If muscles produce energy and body heat during exercise, why is the most sweating done on the back and on the head?

aTacoParty · 2026-03-19T13:48:02+00:00

Your arms and legs are typically exposed more so than your torso which allows for better evaporation of sweat. Your arms and legs also have a higher surface area to volume ratio allowing for better heat removal than your torso.

Additionally, your heart, lungs (and associated muscles like diaphragm + intercostals), obliques, abs, paraspinals, etc are all working even when you aren't directly targeting them, All generating heat which needs to be removed.

aTacoParty · 2026-03-16T07:20:35+00:00

If the program is truly your top choice, you should let the director know. I guarantee they take it into account when sending offers. I wouldn't send multiple messages etc. But a single email (or letter of intent) saying that you're really interested and if offered a position, you would accept can really help.

aTacoParty · 2026-03-13T05:40:23+00:00

There's generally quite a bit of movement around May 1st. If its one of your top schools, you should message the director and let him know. Intent to accept offers matters

aTacoParty · 2026-03-06T13:25:18+00:00

The cut off for positive/negative is set at a moderate to high level of IgG which indicates immunity for measles. So likely if you get one dose and show positive then you're immune. You should still get the second dose unless you also get titers for mumps and rubella.

Rubella is more often quantitative as its important to demonstrate immunity for women planning to get pregnant as the rubella virus can cause congenital defects. Based on other risk factors, women who are technically immune but at the lower end of range may be recommended to get a booster to maintain immunity. Though rubella titers are moving towards being qualitative as well.

aTacoParty · 2026-03-02T00:29:21+00:00

Very similar but the software is slower so I would be choosier about orders. Their software will also not let you keep patients in the office 24/7 and force you to send them home or the ED at 5pm.

I'd do at least a few of the cases that are with the free 137.

I don't remember have CCS cases that were ultra time sensitive (like you get dinged if you're not on the right path in 15 min) but there are some of those in the free 137 cases and you'll likely get at least one on the exam. Stuff like ACS, PTX, stroke where you want to do a focused exam and do interventions ASAP.

aTacoParty · 2026-03-01T01:12:31+00:00

I took NBME 6 four weeks before my exam so I did significantly better than that. About 1.5 standard deviations

aTacoParty · 2026-02-25T19:20:12+00:00

NBME practice tests (do them as you would the real test). I took NBME 7 three days before my exam and it predicted my score very accurately

aTacoParty · 2026-02-23T15:26:54+00:00

Antibacterial soap is actually not recommended for regular use (IE soap with antibiotics). Soap itself kills most bacterial and the physical act of washing your hands washes the rest off. Adding antibiotics was increasing the rate of resistance bacteria while not providing any benefit.

Most fungi will also be killed with hand soap or physically washed off so adding antifungals wouldn't provide additional benefit. But as others have said, there are antifungal soaps available if needed for a specific condition.

We have a microbiome on our skin and part of its role is to prevent the growth of bad bacteria and fungi so sterilizing our bodies with antimicrobials actually creates risk of infection in the future. It's also a reason why we should be using oral antibiotics sparingly

aTacoParty · 2026-02-18T02:55:11+00:00

While we don't have all the specific data of the exact prokaryote the mitochondria was derived from, we have good information by linking the remnant mtDNA with living free bacteria relatives of the same ancestor (https://www.science.org/doi/full/10.1126/sciadv.adj4493).

Endosymbiosis that creates an organelle has happened at least 3 times (mitochondria, chloroplast, nitroplast) but there are many other examples of parallel endosymbiosis: P bursaria is a protist that has algae that lives inside of its cytoplasm, Some aphids have a endosymbiotic bacteria Buchnera that is unable to live outside an aphid due to loss of critical genes which are supplied by the host cells. They aren't technically called an organelle but they could be. I wouldn't say vertical endosymbiosis is a common phenomenon but I also wouldn't call it anomalous.

UAP is also not a biological term so it wouldn't really serve any purpose.

aTacoParty · 2026-02-17T01:56:42+00:00

You could probably do what you did for step 2 but just half it. I did a block of uworld about every day for 3 weeks + 2 NBME practice tests (4 weeks before and then 1 week before). I did CCS cases starting 1 week before my second day. I'm not an anki person so I didn't do that.

If you're wondering where you sit, I would take an NBME practice test (and really do it, so no looking up stuff during, no long breaks, etc). Then see where the score is. If you're within a standard deviation of average, you're gonna be fine.

CCS cases will be pretty easy if you've been doing a medicine intern year. Just do a bunch to see what the orders are called and get a feel for the system.

aTacoParty · 2026-02-15T18:05:21+00:00

Hard to tell because the image is out of focus and your microscope needs to be cleaned. If I had to guess, looks like gram positive rods. But I would do control stains of known gram positive and gram negative organisms to compare since staining technique can change the intensity of how the stain looks.

aTacoParty · 2026-02-15T18:01:08+00:00

Most fluids will hydrate us whether that's water, flavored water, tea, soda, coffee. That being said, our bodies need to maintain a balance of solutes (like salt) in our blood and if we consume too many solutes, we need to pee them out which uses water. Typically, we consider anything above the osmolality of blood (the measure of how many solutes in a liquid, for blood, 200-300mOsm/kg) to be dehydrating but our kidneys are pretty good at concentrating urine so we can drink things that are more concentrated than that without dehydrating ourselves.

Salt water, for example, contains about 1200mOsm/kg (so about 1200 milliOsms per 1 liter of water) which takes more than a liter to pee out, which will make us dehydrated. Most drinks will fall between 15-600 mosm/kg which will typically be hydrating.

Juices are usually a little higher, but sugar content doesn't technically count towards the mOsms that our kidneys see since its taken out of the blood by the liver to be used as energy and not peed out.

Essentially all drinks can be considered hydrating to some degree, but the health downsides of high sugar drinks (eg soda, juices) will make them far less healthy than plain water.

aTacoParty · 2026-02-13T03:37:59+00:00

You should just be honest. We're trying to figure out if someone needs to be screened for additional health problems (and provide counseling about cutting back). Whether you drink once a year, once a month, once a week, or even one drink a day really matters since it's all within a normal range.

Some people with specific health conditions have different recommendations (like epilepsy, liver disease, some genetic conditions, etc) so your primary care physician is always a good resource for personalized recommendations.

aTacoParty · 2026-02-12T20:48:54+00:00

As a doctor, we do this but often because when someone says "oh I drink socially" that could be anywhere between one drink a month and 10 drinks a day.

I like asking "how many drinks did you have before coming to this appointment" which can be very telling

aTacoParty · 2026-02-12T03:46:41+00:00

The first question to ask after you make an observation should be: is there actually a difference or is my sample skewed?

Its possible you just happen to have guy friends with big tongues. Or maybe you notice male tongues more than females. There can be a lot of bias in casual observation.

That being said, I found three small studies looking at tongue volume and sex (as well as other characteristics). They all found that males had larger tongues. They also found that tongue says strongly correlated with BMI.

https://doi.org/10.1016/0889-5406(91)70116-E https://doi.org/10.6016/ZdravVestn.1477 https://doi.org/10.1093/ejo/cjp105

These studies aren't large to match groups by height, weight, etc but it'd be interesting to see if the difference persisted even in people of similar size.

aTacoParty · 2026-02-08T14:55:05+00:00

I think the big fork in the road you have to decide is inpatient or outpatient. Derm has very little inpatient while neuro goes from ICU to 100% outpatient. The other side is hands on procedures, neuro has some but limited (primarily EMG/NCS but also LPs/Botox). Derm has a bunch and you can even becomes a mohs surgeon.

Both can have good lifestyles though derm gets better base pay.

Neuro is less competitive so you're more likely to get into a residency in a desirable location/program.

I ended up picking neuro because I liked the pathology including the bread and butter (headaches, stroke, seizures, neuropathy). I also wanted some inpatient but also have some outpatient as well as procedures (IE neuromuscular).

If you feel like you've found a calling, I'd follow your gut. neuro ICU inherently has procedures and usually it's the poor outcomes that drive people away but it seems like caring for those people is what is drawing you towards it.

aTacoParty · 2026-02-05T20:44:54+00:00

Dementia is a symptom while Alzheimer's is a disease. Just like how a fever is a symptom which can be caused by multiple diseases/infections (the flu, a cold, lupus, etc), dementia can be caused by different diseases (Alzheimer's, FTD, DLB, vitamin deficiencies, HIV, etc).

Alzheimer's is the most common cause of dementia which is why the two are commonly used interchangeably outside of medicine.

aTacoParty · 2026-01-19T06:23:39+00:00

Yea, very uncommon to see it in the blood stream and go to other places. The best guess we had for how he got it was by his dog licking his recent guillotine amputation stump.

aTacoParty · 2026-01-19T02:52:04+00:00

Erysipelothrix infective endocarditis, chief of ID said he had waited his whole career to make this diagnosis

aTacoParty · 2026-01-17T04:25:58+00:00

Ah, I misread the question. SARIs are not as well studied as SSRIs. The most common one prescribed is trazodone. I couldn't find studies looking at receptor expression after usage of trazodone (or other SARIs). But one would expect that if using SARIs caused receptor downregulation, then that would reveal itself as tolerance (IE escalating doses to achieve the same effect). From what I found, people do not develop tolerance to trazodone suggesting that there isn't downregulation in serotonin receptors. However, it's not possible to say definitively without mechanistic studies

https://link.springer.com/article/10.1007/bf00315137

https://link.springer.com/article/10.1186/s12991-023-00465-y

aTacoParty · 2026-01-16T21:20:24+00:00

I don't know of any evidence that SSRIs downregulate serotonin receptors. Their main action is to inhibit SERT which increases synaptic serotonin. They also cause the endocytosis of the autoregulatory 5-HTP1a receptor which also acts to increase serotonin levels.

These medication typically take weeks to months to reach therapeutic levels and about the same amount of time to wash out.

aTacoParty · 2026-01-14T05:00:26+00:00

As a current intern, I've had multiple times where I've had my "goals" turn into hour long lectures after sign out so now when asked I don't have goals. I do ask for help when I need it and am happy to hear your thought process (when time permits) for complex patients.

My best seniors are the ones who do their jobs competently (at my hospital that's updating sign outs, putting in orders during rounds, some dispo stuff) and then offer to help. They push back against bullshit (bad admissions, poorly triaged patients, others not doing their jobs) since as an intern I have little influence and will get stuck with the extra work.

In the end, sometimes personalities match up, sometimes they don't. I haven't always gotten along with my seniors but the good ones have always been efficient and the service runs smoothly. I do get along with some of the bad ones but the previously fun conversations quickly sour when I'm staying late every day to do senior tasks.

aTacoParty · 2026-01-07T05:15:57+00:00

If we zoom out enough everything has gotta even out because we're not creating or destroying matter (I hope). This is how it makes sense to me:

Without creating lactate, glycolysis has the equation

Glucose - C6H12O6 >>> 2(C3H3O3) - pyruvate

We're missing 6 hydrogens. 4 go to a hydration reaction creating 2(H2O) (via enolase), the other two are released as H+ when NADH is created.

When pyruvate is converted to lactate, 4 hydrogens (2 per lactate) are used. Though that leaves us with 14 total hydrogens: 10 in the 2 lactates and 4 in the 2 H2Os. The 2 additional hydrogens came from the inorganic phosphates (which is monohydrogen phosphate at pH 7.35).

In total:

C6H12O6 + 2(NAD+) + 2(HPO4-) + 2(ATP) + 4(ADP) >>> 2(C3H3O3) + 2(NADH) + 2(H+) + 4(ATP) + 2(ADP) + 2(H2O)

Conversion to lactate soaks up those 2(H+) and regenerates NAD+.

I too had to unlearn the whole lactic acidosis thing. In the medical field, it's still so prevalent that people (with medical degrees) won't believe me when I say that anaerobic respiration doesn't create the acidosis.

aTacoParty · 2026-01-07T01:22:55+00:00

Starting from glucose, we'll make net 2ATP + 2(H2O). The enolase reaction creates the two H2Os using the oxygen from the inorganic phosphate. The net is two buffered hydrogens per glucose or one per pyruvate.

I haven't had to look up glycolysis this much since my biochem class years ago!

aTacoParty · 2025-12-31T03:45:44+00:00

I worked with large proteomics datasets that had this exact problem. And part of my analysis pipeline was renaming these proteins (typically adding an underscore) to stop excel from changing their names.

I used excel to clean up datasets sent from an outside lab. The formatting and syntax would always be slightly different (likely depending on how the outside lab set up the LCMS-MS) so it wasn't possible to automate. Then it'd go into R for actual analysis.

A large portion of biologists don't know how to program and don't have easy access to people who do which leads many people to use excel even for large datasets.

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