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.

Lung Volumes Definitions and Spirometry

Total lung capacity (TLC): the volume in the lungs at maximal inflation, the sum of VC and RV.

Residual volume (RV): the volume of air remaining in the lungs after a maximal exhalation

Expiratory Reserve Volume (ERV): the maximal volume of air that can be exhaled from the end-expiratory position

Inspiratory Reserve Volume (IRV): the maximal volume that can be inhaled from the end-inspiratory level

Inspiratory Capacity (IC): the sum of IRV and TV

Inspiratory Vital Capacity (IVC): the maximum volume of air inhaled from the point of maximum expiration

Vital Capacity (VC): the volume of air breathed out after the deepest inhalation.

Tidal Volume (VT): that volume of air moved into or out of the lungs during quiet breathing

Functional Residual Capacity (FRC): the volume in the lungs at the end-expiratory position

Forced Vital Capacity (FVC): the determination of the vital capacity from a maximally forced expiratory effort

Forced Expiratory Volume (time) (FEVt): a generic term indicating the volume of air exhaled under forced conditions in the first (t) seconds
FEV1 – Volume that has been exhaled at the end of the first second of forced expiration

Peak Expiratory Flow (PEF): The highest forced expiratory flow measured with a peak flow meter

Types of Systemic Fungal Infections

The following fungal infections (mycoses) can cause pneumonia (lung infection) and the infection can disseminate (spread). In immunocompromised people (ex. cancer treated patients, HIV patients, etc.), fungal infection will lead to systemic disease. Systemic mycosis infection can mimic tuberculosis symptoms like fever, chills, nights sweats, and weight loss.
In immunocompetent people (people with normal immunity), the fungal infection will lead to just lung disease (local infection).

These fungi are di-morphic, which means they can be in the form of mold or yeast. They are mold in the cold (20°C) and yeast in the heat (37°C). The exception is coccidioidomycosis, which is a spherule and not at yeast.

Histoplasmosis
Histiocyte (macrophage) filled with Histoplasma.It’s most common in the southeastern, mid-Atlantic, and central United States; such as the Mississippi and Ohio river valleys. It can cause an acute pneumonia, which presents as cough, fever, and malaise. Chest X-ray will show hilar adnopathy and may demonstrate areas of pneumonia. Disseminated histoplasmosis are more common in HIV patients.
Labs: Microscopy will show macrophage filled with Histoplasma. Can present as coin lesions that is calcified on chest x-ray.

Key Scenario: Found in soil and droppings of birds bats so, cave exploration and cleaning bird coups is associated with the fungus. Also, doing activities that disrupt soil.

Blastomycosis
Broad-based budding with thick double refractice walls.
It’s endemic in the south-central and north-central United States. It affects the lungs, skin, bnes, joints, and protaste. Infection in immunocompromised hosts is uncommon. Primary pulmonary infection may be asymptomatic or present with flu-like symptoms. Forms granulomatous nodules.
Labs: Microscopy will show broad-based budding; same size as RBCs. Diagnosis is made by use of potassium hydroxide (KOH) prep to reveal big broad-based budding in sputum and tissues. The organism will show thick double refractive walls around it. 
Coccidioidomycosis
Spherules filled with endospores.It’s endemic in the southwestern United States, as well Central America and South America. Primary pulmonary infection has a non-speicif features, such as fever, fatigue, dry cough, weight loss, and pleuritic chest pain. It can spread to bones as skin; cutaneous findings, such as erythema multiforme and erythema nodosum, as well as arthlagias, are common.
Labs: Microscopy will show spherules filled with endospores.
Key Scenario: Patient gets infected after and earthquake, because the spherules in dust are thrown up in the air. 

Image Source: Medscape

Rx: Treated with fluconazole or ketoconazole for local infections. Amphotericin B for systemic infections.