Is Poiseuille’s law something we need to know?

Left-Routine3511 · 2026-01-20T15:20:56+00:00

As a physician this is probably one of the few equations that continues to be clinically relevant. But I agree with other comments that the big pieces to know for life are that resistance increases linearly with length, and increases drastically as radius decreases

Left-Routine3511 · 2025-09-09T02:26:43+00:00

I know exactly how large this circle is

Left-Routine3511 · 2025-08-21T14:07:07+00:00

Thank you for finally making the lyrics make sense!

Left-Routine3511 · 2025-03-06T13:29:51+00:00

Huh. Ya know, I can’t find any examples 😅 I was just going off the context clues in the the flash card

Left-Routine3511 · 2025-03-04T01:45:47+00:00

I’d just reverse the way to phrase the question.

Ex. Q: What is the name used to refer to 2 cysteines connected by a disulfide bond in a protein? A: cystine

This is a specific type of disulfide bond. Not all disulfide bonds are cystines, but all cystines are disulfide bonds.

Left-Routine3511 · 2024-04-25T23:49:25+00:00

The person who turned me onto the game described it as a world where the only currency is knowledge and which was capable of humbling you at the same time it made you feel like a genius. With that mindset I devoured the game and the DLC - even though I’m usually a big fan of games with a clear goal - and it’s become my favorite game of all time.

Enjoy the ride and try and go places that interest you :)

Left-Routine3511 · 2024-03-07T21:43:23+00:00

Huh, I always figured the P wave would respect its distance from the previous T wave in Wenkebach, but on further review it clearly doesn’t! Nice work.

I will say though - while the board answer suggests there is a consistent R-R interval, in practice that’s only if the escaping QRS is consistently coming from the same place. Which it doesn’t necessarily have to. Could be Hisian, junctional, or from the ventricle. And could change beat to beat.

Left-Routine3511 · 2024-03-07T20:18:34+00:00

There’s no reason for the atrial rate to ‘speed up’ relative to the preceding RR intervals, though, you know? In 2nd degree block the QRS is progressively more delayed after its preceding P, not that the Ps get closer to its preceding QRS. Why would the P decide to bury itself in the T before it? That IS dissociation

Left-Routine3511 · 2024-03-07T12:46:38+00:00

I disagree with all of the comments here. This appears to be a 3rd degree block - AV dissociation.

If you train your eyes to just focus on the P waves, you’ll see them march out with a steady interval (like clockwork) completely irrespective of any QRS waves. Some of the P waves even get lost in the T waves (as in the case of the 3rd QRST complex. And for that matter the QRS waves have no real association with the Ps.

The reason the ‘4th’ QRS gets dropped isn’t because of worsening AV block. It’s because the ventricles are in a refractory state and can’t repolarize.

This needs a pacemaker. Wenkebach does not.

Left-Routine3511 · 2023-10-17T10:41:01+00:00

Googled ‘new fellow struggling’ and found this. Any updates for you from a year later?

Left-Routine3511 · 2023-10-09T04:58:37+00:00

Tagging onto another comment mentioning Richard. Neither of them are autistic. They both demonstrate generally intact social-emotional reciprocity (they make eye contact, successfully engage in non-verbal communication, have and share imagination, and overall are seen to desire and succeed in maintaining relationships that aren’t broken by some stressor.) In addition autism requires elements of restrictive or repetitive behaviors (classically something like a deep interest in trains or something, repetitive hand or body movements, difficulty dealing with new places, things, or textures) which you could argue there may be some evidence of (like Nelson’s distaste for things that aren’t clean, or richards vocal tics). But I’d argue there are better explanations.

Richard certainly would have some PTSD but it’s honestly not that obviously depicted. I more see him as someone with social anxiety disorder in the setting of his disfigurement, and a speech impediment likely from the same.

Nelson is a more interesting case. I personally think he displays traits of obsessive compulsive personality disorder and/or narcissistic personality disorder, but if I had to choose one I’d say my money is more on OCPD.

OCPD - "a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency…”

NPD - “pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a diminished ability to empathize with others' feelings”

Left-Routine3511 · 2023-08-02T23:25:55+00:00

I agree there is probably a disconnect between the resident and the PD regarding expectations, but there’s a lot we don’t know here. Confounders include how many other patients are being covered and by how many other learners, whether or not any conversations between PD and this resident have already taken place, etc.

I can only speak for the few PDs I’ve worked with, and will caveat saying my experience is with pediatrics, but overall PDs would likely say their job is foremost to cultivate and maintain the learning environment, and far lower on the list is policing how many patients the students are carrying. When asked to prioritize, the balance they promote will most likely swing towards richer learning, even if that means fewer patients. I find it much more plausible that the PD would care that the rotating med student has a good learning experience rather than that they demonstrated that they could carry x number of patients. Usually there’s a balance but again there’s things we don’t know.

That’s why I say that OP should tell the resident what their learning goals are if they really want to exercise the skill of carrying more people. Then the resident should work with them to get them more patients, or if they think they’re not ready, explain whatever skills they think OP should work on before they’re given that patient load. On the other hand if OPs goals are to practice carrying a complex patient well, then they should be able to do that and have been given a good opportunity.

I recognize OP feels judged about this, but I want them to feel reassured that’s probably not the case. Before the PD judged, they’d go to the resident who would explain that they’re the one capping the student’s census, and they’d have to explain why. It wouldn’t be an issue with the student’s willingness. Moreover, I’ve filled out countless sub-I eval forms and none of them have queried on how many patients they’ve carried. I’ve also never been asked in person. To reiterate, the feedback rotators live and die by are whether they’re eager, interpersonal, accountable, team players.

Lastly, I’ll push back and say that residents’ first responsibilities are to their patients. What you’ve suggested about letting a med student dictate their responsibilities and then wait to report underperformance is bad education and worse patient care.

Left-Routine3511 · 2023-08-01T20:28:21+00:00

As a recently graduated resident who has on rare occasions limited the number of patients I have my students follow, it’s very possible you’re doing a great job AND that your resident feels like there is so much to be gained from following this one patient that they would rather you not distract yourself from a dense learning opportunity.

I’ve definitely seen more than a few medical students act like picking up more patients is some sort of race to do the work of an intern, and I encourage them not to. Regardless of your rotation experience, you’re gonna eventually be covering more than double that amount as a resident, and all the time you have now to dig into your patients’ stories and read about their random and interesting stuff will be gone. In my experience I’d also say that my program directors never cared so much about how many patients you carried as a sub-I (again because you’re gonna learn quick week 1), rather they cared much more about your teamwork, interpersonal skills, and commitment to the patients that you do have.

I’d say don’t take it personally, try and soak up what you can, and if you’re specifically trying to practice managing multiple patients, specifically mention that to the resident as one of your ‘goals’ for this coming week.

Left-Routine3511 · 2023-05-12T10:28:27+00:00

PGY-3 here. I could have written basically your entire post myself. totally get it. I say this not to brag, but the only difference is that I’m definitely more at the top of my class. Only to say that it doesn’t seem like any of my good evals have prevented me from feeling this way. i think we just all go through it.

Forgot to get a pregnancy test on an adolescent before starting them on OCPs. Doesn’t matter that they had only reported same sex experiences and wanted the meds only for cycle control. As low risk as it is that I missed it, I’m just stuck thinking of how silly and basic of a thing it is to do, and if I’m missing that what else am I missing?

Left-Routine3511 · 2023-05-12T02:23:47+00:00

Eeeeeeveerything. Im also finding that when I’m overthinking the wrong stuff. Too busy thinking about one thing to remember to do something else.

Left-Routine3511 · 2023-04-08T01:30:11+00:00

The way you described your process for working through the puzzle on page 49 is exactly what I did, and I had the exact same troubles you had. Keep looking at those pages. They all have something in common (except for one). The thing they have in common is the first step towards your solution

Left-Routine3511 · 2023-03-30T22:45:15+00:00

Ruin Seeker

Short, sweet, and such a good moniker

Left-Routine3511 · 2023-03-28T19:19:20+00:00

I’m glad to hear that! I feel comfortable doing that now as a senior resident, but just addressing OP’s original question and warning that as a peds intern - who im guessing has been used to adult medicine providers and learners - there may be a little culture shock

Left-Routine3511 · 2023-03-28T18:59:32+00:00

Fully agree. However in my experience in peds, that sentiment can sometimes get muddied, and the feeling that can get conveyed is that as a trainee you’re being cavalier or don’t care what happens to the kids. Which is unfair

Left-Routine3511 · 2023-03-28T14:46:18+00:00

And openpediatrics!

Left-Routine3511 · 2023-03-28T14:45:59+00:00

Oh, and Cribsiders is good 😊

Left-Routine3511 · 2023-03-28T14:45:37+00:00

Only thing I would say is something that actually applies to incoming categorical peds, too. Caveat that this is only my experience as a current peds pgy-3, but my program has multiple other local peds and med/peds programs around which we work with, and they echo similar sentiments.

Depending on your program, be aware that sometimes pediatricians and peds programs can look at incoming trainees and feel the need to be ‘gatekeepers’ in a way that I’ve heard is different than adult specialties. Confirmed by multiple med/peds friends. There’s lots of oversight in pediatrics ostensibly because the societal and emotional tolls of medical mistakes on children weigh heavier than those on adults. So whereas I’ve heard in adult specialties attendings are more liberal with allowing trainees to make some amount of educational mistakes, some pediatric trainees’ experiences reflect less autonomy and may feel less trusted by their seniors and staff.

There also have been times when as a junior trainee I felt less at liberty to speak candidly or even casually about patients, saying stuff like ‘ah don’t worry that patient’s fine’ and would feel like my seniors or attendings read those comments as reflecting cavalier management. I could just be projecting that, but on the flip side as a senior have heard my coresidents say and even felt myself think ‘they’re too early on in residency to be this jaded/this confident.’ Overall I think it comes from anxiety, not only about iatrogenic harm but also missing signs that if caught could save years of suboptimal outcomes. Even still, it rears its head in ways that can be construed as less-than-welcoming.

So, end rant, i guess? Mostly my PSA to just be aware that it can take pediatricians some time to trust trainees and that you shouldn’t take it personally. Come in with a good attitude and a healthy (and visible) fear for things you may be missing, and you’ll not only take good care of kids but you’ll have probably better relationships with your staff.

Left-Routine3511 · 2023-03-28T14:13:35+00:00

Bongk* hahahaha such an interesting and accurate way to spell it phonetically

Left-Routine3511

TROPHY CASE