usmlenotebook - Tumblr blog

[usmlenotebook]

Drug-induced pancreatitis

Drug induced pancreatitis causes HAVOC 

Heart failure/HTN= ACEi/ARBs/diuretics HIV= lamivudine, didanosine, TMP-SMX Autoimmune d/o- azathioprine, mesalamine, corticosteroids  Valpropate/carbamazepine = (antiepiletics) Opiates Chronic pain= NSAIDs, opiates, acetaminophen 

[usmlenotebook]

MELD score

MELD score is INCrediBle 

IN=INR 

N=sodium 

Cr=Creatinine 

B=bilirubin

[usmlenotebook]

[usmlenotebook]

Could you explain what exactly is in a vaccine? Because honestly I'm sure if I would vaccinate my son if I didn't know what chemicals were about to be flowing through his bloodstream. I'm very conflicted on this matter and have heard it very biased from both sides. I just need something objective to go off of

Before I describe the different components involved in a vaccine, I want to address the so-called “bias” when it comes to the vaccine debate. The thing is, there is no “bias” from the medical side. There are facts that are back up by multiple studies, and then there are opinions that are based on fraudulent research done by a physician who has since lost his license.

And then there’s Jenny McCarthy, but we aren’t here to discuss people who offer their opinion on science when they probably don’t even know the difference between a virus and a bacteria.

So what is in a vaccine?

It really depends on the type of vaccine you’re talking about. The antigenic component varies based on whatever disease you’re trying to prevent. I’ll go into that further in a second, but I first want to focus on the “scary stuff” most people are worried about.

Thimerosal

Thimerosal is a preservative used to prevent bacterial and fungal growth. You know, critters that if injected into your child that would probably cause septicemia.  People get freaked out about thimerosal because it contains mercury. The funny thing is, thimerosal is only used in the flu vaccine. It has never been used in the MMR vaccine. It has also never been linked to any toxicity based on multiple studies.

Formaldehyde

Formaldehyde is used to inactivate viruses and detoxify bacterial toxins (like those in the tetanus vaccine.) A purification process is used to remove almost all formaldehyde in vaccines, although a very small amount will still remain. The amount of formaldehyde in vaccines is less than 200 parts per million (.02%) and several hundred times lower than the amount known to harm humans, even infants.  

Antibiotics

Sometimes very small amounts of antibiotic are added to a vaccine (ex. neomycin MMR) to prevent any bacterial growth in the vaccine. If a person is allergic to neomycin, they may end up having an allergic reaction. This is actually a significant (albeit rare) effect that needs to be monitored for.

Adjuvants

Adjuvants are added to vaccines to help increase the immune response to the antigen. None are known to be harmful.

I think the FDA has a really good page that answers most of your concerns as well: https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm187810.htm

And lastly, there are the antigens of whatever disease you’re trying to prevent. So if you’re trying to prevent the flu, the vaccine will contain a killed influenza virus.

I want to end this long post by talking about a few diseases your son would be vaccinated against if you choose to vaccinate. I want you to make an informed decision on your own rather by ridiculing anyone for their misguided opinions on vaccine safety. Vaccines are, quite literally, the most significant medical advancement in all of human history, and I will show this by talking about the various diseases they prevent. I’m not going to discuss all of them because as I started doing this I realized it was going to take a long time to discuss every disease (and I have boards to study for), but I’ll try to highlight the important ones.

Hepatitis B

Hepatitis B, while usually not as big of a concern if you get it as an adult, is extremely detrimental to children. Adults usually clear the illness without any lasting effects. However, children (90% to be specific) are unable to clear the infection and ultimately develop chronic hepatitis. Chronic hepatitis leads to liver cirrhosis, cancer, and death. About 2000 people die a year due to hepatitis B related liver disease in the United States.  This has been in steep decline since we began vaccinating for hepatitis B, as seen from this graph.

MMR

This is the biggie that everyone thinks causes autism even though there is literally no link shown between vaccines and autism. You can google this and find thousands of articles showing no link while there are maybe three that show there is some sort of link. But that’s the thing about research. Just because research says something does NOT mean it is true. Not all research is good research. Some research uses small sample sizes (cough cough Wakefield.) Or the research has a bias and a desired result. There are many things that contribute to what constitutes “bad research” which is why I think everyone should be required to take an epidemiology course at some point in their life, but I digress. Let’s talk about measles and rubella specifically.

Measles is a funny one to me because everyone thinks it’s “just a rash.” This shows the ignorance of many people who really know nothing about the disease they are speaking of. Measles causes 130,000 deaths around the world annually. Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2015 worldwide. However, as more and more people stop vaccinating, we start to lose herd immunity. Measles is a biggie for herd immunity because it is so incredibly contagious. For context, Ebola generally infects 2-3 people that have been in contact with a diseased individual. Measles infects 12-18 people who have been in contact with an infected individual. An outbreak of measles is extremely difficult to control.

Rubella does not generally cause as severe of disease in children. However, the problem with rubella is what it can do to a fetus. Congenital rubella syndrome (caused when a pregnant mother contracts the disease) can result in microcephaly, congenital cataracts, deafness, and heart defects. Since we have started vaccinating, the cases of congenital rubella have basically been eradicated from the US (see figure below.) CRS= Congenital Rubella Syndrome

I have included multiple links throughout this if you want to click to learn more, and I’ve provided more sources below: 

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm

https://www.cdc.gov/hepatitis/statistics/

https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html

https://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-thimerosal-color-office.pdf

http://vaccine-safety-training.org/vaccine-components.html

[usmlenotebook]

Thank you!

really appreciate the sweet messages I’ve been getting from you guys! I’m glad the notes are helpful. I put these notes out because it pushes me to stay focused and not spend 20hrs on youtube instead. Also, thank you to the gazillion new followers (2991 to be exact lol)! hope you guys find these notes useful. I also wanted to let you guys know that if you guys find any mistakes in my posts please let me know because let me just tell you I was writing down some Uworld notes today while listening to The Weeknd and started typing the song’s lyrics instead -___- And finally, if you guys have any mnemonics or anything that you want to submit (medicine related), you can always message me and I’ll be happy to share it! Okay back to Uworld I go 

[usmlenotebook]

We often waste an incredible amount of time wanting to be somewhere else, someone else. Our head-space gets clogged with compare, contrast, what if, why can’t, I should. But you’re never getting this time back. You can’t borrow tomorrow. Please don’t save the best for last. The best is all of you, here, where you are, brightly lit and painfully now, in this breath you’re leaving. Each second dies as it is born; every hello must say goodbye; all is fading in the collapsing hallway of a fragile hourglass, a grain at a time. You are here. The best is you, now.

[usmlenotebook]

LBBB vs RBBB

https://www.youtube.com/watch?v=HR_n00gQj8o

[usmlenotebook]

Going insane

Legit just saw #PCA trending on twitter and my burnt out brain thinks why is posterior cerebral artery trending ? lol I make myself laugh. 

[usmlenotebook]

bringing this back :/

Brain tumours. Happy studying! I will be adding the histo slides corresponding to the tumors soon :)

[usmlenotebook]

Do not let someone else's success get in the way of your progress. Always celebrate other people 's success as well as continuing to work on your own craft. Please don't determine your self worth by the amount of time it takes to you to get to where you want to be and who you want to be. Enjoy this journey and keep working hard.

:)

[usmlenotebook]

Medicine

[usmlenotebook]

Quick way to learn all brainstem lesions.

If you’re like me and you understand the concept of brainstem lesions but just have trouble localizing the symptoms to a part of brainstem, this is perfect! Let e know if this helps you guys!

https://www.youtube.com/watch?v=Owu_ccyt77U

[usmlenotebook]

Mannn does it feel good to finally just get over someone... it’s like a whole sac of potatoes lifted off my heart

[usmlenotebook]

I don’t have dreams, I have goals

Harvey Specter (via cknd)

[usmlenotebook]

[usmlenotebook]

Couldn't have said it better! Happy 2017 everyone !!!

The dumpster fire that was 2016 is over.  Life springs anew in 2017.  Let’s make the best of things and cultivate the newly sprouted year.  Stay positive but stay diligent in facing what’s to come.  Happy New Year!

[usmlenotebook]

How in the world do you memorise all those diseases, organs and other things? I always wanted to be a doctor(currently in gcse, triple science). Do you ever feel like giving up? If so, what stops you. Other than helping others, why medicine? I get pushed away from the thought of medicine because of the workload? The only thing holding me back is doubt and fear of those intelligent ppl, though not brag but i get mostly A*chem Aphys Abio.

This is probably the only question I’ll answer for a while.. not because I don’t have the time to answer all questions but because this question resonates with the state of I’m currently in right now.Do I ever feel like giving up? EVERY SINGLE DAY..let me just say that when people say medicine changes you .. it is an understatement. I think everyone in medicine goes through this phase especially when studying for the boards. When you’re studying, that is ALL you’re doing- day in and day out! 

It’s hard to see how much progress you’ve made and it can be disheartening to see everyone else doing things and getting somewhere in life, while here you are studying and making notes, and ignoring family gatherings. People think it’s hard to memorize all those diseases.. its not because it becomes repetitive after awhile and you just have to know how to recognize them. You become good at picking out “buzz words” and clues. The hardest part is staying focused when there is so much going around you. 

Medicine is not challenging, it will break you down, test your patience and then build you back up again. You become addicted to the ups and downs of it in a way. IT will most definitely change you- you will see it and feel it. But when you’re on that floor talking to patients in the hospital (whether they’re elderly, or kids)- everything just clicks. You’re responsible for people’s lives out there- it is a privilege, never for a second think that it is your right because you think you spent endless hours studying. IT IS your privilege to be talking to these people who put their life and trust in your hands. But to get to experience that, medicine first rips off every layer of you and when it gets to the core of you it challenges you just a little more to see if you really are meant for this. At the end of the day, you have to want this- LIKE REALLY WANT THIS! As for your concern about having doubts- trust me that’s a good thing! Intelligent people don’t just pursue medicine; going through it, is what makes you intelligent. Everyone goes into medicine thinking you need to be intelligent- sure that is true to a certain degree but you have to be strong to pursue medicine. I was definitely not the smartest of the bunch but I am most definitely resilient. I don’t think I ever chose medicine, maybe someday I’ll make a post about how I got into medicine but not now. Sometimes it feels like medicine chose me and I’m sure as hell glad it did because despite the challenges I face everyday, I don’t think I can see myself doing anything else. 

I’m not sure if this answered your question in anyway but I just wanted to speak from my heart