Tutoring Available for USMLE Step 1, Step 2 CK, and Step 2 CS

For those who need tutoring for all three tests, the USMLE Step 1, Step 2 CK, and Step 2 CS, you're in luck because help is available.  Dr. M Rahman is offering tutoring for those who need help.  I mentioned earlier about Dr. F Ahmed's services for Step 2 CS, which is no longer available since he is in his residency currently so he is busy. 

Dr. M Rahman passed all his USMLE tests in the "first-attempt," therefore he is go-to guy for help. He will give you insight on what to do and what not to do.  He has accomplished what most of us are still striving for so be aware of that.

He will provide his prices for his tutoring service.  Dr. Rahman, is still conducting rotations so he knows what you are going through in terms of time, stress, and money.  If you are interested then please use the contact form.


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Don't Jump to USMLE World for Step 2 CK

I've been very busy recently so, I have a hard time keeping up with new posts but I wanted to share something.

One of the biggest mistakes I made was jumping to USMLE World (UW) from the beginning of my study plan.  USMLE World is a learning tool designed for people who already have a foundation of the concept being tested. You can learn a lot from that question bank but unfortunately there will be gaps of information which UW will not provide.  It's better to get another source to get an idea of what you will be tested on.

For example, if you were to learn about electrolytes, UW will test you on it.  However, you may not be able to understand fully on why certain things happen.  So before you start make sure you start off that explains the basic.  Also, if you just recently passed your USMLE Step 1, then you have a head start on your studying.
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Renal Tubular Acidosis Explained

Kidney Tubules AnatomyI hate really hate studying this material but once you understand it, it becomes very easy to memorize.

Remember in renal tubular acidosis (RTA) there is normal anion gap.  [Na - (Cl - HCO3)] = 6-12.
Proximal part is the upper part of the renal tubules, while the distal part is the end part of the tubules.
 
Type II (Proximal)

  1. Pathophysiology: Decreased ability of the proximal kidney tubules to reabsorb most of the filtered bicarbonate because normally bicarbonate is filtered at the proximal tube.
  2. Urine pH: Variable: Urine pH is basic until bicarbonate is depleted, the it is acidic (less than 5.5)
  3. Blood K+ level: Low
  4. Kidney Stones: No
  5. Associations
    • Diagnosis: Infuse bicarbonate and evaluate the urine pH
    • Treatment: Thiazide because it causes volume depletion, which will enhance bicarbonate reabsorption.
    Type I (Distal)
    1. Pathophysiology: Distal tubule is damaged so it is unable to generate bicarbonate. Without bicarbonate, H+ cannot be secreted in the tubule to the urine, raising urine pH.
    2. Urine pH: Urine pH more than 5.5.
    3. Blood K+ Level: Low
    4. Kidney Stones: Yes
    5. Associations
      • Amphotericin use
      • Lithium Use
      • Sickle Cell Disease
      • Autoimmune Diseases (SLE, Sjorgen Syndrome, Rheumatoid Arthritis, etc)
    6. Diagnosis: Infuse acid
    7. Treatment: Bicarbonate to be absorbed in the proximal tubule, because majority of the bicarbonate is absorbed there.
    Type IV (Distal)
    1. Pathophysiology: Decreased or diminished effect of aldosterone at the kidney tubule. Loss of sodium and retention of potassium and hydrogen ions.
    2. Urine pH: Less than 5.5
    3. Blood K+ level: High
    4. Kidney Stones: No
    5. Associations
      • Diabetes
      • Addison's Disease
      • NSAIDs
    6. Diagnosis: Urine salt loss, despite sodium restricted diet
    7. Treatment: Fludrocortisone

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