Medical Thread

[IamDZJ]

can you people not wait 20 years before repainting your freaking examination rooms? and all your posters are yellow from hanging on the wall for too long. it's freaking depressing.

[BarakzaiAbdali]

very good... btw just out of curiosity say you have a patient in fast AF would u use bisoprolol (say its about 120 bpm) amioderone or digoxin... I alwasy go for Digoxin

Depends if they are in Afib with RVR and if it is acute, perhaps contributing to flash pulmonary edema due to inefficiency of the pump function of the heart (diastolic filling time), then acute management centers on simple measures like the 3 doses of dilt (the one that seems to work the best for me ) or metop IV followed up by oral maintenance, but if these measures cause hypotension in the elderly then my attendings and I have resorted to low dose Dig loading and supplementing that with Amiodorone. The clinical practice in the US veers away from Dig in RVR/afib due to controversial information surrounding it from questionable studies about mortality/morbidity when it is utilized alongside its narrow therapeutic index. Wiki links the following article as an example:
http://www.springerlink.com/content/...25f735dd9&pi=3

Amio has its own toxicities as you well know, but its multiple mechanisms of action and its beta blocking affect at the SA node are helpful...

[Dreamer]

I am 24 years old, is it too late for me too be a doctor?

No

[BarakzaiAbdali]

I might need to ask your advise about step 2 for USMLE etc

So I'll tell you how the Americans study for it. Since you are educated in the UK, you should have no issues at all. I hear that the MRCP is actually more gruelling. But what we do is we generally rely on our clinical shelf exams and then we get about 2 to 4 weeks of intense study. The one and only source we utilize is the online USMLE step 2 CK MCQ bank.

Seriously, I must have sat there and did hundreds of those questions a day x 14 days. When you are in the exam you think to yourself "man none of it is on here." But somehow when you reach an average score of 75-80% consistently on the 50 question blocks you end up doing very well on the actual exam.

A few of my in-laws from Khybaar had to deal with the language issues, but they utilized the Kaplan lecture series and the associated texts and supplemented that with the USMLE world Q bank and did pretty well (240s).

So with that in mind, if you have relatives in Peshawar or know folks on this forum they sell the Kaplan texts and have the live DVDs on the markets there from what my in laws tell me. They are pretty well put together.

At the end of the day though, the USMLE World Q bank was my big study tool.

Regarding CK: Its all about rote memorization of that book First AID for the CK. Its very accurate to exam. As a Britisher you should be perfectly able to fly through that exam.

[Dreamer]

Depends if they are in Afib with RVR and if it is acute, perhaps contributing to flash pulmonary edema due to inefficiency of the pump function of the heart (diastolic filling time), then acute management centers on simple measures like the 3 doses of dilt (the one that seems to work the best for me ) or metop IV followed up by oral maintenance, but if these measures cause hypotension in the elderly then my attendings and I have resorted to low dose Dig loading and supplementing that with Amiodorone. The clinical practice in the US veers away from Dig in RVR/afib due to controversial information surrounding it from questionable studies about mortality/morbidity when it is utilized alongside its narrow therapeutic index. Wiki links the following article as an example:
http://www.springerlink.com/content/...25f735dd9&pi=3

Amio has its own toxicities as you well know, but its multiple mechanisms of action and its beta blocking affect at the SA node are helpful...

I had a good case other day... 38 yr old guy came in... he had had a chest infection for the last 3 weeks and had been to see his GP who had told him it was clearing up and gave him some diarolyte as he had the runs as well... anyway he came to hospital 2 days later as he had according to his girlfriend gone "crosseyed" and become increasingly deaf and unsteady on his feet...
saw him and his bloodwork showed him to have an elevated white cell count more than 30 and his CRP was elevated at over 300... he was septic.. on examination he had left lateral rectus palsy and decreased air entry at the right base and crackles at mid zone on right...I ordered a CT scan and am at this point thinking Meningitis? so give him Cefotaxime 2g STAT and then rder a CxR which shows a right sided Pneumonia in mid zone and collapse of his lower lobe... I give him IV Tazocin... CT head comes back and Im no expert but something looks weird in the frontal lobe... the radiology registra wants a repeat with contrast and thats when my shift ends! I was a locum so didnt knw what happened!

[BarakzaiAbdali]

I am 24 years old, is it too late for me too be a doctor?

Not at all, see my prior answers. Its about prereqs and various other things. If you comb through the earlier responses you will see the answer to your question. In fact, age can be seen as a mark of maturity in the American system. Just make sure you satisfy your prereqs (the class work that is needed to apply, take the MCAT, and do the extracurricular work required). Many primary care schools would actually look at your age as an added benefit. Write me back if you need more info.

[BarakzaiAbdali]

Regarding the Steps themselves and how they relate to Afghan medical students its a bit more of a challenge for them. My dad's relatives who trained at Mir Wais/Quetta for house jobs and had time at Nangrahar medical and had to come over were not as familiar with the British system did a little worse on the steps. I believe the reason for this rests in the fact that the American medical system can usually be adapted to pretty well by those that are either from the British system or exposed to it in countries that the British occupied. So Pakistan was occupied by the British for a reasonable enough time length that their language skills and medical curriculum reflected the European model of teaching. However, Nangrahar was really only benefited by doctors like "Red" Duke and other Americans that went over in the 1960s before the fall of Zahir Shah.

For Afghan brothers, I think it is essential to begin reading American case studies and go across the border to be able to secure some sort of house job position if they cannot directly go to the UK or the US first and try to gain exposure.

[BarakzaiAbdali]

Hey guys,

Regarding Mir Wais hospital, serving there, once things cool down in the Kandahar Offensive, might serve as an excellent alternative to serving in the refugee camps. You will likely see some excellent medical cases that stretch and challenge the capabilities of even the most capable and trained physicians and really serve the destitute. I encourage the females on here who are interested in medicine to see if there are options for accompanying doctors/NGOs there if you have a family connection. This sort of relates to my prior posts regarding ways you can show your unique heritage in the realm of patient care. I am sure you will have quiet a bit of experience to discuss in interviews after serving in a place like this that brings together NGOs, governments, insurgents, the local populance, and worldwide academicians/physicians.

Here is an excellent New England Journal article about Mir Wais:

http://www.nejm.org/doi/pdf/10.1056/NEJMp038253

[BarakzaiAbdali]

I have tried opening a thread 10 times and it did not contribute to the views at all. I opened this thread 10 times and the view thing did not go up. I think its because PF has a lot of doctors. you have to realize that PF has a lot of members that are on vacation in Khyber Medical Colllege. Saifullah, Khushal Khan Khattak(these are members)are away for a few months due to studies in KMC but they do view threads. I view this thread when I am in College and when I am home.

I need to know the pre reqs Abdali. I might just get by degree in PolySci and become a doctor. You have influenced me a lot.

Inshallah wrorre, I will be back on tomorrow after work and we will go over this and chart out a course for you to follow. It will serve as a practical example for others that want to investigate making the switch. Thank you for your kind words. I am glad to see the interest that our people have in education. We can start the change here and take hold of our own destinies with Allah's permission of course.

[darwezkhail]

Salaam Admin Khan,

I have a question for you. So the thread celebrated 1000 views yesterday. How does the view count work? Can one individual bump up the count by repeatedly logging on again and again and clicking on the thread? Would viewing the thread from one computer and then another give you two 2 view counts even though its the same viewer?

So after the thread's inception that amounts to on average ~ 70 views/day across 15 days since its creation.

I am wondering where Afghan interests on this forum generally lie so I have the following questions:

1) Within the education forum, how do other threads compare in terms of hitting a 1000 views? Did the stocks and bonds thread hit a 1000 faster than this one, as an example?

2) Within the whole forum, it appears that politics/culture attracts the most commentary in general, but are there other threads (religion, etc) that show a more rapid and sustained interest?

3) Based on the above, what are online Pashtuns generally interested in: are they more attractive to educational issues, religious issues, political issues, etc.

4) It is probably impossible due to the anonymity afforded by the net, but it would be neat to be able to break down views according to female versus male.

Barakzai dear brother,

I applied to just 1 medical school and they said they will contact me for an interview some time in February.

Does this mean I have "made the first cut" or they are pleased with my academic standing and just want to get to know me as an individual? What should I interpret it as? Please make du'a for me people. Insha Allah they will accept me.

[darwezkhail]

I have tried opening a thread 10 times and it did not contribute to the views at all. I opened this thread 10 times and the view thing did not go up. I think its because PF has a lot of doctors. you have to realize that PF has a lot of members that are on vacation in Khyber Medical Colllege. Saifullah, Khushal Khan Khattak(these are members)are away for a few months due to studies in KMC but they do view threads. I view this thread when I am in College and when I am home.

I need to know the pre reqs Abdali. I might just get by degree in PolySci and become a doctor. You have influenced me a lot.

I might look at KMC as a back up. It sounds appealing.

Saifullah if you read this please let me know.

[Dreamer]

post interesting cases!!!!!
I saw a lady in resus who kept being admitted with abdominal pain and vomiting... why the surgeons didnt take her I will never know since an acute abdomen is their remit.. anyway this time the paramedic had bought her back the day after she had been discharged and treated for dehydration... the paramedic had done an ECG trace and it showed new bundle branch block... I repeated the ECG and it showed RBBB .... clearly this was new since looking at old traces it wasnt there, here sats were hanging on arnd 90% and she was slightly tachycardic.... she had a PMH of angina and Im thinking hmmm maybe ACS? (Acute coronary syndrome) If her block was LBBB id be defo this is ACS but with RBBB I was more unsure... asked a cardiology registra who was quite dismissive but suggested I do troponin T anyway at 12 hours and if it came positive to treat as ACS... Then I ordered a CTPA as RBBB if new maybe associated with PE... And guess what Huge PE showed up on the CTPA!

[BarakzaiAbdali]

post interesting cases!!!!!
I saw a lady in resus who kept being admitted with abdominal pain and vomiting... why the surgeons didnt take her I will never know since an acute abdomen is their remit.. anyway this time the paramedic had bought her back the day after she had been discharged and treated for dehydration... the paramedic had done an ECG trace and it showed new bundle branch block... I repeated the ECG and it showed RBBB .... clearly this was new since looking at old traces it wasnt there, here sats were hanging on arnd 90% and she was slightly tachycardic.... she had a PMH of angina and Im thinking hmmm maybe ACS? (Acute coronary syndrome) If her block was LBBB id be defo this is ACS but with RBBB I was more unsure... asked a cardiology registra who was quite dismissive but suggested I do troponin T anyway at 12 hours and if it came positive to treat as ACS... Then I ordered a CTPA as RBBB if new maybe associated with PE... And guess what Huge PE showed up on the CTPA!

Its a great idea to discuss cases in a separate thread.

However, my goal with this thread was to keep this from becoming a thread where medical advice is doled out for online patient care/or where we discuss NEJM articles/cases.

Its here really just provide youngins with information on getting into medicine and provide guidance for folks coming in from the outside.

I would recommend starting another thread in the science forum to discuss medical cases if you want to do that... otherwise the khyberians go nuts and start primping eachother. I really want to avoid people being turned off by coming into a discussion that they do not understand the discussion or they get lost in our medical jargon. They will then feel like they have to sift through tons of information to get to the guidance of how one finds their way to medicine.

I would say more young Afghans need to be directed into medicine at this point with such guidance at hand versus learning clinical medicine before they even get a foot in the door.

However, if something is discussed in the manner of how it helped one interview, write up a case report, etc; anything that helps guide people into the field the way Atul Gawand did here in his essay Letting Go

http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

Then it would help people when interview time comes around to discuss the complex ethical issues that they always ask you about in medical school interviews. I would try to hone it on providing articles like the one above or the Mir Wais one I posted last night from the New England Journal because they will then start reading such articles regularly and that will give them a leg up on their competition in discussing emotion/ethical aspects of medicine with great candor and ease.

[kakargirl]

wrora thank you for the information you gave me it was spot on mashallah may allah swt make you a even bigger success ameen

[darwezkhail]

Goal was to keep this from becoming a thread where medical advice is doled out or and really just provide youngins with information on getting into medicine and provide guidance for folks coming in from the outside.

I would recommend starting another thread in the science forum to discuss medical cases if you want to do that... otherwise the khyberians go nuts and start primping eachother.

Barakzai, why did you ignore me?