Author: Becca

Reapplying to Medical School: FAQs

Reapplying to Medical School: FAQs

  • Author: Becca

Reapplying to Medical School: FAQs

Reapplying to medical school

You have spent years preparing for the day you can click “submit” on your medical school applications: prerequisite courses, volunteering, and shadowing. Everything you have been working for has culminated into this moment. 

You know you have the grades and the MCAT score. You spent your undergraduate years collecting meaningful experiences and devoting your time to extracurriculars like research or community service. Your personal statement brought tears to the eyes of those who read it. Secondary essays were sent your way and you really had the opportunity to prove your candidacy for medical school. 

As a result, you expect to open your email to an outpouring of acceptance offers in a manner that can only be compared to letters from Hogwarts flying in from the fireplace. It is okay to have expectations, but what happens when instead of acceptances you get rejections? What happens when those expectations are not met? The first and most important thing to do is to breathe and realize that it is going to be okay (More on being met with a rejection can be found here.)

While this moment is extremely disappointing, remember that you will grow and be a better medical student and doctor for it. This may be an opportunity for you to pursue a multitude of different experiences of which you may not have been able to otherwise.

What’s next when reapplying to medical school?

The next thing is to take a look at your application with honest eyes and critically consider what areas of your application can be improved upon. The process of reapplying is a great opportunity to find where your application is lacking and take the year to improve not only your application but yourself. Questions to consider when analyzing a previous year’s application:

  • Was my writing reflective of who I am as an applicant?
  • Was my writing thorough and free of errors in the way of grammar, spelling, etc.?
  • Did my personal statement present clearly my motivation to become a physician?
  • Did I apply to schools which had minimum and average statistics in the realm of my own statistics?
  • Did I apply late in the cycle?
  • Were there areas of the interview of which I can improve upon for next cycle?

In order to answer these questions, it may be helpful to sit down with a trusted advisor or school representative in order to get the answers through another’s eyes. 

You might have more questions about where to go next. Below are a few common questions about this process, but I realize this is not a one-size-fits-all topic. If you still find yourself with specific questions about your particular situation, the MyMentor program at MotivateMD can offer you one-on-one advice from current medical students about any aspect of your premed journey.

Does reapplying look bad?

On the contrary, less than half of U.S. medical school applicants matriculate into medical school in any particular year (See the AAMC data here for more information.) Ultimately, the process is implemented to make sure the best students get in. Though when there are so many students that fit their criteria, there are going to be good candidates that inadvertently do not get selected. If someone were to get rejected and then decide to pursue a different career, maybe this action is indicative that the student’s goal was not deeply rooted. 

You and I both know this is not the case. 

Keep applying. Keep trying. From one reapplicant to another, if this is what you truly want, do not let a rejection get in your way. Admissions committees will see your tenacity and perseverance and know that you are willing to put in the work required to succeed in medical school.

When should I reapply to med school?

The answer to this depends on the difference between last year’s application and this one. Ultimately, you should apply when YOU are ready.

Applying a second year with the same application that just got rejected and expecting different results is potentially a recipe for another cycle of rejections. Even if your application was exceptional the first time around, consider that doctors are the kind of people who continue to strive for improvement, even when they are “good enough” by anyone else’s standards. 

If you start once you realize you will not be getting in this year, you will not have much time to significantly change your application. In this instance, perhaps it is best for you to take a gap year and really buckle down to make yourself the best applicant and version of yourself possible. 

On the other hand, if you had other experiences in progress as you were submitting your initial application that were not included, you might have additional entries to add as a reapplicant. In this instance, absolutely try again though remember, whether you apply again is different from one applicant to another.

Should I take a gap year before medical school?

The way I look at it and the way I present the idea to students is, how much of a delta (or change) are you going to be able to show from one application cycle to another? Often, during one application cycle, students dedicate most of their time and hard work to the application itself as opposed to pursuing new volunteering, shadowing, and research opportunities. Therefore, oftentimes students may benefit from taking a gap year in order to really take the time to pursue meaningful experiences over a greater period of time.

Should I retake the MCAT?

This certainly depends! While reflecting holistically on your application, did you perceive your MCAT to be a weaker element of your application? If the answer is yes, create an individualized plan for yourself in order to prepare and take the examination. If the answer is no, continue to harness your time and energy into other activities of which will improve your application.

My GPA is not ideal, should I take additional coursework?

Registering for post-graduate coursework in the way of a master’s or post-baccalaureate program can certainly demonstrate that you have what it takes to endure a rigorous medical education. Keep in mind, some schools and application servers delineate undergraduate vs. graduate GPAs so it may not boost your GPA, but rather serve to prove your candidacy for medical school acceptance.

Were my letters of recommendation (LOR) strong?

This is an incredibly important question to consider and sometimes, evaluating whether letters are strong or not can be difficult. First, consider your professional relationship with the person of whom wrote your letter of recommendation. Is this a strong relationship where the person would be able to write a letter of recommendation on your behalf that is strong, yes, but specific. Sometimes, a generalized letter from a reputable person can look inferior to a less reputable person writing a letter of recommendation that really paints a picture of your character and demonstrates your candidacy for medical school.

Should I expand the applications I send out?

Absolutely! Consider using multiple application servers including AAMC (U.S. MD medical schools), AACOMAS (U.S. DO medical schools), and TMDSAS (Texas medical schools). If you are financially able, increasing the number of schools on your list can certainly concurrently increase your chances of acceptance. Keep in mind that applying to 2-3 application servers can substantially increase the amount of work you will have to complete to have a successful application, so set aside a considerable amount of time for yourself. 

Regardless of which application server you decide to use, be sure to select schools of which you meet their minimum requirements. For DO schools, this occasionally includes having a LOR written by a DO physician. Be meticulous about this since schools will reject you after accepting your fees if you have not met these requirements.

Furthermore, if you have identified that applying late in the cycle was one of your shortcomings, be sure to rectify this in your next application cycle by applying 1-2 weeks within the opening date of that application server.

Writing is not a strength of mine. What should I do?

That is okay! Often pre-medical students have analytical minds and struggle with writing. First, be sure to write with the goal of painting a genuine picture of yourself and your experiences. Admissions committees are not looking for novelists but rather additional information about you so they can make a decision as to whether to interview you or not. If you find yourself struggling with writing, our editors at Motivate MD can certainly help you throughout the writing process from brainstorming to perfecting grammar, spelling, and punctuation.

What should I do to improve my medical school application?

As soon as you submit your first application, you should continue to learn and improve as well as add experiences and accolades to your CV. This is not a time to kick your feet up and wait on acceptance letters to come rolling in. Keep obtaining shadowing hours and learning more about what medicine is about. Keep doing research. Find a new community service project to get involved with. Pick up a new hobby or add additional time for your current one. In terms of experiences, consider the value of your experiences. Sometimes, quality is better than quantity though through multiple hours within an experience, you can inadvertently gain a quality experience. Dedication to a specific activity or experience can go a long way. Overall, be sure to choose experiences that you are interested in. This will make the experience more enjoyable and easier to talk about when applications and interviews roll around.

What matters most is that you can look at yourself as objectively as possible and realize that you have what it takes and that the schools you are applying to would be lucky to have you as an addition to their institution.  

Virtual Rounds Session 13: Hyponatremia (Premed Shadowing)

Virtual Rounds Session 13: Hyponatremia (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 13: Hyponatremia (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Hyponatremia

Hyponatremia is a disease process in which a person has low concentration in the blood. There are multiple etiologies of hyponatremia, and patients can present with low, normal, or high-volume status. Depending on the patient’s sodium levels, they will have no, mild, or severe symptoms. 

Case Highlights 

Mr. F is a 60 yo M with PMH of heart failure and hypertension (high blood pressure) who is presenting to the ED with generalized weakness, shortness of breath, and bilateral leg swelling.  He denies having any other symptoms.

He says that he has been taking his medicines daily, including his normal dose of a diuretic for his heart failure. He did stay that he was visiting New Orleans for his son’s wedding and has been drinking much more water than usual due to the heat, and felt more “swollen” than usual.

Pathology 

What is hyponatremia? Hyponatremia is a low sodium concentration in the blood. It is defined as a concentration less than 135 mEq/L. The patient’s sodium concentration tends to correlate to their symptoms. 

What are the different types of hyponatremia?

  • Hypovolemic hyponatremia (low fluid status, low sodium concentration)
    • Renal causes: thiazide diuretic use, chronic kidney disease
    • Extra-renal: GI loss, pancreatitis, burns 
  • Euvolemic hyponatremia (normal fluid status, low sodium concentration)
    • Hypothyroidism, medication (NSAIDs, sulfonylureas), glucocorticoid deficiency, Syndrome of Inappropriate antidiuretic hormone secretion (SIADH), often associated with small cell lung cancer
  • Hypervolemic hyponatremia (high fluid status, low sodium concentration)
    • Renal failure, cirrhosis, heart failure, nephrotic syndrome

When do people begin to have symptoms?Most people tend to have symptoms with sodium levels under 130 mEq/L. Our patient in the vignette, Mr. F, had a sodium level of 122.

Source: Journal of Geriatric Mental Health

How can one diagnose the type of hyponatremia?

  • Hyponatremia must first be diagnosed through looking at a patient’s sodium level. This is often done with a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), or a Chem 7. 
  • Upon seeing that someone has a low sodium level, it is important to obtain labs including: serum osmolarity, urine osmolarity, and urine sodium
  • The flow chart below shows the way in which hyponatremia is diagnosed 
Source: WikEM
  • The etiology of the hyponatremia will determine best way to treat the hyponatremia

How quickly should one’s sodium be corrected?

  • It is recommended to correct a patient’s sodium slowly, unless they are seizing or on the verge of death, with a correction that does not exceed 8-10 mEq/L/24 hours
  • For example, if someone had a sodium of 125, the goal would be to slowly correct it to 133-135 over the course of 24 hours
  • However, if someone is having seizures or on the verge of death from hyponatremia, it is okay to correct 1mEq/L/hr, until they stop having neurological symptoms (the seizures stop or they begin to seem more awake)
  • We are careful to correct slowly to prevent central pontine myelinolysis, which happens when the sodium levels in the blood go up so quickly that all the water in the myelin cells leave the cells to go to the bloodstream, thereby causing a myelin in the pons to dry up and die. 
  •  This can lead to respiratory failure and death in patients 

Take home points

    1. Hyponatremia occurs when there is a low concentration of sodium in the blood 
    2. This can be caused by a variety of medical etiologies, and it is important to determine the patient’s volume status to correctly diagnose and treat hyponatremia
    3. To properly diagnose hyponatremia, you will need a serum sodium level, serum osmolarity, urine osmolarity, and urine sodium levels
    4. There are many ways to treat hyponatremia, but it is dependent on the cause of the hyponatremia.
    5. It is generally recommended to correct the sodium at a rate of 8-10 mEq/L/ 24 hours to avoid central pontine myelinolysis, or death of the insulation cells around the pons, as this can cause death

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Virtual Rounds Session 12: Liver Pathology (Premed Shadowing)

Virtual Rounds Session 12: Liver Pathology (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 12: Liver Pathology (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Liver Pathology

The liver is important for production of bile, excretion of bilirubin/cholesterol, and metabolism of fats, carbohydrates, and proteins. The liver is also responsible for production of clotting factors responsible for successful fibrin clot formation. Due to the fact that the liver is the site of excretion of drugs, alcohol, and hormones, it can suffer damage in the way of increased fat deposition (steatosis) or scarring (cirrhosis).

Case Highlights 

A 47 y/o M with a PMH significant for HTN presents to the ED with a three day history of shortness of breath. He describes shortness of breath at rest of which is exacerbated by ambulation. His spouse is present and also states that the patient “has been more yellow than usual” and disoriented. He describes intermittent episodes of N/V, occasionally with blood but denies syncope, CP, or LOC. The patient is a daily drinker of alcohol and consumes approximately 1 six-pack of beer per day for “as long as I can remember.” History is also positive for fatigue, diffuse abdominal pain with bloating, and weakness. No previous similar episodes. The patient takes lisinopril for hypertension but denies other medications. 

Pathology 

  1. DEFINITION
    1. Fibrosis of the liver is the result of recurrent insult to the hepatocytes and normal liver architecture of which is often irreversible. 
    2. Historically, cirrhosis has been classified as:
      1. Micronodular (<3mm) 
      2. Macronodular (>3mm) 
      3. Mixed
      4. Usually macronodular → micronodular in end stages of cirrhosis.
  2. ETIOLOGY 
    1. Consider the following causes of cirrhosis:
      1. Alcoholic cirrhosis 
        1. Substance abuse 
      2. Hepatitis (viral)
        1. IVDA, risky sexual behavior 
      3. Hemochromatosis 
        1. Genetic, HFE gene
      4. NAFLD
        1. Poor diet (western diet)
      5. Autoimmune hepatitis 
        1. Genetic, anti-smooth muscle Ab
      6. Wilson’s Disease 
        1. Copper transport, genetic 
      7. Alpha-1-antitrypsin Disease
        1. Genetic 
      8. Veno-occlusive Disease (Budd-Chiari)
        1. Hypercoagulable states
      9. Medications 
        1. MTX, INH
  3. DIAGNOSIS / EVALUATION
    1. On physical exam, you may find the following:
      1. Jaundice 
      2. Gynecomastia, palmar erythema
        1. Increased estrogen 
      3. Spider angiomata
      4. Asterixis 
      5. Fetor hepaticus 
      6. Hepatosplenomegaly
      7. Caput medusae 
      8. Varices 
        1. Rectal, esophageal → GI bleeding
      9. AMS, encephalopathy 
      10. Ascites
    2. In order to diagnose cirrhosis, lab values might show:
      1. ↑ AST / ALT (liver enzymes)
        • AST > ALT in alcoholic cirrhosis 
      2. ↑ ALP, GGT
      3. ↑ Bilirubin 
        • May be normal in compensated cirrhosis, though increase as disease progresses
      4. Albumin (may lead to fluid shifts and ascites)
      5. ↑ PT (loss of clotting factors produced by the liver)
      6. Thrombocytopenia, anemia, leukopenia
      7. ANA, Anti-Smooth muscle Antibody (AI hepatitis)
    3. Furthermore, you might order the following imaging / diagnostic testing in order to confirm the diagnosis:
      • US (first-line) 
      • CT
      • MRI 
      • Biopsy (gold-standard, see below for biopsy of liver cirrhosis.
  4. COMPLICATIONS
    1. Complications of cirrhosis include:
      1. Portal hypertension
      2. Ascites
      3. Spontaneous bacterial peritonitis (SBP) 
      4. Hepatic encephalopathy 
      5. Hepatorenal syndrome
      6. Bleeding
      7. Hepatocellular carcinoma 
      8. Increased risk of infection 
      9. Death 
  5. TREATMENT
    1. Treatment of cirrhosis ultimately depends on the underlying cause:
      1. Viral Hepatitis (B, C) = anti-virals 
      2. Hemochromatosis = phlebotomy 
      3. Wilson’s Disease = penicillamine
      4. Alcoholic = drinking cessation, avoid/manage complications of cirrhosis. 
      5. Medications = stop offending agent 
      6. Veno-occlusive disease = anticoagulation
      7. Autoimmune hepatitis = prednisone, azathioprine

 Take home points

    1. Liver pathology can cause significant morbidity and mortality given the multitude of functions that the liver has, including production of bile, excretion of drugs, and production of clotting factors.
    2. There are many causes of liver cirrhosis of which must be determined in order to implement the correct treatment. 
    3. A combination of physical exam findings, labs, and imaging/diagnostic testing can help diagnose and potentially pinpoint the etiology of cirrhosis. 
    4. Since cirrhosis is often irreversible, treatment can be directed toward not only the cause itself but managing or preventing complications of cirrhosis.

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Virtual Rounds Session 10: Postpartum Hemorrhage (Premed Shadowing)

Virtual Rounds Session 10: Postpartum Hemorrhage (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 10: Postpartum Hemorrhage (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a life-threatening disorder that can lead to shock and death if not treated rapidly. We define PPH as >500mL blood loss in a vaginal delivery or >1000mL in a cesarean section.

Case Highlights 

A 27 y/o G3P2 F at 39 weeks gestation presents to L&D with new onset contractions. The patient received regular, routine prenatal care throughout her pregnancy. This pregnancy was complicated by polyhydramnios and gestational diabetes, diagnosed in the 25th week and controlled with insulin. The labor was augmented with oxytocin delivery proceeded rapidly which resulted in a healthy 4600g (10lb, 2oz) baby boy. The placenta was delivered in its entirety with normal vascularity. The estimated blood loss was approximately 900mL. Following delivery, the patient appeared lethargic and difficult to arouse and experienced one isolated syncopal episode.

Pathology 

When considering PPH, we want to consider the 4 T’s:

  • Tone
    • Uterine Atony – a soft, “boggy” uterus of which has not contracted down after child birth, leading to hemorrhage from dilated spiral arteries.
  • Trauma
    • Lacerations – often the result of vacuum or forceps delivery as well as episiotomy.
  • Tissue
    • placenta – Evident when part of the placenta is missing once the placenta itself is delivered. This leads to bleeding from that part of the placenta.
  • Thrombin 
    • Hypercoagulability – disorders such as Factor V Leiden, DIC,  and other clotting disorders.

The diagnosis of PPH is often made clinically on examination. As stated before, considerable blood losses (>500mL for vaginal delivery and >1000mL for C-section) prompt us to consider PPH. On examination, the patient may appear lethargic with altered mental status (AMS), hypotension, and tachycardia. The following physical exam findings are indicative of specific causes of PPH:

  • Soft, “boggy” uterus = uterine atony 
  • Laceration = genital trauma 
  • Missing placenta = retained placental tissue 
  • DIC = blood oozing from access sites, petechiae

To assist in the diagnosis of PPH, consider getting the following labs:

  • H&H (CBC) – anemia (acute hemorrhage may not reflect for several hours due to loss of whole blood)
  • CMP – electrolyte disturbances
  • Coagulation – coagulopathy 
  • Lactate – tissue ischemia 
  • BUN / Cr – renal failure
  • Type and Cross – for transfusion 

Complications of PPH and severe blood loss include:

  • Severe hemorrhage resulting in hypovolemia, anemia, dilutional coagulopathy, or Sheehan’s syndrome (infarction of the pituitary gland leading to hypopituitarism, see image below)
  • Shock, death

Treatment of PPH ultimately depends on the underlying cause:

  • Uterine Atony
    • Uterine massage 
    • Medications
      • Methylergonovine 
      • Oxytocin 
      • PGF-2a
    • Surgery (Uterine artery embolization/Uterine artery ligation, hysterectomy) 
  • Trauma (laceration)
    • Correct the laceration 
  • Retained placenta 
    • Dilation and curettage (1st), then Total abdominal hysterectomy (if D&C unsuccessful) 
  • Hypercoagulability (DIC) 
    • Replace PLT, fibrinogen (cryoprecipitate), Factors (FFP)
  • Uterine inversion
    • Manual replacement of the uterus 
    • Oxytocin to contact uterus

 Take home points

    1. Postpartum hemorrhage (PPH) can be fatal if not treated rapidly
    2. By definition, PPH is defined as >500mL for a vaginal delivery and >1000mL for a c-section. This can be determined by estimated blood loss during delivery.
    3. In terms of causes of PPH, remember the 4 T’s: Tone, Trauma, Tissue, and Thrombin (clotting).
    4. Complications of PPH include shock, hypovolemia, anemia, dilutional coagulopathy, Sheehan’s syndrome, or death.
    5. Determining the cause of PPH is important since the treatment of PPH varies depending on the cause.

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Virtual Rounds Session 11: Compartment Syndrome (Premed Shadowing)

Virtual Rounds Session 11: Compartment Syndrome (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 11: Compartment Syndrome (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Acute Compartment Syndrome

Compartment syndrome is a dangerous condition which results in increasing inflammation within the affected compartment (typically muscle) and leads to increasing pressures and eventual irreversible ischemic damage to the muscle, nerves, and vasculature. Musculature compartments are defined by their separation via fascial layers (a connective tissue). Fascia is not flexible, so when swelling occurs, the affected compartment gets tighter but is not able to expand to compensate for the increasing pressures. It is considered a surgical emergency and requires a procedure called a fasciotomy in order to save the affected limb. It commonly occurs in the lower extremities, but is also possible in other areas of the body, such as the abdomen. It is generally caused by trauma, casts for broken bones which are set too tightly, and burns resulting in circumferential eschars (scabs).

Medical Jargon (revisit this section as you go through the case and physical exam so you understand the terminology).

  • HEENT: Head, ears, eyes, nose, throat
  • EOM: Extraocular movements/eye movements
  • Erythema: Redness
  • Edema: Swelling
  • Capillary refill: Circulation test-Squeeze a patient’s finger and watch blood refill it. Normal takes </=2 seconds
  • PERRL: Pupils equal round and reactive to light  
  • Normocephalic: Head is of normal size and shape
  • Abrasion: Superficial scratches (like a ‘rug burn’) 
  • Poikilothermia: Inability to regulate temperature, leads to ischemic tissues (due to a lack of blood flow and oxygen)
  • Reflexes: Tests function of motor and sensory neurons (like your patella reflex, L2-4 spinal nerve roots). Graded 0-4 (2 is normal)
  • Delta Pressure: (Diastolic-compartment)/(tissue pressure) (normal </= 30 mmHg)

Case Highlights

A 28-year-old female presents to the emergency department with a chief complaint of right lower leg pain. Patient states that about 2 hours ago she was in her yard cutting down trees when a large branch suddenly fell onto her right lower leg, briefly pinning her to the ground. After the branch was removed, she noted immediate sharp pain, redness of the skin, and tenderness to touch. Since the incident, she has developed worsening sharp pain and decreased sensation to touch. She is not able to bear weight on the leg and has minimal ability to move her right toes and ankle. She has tried icing and ibuprofen for the pain, but says nothing is making the pain better. She says her leg is feeling “tight” and the pain has become unbearable. She is worried that she broke a bone and would like to get imaging…

Physical Exam

  1. Vitals: HR 100 RR 19 BP 160/80 T 98.5 F SpO2: 100%
  2. General: Appears uncomfortable and in moderate distress.
  3. HEENT: Head atraumatic, normocephalic. No tenderness to palpation of neck. Normal ROM of neck. PERRL & EOM intact b/l.
    Lungs: CTAB, no increased work of breathing.
    Cardiovascular: Tachycardic. Radial pulses intact b/l. Capillary refill <2 seconds in b/l UE. Pedal pulses difficult to palpate in RLE. 
  4. Neurological: CN II-XII intact. Sensation to light touch diminished RLE distal to knee. Achilles reflex 1/4 in RLE.
  5. Musculoskeletal: skin overlying RLE appears edematous and tense with diffuse superficial abrasions. Severe and diffuse tenderness to palpation. Pain worse with passive and active flexion and extension of R ankle.

Pathology 

In order to best treat your future patients, you must think carefully about your assessment (differential diagnosis) and be able to rule out the other conditions that may develop in a similar fashion. For our patient, we want to consider the following:

  • Acute Compartment Syndrome
    1. This condition is defined by an abrupt increase in the pressure within a muscle compartment (which houses nerves, blood vessels, and muscle). Each compartment is surrounded by fascia, which does not expand and leads to compression of the internal structures.Caused by trauma (crush injuries), circumferential eschars (scabs), casts placed for broken bones that are too tight. Be suspicious if you find or see…Pain out of proportion to the exam, tight-looking skin, difficulties with range of motion or sensation.The best initial test (and confirmatory test) is to use a manometer to measure the pressure within the muscle compartment (to calculate the delta pressure). Normal ∆ pressure is ≤ 30 mmHg.
  • Deep Venous Thrombosis
    1. This condition presents similarly to acute compartment syndrome. Patients often present with unilateral leg swelling, pain, increased diameter of the affected leg, overlying erythema of the skin and tenderness to touch. It is diagnosed with an ultrasound, which is often able to identify the perpetrating clot as well as labs to assess the patient’s coagulation (clotting) factors. Patients who are immobile (ex. Due to a recent surgery), take certain medications (oral contraceptive pills), or have certain conditions (such as pregnancy) are at an increased risk for the development of a venous thrombosis. It is important to treat patients with medications, such as blood thinners, to prevent the development of complications, such as a pulmonary embolism (this occurs when a piece of the clot breaks off and travels to the lung).
  • Rhabdomyolysis
    1. This is a condition which is often caused by excessive exercise leading to muscle damage and the release of intracellular contents (such as myoglobin and electrolytes) into the bloodstream. Without treatment, patients can develop cardiac arrhythmias (from the excess electrolytes) and severe kidney damage. Treatment is primarily through rest and rehydration to filter the kidneys. Although rhabdomyolysis is often associated with excessive exercise, it can also occur as a result of trauma or other conditions which lead to muscle breakdown.

 Take home points

    1. Acute compartment syndrome is a condition which occurs due to excessive swelling within a fascial compartment (often of the musculature) and subsequent ischemic damage to the vasculature, nerves and muscle itself. 
    2. If left untreated, patients could develop severe complications such as loss of the affected limb, or necrosis of the musculature.
    3. To treat the patient, you must consult surgery (this is a surgical emergency!), collect the delta pressure readings with a manometer to confirm the diagnosis, and prepare the patient for surgery with fluid administration, analgesics, and methods for decreasing swelling (cold packs). 
    4. Finally, make sure you consider emergency medicine as a potential specialty! You’ll have the most exciting career and be trained to handle any situation-you just never know what you’ll see next!

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How to Write a Personal Statement for Medical School

How to Write a Personal Statement for Medical School

How to Write a Personal Statement for Medical School

Be Memorable. Get Accepted.

Undoubtedly, the medical school personal statement, whether for AAMC, AACOMAS, or TMDSAS, is no easy feat. My best advice for students on how to write their personal statement for medical school is to tell me your story. After reading a multitude of personal statements, I have learned that no two stories surrounding the journey to medicine are the same. This is the very idea that makes individuals in medicine distinct through a collection of both diversity of thought and experience. It is a culmination of those stories that allow us to treat patients with the utmost respect and care. Now, how can you tell your story? Let me lead you through that now… 

Introduction

There are three crucial elements of the introduction and are the glue that holds not only the introduction together but also the med school personal statement itself: the hook, narrative lead, and thesis statement.

The Hook

It is of the utmost importance, regardless of how strong your motivation to become a doctor is, to grab the reader’s attention immediately with the first sentence. As you can imagine, medical school admissions committees read hundreds of personal statements. Therefore, our goal should be to make yours stand out among the rest. Are you considering a description of a specific experience or instance in your life? If so, try to use vivid language inundated with imagery. Doing so will allow an emotional and perhaps sensory connection to what you are attempting to articulate. For instance:

BEFORE: I sat in the hospital waiting room eager for what was to come. 

AFTER: My hair stood on end as my stomach tied itself in knots. I could feel the cold hospital air dance around me, nearly taunting me due to the fact that I was unsure of what was to come next.

As you can see, the latter example allows for an extensive description of the scene which places the reader in the scene. Not only does this style make for an aesthetic read but draws the reader into the text, forcing them to continue reading for more.

 

The Narrative Lead

Next, we can develop a narrative lead. A narrative lead is essentially a continuation of your hook. The language that you used in order to create a hook for the personal statement is the same language we will use for the narrative lead. Focus on really developing the scene and story. Consider the following questions after drafting out the scene:

  • Why am I telling the medical school admissions committee this story? 
  • What does this experience mean for my candidacy for medical school?
  • What have I learned as a result of this experience and what does it mean for my future medical education and career in medicine?

These questions will allow you to make the successful transition from a narrative tone to the thesis statement.

 

The Thesis Statement

Finally, the thesis statement is absolutely CRITICAL. I generally flinch when people use capitals, though I want to really catch your attention here. If you take anything away from this, remember that the thesis will be the cornerstone of your personal statement. Without it, the essay lacks a particular level of organization and structure. To that end, the rest of the personal statement will inadvertently tie into the thesis statement, allowing the writing to truly come full-circle with details that are intricately linked together. The thesis statement will not only discuss your motivation to become a physician or pursue medicine but also encompass the themes you will discuss in your body paragraphs. Oftentimes, you may write the remainder of the personal statement and return the thesis once you have developed those body paragraphs. 

Body Paragraphs

Briefly think to yourself, “what are the 3-4 experiences, qualities, or characteristics I want to convey to the admissions committee?” Alternatively, from your initial narrative lead, what is the next logical progression in your story? Did you describe the moment you decided to pursue medicine and the next chapter of your story was volunteering in the hospital or seeking a medical scribing position? We might include these aspects in order to continue telling the story, though be sure to do this in a way that makes sense to you.  It is essential to have your voice permeate the personal statement. Afterall, it is a personal statement. 

Regardless of the experience or next chapter you lay out, make the connection as to how or why it is relevant and/or significant to your future. How does volunteering at the hospital relate to your future? Was there a specific instance that caught your attention and taught you a lesson of which you hold to a high regard? Include it! For each paragraph, try to make the connection back to the thesis statement in one way or another. A simpler way to do this would be to have the thesis tie into the major themes of the paragraphs. In order to do so, read each paragraph aloud and ask yourself, “what is the overarching theme I am trying to demonstrate to the reader with this paragraph?” Then, plug each of those themes into the thesis statement to allow for a cohesive read.

Conclusion

It may feel like at this point the pressure is off, but try not to get too comfortable just yet! The conclusion often presents a unique set of challenges as we must summarize what we talked about without being too repetitive or redundant. A creative way to do so is to refer back to your initial narrative lead. Was there a part of the story you left out that you can incorporate to make the story come full-circle? Is there a specific aspect of the narrative that stood out of which you can make the connection back to? Furthermore, the conclusion will serve as the last words you will leave with the reader. Therefore, we certainly want them to be powerful and allow your voice to diffuse through the personal statement conclusion as well. Consider concluding with closing remarks regarding your motivation to become a physician or pursue medicine, though try to bring a fresh and new perspective.

As you can tell, the medical school personal statement has a lot of moving parts. Regardless, the important thing to remember is that this is your story and only you know it best. Never allow anyone to minimize the impact of your story and inadvertently, your voice. Personally, this is something I am immensely passionate about and I always try to encourage students when I am afforded the opportunity to read their essays. I was always told that writing about a parent or loved one that died is cliche, though it is certainly not cliche for me. It is my story and that is what I stood by and still stand by. Afterall, how could I not use my voice to describe one of the biggest moments of which formed who I am today? I now use my voice to help cultivate encouragement, support, and the creative process in those seeking to tell their own story. 

I leave you with a few final tips in the way of DOs and DON’Ts:

Personal Statement Dos

  • Be confident and tell your story. Along those lines, never allow someone to minimize your story.
  • Take your time and critically consider what it is you would like the admissions committee to know about you. 
  • Allow yourself to write unrestrained. Ignore the character count initially as sometimes students become hyper-aware of this and limit their creative thought process.
  • Once you have your content, structure, and organization settled, THEN work towards meeting the character count.
  • Allow 1-2 people to look over your personal statement to provide constructive criticism. Remember, the Motivate MD team is available to guide you through edits and revisions of your personal statement. 
  • Take a break from writing if you are feeling overwhelmed. Personally, writing in increments allows me a fresh perspective to pursue a new creative outlook. 
  • Emphasize grammar, punctuation, and spelling. A red flag for admissions committees is careless writing in the way of poor grammar or multiple spelling mistakes.
  • Demonstrate your passions, though be sure to include an experience or example of which fortifies your claim.
  • Be specific. In regard to the last point, if you state you are passionate about helping underserved communities – why is that the case? 
  • Focus on organization and structure as well as a clear flow throughout the personal statement.
  • Make an outline beforehand. 
  • Start early.

Personal Statement Dont's

  • Place “blame” or point fingers at other healthcare professionals in your past. Often, mishandled experiences or mistakes in medicine are driving forces to pursuing a career in medicine. Regardless, always show respect.
  • Appear arrogant or overconfident. Doing so may be what gets your essay placed in the “no” pile as opposed to the “yes” pile. 
  • Violate HIPAA rules and regulations. If you decide to use a patient scenario, consider doing one of the following:
    • Use a pseudonym in quotations with the first use to denote to the reader this is, in fact, a fictional name. Then, you may drop the quotations afterwards. 
    • Use initials or an entirely fictional name altogether. 
  • Plagarize or use content of which was not 100% your own. 
  • Be generic or use a famous quotation.
  • Include statistics – including GPA or MCAT scores. This is listed in a specific section on the medical school application so we can certainly save the characters for other valuable details about you.
  • Reiterate similar aspects of which may be in your activities section.

Remember to take the personal statement in stride – this can certainly be one of the most challenging elements for science-minded pre-medical students. Needless to say, myself and the entire Motivate MD team is in your corner. If you have questions or are stuck, you know where to find us. 

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Michaela is a mentor a part of our mentorship program for pre med students​

Michaela B., M.D./MBA

Specialty: Emergency Medicine 

Heather J., M.D.

Specialty: Pathology

Ehab A., M.D.

Specialty: Internal Medicine at NYU

Anuj P., D.O.

Specialty: Anesthesiology at Dartmouth

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Specialty: Emergency Medicine 

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MS2 at NYU School of Medicine

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MS2 at Harvard Medical School

Background: Former freelance content writer

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MS1 at Duke University School of Medicine

Background: Medical School Admissions Mentor at Duke

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MS2 at Temple’s Lewis Katz School of Medicine

Background: Editor for 2 years

Ankitha

MS1 at Wake Forest School of Medicine

Background: Has a love for narrative medicine

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MS2 at the University of Minnesota Medical School – Twin Cities

Background: Minored in Global Health

Chris

MS1 at Penn State College of Medicine

Background: Tutor and Mentor

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MS1 at Medical College of Georgia 

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MS3 at the Dr. Kiran C. Patel College of Allopathic Medicine

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MS1 at Rutgers Robert Wood Johnson Medical School

Background: Advisor and Mentor

Haley

MS1 at Rush Medical College

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MS2 at the University of Iowa Carver College of Medicine

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Tatiana

First Year MD/PhD Student at SUNY Upstate Medical University

Background: Has 2 publications

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MS1 at the Miller School of Medicine – University of Miami

Background: Earned a Masters of Science in Medical Sciences

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MS3 at The Robert Larner, M.D. College of Medicine at The University of Vermont

Background: Medical Student Ambassador

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MS1 at NYU Long Island School of Medicine

Background: Has a love for the intersection of medicine and journalism

Jabre is a mentor in the medical field with MyMentor.

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MS2 at Nova Southeastern University’s Dr. Kiran C. Patel College of Osteopathic Medicine

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MS2 at the University of Iowa Carver College of Medicine

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MS3 at the Burrell College of Osteopathic Medicine

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MS2 at Marian University College of Osteopathic Medicine

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MS2 at the Dr. Kiran C. Patel College of Allopathic Medicine

Background: President of the Surgery Interest Group

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MS2 at McGovern Medical School

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MS2 at Touro College of Osteopathic Medicine

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MS1 at Midwestern University

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MS1 at the Frank H. Netter School of Medicine at Quinnipiac University

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Eric

MS2 at the NYU Long Island School of Medicine

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MS1 at Drexel University College of Medicine

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MS2 at NYIT College of Osteopathic Medicine

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Virtual Rounds Session 9: Bacterial Endocarditis (Premed Shadowing)

Virtual Rounds Session 9: Bacterial Endocarditis (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 9: Bacterial Endocarditis (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Infective Bacterial Endocarditis

Infective bacterial endocarditis is an important topic in medicine and needs to be diagnosed quickly in patients to ensure that they have the best outcome. There are multiple etiologies that can cause infective endocarditis, and in the specific case below, we will discuss a case of infective bacterial endocarditis.

Case Highlights 

Mr. M is a 51 yo M with no reported PMH who is presenting to the ED with fevers, chills, and progressively worsening shortness of breath over the past four days. He was seen in the ED two days prior for the same complaint, but left against medical advice (AMA) to use drugs.

He also states that he has been having bilateral lower extremity swelling and intermittent chest tightness.

Of note, while the patient denied past medical history during the interview, he was found to have heart failure (confirmed by labs and ultrasound) as well as bilateral pleural effusions (confirmed by ultrasound and CT scan) during his last ED visit.

Pathology 

What is endocarditis? Endocarditis is defined as inflammation of the endothelium of the heart, heart valves, or both
• This inflammation is caused by damage to the endothelium of the heart and can lead thrombus (clot) formation that can become infected by circulating bacteria

Who tends to get endocarditis? People most at risk have a diseased or damaged heart (congenital heart disease, rheumatic heart disease, bicuspid aortic valve, previous heart infection). Other risk factors include intravenous (IV) drugs use, immunocompromised states (cancer, HIV), and poor oral hygiene

Which part of the heart does it usually involve? The mitral valve is the most commonly affected valve overall, but the tricuspid valve is most commonly affected in IV drug use

How can one diagnose it? The first thing to do is to assess the patient’s vitals. If the patient has a fever, fast heart rate (>100 bpm), or fast breathing rate (>24 breaths/min) and one of the risk factors above, consider endocarditis.

Labs can show elevated white blood cell count as well as elevated inflammatory markers including ESR and CRP. You will want to also draw three sets of blood cultures prior to treatment.

It is important to obtain a transthoracic echocardiogram (ultrasound of the heart) as soon as possible in someone with suspected endocarditis.

To treat bacterial endocarditis, start broad spectrum antibiotics as soon as possible. Treatment options include: ampicillin/ sulbactam, gentamicin, and vancomycin (all IV). This person will need to be admitted to the hospital for at least a few days.

 Take home points

  1. If Infective bacterial endocarditis is suspected, a transthoracic echo (ultrasound of the heart) should be ordered ASAP
  2. Make sure to ask patients with suspected endocarditis about a history of congenital heart disease, recent oral surgeries, and IV drug use
  3. Staph aureus is the most common pathogen in bacterial endocarditis
  4. The mitral valve is the most commonly involved valve in bacterial endocarditis, unless someone uses IV drugs, then the tricuspid valve is the most likely valve

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Virtual Rounds Session 8: Orbital Cellulitis (Premed Shadowing)

Virtual Rounds Session 8: Orbital Cellulitis (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 8: Orbital Cellulitis (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Orbital Cellulitis

Here’s another great case in emergency medicine and ophthalmology. Orbital cellulitis is a condition which can develop from trauma to the eye creating a niche for infection, a bug bite or even a stye. Due to the fact that the infection is WITHIN the orbit itself (and not just the soft tissue around the eye (AKA periorbital cellulitis)), the patient must be treated quickly to prevent severe complications such as brain abscess or blindness. Follow along with the case below to learn how to recognize, diagnose, and treat a patient with orbital cellulitis.

Medical Jargon

(revisit this section as you go through the case and physical exam so you understand the terminology).

Periorbital swelling: skin around the eye is swollen 

Erythema: Redness

Proptosis: Protrusion of the eye from its socket 

PERRL: Pupils equal round and reactive to light  

Conjunctiva: Whites of your eyes and lining of inner eyelids

Visual acuity: 20/20 is normal (20/40 means a patient with normal acuity can see the object from 40 feet, while the patient with abnormal visual acuity must be 20 feet to see it)

EOM (extraocular movements) appears full with symmetric corneal light reflex: Extraocular movements (eye movements), using a light to check if the eyes are centered normally

Nystagmus: Involuntary jerking eye movements

Diplopia: Double vision (seeing two of something)

Case Highlights 

A 39-year-old male presents to the emergency department with a chief complaint of right-sided headache. He thinks that he first noticed the pain 3 days ago, but notes that he is a security guard and was punched in the right face 2 weeks ago (all the bruising around his right eye has since resolved). He describes the pain as a dull ache around his right eye. He denies any throbbing sensation, photophobia (light makes pain worse), phonophobia (sounds make pain worse). However, he does admit to diplopia (double vision) and sharp pain with eye movements when looking left, right, and down. He says the double vision stops when he covers one eye. He has not taken anything to treat his symptoms and says nothing makes his pain better.

Physical Exam 

No acute distress. He had mild-moderate right-sided periorbital swelling and erythema. No discharge or proptosis. Eyes had PERRL. Conjunctiva are clear bilaterally. Visual acuity: 20/40 without correction at 14 inches. Full visual fields. EOMs appear full with symmetric corneal light reflex and no nystagmus. Patient endorses diplopia and ocular pain with left, right and downward gaze. Ocular pressure normal with tonopen.

Pathology 

In order to best treat your future patients, you must think carefully about your assessment (differential diagnosis) and be able to rule out the other conditions that may develop in a similar fashion. For our patient, we want to consider the following:

  • Postseptal (Orbital) Cellulitis
    • Inflammation of the tissues behind the orbital septum/palpebral fascia and within the eye itself. This could include the eye muscles, globe of the eye, or optic nerve. It can be caused by pathogens getting into the eye through trauma (like getting punched in the face), insect bites, contiguous spread of an infection from the sinuses, spread of an infection through the blood. Be suspicious if you find or see…Swelling, warmth, redness of the eyelid, fever, changes in vision and pain with eye movements. The patient will have abnormal visual acuity, possibly proptosis and swelling of the conjunctiva. Consider getting a complete blood count to evaluate for the presence of abnormally high white blood cell count. The patient must be admitted to the hospital for IV antibiotics and evaluation by ophthalmology. Patients with changes in their vision (ex. 20/40 visual acuity and/or diplopia) must be admitted to the hospital for further evaluation.
  • Preseptal (Periorbital) Cellulitis
    • This condition presents similarly to orbital cellulitis. The patient will have swelling of the soft tissues around their eye, difficulty opening their eye, as well as surrounding pain to palpation and erythema of the overlying tissues. However, what differentiates this condition from orbital cellulitis is the fact that the patient’s infection is only AROUND the eye and not within it.
  • Cavernous Sinus Thrombosis
    • This is a scary condition which is often caused by an infection. The infection leads to the development of a blood clot within the venous system of the brain and can cause blindness, compress some of the major nerves (cranial nerve palsy), cause changes in vision due to abnormal changes in the pupil(s), sensory changes of the face or proptosis. Patients should be started on anticoagulants to thin their blood, antibiotics to treat the underlying infection, and possibly surgery if medicinal treatment does not change or alleviate symptoms.

 Take home points

    1. Orbital cellulitis is a dangerous diagnosis that is caused by a bacterial infection within the eye socket itself. 
    2. If left untreated, patients could develop severe complications such as a brain abscess or blindness.
    3. To treat the patient, you must get a CT scan of their sinuses and orbits to visualize the soft tissues, start IV antibiotics and consult ophthalmology while planning to admit the patient to the hospital for further management (you can’t send a patient home with changes in their vision and on IV antibiotics). 
    4. Finally, make sure you consider emergency medicine as a potential specialty! You’ll have the most exciting career and be trained to handle any situation-you just never know what you’ll see next!

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Virtual Rounds Session 6: Acute Calculous Cholecystitis (Premed Shadowing)

Virtual Rounds Session 6: Acute Calculous Cholecystitis (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 6: Acute Calculous Cholecystitis (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction –Acute  calculous cholecystitis

This is an extremely common diagnosis, and perhaps one of the most commonly performed procedures in General Surgery. With this, however, comes many more serious illnesses that must be identified to decrease the risk of mortality and postoperative complications. Through this case, we will discuss the most common presentation of cholelithiasis while taking into account other etiologies that may present as abdominal pain. 

Case Highlights 

A 45-year-old female with a pmhx of HTN and hypercholesterolemia presents with a complaint of abdominal pain for the past 3 days with associated nausea. She states the pain is diffuse but increased in the upper abdomen. She notes that it became markedly worse after eating dinner last night. Pain is described as being sharp, waxing, and waning, and improved with rest. Pain is stated to be a 10/10 at its worst and 5/10 when at rest. States that she has had about 4 episodes of this pain in the past but cannot recall any specific diagnosis given for the pain. Additionally notes that she started having a dull aching pain in her right shoulder and mid-back. She is status post a total abdominal hysterectomy 1 year ago. She does not smoke, drink alcohol, or use drugs.

Pathology 

Cholelithiasis can be caused a number of different diseases, but the four main risk factors for this can be easily remembered by the 4F’s: Female, Fat, Forty, Fertile. There are two types of stones that can be found in the gallbladder, cholesterol or pigmented, and while the underlying cause for each to occur differs the treatment of the acute illness does not change. It is important to remember that you might find patients that have cholelithiasis for years but do not have any intervention to treat them. This is because having Cholethiasis itself doesn’t warrant surgical intervention and many people are asymptomatic. Intervention is needed when the patient develops cholecystitis as a result of the stones. This is what we will discuss below

Presentation:

Patients will present with intermittent abdominal pain that is worse in the RUQ, and worse right after eating. Some patients may have shoulder or back pain due to referred pain. They may or may not have a fever, nausea, vomiting.

Physical: 

  • RUQ pain, especially Murphy’s sign. This is when the physician palpates under the right costal margin and has the patient take a deep breath in. If the patient has to abruptly stop breathing because of sharp pain this is a + Murphys sign.

Work Up: 

CBC: To look at the WBC level. 

Liver Function Test: to look to see if there are any signs of the patient having a biliary tree obstruction. 

RUQ US: This is the gold standard for visualizing the gallbladder. Looking for signs of a stone, bile sludge, edema around the gallbladder as well as gallbladder wall thickening. 

Treatment: 

In most cases, if this is a repeated instance of cholecystitis, the patient will be recommended to have an elective cholecystectomy. In cases where the patient is not a surgical candidate at the present moment they can return for an elective cholecystectomy at a later date, and for patients will more severe comorbidities the use of cholecystostomy tubes or ursodiol can be done to decrease the symptoms and likelihood of another attack in the future.

 Take home points

    1. Gallstones may be asymptomatic but can be a nidus for infection leading to cholecystitis. 
    2. Always have a large differential list, because abdominal pain can present differently in patients so this will help you look for everything without getting tunnel vision. 
    3. 4 F’s: Female, Fat, Forty, Fertile are the most common risk factors for cholelithiasis. 
    4. Cholecystectomy is not an emergent surgery, but due to the high likelihood of a repeat episode, it is commonly removed to prevent further attacks. 
    5. Always think of Choledocholithiasis (CBD obstruction due to a stone) as this can lead to Cholangitis which needs to be treated medically first.  
    6. RUQ US is the gold standard diagnostic test for Cholecystitis.

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Virtual Rounds Session 5: Thyroid Disorders (Premed Shadowing)

Virtual Rounds Session 5: Thyroid Disorders (Premed Shadowing)

  • Author: Becca

Virtual Rounds Session 5: Thyroid Disorders (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Thyroid Disorders

The thyroid is essential to the metabolic functions of a multitude of organs in the body. Besides thyroid cancer, there are two primary classifications for thyroid disorders: hypothyroidism and hyperthyroidism.

Case Highlights 

A 35 y/o F attorney presents to the clinic with worsening fatigue. She notes that for the past 2 months she has been experiencing lingering tiredness despite sleeping 8+ hours per night. She denies depression and states “I am too busy for that” but does report constipation, hair loss, and a 10-lb weight gain over two months despite not feeling very hungry. She notes at the firm, most of her co-workers are hot while she is bundled up with “as many clothes as I can find.” Her last normal period was “normal,” though she does admit there was a heavier flow than usual. She states previously she felt very well with a lot of energy but recently had “a cold and felt terrible” following this. No significant PMH.

Pathology 

Above: Hypothalamic-pituitary axis

There are primarily two ways to classify thyroid disorders:

  1. Hypothyroidism
    1. Insufficient production of thyroid hormone
      1. Ex. Hashimoto’s thyroiditis
    2. Symptoms include:
      1. Weight gain  
      2. Cold intolerance
      3. Fatigue
      4. Bradycardia
      5. Constipation
      6. Weakness/fatigue
      7. Hair loss
      8. Menstrual irregularities
      9. Edema 
  1. Hyperthyroidism 
    1. Increased or excess production of thyroid hormone
      1. Ex. Grave’s disease 
    2. Symptoms include:
      1. Weight loss
      2. Heat intolerance
      3. Anxiety /insomnia
      4. Palpitations / tachycardia
      5. Diarrhea
      6. Weakness / myopathy
      7. Menstrual abnormalities 

In terms of risk factors, etiologies, or exposures of which place one at risk for developing a thyroid disorder, we might consider the following:

To diagnose thyroid disorders, the gold standard test is the TSH. The TSH value in combination with the Free T3/T4 can point us in the direction of whether we are dealing with a hypothyroid or hyperthyroid state.

Treatment is directed towards whether we are dealing with hypothyroid or hyperthyroid state:

  1. Hypothyroidism:
    • Levothyroxine / synthroid (thyroid hormone supplementation) 
  2. Hyperthyroidism:
    • Radioactive Iodine Ablation / Surgical excision (definitive treatment)

THEN

    • Levothyroxine / synthroid (thyroid hormone supplementation) 
    • Propranolol (symptomatic relief)

 Take home points

    1. Thyroid disorders are divided into hypothyroid and hyperthyroid. 
    2. Hypothyroidism is insufficient thyroid hormone production while hyperthyroidism is excess or increased thyroid hormone production.
    3. Symptoms of hypothyroidism are consistent with slowing of metabolic function. Hyperthyroidism is reflective of increased metabolic function.
    4. TSH is the gold standard test for diagnosing thyroid disorders. 
    5. Treatment is directed at either supplementing thyroid hormone of which is missing (levothyroxine, synthroid) or eliminating the source of excess thyroid hormone (ablation/excision) and then supplementing thyroid hormone after (levothyroxine, synthroid).

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