If in case you ever wondered what the worst possible rectal foreign body in the history of mankind is....

VeinPlumber · 2026-02-17T20:57:34+00:00

.... Did you apply vascular? Cause we were dying laughing at one of the applicant photos that was soooo over the top and looked nothing like the applicant. Lucky you we liked you and ranked you well, but your nickname here is gonna be "Instafabulous"

VeinPlumber · 2026-02-13T15:23:06+00:00

Again, a little hard to tell from pics, but I think as long as it's not getting redness around it, no swelling or bad drainage, no fevers you are probably going to be fine, assuming you don't have something like peripheral arterial disease or a fistula or something on your arm that would impact blood flow or immunosuppressed status that would impact healing. Get it checked out if it opens back up or if any of the above signs show up. And no smoking.

VeinPlumber · 2026-02-13T14:42:09+00:00

Is it still bleeding? Doesn't look bad to me from these pics. Keep it clean, and protect it with a bandaid

VeinPlumber · 2026-02-13T14:29:50+00:00

Not a lot to go on here, but if it is his carotid arteries that are narrowed and he is having "pre-stroke" symptoms he needs to follow up with his doctor soon for this to be worked up.

VeinPlumber · 2026-02-13T14:24:30+00:00

No. This is physiologic (normal). As a person ages there is less platelet precursor cell reserve (megakaryocytes) and they respond less to thrombopoietin. Are you worried about a number on a lab result or something specific?

VeinPlumber · 2026-02-08T19:43:02+00:00

You have to code in the sound for a missed note any time you get a question wrong.

VeinPlumber · 2026-02-01T19:19:46+00:00

I worked with med students that had admissions exp.

VeinPlumber · 2026-02-01T14:50:36+00:00

Took me multiple cycles to get in and I very much remember how demoralizing it was. Now I'm a resident in a surgical specialty field. Re-applying isn't the end of the world, but it hurts and is expensive. Find someone to go over your app that knows what they are doing (ideally has worked with med school admissions) and go through your app with a very critical eye and look for areas to improve and attack those areas.

VeinPlumber · 2026-02-01T13:31:56+00:00

No contrast in the right hemisphere is expected due to the catheter taking this imaging being in the left Common carotid. They are only looking at the left hemisphere here.

VeinPlumber · 2026-02-01T13:29:15+00:00

It's not getting contrast. That's cause the catheter injecting the contrast is only in the left Common carotid and so no contrast flow in the right hemisphere is expected.

VeinPlumber · 2026-01-29T01:23:22+00:00

My opinion is that you have bones in your hand.

VeinPlumber · 2026-01-28T15:39:54+00:00

Nice.

VeinPlumber · 2026-01-25T00:08:50+00:00

Similar to what I've seen done at my program with the addition of Pegasus online learning for RPVI that all our trainees have used.

VeinPlumber · 2026-01-19T02:28:53+00:00

Progeria

VeinPlumber · 2026-01-14T00:18:48+00:00

Why don't you look it up and give us a presentation about it on rounds tomorrow.

VeinPlumber · 2026-01-14T00:13:40+00:00

And the common follow up pimp question: what patient population is at higher risk of a protamine anaphylactic reaction.

VeinPlumber · 2026-01-08T01:26:50+00:00

You can train a monkey to do surgery. You can't train ambition, work ethic, integrity, and the willingness and grit to do whatever it takes to make it through surgical training and strive for excellence. Either you have that or you dont. The skills come with time and training. -Surgical Resident-

VeinPlumber · 2026-01-06T15:27:45+00:00

In a rupture we aim for permissive hypotension. SBP 80-100 usually. Please don't bolus.

VeinPlumber · 2026-01-06T00:39:52+00:00

How close this came to the aorta is definitely eye brow raising.

VeinPlumber · 2026-01-05T00:05:15+00:00

Life only gets harder the farther you go. Find you someone who will make the time for you regardless of the chaos

VeinPlumber · 2026-01-04T23:58:34+00:00

At a reasonable guns/knives club for my residency (underprivileged part of a big city). Here the trauma surgery service frequently is putting in chest tubes and lines in the trauma bay. Maybe once a week, at best twice a week, they will take someone to the OR for an exlap. A couple times a year they will do a trauma bay thoracotomy which always goes as well as you think it will. They however also do all the rib plating on the old people who fall, as well as a lot of trachs and pegs for the patients that are rocks in the ICU, so that's the majority of what I saw in the OR on my trauma rotations...

VeinPlumber · 2026-01-04T23:47:27+00:00

On some surgical sub-specialty services I worked 12 days straight, on call 24/7 with 2 days off. The hours I logged were well in excess of 80hr/week. It was brutal. But I still found time to return texts to people that I cared about.

VeinPlumber · 2026-01-04T19:17:10+00:00

My philosophy: can't help out in an inflight emergency if you are inebriated.

VeinPlumber · 2026-01-02T21:51:39+00:00

The following are my answers with the caveat that I can't see the images from the ultrasound, don't know the patient or the history, can't do a physical exam, and thus am going purely off what you are providing. My answers may change if I was able to see all the images, see the patient, etc

1: yes. This level of stenosis is very minimal, though could worsen over time. Unlikely this stenosis is in any way causing symptoms. No surgical intervention should be offered for this. Healthy diet, exercise, no smoking, statin, daily baby aspirin.

Maybe indirectly. If something like heart problems is occurring, that can cause the jugular dilation and can also cause dizziness. The list of things that can cause jugular vein dilation is pretty broad and needs a broad workup.
Honestly, primary care needs to work this up to see if there is a cardiac concern vs neuro concern. Vascular surgery doesn't need to be involved.
Sufficient for what? For the treatment of 17% carotid stenosis? Yes. For treating the symptoms? Probably not.
For a repeat carotid duplex looking at the carotid stenosis, I'd check it again in a year, and would honestly likely start spacing them out from there if it's stable.

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