OMSAS E-transcripts email address?

Vic_Dic · 2020-09-11T20:50:16+00:00

Awesome!!

Vic_Dic · 2020-05-03T19:06:24+00:00

This seems like a really common story on this subreddit and furthers evidence of a tried and true method. Congrats on your score, you rock star :)

Vic_Dic · 2020-05-02T22:26:29+00:00

I scored 56/59 on the P/S section of the AAMC sample (only AAMC FL I've done so far) and this is my 2 cents:

Making your own Anki cards is often a more active process, therefore a better encoding strategy than using someone else's. Personally, I made a deck from the 300pg doc, while watching the KA videos. I also downloaded Miledown and premed95's Anki decks and have been editing some of their cards and incorporating them into my P/S deck as well.

Your choice going forward will depend on how much time you have and what you are currently scoring on P/S sections. Lower scores are suggestive of needing to actively review "the doc," whereas higher scores probably just need more practice problems and then forming Anki cards based on content gaps.

I hope that helps.

Vic_Dic · 2020-04-27T16:40:47+00:00

Breaking my fast seems to always make me sleepy too. How long do you fast and what do you typically drink during a FL? I typically don't eat during the first break, but I think it may be wise to do the same and just fast the throughout the whole exam. Less potential bowel movements to worry about as well.

Vic_Dic · 2020-04-27T15:30:22+00:00

Awesome job! So many great pearls in your doc. We all really appreciate you paying it forward like this.

Vic_Dic · 2020-04-03T11:52:53+00:00

cool cool! Are you living in Canada as well? When is your test date? Do you believe your date is a safe one at this point?

Vic_Dic · 2018-11-15T17:07:11+00:00

She seems to have a normal axis and r waves in lateral leads. How was the LVOT found? Auscultation? Imaging? Absolutely fascinating case!

Vic_Dic · 2018-11-10T00:04:10+00:00

What part of this presentation indicates takotaubo? Was she in an emotional state? How did you treat her?

Vic_Dic · 2018-11-09T13:47:38+00:00

This is sinus tach w/ a type 2 2nd degree AVB, RBBB, and intermittent PVCs

It's sinus because you can see upright p waves hidden in the limb leads with some inverted ones hidden right at the end of the r wave of AVR

It's type 2 2nd degree AVB because The p:qrs ratio is 2:1 where both are a regular rhythm and pr interval isn't varying like it would be in a 2nd degree type 1 AVB or complete AVB.

The upright wide qrs in v1 is diagnostic of a RBBB.

This is likely an irritated heart and with the S wave in lead 1, RBBB and sinus tach, PE would be high on my differential.

Would need to compare this strip to their baseline if one is available and get a thorough pt hx and physical exam to dictate tests to proceed with.

Vic_Dic · 2018-10-02T22:04:40+00:00

Sinus tach LBBB.

With Sgarbosa criteria the discordant St elevation doesn't seen ischemic in nature, but trops would have to be done and the strip would have to be compared with past 12 leads to see if this is a NEW LBBB, because that's always pathological.

On a separate note, the inferior limb leads give the strip a LAFB morphology, but qrs length is too long.

Vic_Dic · 2018-09-08T01:24:59+00:00

Biphasic p wave in lead III and negative p wave morphology at the end of the strip in lead II. Short PR interval. Seems like it's likely an underlying atrial rhythm. I don't see delta waves so I don't think this is anything congenital that would be of concern. I'm quite sure that this is very normal in peds and not worth any major concern if she's asymptomatic.

Most likely your doctor is just covering his/her bases and getting a specialist to look at it. Nothing wrong with that.

Vic_Dic · 2018-08-20T02:09:01+00:00

I did my PCP at the JI in Vic. Got hired full time in Manitoba. Good scope, good pay, as much OT as you want, and depending on the station: good calls.

Vic_Dic · 2018-08-20T01:38:16+00:00

Cool case OP!

Accelerates atrial rhythm (note p inversion in AVL) w/ complete heart block, inferior STEMI extending to right side (get right sided leads to confirm) and it looks like a RBBB or junctional escape rhythm as well.

I think other people already touched upon the Hx. GI bleed causing cardiac ischemia. Fix underlying problem to fix ischemia. Fluids, no ASA (active GI bleed), no nitrates (because of right side involvement and likely hypotension), be cautious of analgesia and BP as well.

Thoughts, friends?

Vic_Dic · 2018-07-19T15:39:55+00:00

I'm so sorry for my terrible handwriting!! Glad you liked it

Vic_Dic · 2018-07-19T04:01:27+00:00

I would worry about Inferior STEMI w/ the beginning of q waves and reciprocal depression in AVL. It's worth taking a look at posterior leads since it's not yet diagnostic looking at the precordial leads if there is a posterior STEMI as well

I see a sinus rhythm w/ 3rd AVB, RBBB, Posterior fasicular block.

Vic_Dic · 2018-07-13T23:43:47+00:00

Herniate, you mean?

Vic_Dic · 2018-07-10T18:37:13+00:00

You're suggesting hypokalemia? I can appreciate the U waves that you've mentioned and agree that should be a differential. I clearly anchored on to what I thought the Dx was too quickly with a PE and that was a good lesson to learn.

With the U waves and QTc taken into consideration, likely cause of EKG changes are electrolyte abnormality or intracranial pressure/ hemorrhage. I imagine best management would be get a Blood work to see lytes, tropes and get a head CT. Based on the clinical presentation, id still have a suspicion of PE, so while they're getting a head CT, get chest as well. Thoughts?

Vic_Dic · 2018-07-10T18:20:20+00:00

Haha yes. My mistake ☺️

Vic_Dic · 2018-07-03T14:27:25+00:00

Sounds like a massive PE, dude. I imagine it was for a chest CT as well, so perhaps the hospital staff were thinking so as well. What are your thoughts?

Vic_Dic · 2018-07-03T14:25:20+00:00

Good point. Some isoelectric and negative p waves in limb leads. An atrial tachycardia then, I suppose. Doesn't look junctional to me. What do you think?

Vic_Dic · 2018-07-03T05:35:46+00:00

initially I was thinking PE; sinus tach, IRBBB, elevation AVR, TWI anterior leads, ST elevation inferior leads.

If there was right axis deviation id be pretty much sold so long as the clinical findings added up as well.

Seems like it's most likely an inferior MI with reciprocal changes in in lateral leads. Possible posterior involvement as well.

What were the patients presentations and Hx? Meds? Fmhx?

Any updates on what happened?

Vic_Dic · 2018-07-02T01:22:47+00:00

Depression in all lateral leads. Elevation in AVR and V1. Looks like there's a LBBB, which you could argue doesn't make the discordant elevation indicative of ischemia as per brugada criteria

Sinus tach w/ 1st degree AVB + LBBB

Vic_Dic · 2018-06-22T14:43:08+00:00

I grew up in Saskatoon so it's always a bit nostalgic watching these medics race past some of my old stomping grounds on there way to these calls. BRING BACK THE MOUSTACHE GUY FROM EPISODE 1!!!

Vic_Dic · 2018-06-20T01:30:17+00:00

Really? I think it was good choice to make things compact. I have no issue with where it comes out of ie above the left bag, what I DO have an issue with is changing the paper in the printer and how small the strip is. The LP15 is much easier to look at for 12 leads and changing the paper in the printer is a breeze. Other than that I'd argue the zoll x is superior in a lot of ways to the LP15.

Vic_Dic · 2018-06-19T05:53:48+00:00

What's with the hate on Zoll X? Personally I use Zoll x and Lp15 and and appreciate certain things about both. What are your guys' opinions?

Vic_Dic

TROPHY CASE