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Michael Jordan Sucks

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At least he did at one point. When he was 10 years old he could only sink 10 to 20% of his shots according to Dick Neher, Jordan’s coach on his first organized basketball team. Neher was also Jordan’s baseball coach. He recalls, “He wanted to be No. 1… If we ran laps, he wanted to be the first to finish them,”

Many also believe that Jordan was cut from the sophomore varsity basketball team at Laney High School in Wilmington, North Carolina. Ruby Sutton, Jordan’s former phys-ed teacher and Fred Lynch, his former assistant coach at Laney deny it though.

“Nobody could have predicted Mike would become a Hall of Famer, or any of the other things he has become,” says Lynch. He had some serious shortcomings. As a sophomore he was only 5’11”. Lynch believes that this ultimately helped his development. He had to compensate for his short height by getting really good at ball handling, shooting and footwork. He also recalls the days Jordan played on the freshmen football team at Laney, “Jordan worked on his skills relentlessly.”  

As a sophomore at the University of North Carolina he was named player of the year by the sporting news. He was an NBA Rookie of the year, 5 time NBA MVP, 6 time NBA champion and garnered ton of other accolades. His peers like Patrick Ewing, Larry Bird, Earvin “Magic” Johnson, Hakeem Olajuwon and Charles Barkley – superstars in their own right, agree that he’s the greatest basketball player of all time. On Friday September 11^th, he was inducted into the Naismith Basketball Hall of Fame and it was a big deal here in Chicago.

So what’s the point? The point is, greatness in your field is developed, not inherited. Becoming great is a simple process that takes consistent effort.

For a simple system to become a great medical student click here: http://www.medicalschoolreport.com/free-book

Source: September 9^th, 2009 issue of the Charlotte Observer

Source: NBA Encycolepedia.

Resident Doctor Reviews The 4.0 GPA Learning System®:

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Resident Doctor Reviews The 4.0 GPA Learning System®:

Hey everybody,

Dr. Joshua Babu is a Psychiatry resident at the University of Wisconsin-Madison and he reviewed the 4.0 GPA Learning System® a few days ago. He pointed out things that we didn’t even realize. Here it is:

“Medical school is one of the most taxing trials (both physically and mentally) that a person can choose to go through in life. The keys to success in medical school involve many factors including: having the right resources, having good teachers, nourishing your mental health, and a sincere willingness to work very hard. However, even a person who has all these aspects working for them will have a difficult time in medical school without an overall strategy to maximize efficiency in this time-crunched environment with little margin for error.

Instead of going through the painstaking and clumsy method of stumbling through various ineffective and inefficient methods of study and preparation for surviving medical school, The 4.0 GPA Learning System® teaches students a refreshing, innovative and evidence-based approach to studying for exams and to excel in the academic world. Perhaps most importantly, with this scientific method, students will be able to manage time effectively, leaving room for physical recovery and emotional well being.

After extensive review, I have found that the quality of the content in this program is excellent. It is presented very personably, realistically, and eloquently. From the expert advice and insight given in the book, to the style and sincerity demonstrated in the audio presentation, the content seems proven, logical, and appealing in its potential to maximize a student’s performance.

The quality of the product is superb in its organization. The information is presented nicely through visual and audio format which will appeal to many people. And the program for timing your studying will be very useful during the main months of medical school as well as the weeks of cramming prior to Step 1, as students really push their limits of mental endurance to see how much they could study in a day.

One critique I have of the product is that it may not be for everyone. It will appeal most to the people who have a certain degree of the obsessive compulsive personality type. Granted, many people who get into medical school will have a certain degree of that personality type anyway.

In summary, a systematic approach is what most students lack that prohibits them from succeeding in medical school, despite whatever other advantages they may have. Raw talent and/or an intense drive to win are insufficient without a proven strategy.

I would definitely recommend The 4.0 GPA Learning System® to medical and pre-medical students as it is hands down the most comprehensive resource available that highlights the basic and universal aspects of success in medical education. The authors have put in a lot of effort to pinpoint common mistakes and pitfalls that almost every medical student makes during the first two years of medical school, as well as reveal some of the biases and fallacies of medical education. The time and precious energy that the insight in this resource frees up is invaluable and will more than make up for the price.”

Dr. Joshua Babu

Residency position at: University of Wisconsin-Madison; Psychiatry Program
M.D. from University of Illinois College of Medicine at Rockford
B.A. in psychology from the University of Illinois at Chicago
B.S. in biology from the University of Illinois at Chicago

Posted by: Cesar Orellana Publisher and Editor
MedicalSchoolReport.com

For a FREE preview of the 4.0 GPA Learning System® visit: http://www.medicalschoolreport.com/free-book

Quack Doctors

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This is pretty funny. Enjoy.

Cesar E. Orellana

Publisher and editor

www.MedicalSchoolReport.com

 

PS: This is how not to be a quack: www.MedicalSchoolReport.com/free-book

What Surgeons Think About That You Probably Don’t

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Every surgeon, perioperative nurse and support staff has to develop a surgical conscience. In one respect, this is an unwavering adherence to aseptic technique during the perioperative period. Every aspect of the environment in the OR - equipment and personnel, are inspected and monitored closely for the entire duration of any surgical procedure.

 

If you consider that some of the predominant resident microorganisms on the skin include Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus viridans, Corynebacterium diptheriae, Enterococci, Proprionibacterium, Peptostreptococci and many others, it’s pretty clear that anything less than the strictest adherence to sterility will increase the potential for postoperative infection. That’s why you can’t come near an OR without first having put on hospital-issued scrubs, a surgical cap, a face mask, shoe covers and gloves. If you’re actually going to participate in the procedure, then we’re talking about a PAINFUL, 5 or 10 minute mechanical cleansing of the hands and forearms, followed by being dressed in a sterile surgical gown and gloves by a staff member.

 

You have to take a scrub class prior to being permitted to enter the OR, and during the class you think to yourself, “Easy enough. I got this.” only to find out during your first real experience scrubbing in, that you really don’t. You walk into the OR and everyone around you can literally smell the scent of rookie emanating from your apocrine sweat glands. Everyone’s eyes immediately begin looking you up and down to see if you forgot any of the mandatory accoutrements. They’re just waiting for you to touch an instrument that hasn’t been prepped or part of the patient that hasn’t been painted with iodine solution; they’re waiting for your biceps to tire and slowly let your hands down from the altar boy position (elbows flexed, with your hands interlocked in front of your sternum - like you’re praying). The second you let up your vigilance… you and everyone else is going to hear about it.

 

Truthfully, it’s a pretty scary experience. It’s supposed to be. Knowingly or not, the surgical staff wants to scare the bejesus out of you because they know that even if you don’t yet fully appreciate just how vulnerable to infection a patient with an open incision can be, at the very least, you’ll try your damndest not to contaminate the sterile field and risk being humiliated in front of your attending.

 

So the first time you walk into an OR, you enter with an appreciation for clinical hygiene, but as you walk out, you do so with the beginnings of a surgical conscience engrained in your mind.

 

This is the voice within you that holds you to the same standard of aseptic technique when you’re scrubbing in alone and no one is around, as when you’re you being scrutinized by your superiors. The surgical conscience is the acceptance of the fact that every decision you make from the moment you decide to enter the OR, to the moment you leave is critically important to the outcome of the procedure and ultimately to the health of the patient.

 

This thought got my philosophical gears going and I came up with a profound thought. It’s intuitive that a high level of attention to detail in the clinical setting is going to save lives. It may not be so obvious, but as a medical student, isn’t our attention to detail in our pre-clinical training just as important?

 

Maybe it’s a bit stretch, but shouldn’t be there such a concept as the pre-clinical conscience? If so, making the right decisions about when and how to study would be akin to making the right hygienic decisions in the surgical setting.

 

Along that train of thought then, the ritual of the scrub-in would be to surgery, as your independent study ritual in your pre-clinical years would be to your future clinical practice.

 

What if you applied the same standard of conduct in the OR to other areas of your medical training? How much better would you be as a medical student? I certainly believe that your conscience will dictate the caliber of student you will be. I also believe that it will dictate the caliber of physician you will be.

 

Here’s why:

 

When faced with a decision, the conscientious student of medicine will choose to dedicate the right amount of time to focus on the course work they are expected to. The conscientious student will choose to discern data that is relevant to clinical practice from material that isn’t. The conscientious student will then choose to learn that information. Later, the conscientious physician can choose to draw upon the relevant data they have identified and learned prior, to make the right medical management decisions.

 

Let’s look at a clinical scenario to illustrate this:

 

A 24 year old Asian female phones your clinic complaining of dysuria (burning when she pees) . She also thinks she’s running a fever. A conscientious physician knows that her symptomatology is consistent with a urinary tract infection. They also know that they should have her come into the office immediately for further work up.  They also know the test of choice is a urinalyasis, which in this case came back positive. The conscientious physician knows that urine culture is not necessary at this stage. And they also know that first line, empiric antibiotic treatment is a double strength tab of Bactrim™ every 12 hours for 10-14 days. The conscientious physician also knows that Bactrim™ is a synergistic combination of the drugs trimethoprim and sulfamethoxazole (double strength tab 800mg of sulfamethoxazole and 160mg of trimethoprim). Further, they would not forget the fact that sulfamethoxazole is a sulfa drug. Surely they know they had better inquire if the patient has a known sulfa allergy. If they do, an alternative antibiotic they would know they could use is Ciprofloxacin. They also better be sure that the patient doesn’t have renal insufficiency, as Bactrim™ is excreted in the urine.

 

In order to ensure that the above information was memorable and accessible, the conscientious physician might have chosen to ignore the fact that sulfa drugs are named as such because they are derivatives of para-aminobenzenesulfonamide when they were learning this material as a student.  I can’t see how that bit of data would influence anyone’s medical management. Can you?

 

This scenario is a vivid example of how to take information that may be presented to you in a vacuum in medical school and how to have the foresight to apply it to clinical practice.

 

So I hope you can see how being a conscientious student of medicine can have a huge impact on the quality and quantity of information you are able to learn and apply. It’s the right approach to take in your training, not only because it’s ethical, but because it will also help you get the best grades in school.

 

Take away point: The concept of the surgical conscience is having the highest standards for your conduct and your decision making, whether others are watching you or not. In the OR it means scrubbing in properly and adhering to aseptic techniques. Similarly, in your pre-clinical training it is committing to finding and learning as many clinically relevant concepts in your course work. Knowing and being able to apply what you have learned will ultimately dictate the quality of healthcare you can deliver for your patients when the time comes.

 

Yours for higher grades and an infinitely better lifestyle in medical school,

 

Cesar E. Orellana

Publisher and editor

www.MedicalSchoolReport.com

 

PS: For an easy recipe to help you become a conscientious student, visit: www.MedicalSchoolReport.com/free-book

 

References:

Levinson, Warren. Review of Medical Microbiology and Immunology, 10th Edition. Lange. 2008.

McGraw Hill Medical. Drug Monographs.

Free points on your NBME Shelf Exams and USMLE Step 1

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Now this isn’t the sexiest topic in medicine, but it really is an important one. So pay close attention and you’ll be breezing through the boards in no time.

As you may know,  USMLE step 1 comprises 336 questions divided into 7 blocks of 48 questions. At 48 questions per block that leaves you with an average of 1.25 minutes per question (1 minute and 15 seconds).

One of the simplest ways to save time and earn more points on USMLE Step 1 and your NBME Shelf exams is to know your lab values.

Without a doubt, you will encounter many vignettes that will include lab values. You will be required to interpret these values in order to answer the question correctly.  Information presented to you from the history and physical can point you in the right direction, but if lab values are given and you don’t know how to interpret them, you’re pretty much just making an educated guess.  Clinicians in the real world won’t write a diagnosis without lab confirmation if they can avoid it, and on tests, you shouldn’t either.

Let me show you what I mean.  

Sample vignette:

You are presented with a patient that has fever, fatigue and tender hepatomegaly. A liver profile study reveals mild elevation in levels of AST and ALT (AST: 496 IU/L and ALT: 212 IU/L).  The patient has a history of drinking 80 ounces of beer daily for the past 25 years and denies any blood transfusions, tattoos and any high risk sexual activity. What is the most likely diagnosis?

Your approach:

Firstly, you notice that this patient’s AST and ALT levels are significantly higher than the upper limit of normal for AST and ALT (20 IU/L for both enzymes). Next we recall that the patient has an enlarged liver, fatigue and a fever. So we’re thinking that the patient has hepatitis.  Next, you notice that the AST:ALT ratio is slightly higher than 2:1. An AST:ALT ratio of 2:1 is commonly found in alcoholic hepatitides. Based on the patient’s history, we can be quite confident that viral hepatitis is an unlikely diagnosis since our patient does not have any risk factors (blood transfusions, tattoos, or risky sexual activity). Also, the ALT would be greater than the AST in the patient’s lab work if this were the case.

On your NBME Shelf exams and USMLE Step 1 you will be given reference ranges for many different lab values. As you might expect, this is a lot of information. Before you can interpret lab data presented to you in a vignette, you have to know the reference range for that marker. If you don’t know it off hand, you have to locate it among all the other lab values available. This can be harder than you think if you’re under the gun in an exam and time’s a tickin’.

To save time, familiarize yourself the different lab sections. In that regard, the new FRED 2 – the new USMLE software program has a search function that makes this a lot easier.  Lab values are subdivided into four sections:

1. Blood

2. Hematologic

3. Cerebrospinal Fluid

4. Sweat, Urine, BMI

If you’re presented with a patient who has a K+ level of 3.1 and you don’t know the reference range, knowing where to locate this value will make your life a lot easier. You should know that this value is located in section 1- Blood. The reference range for K+ is 3.5 to 5.0mEq/L by the way.

Obviously, memorizing lab data that you will have at your finger tips during an exam is a waste of time. But you should be familiar with some very commonly ordered laboratory studies.

Common lab studies you should be familiar with include:

basic metabolic profile (BMP), complete blood count (CBC), liver profile, cardiac enzymes, arterial blood gas (ABG), and lipid profile.

BMP includes:  Na+, K+, Cl-, HC03-, blood urea nitrogen (BUN), creatinine, glucose

CBC includes: white blood cell count (WBC), hemoglobin (Hb), hematocrit (HCT), platelet count

ABG includes: pH, PaCO2, PaO2, SaO2 , HCO3-

Liver profile includes: AST, ALT, ALP

Cardiac enzymes include: CPK, CK-MB, troponin I,

Lipid profile includes: total cholesterol, triglycerides, LDL, HDL

I’ve gone ahead and gathered the 2009 lab values published by the National Board of Medical Examiners and posted them below. Print them off and familiarize yourself with them as you’re going through your course work in your first and second years. You’ll be glad you did.   

Yours for higher grades and an infinitely better lifestyle in medical school,

Cesar E. Orellana

Publisher and editor

www.MedicalSchoolReport.com

 PS: For a helpful resource related to this article, visit: www.medicalschoolreport.com/free-book

 

USMLE Laboratory Values

* Included in the Biochemical Profile (SMA-12)

 

BLOOD, PLASMA, SERUM	REFERENCE RANGE	SI REFERENCE INTERVALS
* Alanine aminotransferase (ALT), serum	8–20 U/L	8–20 U/L
Amylase, serum	25–125 U/L	25–125 U/L
* Aspartate aminotransferase (AST), serum	8–20 U/L	8–20 U/L
Bilirubin, serum (adult) Total // Direct	0.1–1.0 mg/dL // 0.0–0.3 mg/dL	2–17 µmol/L // 0–5 µmol/L
* Calcium, serum (Ca2+)	8.4–10.2 mg/dL	2.1–2.8 mmol/L
* Cholesterol, serum	Rec:<200 mg/dL	<5.2 mmol/L
Cortisol, serum	0800 h: 5–23 µg/dL // 1600 h: 3–15 µg/dL	138–635 nmol/L // 82–413 nmol/L
	2000 h: < 50% of 0800 h	Fraction of 0800 h: < 0.50
Creatine kinase, serum	Male: 25–90 U/L	25–90 U/L
	Female: 10–70 U/L	10–70 U/L
* Creatinine, serum	0.6–1.2 mg/dL	53–106 µmol/L
Electrolytes, serum
Sodium (Na+)	136–145 mEq/L	136–145 mmol/L
* Potassium (K+)	3.5–5.0 mEq/L	3.5–5.0 mmol/L
Chloride (Cl-)	95–105 mEq/L	95–105 mmol/L
Bicarbonate (HCO3-)	22–28 mEq/L	22–28 mmol/L
Magnesium (Mg2+)	1.5–2.0 mEq/L	0.75–1.0 mmol/L
Estriol, total, serum (in pregnancy)
24–28 wks // 32–36 wks	30–170 ng/mL // 60–280 ng/mL	104–590 nmol/L // 208–970 nmol/L
28–32 wks // 36–40 wks	40–220 ng/mL // 80–350 ng/mL	140–760 nmol/L // 280–1210 nmol/L
Ferritin, serum	Male: 15–200 ng/mL	15–200 µg/L
	Female: 12–150 ng/mL	12–150 µg/L
Follicle-stimulating hormone, serum/plasma	Male: 4–25 mIU/mL	4–25 U/L
	Female: premenopause 4–30 mIU/mL	4–30 U/L
	midcycle peak 10–90 mIU/mL	10–90 U/L
	postmenopause 40–250 mIU/mL	40–250 U/L
Gases, arterial blood (room air)
pH	7.35–7.45	[H+] 36–44 nmol/L
Pco2	33–45 mm Hg	4.4–5.9 kPa
Po2	75–105 mm Hg	10.0–14.0 kPa
* Glucose, serum	Fasting: 70–110 mg/dL	3.8–6.1 mmol/L
	2-h postprandial: < 120 mg/dL	< 6.6 mmol/L
Growth hormone - arginine stimulation	Fasting: < 5 ng/mL	< 5 µg/L
	provocative stimuli: > 7 ng/mL	> 7 µg/L
Immunoglobulins, serum
IgA	76-390 mg/dL	0.76–3.90 g/L
IgE	0–380 IU/mL	0–380 kIU/L
IgG	650–1500 mg/dL	6.5–15 g/L
IgM	40–345 mg/dL	0.4–3.45 g/L
Iron	50–170 µg/dL	9–30 µmol/L
Lactate dehydrogenase, serum	45–90 U/L	45–90 U/L
Luteinizing hormone, serum/plasma	Male: 6–23 mIU/mL	6–23 U/L
	Female: follicular phase 5–30 mIU/mL	5–30 U/L
	midcycle 75–150 mIU/mL	75–150 U/L
	postmenopause 30–200 mIU/mL	30–200 U/L
Osmolality, serum	275–295 mOsmol/kg H2O	275–295 mOsmol/kg H2O
Parathyroid hormone, serum, N-terminal	230–630 pg/mL	230–630 ng/L
* Phosphatase (alkaline), serum (p-NPP at 30°C)	20–70 U/L	20–70 U/L
* Phosphorus (inorganic), serum	3.0–4.5 mg/dL	1.0–1.5 mmol/L
Prolactin, serum (hPRL)	< 20 ng/mL	< 20 µg/L
* Proteins, serum
Total (recumbent)	6.0–7.8 g/dL	60–78 g/L
Albumin	3.5–5.5 g/dL	35–55 g/L
Globulin	2.3–3.5 g/dL	23–35 g/L
Thyroid-stimulating hormone, serum or plasma	0.5–5.0 µU/mL	0.5–5.0 mU/L
Thyroidal iodine (123I) uptake	8%–30% of administered dose/24 h	0.08–0.30/24 h
Thyroxine (T4), serum	5–12 µg/dL	64–155 nmol/L
Triglycerides, serum	35–160 mg/dL	0.4–1.81 mmol/L
Triiodothyronine (T3), serum (RIA)	115–190 ng/dL	1.8–2.9 nmol/L
Triiodothyronine (T3) resin uptake	25%–35%	0.25–0.35
* Urea nitrogen, serum	7–18 mg/dL	1.2–3.0 mmol/L
* Uric acid, serum	3.0–8.2 mg/dL	0.18–0.48 mmol/L

 

USMLE Laboratory Values

HEMATOLOGIC	REFERENCE RANGE	SI REFERENCE INTERVALS
Bleeding time (template)	2–7 minutes	2–7 minutes
Erythrocyte count	Male: 4.3–5.9 million/mm3	4.3–5.9 x 1012/L
	Female: 3.5–5.5 million/mm3	3.5–5.5 x 1012/L
Erythrocyte sedimentation rate (Westergren)	Male: 0–15 mm/h	0–15 mm/h
	Female: 0–20 mm/h	0–20 mm/h
Hematocrit	Male: 41%–53%	0.41–0.53
	Female: 36%–46%	0.36–0.46
Hemoglobin A1c	< 6%	< 0.06%
Hemoglobin, blood	Male: 13.5–17.5 g/dL	2.09–2.71 mmol/L
	Female: 12.0–16.0 g/dL	1.86–2.48 mmol/L
Hemoglobin, plasma	1–4 mg/dL	0.16–0.62 mmol/L
Leukocyte count and differential
Leukocyte count	4500–11,000/mm3	4.5–11.0 x 109/L
Segmented neutrophils	54%–62%	0.54–0.62
Bands	3%–5%	0.03–0.05
Eosinophils	1%–3%	0.01–0.03
Basophils	0%–0.75%	0–0.0075
Lymphocytes	25%–33%	0.25–0.33
Monocytes	3%–7%	0.03–0.07
Mean corpuscular hemoglobin	25.4–34.6 pg/cell	0.39–0.54 fmol/cell
Mean corpuscular hemoglobin concentration	31%–36% Hb/cell	4.81–5.58 mmol Hb/L
Mean corpuscular volume	80–100 µm3	80–100 fL
Partial thromboplastin time (activated)	25–40 seconds	25–40 seconds
Platelet count	150,000–400,000/mm3	150–400 x 109/L
Prothrombin time	11–15 seconds	11–15 seconds
Reticulocyte count	0.5%–1.5%	0.005–0.015
Thrombin time	<2 seconds deviation from control	<2 seconds deviation from control
Volume
Plasma	Male: 25–43 mL/kg	0.025–0.043 L/kg
	Female: 28–45 mL/kg	0.028–0.045 L/kg
Red cell	Male: 20–36 mL/kg	0.020–0.036 L/kg
	Female: 19–31 mL/kg	0.019–0.031 L/kg

USMLE Laboratory Values

CEREBROSPINAL FLUID	REFERENCE RANGE	SI REFERENCE INTERVALS
Cell count	0–5/mm3	0–5 x 106/L
Chloride	118–132 mEq/L	118–132 mmol/L
Gamma globulin	3%–12% total proteins	0.03–0.12
Glucose	40–70 mg/dL	2.2–3.9 mmol/L
Pressure	70–180 mm H2O	70–180 mm H2O
Proteins, total	<40 mg/dL	<0.40 g/L

 

USMLE Laboratory Values

SWEAT	REFERENCE RANGE	SI REFERENCE INTERVALS
Chloride	0–35 mmol/L	0–35 mmol/L
URINE
Calcium	100–300 mg/24 h	2.5–7.5 mmol/24 h
Chloride	Varies with intake	Varies with intake
Creatinine clearance	Male: 97–137 mL/min
	Female: 88–128 mL/min
Estriol, total (in pregnancy)
30 wks	6–18 mg/24 h	21–62 µmol/24 h
35 wks	9–28 mg/24 h	31–97 µmol/24 h
40 wks	13–42 mg/24 h	45–146 µmol/24 h
17-Hydroxycorticosteroids	Male: 3.0–10.0 mg/24 h	8.2–27.6 µmol/24 h
	Female: 2.0–8.0 mg/24 h	5.5–22.0 µmol/24 h
17-Ketosteroids, total	Male: 8–20 mg/24 h	28–70 µmol/24 h
	Female: 6–15 mg/24 h	21–52 µmol/24 h
Osmolality	50–1400 mOsmol/kg H2O
Oxalate	8–40 µg/mL	90–445 µmol/L
Potassium	Varies with diet	Varies with diet
Proteins, total	<150 mg/24 h	<0.15 g/24 h
Sodium	Varies with diet	Varies with diet
Uric acid	Varies with diet	Varies with diet
BODY MASS INDEX (BMI)	Adult: 19–25 kg/m2

 

Source: Fred 1USMLE Step 1 Orientation Program  http://usmle.org/Orientation/2009/menu.html