya cara tersendiri bagaimana membantah tuduhan terhadap Muslim sebagai Terroris.

Ulama mu'alaf yang bersyahadat tahun 2001 itu, dengan cara tercepat dan terbaik yang amat mengena bantahan dan menangkal dakwaan Muslim dengan terorisme.

Dalam sebuah ceramahnya, ia menyampaikan bagaimana cara ia menyangkal tuduhan itu :

Siapakah yang menyulut perang dunia pertama? Apakah orang Islam?

Siapakah yang menyulut perang dunia kedua? Apakah orang Muslim?

Siapakah yang menjatuhkan bom atom atas Hiroshima? Apakah orang Islam?

Siapakah yang membantai 20 juta suku Aborigin di Australia? Apakah orang Muslim?

Siapakah yang membantai lebih dari 100 juta suku indian merah di Benua Utara Amerika? Apakah mereka orang Islam?

Dan siapakah yang membantai lebih dari lebih dari 50 juta Indian merah di benua Selatan Amerika? Apakah mereka orang-orang Muslim?

Siapakah yang menjadikan lebih dari 150 juta manusia dari Afrika sebagai budak (apartheid), Diantara 77 % dari mereka mati di perjalanan dan dikubur di lautan Atlantik? Apakah orang Islam?

Bukan, bukan orang Islam. (Lalu siapa?)

Sebaik-baik ucapan adalah yang singkat dan mengena.

As the popularity of smartphone of tablet computing expands, so too does the library of apps. The following is a list of iOS apps that might be of interest or use for the curious, for the learners, and for the clerks.

Laboratory

LabDx: A reference tool for common laboratory investigations.

Acid Plus: A calculator tool that helps tease out the type of acidotic or alkalotic process involved.

Lytes: A basic reference to the common electrolyte abnormalities, the causes, signs, and symptoms.

Calculators

BiliTool: An online tool that has an optimized mobile format, this tool helps calculate bilirubin levels in neonates and gives recommendations based on the risk stratification of jaundice.

Qx Calculate: A free calculator for many of the formulas and algorithms in medicine including risk calculators and unit conversions.

MedCalc Pro: A premium calculator that has a more streamlined design and more formulas than Qx Calculate. It also allows you to save patient values for use in multiple calculations.

Pharmaceutical

Lexicomp: The standard for monograph information, this subscription-based app includes routine updates to the drug database for newly added medications and warnings. It includes a drug interactions calculator.

Epocrates: For the free alternative, Epocrates continues to be a favorite among my classmates and attendings. It includes the standard dosing and regimens for medications but offers less detailed information regarding them compared to Lexicomp.

Micromedex: Another decent alternative that is updated regularly with the most recent warnings and medications. There is a basic free form with premium add-ons including the drug interactions tool.

Anatomy

Netter’s Anatomy Atlas: Netter is a household name in the world of medical illustrations and all of his anatomical plates have been compiled in this app. A good quick reference of study tool.

Pocket Anatomy/Essential Anatomy: Moving into the third dimension, these two apps despite a premium price, a useful study tool for anyone interested in medicine.

Muscle System Pro III: For the anatomical enthusiast wishing to see muscles in all their detail and intricacies. Premium.

Skeleton System Pro III: For the anatomical enthusiast wishing to see bones in all their detail and intricacies. Premium.

Brain and Nervous System Pro III: For the anatomical enthusiast wishing to see nerves in all their detail and intricacies. Premium.

Radiology

Radiology 2.0: One Night in the ED: A case-based radiological app that goes through the common presentations with a methodical approach.

Clinical

Medscape: A basic app that includes drug interaction calculator, a procedures reference and daily news in the world of medicine.

Skyscape: A free app that includes a number of resources to help with clinical decision making. Designed to be a one-stop shop, you can purchase and subscribe to more features and resources within depending on your needs.

Eponyms: For the medical student, half the battle is learning the language of medicine. Eponyms explains the common and obscure terms and signs of medicine named after their discoverers. 

Bugs and Drugs: A reference tool for antimicrobial therapy, the dosing guidelines and the sensitivity tables of all antibiotics.

PEPID: A clinical companion tool that provides summary information around conditions, include a brief explanation of the condition, the investigations, differential, and the treatment plan. Written in a concise form for the learner on the go.

UpToDate: The clinical companion tool that is a favourite among the attendings. This subscription-based app comes in both an online or offline version and mirrors the desktop counterpart. Including in-depth review of disease states and clinical pearls surrounding therapy.

DxSaurus: A differential diagnosis generator that works around your working diagnosis or the symptoms you see.

Reference

The Merck Manual: Professional Edition: A digital, pocket version of the original reference. Disease states can be searched by section or by symptom.

Toronto Notes 2012: While not exactly an app, this textbook is an excellent reference for any medical student and is one that I read during quiet moments on shift. A digital copy of this textbook stays with me in my eBooks library.

Principles and Practice of Hospital Medicine: This is also not an app but an eBook. An excellent reference for internal medicine, it offers great deal of information and clinical pearls for the hospitalist. 

Tools

Google Translate: For the moments where language is a barrier, this could be the only useful way to gather patient information.

Flashlight: For the times on call where we do not want to disturb other patients in a dark room as we make our way around.

Evernote: A note-taking tool to keep and sort out clinical pearls or to document clinical moments.

Drive/Dropbox: A cloud-based service like Drive or Dropbox offers an opportunity to store algorithms, guidelines, or textbooks that you can access anywhere. Now available on your phone or tablet.

Review

USMLE World QBank: For the medical student preparing for exams, the QBank is an important resource to have.