Author: Mobeen Syed

USMLE Step 1 Books

Very often students ask me about the books they should use for the steps’ preparation. Here are a few principles and book names that I have gathered over the years from our students that prepare and take tests with various results.

Principles:

  1. Every book is valuable, however, everyone has a different taste and different ways to understand. Hence, you will have to choose your own set by reading various books.
  2. Read a topic for example pathology of asthma from all candidate books and see which one helps you the most in terms of style of writing, diagrams, distractions, and recall. Mind it, when you will read the same topic from each book, you will become better from one to the next book. You might incorrectly conclude that the last book you read the topic from is better. To counter this bias, read another topic in the reverse order. Mix it up for a few topics and choose your favorite writer.
  3. Each book has some great points and some points that are missing. If this was not the case then all of them will be the same one book. Furthermore, some books are textbooks, some are review books, some are notes, and so on. Don’t compare a textbook to a notes book.
  4. It is not necessary to choose a set that is by one company e.g. all Kaplan’s books, or all Becker’s books or all DrBeen’s topics, etc.
  5. Once you have a set chosen then stick to it. As each book is written differently, they all have different deficiencies. Accept this instead of running after every book and ending up with a pile of books that you cannot review in a timely fashion.

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Two years ago. I sat at my desk checking other successful brands in the field of medical education. I was awestruck by how many friends, fans, and followers they had. I felt that this was your way of saying thank you to those who were helping you. At this moment, I thought, I will never be able to do this. This recognition is reserved only for the best.

Then I got to work – as you know, I always do. I wrote down my philosophy. When I die I hope people say, “he worked tirelessly to improve patient care.” I didn’t care if drbeen was small, or we practically had no fans or followers, or that we were a brand not even worth noticing.

Two years later, we’ve just crossed half a million fans and followers this month. I am sitting at my desk, with eyes welling up. Overwhelmed with your love and support.

I have no words to say you thank you, jump into my melting heart, feel it and know that it is my thanks to you. 💕🌹

Thank you for your love and support. We will continue to offer our services and make them even better because you are worth it. Because YOU ARE IMPORTANT to us. Because we are nothing without you. Thank you again. 💕💕💕

Love you

Dr. Mobeen

Question: surgery case – ID SUR1001

64 y F with Hx of emphysema, HTN, laparoscopic hemicolectomy for Stage 2 colorectal cancer, and femoral hernia who presents with cramping abdominal pain, nausea, and vomiting. Her last bowel movement was yesterday morning. On exam, she has a distended abdomen with mild diffuse tenderness without rebound or guarding. She has a lump in her left groin which is reducible and non-tender.

Vitals: T 37.2C, HR 98, BP 138/74, SpO2 93%.
Her WBC is 10.1, Hb 11.4, BUN 39, Cr 1.1, LFTs normal. CT Abdomen / Pelvis shows dilated loops of small bowel with a transition point.

What is the appropriate management?

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The heart pumps a volume of blood into the lungs which after getting oxygenated is transported back to heart. This oxygenated blood is then pumped out of the heart and into the aorta and subsequently into the systemic circulation. As a consequence, at any given time the lungs (pulmonary vasculature) contain around 500ml of blood, thereby allowing them to function as a reservoir of the blood. This reservoir volume is increased by 500 ml when the person is in the supine or lying down position. This is because in supine position there’s an increased venous return (due to the effect of gravity) to the right heart from the peripheries and therefore more blood accumulates in the central parts of body. Upon standing up, this extra 500ml of blood gets redistributed under the effect of gravity, to the now more dependent parts of the body which includes the peripheral tissues and the lower extremities.

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The division of vasculature in the pulmonary circuit is somewhat different from that in the systemic circulation. The arteries in the pulmonary circuit divide in a binary fashion, thereby following the pattern of division of the airways. The veins too exhibit a pattern similar to the arterioles and the bronchioles, thereby finally converging into forming one large pulmonary vein. These pulmonary veins transport the oxygenated blood back to the heart.

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NODAL ACTION POTENTIAL VS. VENTRICULAR ACTION POTENTIAL

The nodal tissues and the Purkinje fibers exhibit automaticity in their properties as they are able to undergo spontaneous depolarizations. In other words, these tissues do not require the need of an external stimulus or a trigger to undergo depolarization. This is in contrast to ventricular fibers that do not show automaticity. The reason behind this phenomenon can be explained as follow:

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  • The resting membrane potential (RMP) of nodal tissues is less negative than the RMP of ventricular fibers. This allows the nodal tissue channels to operate in a semi-activated state even during the resting phase of the action potential. The comparatively more negative ventricular fibers do not show this property and hence, are not easily activated by low voltage impulses.

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Nitric Oxide is called an endothelium derived relaxing factor (EDRF) as it is released by the endothelium of the blood vessel. EDRF cause relaxation of the vascular smooth muscle, and as a result cause vasodilation of the blood vessel. The following factors contribute to the release of nitric oxide from the endothelium:

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  1. Blood travelling at high velocity causes a shearing effect on the wall of the blood vessels. As the endothelial cells endure a drag force produced due to friction. This results in a mechanical trigger which stimulates release of nitric oxide.

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