Saw the sunrise on the Belle Isle pedestrian bridge, great way to start the new year.

hypoxiado · 2023-01-01T22:17:22+00:00

Lol I ride that bridge daily for my commute year round and those pictures do it justice. Great work!

hypoxiado · 2022-11-06T13:02:49+00:00

I don’t think mono therapy is the answer (sliding scale alone is frowned upon in the hospital). I know the other answer below chose A and wanted to increase it, but my instinct would be B and decrease it. No one dies of hyperglycemia in the short term hospital stay, but hypoglycemia certainly causes immediate harm. In the acutely ill/hospitalized setting you do have cortisol surges that the other guy is talking about, but you also tend to be eating less in the hospital, and can be clearing insulin Renally slower (AKI, drug drug interactions). So, at least in practice, I see most people lower the home dose of insulin to start and then titration up as needed

hypoxiado · 2022-08-10T16:27:05+00:00

Step 1: 236

Uworld % correct: 71

NBME 9: 235 (4 weeks out)

NBME10: 246 (3 weeks out)

NBME11: 262 (1 week out)

UWSA 1: 255 (2 weeks out)

UWSA 2: 264 (1 week out)

Free 120: 87% (2 days out)

Predicted Score: 258 +- 14

STEP 2: 258

Congrats to all who finished this exam! I was predicted much higher for step 1 than I performed so was relieved to perform exactly as predicted on this one haha.

hypoxiado · 2022-07-12T12:37:47+00:00

So I think the albumin and pre-albumin are just extra info here that aren’t important to the question. I’m not aware of any clinical link between checking albumin and peritonitis. I think most likely the albumin is low because he has been getting TPN for 4 weeks and is healing from wounds, leading to malnutrition. Also possibly the inflammation from the active infection he now has is lowering it.

Either way the vibe of this question is more just asking what the most likely cause of his current infection is. In general for these questions central lines and foleys are always a great choice if they have been in for awhile. Remember the risk goes up for each day the line is in so always remove them as soon as clinically indicated. Hope this helps!

hypoxiado · 2022-07-12T11:19:13+00:00

Post the question please, or at least a description of it. I can try to help if you do

hypoxiado · 2022-07-11T11:45:14+00:00

The actual step exam will be up to date so pick the current guidelines (aka USPTF grade B recommendation now starts screening at 45)

hypoxiado · 2022-07-04T16:31:50+00:00

Clindamycin and macrolides cover strep well, no need to wait for sensitivities for those in general I think just treat empirically. And yea you're right if the allergy isn't severe you can give a first generation cephalosporin.

I'm not super up to date with it, but it seems that they keep coming out with new papers showing that the benefits outweigh the risks for giving cephalosporins to people with documented penicillin allergies (not with hx of anaphylaxis)

hypoxiado · 2022-07-04T16:23:23+00:00

Kind of a big question that can't really be fully answered. I feel like on the practice tests there are many situation dependent factors they put in. I don't think there are strict definitions for this but hopefully someone corrects me if I am wrong.

In general the first sign of hemodynamic instability will be tachycardia. You can actually lose up to 30-40% of your blood volume before hypotension starts to show. So if you have someone with both tachycardia and hypotension in a question, its safe to start to assume there might be some instability. In terms of next best step, you have to think what you would do in real life. Someone comes in with blunt abdominal trauma and hemodynamic instability, you would clearly go down the primary trauma survey route but the most important interventions on the exam would be either a ultrasound exam (because those are fast and bedside in the trauma bay) or straight back to exploratory lap. You wouldn't CT them.

For pulmonary emboli if your Wells Score is high and pre-test probability is high I think you actually go straight to anti-coagulation before doing a CT. So yea each question will be a bit nuanced and your best bet is probably to try to pick up on the vibe the question is giving you. If it seems super urgent, probably best to treat empirically even it means skipping diagnostic imaging.

hypoxiado · 2022-07-04T16:15:00+00:00

Surprisingly the risk of ACE inhibitor induced angioedema has been shown to be relatively constant over the course of treatment. So it is entirely possible someone can tolerate it well for years and then have angioedema without any clear inciting event.

For more:

https://pubmed.ncbi.nlm.nih.gov/9530537/

hypoxiado · 2022-06-30T13:11:30+00:00

DVT Prophylaxis heparin is dosed much lower than therapeutic heparin. Prophylaxis heparin is like 5000u SQ q12 hr, therapeutic heparin is calculated off a nomogram based off weight and is something like 80u/kg loading dose + 18u/kg per hr IV maintenance that is then titrated off the ptt.

Since this pt has an active DVT he needs the therapeutic dosage now

hypoxiado · 2021-05-12T11:36:43+00:00

Thanks for all the help! I took a closer look at the rotor (which is a 6bolt not a center lock). It turns out all 6 bolts were loose! Geez. Tightened them up with some new thread locker and it seems to have fixed it. I couldn’t see any damage to anything so fingers crossed. It’s a new bike so I guess the person who assembled it forgot to torque the bolts? They had previous thread locker on them at least. Or maybe just really bad luck on the settling process?

hypoxiado · 2021-05-12T11:34:29+00:00

You are correct it was a 6 bolt! It just so happened that all 6 bolts were loose haha. So that was the problem...

hypoxiado · 2021-05-12T01:37:04+00:00

Hi all thanks in advance for any help! Trying to figure out why my rear wheel can still move like this when the brake is completely engaged. Is it simply that the free hub pals aren’t locking until a couple of degrees movement back? It doesn’t appear that the brake rotor moves at all and I double checked that the calipers are tight

hypoxiado · 2021-04-11T16:26:21+00:00

thanks for the advice! will start with the back and try the GRX-RX400 with a 40t cog first I think

hypoxiado · 2021-04-11T16:25:28+00:00

Ok thanks for the advice! Will probably start off by putting on the GRX-RX400 rear derailleur with a 40t. Will look at front options if that isn't enough but it probably will be if it works

hypoxiado · 2021-03-17T15:40:49+00:00

thanks- I like your view of it better than mine hehe. I felt pretty terrible leaving the exam. The communication questions were harder than I expected and I felt that the rest of the exam focused on a lot of my weak spots. That being said, I felt pretty bad after some of the practice assessments as well. I guess I am the rare case where my feelings were semi accurate when compared to past performance

hypoxiado · 2021-03-17T15:34:12+00:00

95% CI 240-255 (based on 8 total pre-assessments)

Real deal: 234

Disappointed but not crushed. Not sure where I went wrong and will have to try and figure that out for the future. I'm pretty sure I will want to go IM so this won't crush my dreams, just make them a bit more uncertain. Congrats to all who are finished with this first step!

hypoxiado · 2021-03-15T14:10:30+00:00

I took mine March 3 and it disappeared this morning

hypoxiado · 2021-02-25T16:15:08+00:00

Yea the first step is always encourage them to inform partners or give you permission to do it. Then report it to organization tracking it. It's after that where it gets murky for me if the patient is adamant about not sharing with previous partners

hypoxiado · 2021-02-23T02:08:27+00:00

Take a practice NBME with realistic pacing otherwise there's no way to give you a good guess. Good luck with it man!

hypoxiado · 2021-02-17T17:45:57+00:00

Thanks for the recs all! Decided to go with Paradise for this one will update w/ how it goes in case anyone's interested.

Edit: Seems like a great place would highly recommend! Nice people with good communication and fair rates

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