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Beating Clinical MCQs in #USMLE or #boards2023 when you don’t know the answer! 🩺📝

🧵👇Check out 10 strategies to approach this challenge

#MedTwitter #MedEd #IMG #ECFMG #foamed #medicalstudent #internalmedicine #BoardExams #medicaleducation
Don't panic! 😱

Try to work through the question, use strategies below to narrow down the choices and make an educated guess. 💪🤔💡

General approach to MCQs: Reverse reading 📖🔙💭

a) read the MCQ starting at the last sentence in the stem (the actual question)
b) glance over the answer options
c) then work your way back to the stem

🧠I find this an effective technique to prompt & orient the brain.

Read 11 tweets
1/ Do you know who this man is? 🧵

He’s Fredrick W Mott, an English 🏴󠁧󠁢󠁥󠁮󠁧󠁿surgeon who identified cells with multiple spherical inclusions packed in their cytoplasm in the brains of monkeys with trypanosomiasis.
2/ In the early 1900s, he identified them as plasma cells in inflammation and called them morular cells (Latin morus=mulberry). He was later given the honour of having these cells named after him.

Image credit:…
3/ It was actually William Russell, a Scottish 🏴󠁧󠁢󠁳󠁣󠁴󠁿physician before Mott, who recognised these inclusions contain immunoglobulin. The individual cytoplasmic inclusions (Russell body) are hence named after him.

Image credit:…
Read 5 tweets
Resources to study #Neurology

Adams and Victor’s. By far my favourite textbook.
The book is more clinically oriented, coloured with anecdotes and mental models. Reading it feels like seeing a pt in the ward/OPD

#MedTwitter #neurotwitter
It has elements of philosophy, history and is written eloquently.
Whimsical, yet profound, it’s teachings stay with me. Added bonus, my Guru in Neurology finds mention in the text 🙃 I’d recommend this for #mbbs #md and #dm students
Bradley is the standard #textbook in #neurology. A great book, it’s more like #Harrison. Great for information, latest research and management. Essential for the DM #neurology candidate, but also useful for MD #internalmedicine
Read 11 tweets
A👨, HIV + (CD4 = 25 cells/mm3): rash on arms, hands, chest, & buttocks compatible with #monkeypox
Ocular: redness, pain, itching, swelling, discharge, photosensitivity, & vision changes

Unilateral conjunctivitis, ulcer, & keratitis (fig.)

#ophthalmology #IDtwitter
A PCR swab of the conjunctival lesion:➕for Orthopoxvirus


#eye #ojo #oftalmologia
Patients with #monkeypox can experience serious ocular complications:
5 consecutive patients with ocular monkeypox, have experienced delays in treatment, prolonged illness, hospitalization, & vision impairment.

DOI:… #MedEd #MedTwitter
Read 8 tweets
Jokes like these are especially damaging and hurtful to patients with chronic illnesses. Additionally, they "validate" provider bias and "normalize" providers' lack of compassion when caring for certain groups of people. There's a lot to unpack, so buckle up 🧵🧵. 1/x Image
1. Using "frequent flyer" as a term to describe patients is dehumanizing, provides very little clinical information and context besides the fact that you think this person comes to the ER/ hospital frequently, and has been shown to ⬆️⬆️ implicit bias of those who read the chart.
Using unproductive terms like "frequent flyer" provides no differentiating information. The person with a life-long #chronicillness, a child who frequently is hurt, an under-resourced adult, and someone with a substance use disorder all fall into the same bucket clinically.
Read 13 tweets
1/Feeling lucky? Or feeling evidence based?
A #tweetorial about how to read a #pituitary #MRI using data and know if there’s cavernous sinus invasion w/the Knosp score.
#medtwitter #FOAMed #radres #neurorad #FOAMrad #neurosurgery #medicalstudent #meded #USMLE #endocrinology Image
2/The hardest part of a pituitary MRI is deciding if there is cavernous sinus invasion. It makes sense that the more lateral a tumor goes on MRI, the more likely it has invaded the sinus—bc it is going the direction of the sinus. But how far is far enough? Image
3/This is important bc each time a radiologist makes a call on imaging, they make a bet & they are betting their credibility. And unlike other bets, there is only 1 wager—all in! So it is important to not call it when you might be wrong, bc overcalls destroy credibility. Image
Read 15 tweets
1/ Many folks have messaged me asking for guidance regarding #USMLE, so I figured I might create a thread on how I was able to take all exams (except step3) while still in #medicalschool.
The following 🧵 is what I found useful for me, obviously doesn't apply to everyone.
2/ Disclaimer, I was an average #medicalstudent, no genius or prodigy.
I put in the extra effort and it paid dividends.
I graduated in Nov 2012, as an #IMG and matched into surgery in Mar 2013. If I can do it, so can you, just remember no shortcuts in life.
3/ The first time I heard of #USMLE was in Dec 2010, when my buddy was studying for it.
It was around that time I looked into studying for this "international exam" as I would falsely assume.
Once I did some digging, I realized, everyone has to take it to practice in the US.
Read 22 tweets
Hey #Medtwitter & #Neurotwitter With 2 simple rules you can learn the #basalganglia direct and indirect pathways for the LAST TIME and actually remember them! 🤯Here’s how! 🧵 :
#MedEd #medicalstudent #Neurology #Neurologyresident #Movementdisorders #Neuroscience #Neuroanatomy
Rule 1: The “OG” basal ganglia (striatum and globus pallidi) use GABA ➖as their neurotransmitter. Everything else uses glutamate ➕.

Rule 2: Once you know Rule 1, all you have to do is memorize the order of the structures:

Direct pathway: CS___GiT
Indirect pathway: CS GeS GiT
Both pathways start with
cortex (C)>striatum (S)
and end with globus pallidus internus (Gi)>Thalamus (T).

For the indirect, just add GeS (Globus pallidus externus>STN) in the middle!
Read 5 tweets
#MedicalStudent #UkraineRussie @GastroOneIndia
As the government of India is with the 20,000 students who have come back from Ukraine or are in the process of coming back, I will believe what Scindia said on board the air craft that brought them back that Government of
India is with them in every step if;

Government of India ensures that these 20,000 students get immediate admission in MBBS Course in India.

Government of India waves their fees for MBBS Course.

Government of India brings back students from all over the world who
are out doing MBBS Course and gives them admission in India at the same fees that they were paying abroad.

Government of India allows them to continue from the same stage in their studies in India without subjecting them to any entrance examination or
Read 4 tweets
#MedicalStudent #UkraineCrisis
One student has been killed in shelling in Ukraine. He is from Karnataka.

BJP IT-Cell and its Twitter Army is blaming the student for being outside and not following advisories issued by Modi Sarkar. They are blaming him for getting killed.
They want to protect the image of Modi Sarkar at all cost. Even if they sound completely ridiculous in doing so.

They are almost saying that this student went and stood outside in the open and then ran under a falling shell and decided to kill himself while Modi G was trying to
save him.

And why call the rescue operation from Ukraine as Operation Ganga? What an asshole. Why not call it Operation Narmada or Operation Satluj? Everything that happens will be used to garner votes. Even deaths will be used to garner votes. Remember Pulwama? 42 Soldiers
Read 4 tweets
An in-depth review of metacarpal fractures.

If you're interested in orthopedics you'll definitely want to check this review out!

What is an eponym for this fracture? Image
This patient is presenting with an intraarticular fx of the 5th metacarpal base.

This fracture is similar to a Bennett's fx (an intraarticular fx of the 1st metacarpal base).

This fracture goes by a few eponyms: a reverse bennett, baby bennett, or mirrored bennett. Image
A Ronaldo fracture is a comminuted fracture of the 1st metacarpal base. (shown above)

Displacement of a Reverse Bennett fracture is due to which of the following muscles?
Read 14 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
1/ 🧵

Time for a #tweetorial on simple #ECG interpretation

When I learned to read ECGs, my biggest fear was to miss an important finding!
To avoid that: Be systematic❗️

My simple approach to ECGs with 8 steps 🪜👇

#medicalstudent #education #cardiotwitter #medtwitter #EPeeps

‼️ All following ECGs are with paper speed of 25 mm/s and a signal gain of 10 mm/mV ‼️

1 small square = 40 ms
1 big square = 200 ms

Now we are ready to read the ECG systematically

1⃣ Rhythm

Sinus rhythm or abnormal rhythm?
(Also note if regular or irregular)

Normal: One P-wave precedes each QRS complex (sinus rhythm)

Interpret from the lead that shows the P-wave most clearly (usually lead II)
Read 16 tweets
He's right.

It shouldn't take an Oxford educated, white, middle aged, privileged male pillar of the scientific press to get ill before any patient gets taken seriously, but now that @GeorgeMonbiot has arrived, perhaps at last, we can DO SCIENCE on #MECFS

When we DID SCIENCE (in the rest of the world in the last 2 decades, just not in England) we discovered biomarkers. We discovered findable, physical signs, that show measurable changes are present in multiple systems.

Yes. ME has been found. You didn't know that? Ask why not?
To be explicitly clear here, so you can be in no doubt, the words "immunological, cellular and neurological abnormalities" here tell you what has been found.


Broken things that show up if you look in the right places.

Immune system broken things. Cells. Nerves.
Read 17 tweets
2017: #young #male after a #trip to Hills with '#Naturalists'. Fever and abnormal liver tests. #jaundice in a week. Long evaluations multiple places. Following up as fever of unknown origin. Father a pastor. Son denies everything, studious. #Liver #biopsy done.
#livertwitter Image
Classical #liverpath
Top:Lobular #inflammation, #Portal triaditis; Bottom: central venulitis, perivenular #cholestasis
Asks young man alone, 1hr #interrogation
#Cocaine induced #Hepatitis
Its pays to invest in good #clinical #history
Read 3 tweets
Strange cause for #cirrhosis
Maybe very #rare #MedEd
53yrs man, voice change, recurrent headaches, male breast enlargement. Stops socialising. Has bleed one day, #endoscopy varices, #biopsy fatty liver cirrhosis
No metabolic syndrome.
MRI Brain done. #livertwitter #radio
1/3 Image
What is the diagnosis?
In patients with cirrhosis, always try to find the cause in those who present early. There is no idiopathic, no cryptogenic. Its all 'missed' cirrhosis.
2/3 #liverpath
#MedTwitter #pathology #radiology #MRI #brain #Neurology #Endocrinology #NeuroTwitter Image
#diagnosis: #fatty liver related cirrhosis due to #pituatory macro adenoma with high prolactin, high GH, low #thyroid function. #clinical examination, acromegaly features with central obesity. #Examine 1st, then investigate. #MedicalStudent #medicine #MedStudentTwitter
Read 4 tweets
#livertwitter #irad
For patients with #cirrhosis without #liver failure, we believe in early and aggressive #treatment for #portal hypertension (increased liver pressure) with #TIPS and also knockout all big parasitic #shunts (done here with a plug) 1/3
@SRajesh_IR is 💯 on it Image
The #satisfaction of seeing those large bunch of #bleeding and #encephalopathy source #disappear is quite nice!
#MedTwitter #Medical #medicine
#MedicalStudent #MedEd
@SIRRFS 2/3 Image
In due course, we see the #spleen size reduce, as portal #hypertension comes under #control
Has anyone else noticed the dynamics of spleen post TIPS and its relevance? @keithppereira @CHICKVIR @SIRspecialists #radiology #aasld #easl #apasl
3/3 Image
Read 3 tweets
Mind boggling case
13-year old girl
5 - 6 years on #ayurvedic treatment (shown below) for #Epilepsy. #Ayurveda promised no more #seizure.
Now jaundice, fluid in abdomen, dark pigmentation
#livertwitter #MedTwitter #MedEd #Science #ScienceMatters #pathology #MedicalStudent
#liver #biopsy
Diagnosis: severe #alcohol #hepatitis and underlying #incomplete septal #cirrhosis (rare, #hepatoportal sclerosis) - 2 diseases in one liver! #radiology
See retrieved #Ayurveda #drugs analysis results.
#Chemicals & #Toxicology analysis
#alcohol content - total 26.17 % v/v
#Arsenic content - total 2461.367 mg/kg
Single highest #Herbal #medicine - Arsenic was 1982.44 mg/kg
Two #ayurvedic drugs also contained #CLONAZEPAM - a modern medicine with anti seizure property😞
Read 4 tweets
Just announced by @AAMCtoday: ERAS delayed; applications/MSPE released Oct 21.

Other recommendations:
- Limit away rotations
- Conduct virtual interviews
- Perform holistic review

What's missing? A mechanism to limit applications. @jbcarmody #meded 1/…
Applications have been rising for years. With #COVID #pandemic related disruptions to clerkships, aways, volunteer/research opportunities, #medicalstudent anxiety will be at an all time high (understandably). 2/
We are bound to see an even steeper increase in application numbers. Please head over to @jbcarmody for his excellent blog posts on application fever for more info on the background and myths surrounding application caps:…… 3/
Read 11 tweets
Not all hypotension is from hypovolemia. Then why load every hypotensive patient with #fluids? 🤔 An excerpt from a previous lecture. Very basic. Intended for #medicalstudent #MedEd
Experts, stay away 😄
First, what happens when somebody is hypovolemic?
The cardiac output drops
Unless doing #POCUS, we are not measuring cardiac output. We are measuring blood pressure. So, why does it drop? because it depends on the cardiac output!
Read 17 tweets

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