USMLE HI-5

The BEST USMLE PAGE EVER!!

Hello Everyone, That's Zeeshan Mansuri (Zee Man) here. Welcome and Happy New Year!! Sorry for being inactive in December. It's time to make some new beginnings this new year!! The page will be super active from Tuesday (tomorrow) i.e. 5th January, 2016 with the following updates: 1) 5 USMLE styled questions with explanations every day, courtesy: Osmosis, a Johns Hopkins based USMLE startup used by OVER 18,000 US students. Check them out!! The questions will be posted everyday 4 hours apart starting in the morning at 5 AM Eastern Standard Time. So the answer to the 5 AM question will be posted at 9 AM, the answer to the 9 AM question will be posted at 1 PM....so on and so forth. 2) Either one of the 3 sets of cards: #Zee5-K, #Zee5-F and #rapidreview. #Zee5-F (5 things you MIGHT NOT know): Important stuff about USMLE which general review books MISS in the form of 5 facts about a specific topic which you MIGHT NOT know. It is quick and extremely high yield! #Zee5-K (Keep it simple): These cards will be about 5 most likely questions about a disease in Step 2 CK...It will be short and extremely high yield.... #rapidreview: 10 high yield facts in Question and Answer form! 3) High yield videos to help your remember some important facts. All together, that's up to 50 NEW HIGH YIELD CONCEPTS every day!! 4) If anyone wants to create content and join USMLE HI-5 or has any questions or doubts, inbox me. 5) © 2016 USMLE HI-5 (https://www.facebook.com/usmlehi5/). Creative Commons Attribution-ShareAlike 4.0 International Public License. So all those preparing for the exams, brace up. We are back to rock the show!! Let's go get our dream score!!! All the best, Zeeshan Mansuri (Zee Man)

Mission: To get you to your dream USMLE score!

(Danielle Nelson's story)

This was me 5 days ago at the West Allis Hospital. I have COVID-19. I tell you this because it has been a terrifying moment in my life and I urge you to take care. I also share this really personal thing with you so you can see a face of someone who actually has it. This global pandemic felt so abstract to me. Until it didn’t.

I am a generally healthy person. I have no underlying health conditions. Before March, I had never spent a night in a hospital bed. About 3 weeks ago, I started having chest pain. I self-quarantined but I wrote it off as anxiety. About 2.5 weeks ago, I got a fever. Despite regular Tylenol and ice packs, it could not be controlled. After a week of this and sleeping 20 hours a day, I went to the ER. They tested me and sent me home. A few days later I barely had the energy to get to the bathroom. I was so tired and winded. I went back to the ER and was admitted.

For the week I was in the hospital I had to have help going to the bathroom. The doctors were having a hard time controlling my fever. I slept covered in ice packs. My blood pressure was dangerously low. I was getting IV fluids because I was severely dehydrated. I could barely eat. I was on oxygen because I had a hard time breathing due to the pneumonia and fluid in my lungs. I feel so lucky I didn’t need a ventilator. When I had moments of physical relief, I sobbed. I tried to focus on my meditation app. I tried to reply to texts. I reflected on my life. I told my mom and Patrick I loved them.

I was released from the hospital 4 days ago but it’s not over. I am tired. I can do a little something and then have to rest. In fact, I write this with my head on a pillow.

The doctors are confident I’ll pull through, but there is always a caveat (“We aren’t sure exactly how this virus works.”). This caveat leaves me edgy. I’m afraid of taking 2 steps forward to take 3 steps back but so far I’m trusting the improvements my body is making. I feel a little better every day. Being home has really helped my spirits.

If you are afraid, I understand. I’ve looked face first into the beast and I am still afraid for me and for all of those who have yet to get COVID-19. If you have been diagnosed and are losing your mind, I want to be there for you to the best of my ability. DM if you are able. It doesn’t matter if we haven’t talked since elementary school, or barely at all. While not everyone will get as sick as I did, many will have mild symptoms and unknowingly spread it. Some will be more sick. I hope very few.

As I was being discharged, my pulmonary doc earnestly said, “Please tell people what happened to you.” I’m setting aside my tendencies toward privacy and I’m honoring his request. I guess it’s the least I can do to thank him for being on the frontline for me. Please take care of each other. And please take care of yourself.

This was me 5 days ago at the West Allis Hospital. I have COVID-19. I tell you this because it has been a terrifying moment in my life and I urge you to take care. I also share this really personal thing with you so you can see a face of someone who actually has it. This global pandemic felt so abstract to me. Until it didn’t.

I am a generally healthy person. I have no underlying health conditions. Before March, I had never spent a night in a hospital bed. About 3 weeks ago, I started having chest pain. I self-quarantined but I wrote it off as anxiety. About 2.5 weeks ago, I got a fever. Despite regular Tylenol and ice packs, it could not be controlled. After a week of this and sleeping 20 hours a day, I went to the ER. They tested me and sent me home. A few days later I barely had the energy to get to the bathroom. I was so tired and winded. I went back to the ER and was admitted.

For the week I was in the hospital I had to have help going to the bathroom. The doctors were having a hard time controlling my fever. I slept covered in ice packs. My blood pressure was dangerously low. I was getting IV fluids because I was severely dehydrated. I could barely eat. I was on oxygen because I had a hard time breathing due to the pneumonia and fluid in my lungs. I feel so lucky I didn’t need a ventilator. When I had moments of physical relief, I sobbed. I tried to focus on my meditation app. I tried to reply to texts. I reflected on my life. I told my mom and Patrick I loved them.

I was released from the hospital 4 days ago but it’s not over. I am tired. I can do a little something and then have to rest. In fact, I write this with my head on a pillow.

The doctors are confident I’ll pull through, but there is always a caveat (“We aren’t sure exactly how this virus works.”). This caveat leaves me edgy. I’m afraid of taking 2 steps forward to take 3 steps back but so far I’m trusting the improvements my body is making. I feel a little better every day. Being home has really helped my spirits.

If you are afraid, I understand. I’ve looked face first into the beast and I am still afraid for me and for all of those who have yet to get COVID-19. If you have been diagnosed and are losing your mind, I want to be there for you to the best of my ability. DM if you are able. It doesn’t matter if we haven’t talked since elementary school, or barely at all. While not everyone will get as sick as I did, many will have mild symptoms and unknowingly spread it. Some will be more sick. I hope very few.

As I was being discharged, my pulmonary doc earnestly said, “Please tell people what happened to you.” I’m setting aside my tendencies toward privacy and I’m honoring his request. I guess it’s the least I can do to thank him for being on the frontline for me. Please take care of each other. And please take care of yourself.

-Danielle Nelson

My routine: I wake up and check my temperature. I shower. Dress in normal clothes to drive to work. Change into scrubs at work. Change my non contaminated shoes to my “contaminated shoes”. Wear the gear below. See patients where I place on more gear. After 10-12 hours, change out of my scrubs at work into my normal clothes. Wash/sanitize my hands for the 100th time that day. Clorox my shoes, my stethoscope, my desk, my phone. My goggles. Pretty much everything including the wall if my shoes touched that. Drive home. Call Carl to make sure kids are away. Change out of clothes in garage. Run to basement. Shower. Decontaminate. Self isolate from my family who reside upstairs. Eat and watch Netflix by myself. FaceTime w Carl and the kids. Check my temperature before bed. Day starts over again. Does this sound awful? Well it is. Please please Stay home and Wear a mask so us frontline healthcare workers don’t have to do this for months and months 🙏

Credits: Dr. Lizbeth Dmh

My routine: I wake up and check my temperature. I shower. Dress in normal clothes to drive to work. Change into scrubs at work. Change my non contaminated shoes to my “contaminated shoes”. Wear the gear below. See patients where I place on more gear. After 10-12 hours, change out of my scrubs at work into my normal clothes. Wash/sanitize my hands for the 100th time that day. Clorox my shoes, my stethoscope, my desk, my phone. My goggles. Pretty much everything including the wall if my shoes touched that. Drive home. Call Carl to make sure kids are away. Change out of clothes in garage. Run to basement. Shower. Decontaminate. Self isolate from my family who reside upstairs. Eat and watch Netflix by myself. FaceTime w Carl and the kids. Check my temperature before bed. Day starts over again. Does this sound awful? Well it is. Please please Stay home and Wear a mask so us frontline healthcare workers don’t have to do this for months and months 🙏

Credits: Dr. Lizbeth Dmh

Credits: Mount Sinai!

Credits: Mount Sinai!

Superhumans against Covid-19

Northshore LIJ hospital has now treated 1000 Covid-19 patients successfully 👏👏👏

Northshore LIJ hospital has now treated 1000 Covid-19 patients successfully 👏👏👏

"Not at my age, don't intubate me. I have lived my life and I told them 'Let me go peacefully'."

A 95-year-old Swiss woman is back at home and online with her 10 grandchildren and 11 great-grandchildren after recovering from a week in intensive care with COVID-19.
Gertrude Fatton told Reuters she had been treated in an isolation room and at one point refused to be intubated to help her breathing.

"Not at my age, don't intubate me. I have lived my life and I told them 'Let me go peacefully'."

After a week of treatment with antibiotics and the malaria medicine chloroquine, she said she was now happy to be back home in the western French-speaking canton of Neuchatel with her cat and her family.

"I hope to get back enough strength to live a bit longer. I have grandchildren, great-grandchildren, I would like to see and hear them. I chat with them over [the] internet, on my iPad."

Fatton said she had been sick in bed at home in the town of Le Locle for a week before developing breathing problems. An ambulance rushed her to hospital in La Chaux-de-Fonds.

"They took my blood and my blood pressure. They put antibiotics directly in my veins three times a day. It was very difficult but it was ok," she said.

"I wasn't afraid of dying, no. Not at my age, 95 after all, it's time to go. But I didn't think I was going to die, absolutely not. I was not afraid," she said.

Fatton, who uses a walker, said she had been healthy all her life, although she took blood pressure medicine and occasional cough syrup for bronchitis.

Her daughter Jacqueline Fatton recalled, "When the doctor called to tell me that the oxygen in her blood was dropping and they had 24 hours to stop it, I was really, really afraid and thought I would lose her that night.

"The next day the doctors said 'we are going to go for it and try all the medicines that we can' - By the third day, the oxygen was back up and the drugs worked extremely well.

"I could call twice a day with the mobile phone. When I saw that she could speak to me without coughing much, I knew that we had won," Jacqueline said.

Credits: Reuters

"Not at my age, don't intubate me. I have lived my life and I told them 'Let me go peacefully'."

A 95-year-old Swiss woman is back at home and online with her 10 grandchildren and 11 great-grandchildren after recovering from a week in intensive care with COVID-19.
Gertrude Fatton told Reuters she had been treated in an isolation room and at one point refused to be intubated to help her breathing.

"Not at my age, don't intubate me. I have lived my life and I told them 'Let me go peacefully'."

After a week of treatment with antibiotics and the malaria medicine chloroquine, she said she was now happy to be back home in the western French-speaking canton of Neuchatel with her cat and her family.

"I hope to get back enough strength to live a bit longer. I have grandchildren, great-grandchildren, I would like to see and hear them. I chat with them over [the] internet, on my iPad."

Fatton said she had been sick in bed at home in the town of Le Locle for a week before developing breathing problems. An ambulance rushed her to hospital in La Chaux-de-Fonds.

"They took my blood and my blood pressure. They put antibiotics directly in my veins three times a day. It was very difficult but it was ok," she said.

"I wasn't afraid of dying, no. Not at my age, 95 after all, it's time to go. But I didn't think I was going to die, absolutely not. I was not afraid," she said.

Fatton, who uses a walker, said she had been healthy all her life, although she took blood pressure medicine and occasional cough syrup for bronchitis.

Her daughter Jacqueline Fatton recalled, "When the doctor called to tell me that the oxygen in her blood was dropping and they had 24 hours to stop it, I was really, really afraid and thought I would lose her that night.

"The next day the doctors said 'we are going to go for it and try all the medicines that we can' - By the third day, the oxygen was back up and the drugs worked extremely well.

"I could call twice a day with the mobile phone. When I saw that she could speak to me without coughing much, I knew that we had won," Jacqueline said.

Credits: Reuters

The Ophthalmologist who returned to Internal Medicine after 20 years to help fight Covid-19 (Part 3)

Good morning. So today is Day 3 of my redeployment as a 20 year Ophthalmologist to work the COVID floors at Mount Sinai. Here are some of my thoughts:

I think that we are now in the 3rd week of a complete NYC shutdown. If the incubation period for Covid is about 2 weeks, that means that there has been a tremendous drop off in new infections. We are seeing that here. Yes, the hospital and many NYC hospitals are full of Covid patients; but most of those are from prior to the shutdown. I have enclosed some pics below of my pre-deployment commute to work. My office is in the heart of Manhattan on 57th Street and 7th Avenue.

Secondly, treating and admitting pneumonia patients is fairly straight forward. Even without my pre-Ophthalmology Internal Medicine Boards, I could have done this without much retraining.

The hardest part obviously would have been to learn the new EHR which is Epic. Lucky for me, we use Epic in my office.

The photos below were taken during my RUSH HOUR commute into Manhattan (around 8:30 AM) before my deployment. This is how we flattened the curve.

Douglas Friedrich, MD

The Ophthalmologist who returned to Internal Medicine after 20 years to help fight Covid-19 (Part 3)

Good morning. So today is Day 3 of my redeployment as a 20 year Ophthalmologist to work the COVID floors at Mount Sinai. Here are some of my thoughts:

I think that we are now in the 3rd week of a complete NYC shutdown. If the incubation period for Covid is about 2 weeks, that means that there has been a tremendous drop off in new infections. We are seeing that here. Yes, the hospital and many NYC hospitals are full of Covid patients; but most of those are from prior to the shutdown. I have enclosed some pics below of my pre-deployment commute to work. My office is in the heart of Manhattan on 57th Street and 7th Avenue.

Secondly, treating and admitting pneumonia patients is fairly straight forward. Even without my pre-Ophthalmology Internal Medicine Boards, I could have done this without much retraining.

The hardest part obviously would have been to learn the new EHR which is Epic. Lucky for me, we use Epic in my office.

The photos below were taken during my RUSH HOUR commute into Manhattan (around 8:30 AM) before my deployment. This is how we flattened the curve.

Douglas Friedrich, MD

Superhumans against Covid-19

Surviving COVID-19 with Neurological Involvement from the perspective of a Neurologist

To be honest, it was very scary to go through no matter how much specialized medical training one has, but I was fortunate to have far less anxiety observing my own neurologic deterioration with an academic interest and an appreciation of the neuroanatomy involved.
After 17 days of mild lower respiratory symptoms, I lost all sense of smell and taste. This was likely the introduction of the virus into my brain traversing the cribriform plate via my olfactory bulb (Reference #1). The SARS-COV-2 Virus likely damaged my olfactory receptor neurons directly.
The same day I had a syncopal episode followed by a bizarre frightening well-formed visual hallucination that my Fiancé turned into a monster (FYI she is an angel not a monster) and climbed out of my couch to get me. This was likely the earliest involvement of my reticular activating system. The reticular activating system, or RAS, is a piece of the brain that starts close to the top of the spinal column and extends upwards around two inches. It has a diameter slightly larger than a pencil. All of your senses (except smell, which goes to our brain's emotional center) are wired directly to this bundle of neurons that's about the size of your little finger (Reference #2). It also helps maintain consciousness and will be most affected over the next couple of days. At this point my sleep was being interrupted, but I had not yet fully understood why. The understanding as to why will become existentially painful, almost nightmarish to me in the next few days.
Three days later, I started to develop auditory hallucinations, some kind of Russian music playing in a loop. I don’t speak Russian, but I expect if I did he was singing “Everything is going to be alright, don’t worry, but it is about to get much, much scarier”. Again, likely my RAS acting up. I then became paranoid and started acting irrationally. Perhaps the communication with my RAS and my limbic system. I was also filled with boundless energy which made the next four days of insomnia more tolerable. Perhaps my RAS protecting itself.
The next three nights I did not sleep more than 30 seconds. Any attempt at sleep would result in overwhelming rigor. This was likely due to “cytokine storm” (Reference #3). I was also beginning to realize that my primitive respiratory center was starting to fail me. If I did not consciously focus on breathing then I would stop and die.
As a Neurology Resident almost 20 years earlier I was fascinated by the condition, Ondine’s Curse. In the ancient mythical story, a young nymph named Ondine falls in love and marries. Upon discovering that her husband has been unfaithful to her, she uses her supernatural powers to set a curse on him. Ondine’s curse is an unusual spell that sneakily robs her disloyal husband of rest. He is doomed to a life in which he retains the ability to breath-but only when he is awake and conscious. Once afflicted by Ondine's curse, the victim cannot breathe if he falls asleep—and therefore must choose between sleeping and remaining alive (Reference #4). This localizes to the lower lateral medulla.
Four days later, I was ready to give up entirely. I voluntarily stopped breathing and lost consciousness. I was ready to embrace death with open arms. The nurse who was monitoring my vitals at the desk rushed in and woke me up and connected me to oxygen. But death will not come that easily.
That evening I started steroids, hydroxychloroquine and azithromycin and slept 1 hour and the next morning woke up and 99% of my Neurologic symptoms had resolved. Two days later my sense of smell and taste returned.

I hereby consent to resharing, reposting , and distribution of my statement as long at it remains unaltered.

Andrew Faskowitz, DO
Board Certified in Neurology
Subspecialty Certified in Pain Management
Subspecialty Certified in Hospice and Palliative Medicine

References:
#1 The Neuroinvasive Potential of SARS-CoV2 in Respiratory Failure
https://www.practiceupdate.com/journalscan/67381/1/24…

#2 Introduction to Psychology: Tutoring Solution / Psychology Courses, Study.com Instructor: Sharon Linde
https://study.com/…/reticular-activating-system-definition-…

#3 COVID 19 induced Acute necrotizing encephalopathy (ANE) within the bilateral medial temporal lobes and thalami associated with Cytokine storm syndrome
https://www.diagnosticimaging.com/…/brain-images-reveal-pos…

#4 Ondine's Curse: Causes, Symptoms, and Treatment
https://www.neurologytimes.com/…/ondines-curse-causes-sympt…https://www.neurologytimes.com/stroke/ondines-curse-causes-symptoms-and-treatment?fbclid=IwAR3uDZgg6upMyYtjQrH826wA4pz2zGbnB9evtrnqwsul2V-2M1IkbQui1fc

Surviving COVID-19 with Neurological Involvement from the perspective of a Neurologist

To be honest, it was very scary to go through no matter how much specialized medical training one has, but I was fortunate to have far less anxiety observing my own neurologic deterioration with an academic interest and an appreciation of the neuroanatomy involved.
After 17 days of mild lower respiratory symptoms, I lost all sense of smell and taste. This was likely the introduction of the virus into my brain traversing the cribriform plate via my olfactory bulb (Reference #1). The SARS-COV-2 Virus likely damaged my olfactory receptor neurons directly.
The same day I had a syncopal episode followed by a bizarre frightening well-formed visual hallucination that my Fiancé turned into a monster (FYI she is an angel not a monster) and climbed out of my couch to get me. This was likely the earliest involvement of my reticular activating system. The reticular activating system, or RAS, is a piece of the brain that starts close to the top of the spinal column and extends upwards around two inches. It has a diameter slightly larger than a pencil. All of your senses (except smell, which goes to our brain's emotional center) are wired directly to this bundle of neurons that's about the size of your little finger (Reference #2). It also helps maintain consciousness and will be most affected over the next couple of days. At this point my sleep was being interrupted, but I had not yet fully understood why. The understanding as to why will become existentially painful, almost nightmarish to me in the next few days.
Three days later, I started to develop auditory hallucinations, some kind of Russian music playing in a loop. I don’t speak Russian, but I expect if I did he was singing “Everything is going to be alright, don’t worry, but it is about to get much, much scarier”. Again, likely my RAS acting up. I then became paranoid and started acting irrationally. Perhaps the communication with my RAS and my limbic system. I was also filled with boundless energy which made the next four days of insomnia more tolerable. Perhaps my RAS protecting itself.
The next three nights I did not sleep more than 30 seconds. Any attempt at sleep would result in overwhelming rigor. This was likely due to “cytokine storm” (Reference #3). I was also beginning to realize that my primitive respiratory center was starting to fail me. If I did not consciously focus on breathing then I would stop and die.
As a Neurology Resident almost 20 years earlier I was fascinated by the condition, Ondine’s Curse. In the ancient mythical story, a young nymph named Ondine falls in love and marries. Upon discovering that her husband has been unfaithful to her, she uses her supernatural powers to set a curse on him. Ondine’s curse is an unusual spell that sneakily robs her disloyal husband of rest. He is doomed to a life in which he retains the ability to breath-but only when he is awake and conscious. Once afflicted by Ondine's curse, the victim cannot breathe if he falls asleep—and therefore must choose between sleeping and remaining alive (Reference #4). This localizes to the lower lateral medulla.
Four days later, I was ready to give up entirely. I voluntarily stopped breathing and lost consciousness. I was ready to embrace death with open arms. The nurse who was monitoring my vitals at the desk rushed in and woke me up and connected me to oxygen. But death will not come that easily.
That evening I started steroids, hydroxychloroquine and azithromycin and slept 1 hour and the next morning woke up and 99% of my Neurologic symptoms had resolved. Two days later my sense of smell and taste returned.

I hereby consent to resharing, reposting , and distribution of my statement as long at it remains unaltered.

Andrew Faskowitz, DO
Board Certified in Neurology
Subspecialty Certified in Pain Management
Subspecialty Certified in Hospice and Palliative Medicine

References:
#1 The Neuroinvasive Potential of SARS-CoV2 in Respiratory Failure
https://www.practiceupdate.com/journalscan/67381/1/24…

#2 Introduction to Psychology: Tutoring Solution / Psychology Courses, Study.com Instructor: Sharon Linde
https://study.com/…/reticular-activating-system-definition-…

#3 COVID 19 induced Acute necrotizing encephalopathy (ANE) within the bilateral medial temporal lobes and thalami associated with Cytokine storm syndrome
https://www.diagnosticimaging.com/…/brain-images-reveal-pos…

#4 Ondine's Curse: Causes, Symptoms, and Treatment
https://www.neurologytimes.com/…/ondines-curse-causes-sympt…https://www.neurologytimes.com/stroke/ondines-curse-causes-symptoms-and-treatment?fbclid=IwAR3uDZgg6upMyYtjQrH826wA4pz2zGbnB9evtrnqwsul2V-2M1IkbQui1fc

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