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According to the Catholic church this week is Holy Week. I don't know if that means to study more or not study at all. For sure I have to pray. But pray to concentrate better while studying or pray to pass the test without studying. -- Hopefully I'll find answers to these questions as I trek along.

There are many parallels between the life of Jesus and IMGs. At least how we start and how we end. During Palm Sunday we start like Jesus with great hope, cheers and best wishes for a bright future but we end crucified, whipped, unfairly judged, humiliated by our own: other physicians.

Today I'm going to start the Via Crusis...the way to the Cross. The painful road of reviewing as much as I can, of dusting old books that I've read so many times but hardly recall anything. So once again I pledge to study, to abide by a study plan hoping that something will stick to my brain. And when the time comes to sit for this test, God will illuminate and welcome me into his Kingdom.


Edited by xenopus on Dec 30, 2014 - 8:53 PM. : typos


Good luck Xeno. I wish you all the best in your journey my friend.


Thanks Christieandj12, good luck to you too, I don't want any more SOAP for next season. It's simply to risky. Have you taken Step 3 already?


No. I am preparing now. I will aim to take it in June/July.

On Apr 04, 2012 - 2:15 PM, xenopus responded:
Great, I'm glad you're sharing paths with us.


Good luck xeno smiling face)

I will join you on this step 3 path soon.....hopefully!

On Apr 04, 2012 - 2:17 PM, xenopus responded:
Hi doctor4usmle, congratulations on your match!!!. You made it!. See you on the Step 3 prep.


Let me recover this from another thread: 

FiO2 and PEEP reflect Oxygenation, while RR and Tidal Volume reflect Ventilation. All these variables are interdependent so modification of any one of them can affect the others as well. But to simplify ventilator settings management we should have mental shortcuts to get a desirable result quickly.

In that regard, FiO2 and PEEP are all about PRESSURES (FiO2 is simply a different way to say Partial Pressure of Oxygen) and so are more likely to bring a change of O2 saturation or PO2 in blood gases in the correct direction.

On the other hand, Resp Rate & Tidal volume are all about VOLUMES or Ventilation. So modification of them are more likely to bring brisk changes in PCO2 in blood gases as a reflection of ventilation.

Conclusion and mental heuristic:

FiO2 & PEEP = Pressures = Oxygenation
RR & Tidal Volumes = Volumes = Ventilation (by the way, volume ventilation is RR x Tidal volume). So volume ventilation says it all, when you want ventilation, play with volume ventilation (i.e, Resp Rate or tidal volume)



If you measure DLCO in ARDS, it should be low, but you don't have time for that, so why not measure the PaO2 from ABGs divided by the FiO2?

If it's <200 in the presence of a normal capilary wedge pressure (which rules out CHF or cardiogenic shock), you got it (ARDS). 

Consider for example:

  PaO2 = 80

  FiO2 = ambient = 0.21

  PaO2/FiO2 = 400, so no ARDS

Same PaO2 = 80 but now you're giving oxygen by mask, say 50%. 

PaO2/FiO2 = 80/0.5 = 160, so ARDS!


Now, if PaO2/FiO2 is in between 200-300, you've got a similar phenomenon but with a different name: Acute lung injury. 

Edited by xenopus on Apr 13, 2012 - 6:55 AM


Because you can improve oxygenation by PEEP in ARDS (by opening up collapse alveoli), you can use low tidal volumes (6 mL/kg) and so you avoid barotrauma. 


Revisiting this topic once again.


I wasn't aware of a rash developing after amoxicillin treatment of Infectious Mononucleosis.

Why is that? 


I knew about Necrotizing enterocolitis as one of those new diseases that appear as technology allows younger babies to live ex-utero. Respiratory Distress Syndrome of the Infant as well as Retinopathy of Prematurity could be the other two, but I was totally unaware of this one:

Bronchopulmonary Dysplasia, which is a kind of neonatal emphysema because of abrogated lung development, in turn due to early mechanical ventilation in preterm babies (<30 weeks of gestation or <1250 grams of weight). Very interesting (  


Hodgkin's lymphoma is in the differential of tuberculosis, especially its B type symptoms. Let's see if I come up with an easy way to memorize its stages

Edited by xenopus on Apr 09, 2012 - 2:11 PM


I failed a question about urinothorax as a cause of pleural effusion. It followed Light's criteria of a transudate but I didn't pay attention to the creatinine. In the following article, the urinothorax creatinine was even higher than the seric one. Interesting case.


Apparently if you hyperventilate too much you could cause cerebral metabolic acidosis: Vessel constriction. Same mechanism you'd use to limit cerebral edema: hyperventilation.


Legionella micdadei is the only member of the Legionella species to be acid-fast (bacilli). Also called Pittsburgh pneumonia agent. 


I need to learn more about Periodic Breathing and all the pathophysiology regarding altitude. The following link for further reference


Breathing patterns might have some relevance here

Edited by xenopus on Apr 10, 2012 - 8:40 PM


Chest syndrome physiology is more complicated than it seems. It thought it was just RBCs adhering to each other. No, it's more than that. On top of it, the lung in sicke cell disease is also target of infection, but new to me, fat embolism. See for yourself.


Edited by xenopus on Apr 10, 2012 - 8:35 PM


The pneumonia severity index is too tough to memorize, the CURB-65 is much easier, as these condos that might not have too much of a curb appeal. 


Edited by xenopus on Apr 13, 2012 - 6:56 AM



I like your posts, I am preparing for Step 3 also on a vary slow pace , so this is very motivational.


On Apr 13, 2012 - 11:25 AM, xenopus responded:
Thank you tuti_hami, please join. Any comments are welcome, I'm still working in Pulmonology, it's a little complex because every new book I get my hands on, I always find something new so I haven't been able to close this chapter.

Congrats on your matching!. 


No congrats for me, no MATCH for me, no change. just a little peace untill next september when the madhouse is opening the door again.

Until then Step 3 and eyeballing the possibilities... and looking for clinical experience. 

On Apr 14, 2012 - 12:39 PM, xenopus responded:
I'm sorry tuti_hami, I apologize, I should've confirmed it, but it seemed to me that you were in the large crowd that matched. I agree with you, we have some peace in the meantime. According to many interns it's better to take Step 3 before residency. The fact that interns also struggle with Step 3 means that there's really no big difference between those who matched and those who didn't. I still believe the gates should be much larger as the number of patients needing us in the U.S. as well as our countries is astronomical. The unmet needs in health care are astounding. Yet the system has the luxury of leaving doctors looking for alternative jobs. Let's keep on working wink

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