Discover and read the best of Twitter Threads about #USMLE

Most recents (24)

If you’re an IMG who studied medicine in English and passed all #USMLE steps, you should NOT be required to sit for an English language exam.

Enough with the ripoff and making money out of the poor students.
If you’re an IMG (or US graduate) who passed all #USMLE steps and interested in primary care in rural areas (where there is DIRE need for primary care physicians), you should be offered contracts with competitive salaries.
If you’re an IMG (but a US citizen) who passed all #USMLE steps and interested in primary care, you should be offered a chance to do your residency training in the Indian Health System or Bureau of Prisons.
Read 7 tweets
Acetaminophen Toxicity algorithm. Very helpful

#Meded #medtwitter #USMLE #MRCP #razausmlemnemonics
via @ibcc
Pathophysiology of acetaminophen toxicity
Rumack-Matthew Normogram used for acetaminophen toxicity
Read 3 tweets
Pay attention to this thread:

Sodium/Glucose Cotransporter *2* (SGLT2) receptors are in the *1st* part of the proximal tubule, where 90% of glucose reabsorption occurs & also where SGLT2 inhibitors like empagliflozin work.

SGLT *1* receptors are in the *2nd* part of the tubule. Image
SGLT2i ↓ systolic HF mortality in patients with OR without diabetes.

Drugs that ↓ systolic HF mortality:
•ß-blockers (metoprolol, bisoprolol, carvedilol)
•Hydralazine (with nitrates)
•Neprelysin inhibitor (sacubitril)
•SGLT2 inhibitors Image
Additionally, SGLT2 inhibitors ↑ sodium delivery to macula densa and SLOW the progression of GFR decline in kidney disease by restoring the tubuloglomerular feedback (TGF) and are associated with DECREASED mortality from kidney disease among patients with diabetes. ImageImage
Read 8 tweets
Preparing for Step 2CK:
1. UWorld: I can't stress enough how important this is!!! Give it as much time and dedication as possible. The more you're thorough with it, the better!
#medtwitter #USMLE #step2
I started UWorld with just Medicine, when I was halfway done, I added Surgery, and so on. So towards the end I was solving mixed blocks. Start timed mode as early as possible: Q. stems can be really long, and require a lot of practice to get through quickly.
2. Divine Intervention Podcasts: These are GOLD. (God bless Divine! 🥺❤) Must listen: No.s 37, 97, 184, 204, 231 (Risk Factors/Most Common/ Military)

3. Mock exams: UWSAs and NBMEs
Read 7 tweets
Duration of Antibiotic Therapy
Deciding on the duration of antimicrobial therapy for an infection is neither straightforward nor simple. 👇
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx

Most ID guidelines are based- either expert opinions or evidence-based medicine. Historically, duration of ABX Rx were based on arbitrary extension of days(magic numbers like 7, 10 & 14 days) rather than on reliable evidence with the main aim to ⬇️ failures & avoid underRx.

There is growing evidence to support for shorter courses. It is important for prescribers to be up to date with best practices. Duration of therapy plays a pivotal role in antimicrobial stewardship programme within the global effort to optimize antibiotic use &⬇️resistance.

Read 26 tweets
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor


4-chloro-N-(2-furyl-methyl)-5-sulfamoyl-anthranilic acid, member of the sulfa’s. Potent natriuretic drug, inhibits Na+-K+-2Cl− cotransporter in the ascending limb of the loop of Henle.
Direct Vd effects results in its therapeutic effectiveness in the Rx of acute pulm edema.

Vasodilation leads to reduced responsiveness to vasoconstrictors, such as angiotensin II and noradrenaline, and decreased production of endogenous natriuretic hormones with vasoconstricting properties.

Read 15 tweets

Edema of the deep dermis & subcutaneous tissues.

Etiology, types and treatments👇👇👇👇⬇️⬇️⬇️⬇️👇👇👇👇


#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
Mast cell–derived mediators tend to affect layers superficial to subcutaneous tissue, including the dermal-epidermal junction. These mediators cause urticaria & pruritus.

In bradykinin-mediated angioedema, the dermis is usually spared, so urticaria & pruritus are absent.
Read 7 tweets
Pseudomonas aeruginosa (PA):

Gram-negative bacillus found widely in nature, in soil and water.

#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor @ImproveDX
The genus Pseudomonas >140 species,> saprophytic & >25 species are associated with humans. Most known to cause disease in humans are associated with opportunistic infections.

⬆️ MR : ⬇️ host defenses, resistance to ABX & production of extracellular enzymes & toxins.
Often found in water in sinks & can contaminate respiratory equipment, which can serve as an environmental reservoir, especially in ICUs. Is the most serious pathogen causing ventilator-associated pneumonia & remains the most important pathogen in patients with CF.
Read 15 tweets
Acute cognition change with altered consciousness & impaired attention that fluctuates over time. Often unrecognized & unRx. May be preventable & early detec/ facilitates urgent assessment &Rx 1/16
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
The criteria for delirium listed in the Diagnostic and Statistical Manual of Mental Disorders vs Confusion Assessment Method (CAM) 👇👇. CAM has a sensitivity of 94% to 100% and a specificity of 90% to 95%.
2/16 Image
disturbances of sleep, altered psychomotor activity, and changes in emotion (eg, anxiety, apathy, lability, irritability, or anger). Subtypes of delirium are hyperactive, hypoactive & mixed. Hypoactive form >> hyperactive form. Inattention is hallmark. 3/16
Read 17 tweets
The HPA Axis and Adrenal Fxn.
Typical excretion of cortisol ➡️diurnal pattern with peaking in the a.m, ⬇️toward the afternoon, & ⬆️ in the early p.m. The basal adrenal production of cortisol is 10-15 mg daily. #MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
Physiologic & psychological stress can boost daily production of cortisol to 3 or more times typical levels.
Adrenal insufficiency: caused by a disease involving the adrenal gland itself (primary AI) or one altering its regulation by the hypothalamus and pituitary (secondary AI)
Primary AI results from destruction or replacement of the adrenal cortex. Addison’s disease (autoimmune destruction of the adrenal cortex) accounts for 80% to 90% of primary AI. Image
Read 13 tweets
💣 This one is going to be a mine-field... Here's why I decided to pursue a medical career in the US 🇺🇸 rather than the UK 🇬🇧. NOTE: this is not me saying what OTHER people should do, simply giving my own thinking. You are free to disagree, there's no 'right answer'. 🧵 1/
🤩 New Experience: I'd spent the majority of my life in the UK, dad was a doctor, I went to a 'good school', got into a 'good uni', and became a doctor. Felt like if I stayed in UK, best case scenario, my life would just be on repeat, now through dad's eyes. Felt too safe. 2/
💵 Money: bet you didn't think I'd go there this quickly, right? (That's the sound of 100 keyboard warriors pressing delete on their "OBVS JUST FOR THE MONEY!!!!" tweets.) Yep, I didn't think being a doctor in the UK was a well-compensated job for how stressful and long... 3/
Read 16 tweets
I went to one of the top 10 medical schools in the world (Imperial College London), got a 'distinction' in every exam, in every year, and scored in the top 1% on the #USMLE Step 1 when moving to the USA. Here's my 5 tips for how to study more effectively for exams... 🧵 1/
🙅🏽‍♂️ 1) NEVER compare your study style with ANY other student. The #1 cause of anxiety and confusion amongst students is looking at those around them and being convinced that they're doing something wrong, or 'falling behind'. Every single year, there would be some students... 2/
who would be "revising" from week 1, books in front of them on the table, walking home from the library late at night - and who would fail. There would be others who never went to lectures or the library and 'got serious' at tactical times throughout the year - and passed! 3/
Read 12 tweets
1/ #tweetorial

Do Not Confuse Mobitz Type I and Mobitz Type II AV Block - Key Points

➡️ Mobitz type I AV Block is characterized by a lengthening P-R interval and a shortening R-R interval followed by a nonconducted P wave.…

#foamed #medtwitter #meded

➡️ Mobitz type I AVB produces a characteristic and distinctive pattern of grouped beats on the ECG.

➡️ The most common location of conduction block in Mobitz type I is at the level of the AV node.

#usmle #cardiotwitter #Cardiology

➡️ Mobitz type I AV Block, also known as Wenckebach, is generally seen in younger patients and athletes.

➡️ Most patients with Mobitz type I AVB are asymptomatic and require no additional evaluation or treatment.
Read 7 tweets
Neuroanatomy TOTD #4
1/5 Answer: The orange structure is the cavernous sinus (CS), a paired dura-lined venous cavity on either side of the sella. The sinuses are split into numerous “caves” by fibrous septae (hence the name). #neuroanatomy #neurorad #medtwitter #neuroanatomyTOTD Image
2/5 Note that the paired sinuses are often variably connected by “intercavernous sinuses”. While the CS is often taught for its relationship to the ICA and cranial nerves, I find that medical students and residents rarely understand the flow of blood through the sinus.
3/5 The CS receives blood from sup. and inf. ophthalmic veins draining the orbit--This is how a facial/orbital infection spreads intracranially to CS (classic #usmle ?). The sphenoparietal sinus as well as the superficial middle and inferieor cerebral veins also feed into the CS. Image
Read 5 tweets
So I read this trainwreck of an article from beginning to end. I have thoughts. This article is clearly racist, "blaming" underrepresented in medicine minorities (Black and Latinx Americans) for not being "good enough" to be cardiologists, and also whiny…
At start, while Dr. Wang provides useful historical context, he already introduces his (wrong) opinion on why URM numbers are low: "AAMC short‐term goal was missed because of a paucity of qualified candidates, particularly blacks" qualified URMs are not mentored in colleges...
He blames "holistic admissions processes" for creating a track only for whites/Asians based on objective tests and grades, and "subjective" criteria for Blacks/Hispanics causing "Severe academic difficulties for underrepresented minorities were noted as early as the mid‐1970s"
Read 30 tweets
- Make an initial list of programs you are interested in applying to.
- Do your #research: curriculum, front loaded?, number of residents, night float?, location, categorical or advanced (needs IM prelim)?
- Start asking for LoRs (May have to remind writer at least once)

- Start working on your PS
- Have a note or document on your phone/PC for
ideas: You never know when a moment of inspiration
may happen!💡).
- Make as many corrections as needed
- Contact programs with any questions, specially if something is not clear to you

Read 9 tweets
Are you wondering why you should join the Dr. HealthThenMore Tutorials?
Watch this video to find out the top five reasons you should so.

Click the link to watch.

#USMLE Image
The complete video on
Read 3 tweets
Happening now: In the middle of the #COVID19 pandemic #FutureDoctors can’t take #USMLE exams for licensure because of failures at @NBMENow, @TheUSMLE, @TheFSMB, and @PrometricGlobal, putting current and future patients at risk. 1/12
Did you know: after years of school, $100k’s of debt, months of 12hr/day dedicated study, students are reporting @PrometricGlobal, @NBMENow, @TheUSMLE are cancelling exams for medical students with < 24 hours notice. 2/12
After @PrometricGlobal cancelled exams, they also turned off phone lines, locking out students with disabilities or other ADA protected accommodations from the only mechanism to reschedule the most important exam of their lives. 3/12
Read 12 tweets
I’m going to go out on a limb and hypothesize that glucose-6-phosphate dehydrogenase (G6PD) enzyme level/function plays a central pathophysiologic role in host cell response to SARS-CoV2 infection. Explains a lot of clinical observations. #Coronavirus #COVID19.
I’m a little rusty on my #biochemistry, but I did get a degree in it back in the day from @Harvard, & I do remember enough about G6PD deficiency from #USMLE #Step1 @YaleMed before becoming a #Radiologist. So here it goes...
Read 27 tweets
I’d like to talk about the finances - and potential financial conflict of interest - at the National Board of Medical Examiners.

This is gonna be a long one - but thanks for hearing me out.

Yesterday, I started a discussion about how our focus on #USMLE Step 1 was hurting both undergraduate and graduate medical education.

It’s gotten a lot of attention, probably because I highlighted a comment from the CEO of the NBME that touched a nerve for a lot of you.
Beyond that quote, when I read the article, what struck me was this:

The CEOs of the NBME and FSMB expressed numerous concerns about adverse effects of making USMLE Step 1 pass/fail...

...but loss of revenue to the @NBMEnow was not mentioned.
Read 37 tweets
In response to this thread about using #USMLE Step 1 scores for residency selection, many people have asked some variation of this question:

“But without Step 1 scores, how will we possibly select residency applicants?”

I have a few things to say about that. (1/x)
First, a reminder. The USMLE is a licensing exam. It is intended to discriminate between test-takers with sufficient content mastery to be licensed as a physician, and those who do not have such mastery.

It was not intended to discriminate among higher scores. (2/x)
So first of alll, it’s not entirely clear what you are measuring when you have an applicant with a 225 and a 245 and a 265.

(But probably, you are measuring test preparation, test-taking strategy, and memorization of increasingly arcane minutae.). (3/x)
Read 20 tweets
Today, I reviewed course feedback for a second-year medical school course. In response to a request for areas for improvement, one student wrote this.

The sentiment is extremely common, but rarely have I seen it stated so succinctly.
We have a major problem with the overextension of #USMLE Step 1. I’m not the first to point this out.

But to the extent that the product of medical school/licensure is a public good, can we please start asking questions about whether our systems are producing the good we desire?
One obvious solution is to report USMLE Step 1 scores as Pass/Fail.

This is, after all, what the test was designed for - to broadly determine which candidates have sufficient subject mastery to be licensed.
Read 10 tweets
حتكلم ان شاء الله بالتفصيل عن البورد الامريكي والكندي وكيفية التحضير لهم
باتكلم عن دي الدولتين فقط للاسباب التالية
١- نظام الرزدنسي والتعليم الجامعي للاطباء في السعودية مطابق لهذه الدولتين .
Read 94 tweets
- Factor VIII deficiency, X-linked recessive
- Increased bleeding risk (after minor trauma or surgery)
- High PTT corrected on mixing study, normal PT, normal bleeding time
#MedRxed #USMLE #medschool #meded #Medicine
- Treatment: Desmopressin (for mild cases), Factor VIII Replacement (for severe cases).
- Patient may develop inhibitor or antibodies to Factor VIII and requires treatment modification.....
#MedRXeD #USMLE #ABIM #primarycare #Meded
HEMOPHILIA A w/ Factor VIII Inhibitors
- If inhibitor titer < 5 Bu/ml: Increase dose of FVIII
- If titer > 5: Activated prothrombin complex concentrate, Activated recombinant FVII, Porcine Factor VIII
#MedRxeD #ABIM #Hematology #Meded
Read 4 tweets

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