Surgio.info

01/06/2024

2nd-Degree AV Block

 2nd-degree AV block occurs when there is an occasional on time but non-conducted P wave due to the presence of disease within the AV conduction system
 If every other P wave is non-conducted, this is called second-degree AV block with a 2:1 pattern (“2:1 AV block”)
 2:1 AV block may be caused by either Mobitz I or Mobitz II 2nd-degree AV block
 Since every other P wave is non-conducted in 2:1 AV block, it is difficult to tell if Mobitz I or Mobitz II is present based on the EKG alone
 The only reliable way to distinguish between Mobitz I and Mobitz II in a patient with 2:1 AV block is if there is a change in the pattern of conduction that is captured on EKG
(a) If two or more sequential beats occur in which the P wave is conducted:
• If PR interval is constant: Mobitz II
• If PR interval prolongs: Mobitz I

(b) If complete heart block develops:
• Narrow escape rhythm (junctional): Mobitz I
• Wide escape rhythm (ventricular): Mobitz II
Do not use the width of the baseline QRS complex to determine if Mobitz I or Mobitz II is present
Maneuvers that alter the heart rate may help to distinguish between Mobitz I and Mobitz II in patients with 2:1 AV block (though not always conclusive)

01/06/2024

First-degree AV Block
• PR interval prolonged (> 200 ms)
• Represents delayed conduction through AV node, not blockage
Causes of First-degree AV Block:
Physiological:
• Sleep
• Athletes
Pathophysiological:
• Often due to age-related fibrosis of the conduction system
Medications:
• AV-nodal blocking agents like beta blockers, calcium channel blockers, digoxin
T Wave Characteristics:
• Should have smooth upstrokes and downstrokes
• Presence of notches/bumps in T wave may indicate superimposed P wave
Differentiating P Waves in First-degree AV Block:
• PR interval markedly prolonged, RP interval may become shorter than PR interval
• P wave may resemble retrograde P wave
Use P wave axis for differentiation:
• Positive in leads I and V4-V6
• Negative in lead aVR (atria depolarize right to left)
• Positive in leads II and aVF (atria depolarize superior to inferior)
Retrograde P Wave Axis:
• Negative in leads II and aVF
• Positive in lead aVR

06/26/2023

𝑩𝒆𝒄𝒐𝒎𝒊𝒏𝒈 𝒂 𝑪𝒐𝒏𝒔𝒖𝒍𝒕𝒂𝒏𝒕 𝒊𝒏 𝒕𝒉𝒆 𝑼𝑲 𝒗𝒔. 𝒕𝒉𝒆 𝑼𝑺

When it comes to becoming a consultant in the UK or the US, the time it takes can vary. In the UK, the training period for medical and surgical specialties is around 8-9 years, from ST1 to ST8. In the US, the process is slightly different, with 2 years of post-MBBS training followed by 3 years of residency, and then 3 years of fellowship, since most people don’t want to stop at residency alone. This means it takes around 8-9 years to become a consultant in the US as well.

Of course, there are some people who are able to complete Step 1 in their third year of medical school and Step 2 during their internship. These people can apply to the US residency program after completing their internship and will spend around 7 years in total.

In terms of the H1B/J1 visa dilemma, it’s worth noting that if one opts for an H1B for residency, it can be tough to get into a competitive fellowship. On the other hand, if one opts for a J1 visa, getting into the Green Card and citizenship line can be challenging. There is also the provision of returning to your home country after residency in the US for at least two years. However, some places do offer a waiver if you work in rural areas for 2 years, such as New Jersey.

Overall, becoming a consultant takes more or less the same amount of time in the US and the UK, with maybe a difference of 2 years at most. It’s important to consider your own goals and preferences when deciding between the two options.


https://surgio.info/usmle-vs-plab/

06/25/2023

𝐂𝐡𝐨𝐨𝐬𝐢𝐧𝐠 𝐁𝐞𝐭𝐰𝐞𝐞𝐧 𝐏𝐋𝐀𝐁 𝐚𝐧𝐝 𝐔𝐒𝐌𝐋𝐄: 𝐏𝐫𝐨𝐬 𝐚𝐧𝐝 𝐂𝐨𝐧𝐬 𝐭𝐨 𝐂𝐨𝐧𝐬𝐢𝐝𝐞𝐫 𝐟𝐨𝐫 𝐘𝐨𝐮𝐫 𝐌𝐞𝐝𝐢𝐜𝐚𝐥 𝐂𝐚𝐫𝐞𝐞𝐫
First and foremost, both are licensing exams. They allow you to practice in their respective country.

Choosing between PLAB and USMLE depends on your individual goals and preferences. Both pathways have their pros and cons.

After clearing all the steps of USMLE and getting ECFMG certification, you need to undergo the match and secure a spot in a residency program.

With PLAB and GMC registration, you won’t immediately get a residency. Instead, you must first work in a non-training job for a few months, secure a CREST form, and then apply for the CT1/ST1 training program. If you fail to get a residency spot after USMLE, it can be distressing, while with PLAB, you still have a non-training job in the UK.

The UK has a longer specialty training program than the US, and the US pays more but has longer working hours, especially for surgical specialties. The US also has more visa issues compared to the UK, but it’s better for research. In terms of exam difficulty, PLAB is easier than USMLE. Ultimately, you must adjust to the country’s healthcare system and culture wherever you go.

It’s essential to weigh your options carefully and choose what aligns with your future goals as a doctor and as a person. Remember, success depends on learning how things work in your chosen country.



https://surgio.info/usmle-vs-plab/

06/24/2023

Syncope: An Approach to Diagnosis:
The duration of syncope is the most important thing to differentiate whether it is true syncope or any other problem. An eyewitness is required to ask this question because the patient can’t give accurate information.

If the duration is greater than 5 minutes, it is not a true syncope

Consider the following conditions:

Medication Side effects
•Alcohol blackout
•Narcolepsy
•Drug intoxication

If the duration is less than 5 mins, ask the following questions:

•Tonic-clonic movements of the body during syncope
•Bladder and Bowel Incontinence
•Post-event confusion
If the above-mentioned conditions occur, it may be labelled as Seizures and if not then it is called true Syncope.

However, it’s worth mentioning that not all seizures manifest with these characteristics, and syncope can sometimes present with brief jerking movements or confusion after regaining consciousness. Therefore, a comprehensive evaluation by a healthcare professional is needed to differentiate between the two.


https://surgio.info/history-taking-of-syncope-an-approach-to-diagnosis/

06/22/2023

Caput Medusae
Caput medusae is a medical term used to describe a specific physical finding in individuals with chronic liver disease (CLD). It refers to the appearance of dilated and engorged veins that radiate from the umbilicus (belly button) to the abdominal wall. The name “caput medusae” is derived from the mythological Greek figure Medusa, who had snakes for hair.

Caput medusae is a result of portal hypertension, a condition where there is increased pressure in the portal vein and its branches. In CLD, liver damage and scarring, such as in cirrhosis, can cause obstruction of blood flow through the liver. This leads to increased pressure in the portal vein, which forces blood to find alternative pathways to return to the systemic circulation. The dilated veins around the umbilicus are collaterals that develop as a result of this redirected blood flow.

The presence of caput medusae is a clinical sign of advanced liver disease and indicates the presence of portal hypertension. It serves as a visual indicator for healthcare professionals during physical examination.

06/19/2023

The Irish Medical Council (IMC) is the regulator of the medical profession in Ireland. It is a statutory body established under the Medical Council Act 1978. The IMC’s main functions are to:

Maintain the register of medical practitioners licensed to practice in Ireland;
Set standards for medical education and training;
Investigate complaints about doctors;
Take disciplinary action against doctors who are found to be unfit to practice.
The IMC is also responsible for promoting public awareness of the medical profession and its standards. The IMC’s current CEO is Philip Brady.

The IMC is funded by a combination of registration fees, government grants, and income from its publications. The IMC’s headquarters are located in Dublin.

https://surgio.info/imc-registration-for-pakistani-doctors/

06/18/2023

Exam Pattern of UKMLA
What is UKMLA: Applied Knowledge Test (AKT)
The Applied Knowledge Test (AKT) is a computer-based assessment that forms part of the UKMLA, which is a new test that will replace PLAB from 2024. The AKT tests the knowledge base behind independent general practice in the UK within the context of the NHS.

Candidates who pass the AKT will show they can apply knowledge at a high enough level for independent practice. The AKT consists of 200 multiple-choice questions and has a duration of 3 hours and 10 minutes.

The AKT covers three themes: readiness for safe practice, managing uncertainty and delivering person-centered care. The AKT is one of the two parts of the UKMLA, the other being the Clinical and Professional Skills Assessment (CPSA).



What is UKMLA: Clinical and Professional Skills Assessment (CPSA)
The Clinical and Professional Skills Assessment (CPSA) is one of the parts of the UKMLA, which is a new test that will replace PLAB from 2024. The CPSA is a practical assessment of clinical skills and professionalism.

It is embedded within UK medical schools’ final exams and each medical school calls it something different – for example, an Objective Structured Clinical Examination (OSCE) or Objective Structured Long Examination Record (OSLER). The GMC will publish the requirements that all CPSAs must meet. The CPSA will cover three themes: readiness for safe practice, managing uncertainty and delivering person-centered care.

The CPSA is one of the two parts of the UKMLA, the other being the Applied Knowledge Test (AKT).



https://surgio.info/what-is-ukmla-all-you-need-to-know/

06/18/2023

Open WHO
WHO courses are mainly confined with Epidemic and Pandemic diseases i.e. Tuberculosis, Malaria, Dengue and Polio, Infectious Diseases, Malnutrition etc. These courses provide knowledge about Preventive measures, immunization and Daily life interventions to treat communicable diseases.

WHO courses are taught by WHO experts and other leading experts in the field. They are designed to be interactive and engaging, and they offer learners the opportunity to network with other learners from around the world.

To take a WHO course, you must first create an account on the WHO OpenWHO platform. Once you have created an account, you can browse the course catalog and select the courses that you are interested in taking.

WHO courses are free of cost and certification as well. You have to pass the test at the end of each course to claim certification. Such certificates play an important role towards our career.
For more platforms, Click here
https://surgio.info/platforms-for-online-healthcare-courses/ -5147

06/17/2023

Spider Naive
Spider nevi appear as small, reddish or bluish lesions on the skin, often with a central feeding artery and radiating branches resembling a spider or spider web. They are typically found on the face, neck, upper chest, and arms.

Press on central feeding artery and note down if radiating branches disappear, then it is confirmed spider nevi.

https://surgio.info/chronic-liver-disease-clinical-case-presentation/ -4909

CHRONIC LIVER DISEASE, CLD, is characterized by chronic abnormal functioning of liver due to various causes including hepatitis, alcoholic liver disease,

06/17/2023

What are Flapping Tremors/ Asterixis?
Flapping tremors, also known as asterixis, is a type of involuntary movement that can be observed during a physical examination. It is typically seen in patients with liver failure or other conditions that cause metabolic encephalopathy.

To perform the flapping tremor test, the examiner should have the patient sit with their arms extended in front of them, wrists dorsiflexed, and fingers spread apart. The examiner should then observe the patient’s hands for any flapping movements, which are characterized by a sudden drop of the hand and a rebound back to the original position.
https://surgio.info/chronic-liver-disease-clinical-case-presentation/ -4909

06/17/2023

Comparison of Attending Salaries and Training Time in the UK and US
The average Attending (“Consultant”) in the UK earns around $121,900 per year.

The average attending in the US earns around $313,000.

The average time between finishing medical school in the UK and becoming an Attending is around 8 years.

The average time between finishing medical school in the US and becoming an Attending is around 4 years.

https://surgio.info/usmle-vs-plab/ -4919

USMLE vs PLAB: Choosing between PLAB and USMLE depends on your individual goals and preferences. Both pathways have their pros and cons