Author: Mursi.MD

Medical School/

Medelita Scrubs and Lab Coat Review

Hi! You are looking to see if it is worth the money to invest in a Metelita Scrub set and/or white coat. Here is my honest review and you can also check out a haul I made so you can see how they look on.

Click HERE to check out my YouTube Haul of the scrubs and white coat. This is not a sponsored video nor is this blog review.

Break down:
1. Scrub set
2. White Coat
3. Customer service/Interaction with the team.

Metelita has only a few selection for tops and bottoms, however, they are the kind most people gear towards. I love the classic look of a v-cut neckline and although for my scrub bottoms I like the skinnys, I do love their standard leg scrub bottoms as well. I have several scrubs sets and the one I am gearing towards currently are my Metelita scrub sets! I am absolutely in love with the look of the scrubs and ESPECIALLY the comfort. It could literally sleep in them!

As for the Medelita Lab Coat, I like how it makes me feel, meaning it has this boss feel when I wear it. However, it feels super sturdy and heavy. I tried ironing it several times, and it doesn’t look that much better than before. They could definitely go with making it more comfortable. I have used a few different lab coats, and this by far feels the least comfortable. The one I was sent was the Rebecca Slim in size 6. I am NOT discouraging you from getting one. They are still nice, but if comfort is the number one goal, you might do well with a possibly a different pair or a lab coat from Jaanuu. In terms of the size for the Metelita Lab Coats, if you are a size 4, I should get size 6. If you are a size 6, try the size 8. They are nicely fitted for the most part, but if you want to wear a sweater, then you need some room, so going a size up will give you that room.

I genuinely think this brand is filled with a great team of people that want to provide the best products. They are genuine in their work and style. I think that is a very important part of purchasing anything from anyone. You can proudly wear the scrubs knowing not only are you comfortable in them, but you are supporting a great company. Wear things you are proud of. So, the question was, is it worth it? The scrubs: 100%. The lab coat: 85%.

I don’t believe I have a discount code for them, but I will update this post if I do get a discount code. This will provide you guys with some savings if you choose to buy it. And it might compensate me with a very small amount of money as well (who knows).

Check out my Jaanuu Scrub haul and blog post review!

Medical School/

How to Look On-point For Your Next Interview

I think the hottest look is a woman in a suit—BOSS BABE, am I right?! When wearing a suit, whether you are a guy or girl, you just look so much presentable and people just give you this automatic respect. It is like doctors in white coats, automatic respect.

There are three rules to choosing the right suit for you:

  1. You have to look at yourself in the mirror and say “HAWT DAMN, I LOOK AND FEEL GOOD!”. This is absolute. Why? Because in order to bring out the confidence that the suit wants to provide for you, you have to FEEL it. If you feel it to be too tight or too lose, or just not well fitted, KEEP LOOKING. You want to find that suit that makes you feel confident. The suit doesn’t do all the work, it needs you.

    RELATED POST: My YouTube Video of a HM Suits & Slacks Haul
  2. Pick the right color – Black, Navy, Grey, Beige. When you select a color, pick one that goes best with your skin color and features. You can never go wrong with black, but for some people navy blue or grey might look even better. So, don’t just reach out for black. See whether the other colors can make you look even better than that black that we think is the ultimate color for interviews —remember, do not wear any dramatic color choices. Keep away from bright colors! I do like me my black suit though. My go-to right now is all black – top and shoes included.
  3. Flats for women = mehhh! I won’t lie I wore it twice for interviews, and both times I didn’t feel as confident. Heels just makes the outfit. It gives it that UMPH! It just makes it look 10x better, really. Now, I wouldn’t say wear freakin’ stilettos! You still want to be comfortable as you walk around. Now, my older sister who is 5’2” used to wear heels everywhere and her skills in heels is on another level. So, she could get away with it, would I recommend it for those types of people then? NO! Don’t wear more than 2 inches max. I think 1.5 inches is the perfect heel height. You are comfortable and looking like a boss babe. Flats, meh, you will still look amazing if it’s the way you have to go.

What purse? I wouldn’t wear major designers like LV. Keep it simple.

RELATED POST: Looking for cute Sweaters? Check out my Sweater Haul

Let me know how your interview season is going!? Best of luck!

Shop My Favorite/

Current Obsession

You guys, I am obsessed with these three items that are part of my makeup routine. It gives you a flawless look! Literally obsessed!

  1. Conceal + Perfect 2-in-1 Foundation and Concealer and by Milani. It gives my skin a super flawless look. It covers my blemishes. This recently came out and I wanted to try it out as I walked away from buying 42 dollars worth foundation to buying this $9.99 foundation! I got the wrong shade and gave that one to my mom. Compared to my mom’s usual foundation, this foundation also made her face look duey and flawless! I got another one in my color (03, Light beige) from Walmart for $8.50.
  2. Elf Concealer. Everyone is obsessed with the Tart and Two Faced concealers. Unfortunately, if you are on a budget and feel guilty about paying so much for a product, then girl you MUST try elf’s concealers that came out not too long ago. I actually didn’t really used concealers much until I used my little sister’s. I BECAME OBSESSED! Now, when I want to look bright-eyed and done-up, I use it. Guess how much? $5.00 at Walmart and $6.00 at Ulta Beauty. As you can see by the faded letters in the picture, I use them a lot!
  3. Buxom Lip Liner. This is a mini one that came with this package deal of lipgloss and lip liners. I didn’t really care for lip liners until I tried these one out. Now I notice how much of a difference it can make!!! The perfect lip liners can really bring out your lips. You know those pictures you see on IG and these gorgeous girls with full lips and matte lips? Well you can get that look, you just need the right lip liner! I get my lips full with Buxom lip liner. It looks on point!! OB-SESSED! I tried doing it on IG story to show you guys. Check out my IG, it should on my highlights! (@MursiMedical). PS, I tried Kylie cosmetic one, although, I love how the red stays on my lips, but the lip liner, meh. It could be better.

Let me know if you guys try these and what you think of them!

Medical School/

RESIDENCY INTERVIEW QUESTIONS

Well, hello! Ready for your very first interview? Or another interview that you want to crush!? After going to your first, you will feel the groove of the process and it will get easier and easier. I will say, the nerves sometimes still stick around even on your 8th, but it’s under control and quickly fades.

Here is how I am going to divide this post:

  1. Before the interview
  2. During resident dinner
  3. During the interview
  4. After the Interview

Before the Interview

You need to prepare ahead of time: what you are going to wear, what you are going to ask about, how you are going to get there, where you are going to stay, what time you have to be meeting the residents and where and when do you have to arrive for the interview its self. Get organized! (Check out my youtube video on how to schedule your residency interviews: LINK COMING UP).

What I am going to focus on in this post is the interview and resident dinner in itself. You have to be sure to look at their website and learn about the program if you haven’t done so already. If you don’t do this, you will ask about things that have been answered on their website. And while you need something to ask, it is better to show that you have already looked things up and know a lot of the information. So, instead you can mention that you saw this particular info and ask them “how it works” or “who is involved” or “how you can get involved” or “can you elaborate” etc. Also, during this time of getting to know the program, WRITE THINGS DOWN. These are your notes for yourself that you will look back on when you rank — at least that is what I am doing. I also add to these notes after I have done the interview and give my insight on the program and what I appreciated about it — more on this later. Take a small notebook or a large one, I know a lot of candidates carry one of those portfolio cases. Meh, I just used a small note book that I can carry around. In it I wrote down my notes on the program and then my questions that I wanted to ask.

Keep reading for SOME QUESTION EXAMPLES you can ask during the interviews!

During RESIDENT DINNER

Example QUESTIONS FOR THE RESIDENTS:
— I noticed this program is unopposed/opposed, how are you liking it?
— What is your favorite thing about the program?
— How is the faculty and resident relationship?
— What is life outside of the hospital?
— How often do you guys (residents) get together?
— How is the program about resident wellness? Do they try to integrate resident wellness into the program?
— Do you find the didactics helpful?
— What is something you can change about the program?
— As an intern, do you feel that you are being guided/supported?
— Will you be doing a fellowship? What fellowships have residents of this program gone into?
— What is the living cost in this area?

During the resident dinner, be very much yourself. Throughout the whole interview, be yourself. Enjoy your time. Ask questions. These questions can be more personal and less formal. The really cool residents will let you know, “Hey, ask us anything. We will give you the honest truth. We know what it feels like being in your seat, we did that. So, just relax and ask whatever you want”. Something like that. Pay attention to how they talk amongst each other. You can tell how close they are by how comfortable they are with each other for the most part. Pay attention to how they answer questions. If they are hesitant, they are likely trying to hide their real answer. If they are willing to be honest they will flat out tell you everything without a filter. Pay attention to how tired they look. If they are zombies, most likely you will look like a zombie. Pay attention to their energy, their interest, their complaints, whether they are uptight or easy-going. These are all important because these are the people (unless they are in their last year) that you will be working with. You want to be around people you enjoy working with. This is the most important part of the interview season. For the most part, a lot of the programs will have the standard teaching and etc. but the people make or break the program. Sometimes, you might not get a good feel of the residents because there might only be two of them there. So, the next day when there are more of them around, you can get a better feel. For example, I met two residents during the resident dinner and they were super chill but not really energetic. They were very proper with their question answering. They were really nice though, however, it felt really formal. Then the next day after meeting more of the residents, I got a better picture. So, just keep that in mind.

RELAX. I already said this, but definitely relax and you do not need to sell yourself as this extra-ordinary med student! They don’t care about what you have excelled during medical school, they want to know if you are someone they can be with EVERY SINGLE DAY! So, don’t try to sell yourself to them so hard. Just be who you are and they will appreciate you for that, even if they are different than you. You don’t want to be in a program that is ignorant anyway! So, if they do not like you for who you are, then you will have a hard time there. Even if you desperately want them to like you, don’t show your desperation. Be confident. You are you and you are the only you. So, simply be you. I have seen candidates that are so over the top! Annoying questions, loud-proud, make remarks on so many things, doesn’t shut up; I am totally judging them, but if thats who they are, then who gives a shit in what I think about them. I am still going to make the remark that you should watch your limits, as there are limits to everything. So, me personally, I think being way over the top isn’t often caught all too well. You don’t want to be annoying and over-dramatic, but on the other hand you don’t want to be quiet and shy. You want to find a good medium. Someone that has opinion and doesn’t overly share every time a question is asked. Again, RELAX.

During the INTERVIEW

Example QUESTIONS FOR THE ATTENDING/FACULTY:
— How are the residents evaluated?
— Why did you choose to be apart of this program?
— What do you believe are the strengths of this program?
— What do you believe are the weaknesses of this program?
— Does the program help with loans if residents chooses to stay after residency?
— What are the statistics on first-time board passing?
— How does the program prep their residents to pass their boards?
— Is this program hands on?
— Is this program flexible to making changes for the better for residents, if so, what are some changes that have been made recently?
— How does this program promote resident wellness?
— Are there opportunities to do away rotations/global rotations
— How is the program involved with the community?
— What is the patient population like?
— What is the living cost in this area?
— I am interested in ___ fellowship, how can the program help me get prepared for the fellowship?

BE THERE EARLIER THAN START TIME! This is one of the easiest yet very important thing to do. Don’t be just in time, but be there 5 minutes before. Being late is unprofessional and they will judge you on this, especially if they are a stickler. Just tell yourself you have to be there 15 minutes before you actually have to be there. Be sure to give yourself room to make mistakes getting there, finding the parking lot and traffic. Parking situations are always different. Some are easy but some are a bit difficult to locate or a distant to the building and requires walking. So, for example, you have to be at the lobby at 8:15 AM. You checked before hand the distance and time of travel from your hotel to the hospital/clinic/building. You then check again when you first wake up the time of travel, then add 15-20 minutes to it (10 minutes for potential mistake, walk, locating the parking lot; 5 minutes to getting out of your car, putting on your suit jacket and situating yourself, grabbing gum or mint to freshen up your breath, etc). It is 8:10 and you are now at the lobby 5 minutes before hand! Well done!!! If you are rushing, you will be more anxious then you already might be. So, it is NOT worth it sleeping that extra 20 minutes.

If you are late for reasons you had no control over, call the program coordinator (which means you should have their number already at hand to call, just in case). Let them know! You do not want them waiting for you without knowing where you are, what is going on. I screwed up with one of my interviews—but that will be on another post or conversation.

There might be two of you or 15 of you. If there are a lot of you, this is a group interview, where they will take you one by one to interview. The ones not being interviewed will be either watching a presentation, getting a tour, or just sitting around. It all depends. The more organized the program is, the better the experience.

REMINDER: YOU ARE INTERVIEWING THEM JUST AS MUCH AS THEY ARE INTERVIEWING YOU! You want to know WHY YOU SHOULD PICK THEM just as much!!! Be confident. You are there because they were interested in you. They liked you based on what they saw on your application, now let them know that they made the right choice by sending the invite and show them that they should rank you high. The way to do this is to be yourself, answer the questions honestly but well, show them you have what it takes, why you have what it takes and that you would be an essential to their program. ANDDDD, ask them why you should pick them/rank them high — obviously not directly, but indirectly through your questions. Ask them questions to remind them that you are judging them based on their answers too. Know what I mean? Don’t be over the top, but don’t doubt yourself either. Find a good balance between the two.

QUESTIONS THEY ARE DEFINITELY GOING TO ASK

— Tell me about yourself?
— Why did you choose our program?
— Why did you choose this specialty?
— What do you do for fun?

Other questions they might ask

— What would you bring to the program?
— What are your strengths?
— What are your weaknesses?
— Tell me about a time you have overcome a challenge
— What does failure mean to you?
— What are your hobbies?
— How do you deal with stress?
— What was your favorite rotation and why? ( I just realized that I always answered surgery and realized that they were probably looking for the specialty that I am applying for… I was very honest and I gave my reasoning why and through out the the interview, I made it very clear that this is the very speciality I want even though surgery was my favorite—so I don’t feel bad).
— Where do you see yourself in the future?
— If you have any failures on your board exams, you might get asked about it. Just be honest — tell them you screwed up and how it has changed you for the better, blah blah blah.

I will add more to this list when I think of more in the future.

They will give you a tour of the hospital and clinic. Personally, I judge the program big time based on the hospital. I want to see how the patients are being taken care of and whether it is a place I will want to be in every single day. This is my honest truth. Ask them whether there is a pharmacist that rounds, this is helpful. Ask more of your questions geared towards the hospital, calls, etc here if you haven’t asked already or forgot to ask. Honestly, you need to know the answer to these questions so that you can make your rank list. So, ask questions that are important to you! Don’t be shy. I always ask about the cafe/coffee because that is important to me. I look at the cafeteria as well and the options. This is crucial!! LOL. I am a fat ass and get hangry. I know myself enough that I know what settings I work best in and with good food & coffeeeee = great mood me!

Last thing I would like to address here is to BE KIND to EVERYONE! Smile. Show positive energy. Be excited!!! You have been waiting for this moment to come and HERE IT IS!! Trust me you, I couldn’t wait for this time of the year. I was heart broken last year as I saw some of my friends going through the interview trail and I was sitting around. Here I am doing it myself now and it is so fucking exciting! It is nerve wrecking as well because who know what the future holds but I am enjoying it right now either way. I am here in the present and living this moment that I had been nervous about. No matter how many interviews you have, 1 or 20, just give it your all and what happens will happen. It always works out!

After the interview

You can send them a thank you card, personalized. You can email the program coordinator and than them. You can email the program director and thank them. Some people do, some people don’t. Me personally, I didn’t. I am going to send them a card in January and thank them. I am going to write a card and make it more personal, especially to the programs I absolutely loved. This way I am sending them a reminder and so they didn’t forget about me. Will keep you posted on what I do in the future if you guys are interested in knowing.

Thank you guys for taking the time to read this and I do hope that you found this informative. Keep me in your prayers if you did enjoy this post <3 and found it helpful. That will mean a lot to me!

Let me know your thoughts and if you have questions or helpful tips!

Much love
— Mursi

General Medicine/

My Start Of Intermittent Fasting

Hi you guys!! It has been a minute since I wrote a blog post! What have you guys been up to? Here is a quick update on my life.

  1. I was studying for Step 3 then a few personal things happened and I had to take a step back — but I am starting it up again soon!
  2. My older sister and brother-in-law made me an AUNT!!! I was SO excited to meet this baby for the longest time (even before my sister found the love of her life). It is a BOY and he is incredibly cute, smart (I can already tell), OH SO HANDSOME, and the sweetest little boy I have ever laid eyes on. I mean, well, there is also my little brother who is amazing too. Follow me on my IG and you can meet him through my stories! @Dr.Mursi.MD
  3. I applied for residency TODAY! Keep me in your prayers! Also, keep a lookout for residency posts (both, here on my blog and on my YouTube channel).
  4. I GAIN FREAKIN’ WEIGHT. I am so upset because I gained ~20 pounds while studying for step 1 and then lost about 10 pounds of it and now I am back up 10 pounds again (keep reading I will tell you my weight now and my goal)! How the hell did I get here?! I can answer that: Age. Metabolism. Laziness. Unable to control my sweet tooth.

So, intermittent fasting, I have been on and off with this and it does some serious pound-shredding if you are consistent! When I live on my own, I am pretty good about keeping my weight off, it is when I come home from my parent’s house! I swear my mom is my weight’s worst nightmare. She just keeps FEEDING ME.

I have warned her: “Mother, if you tell me to eat more again, I will stop eating completely and go hungry and it will be your fault that I die of starvation! Is that what you want? Me to go hungry?” LOL!! Then she stopped forcing me to eat extra for fear that I wouldn’t eat. Little does she know…. All jokes aside (well, I wasn’t joking..) I am getting into some serious business of feeling my healthier self again.

I currently weigh 140 lbs and my goal is 120. I would like to lose 20 pounds in total–of course, promptly. I have NEVER been about the numbers, but as I am getting older, it is time to be careful. I will be starting my intermittent fasting today. It is currently 6:41 PM. Would you like to start it with me?

I will fast for 14 hours starting now. I am using an app called Zero. You can select the hours you want to fast. Remember, you can drink water during this time, but nothing else. I will check back in one week to update you guys on my weight. I will have to take my weight at the same time (6:30ish PM). Let’s start!!! Here is a screenshot showing my timer. Now it is YOUR TURN, check your start weight, select your goal weight, mark your calendar, and get the app — oh, and start your fasting today!

We can try to lose the pounds together!!

See you in a week in my next post!!

Much Love,
Mursi

General Medicine/

Sunburn | Cause, Prevention & Treatment

We all know what sunburn is (most likely had one at some point), but I don’t think we know enough about it. Let’s take a better look at what happens when you have too much ultraviolet radiation (UVR), why you should protect yourself and how to protect youself.

Excessive sun exposure can lead to acute sunburn (aka solar erythema). The sun damages the DNA directly when you get extensive sun exposure leading to inflammation and the killing of skin cells. This inflammation also causes vasodilation of the skin’s blood vessels leading to the appearance of redness and it can even cause swelling if the burn is pretty bad. Your sunburn will appear red about 3-4 hours post sun exposure. This is why when you are laying under the sun on the beach, you won’t get red right away. You will see it 3-4 hours after. The damage of your skin layer begins within 2 hours after UV exposure.

Why do your sunburn itch and hurt? It’s from the release of mediators including histamine (which causes the itch) and there the formation of prostaglandins (which cause the pain).

“After going to the beach, several hours later I felt fever, chills, nauseous and even vomited. What is going on?” This is from sun exposure. Sunburn most commonly presents with redness of the skin with pain after 3-4 hours of exposure to the sun. You can also have fever, chills, malaise, nausea, vomiting in severe cases. It can blister. The redness will resolve within a week and the skin will peel.

Why do I have swelling after sun exposure? Usually, after sun exposure you have redness, warmth, tenderness, you can even have edema (swelling), and blistering. Swelling can occur in severe sunburn could be due to the inflammatory reaction leading to leakage of capillaries. Blistering is seen in severe cases as well, which mean either you have superficial partial-thickness or deep partial-thickness burn. The deep partial-thickness burn is a second-degree burn. Severe sunburn can also lead to dehydration, heat exhaustion and heatstroke.

“BUT I REALLY WANT TO GET A TAN” If you are trying to get a tan, sunbath when there is less intense sun exposure (don’t lay during peak hours of sunshine (12 AM – 2 PM — this may vary depending on your location). Also, lay for a short duration. I understand your desire of wanting a tan! I want that glowing tanned skin look too! In fact, when you get a tan, this will increase in skin pigmentation and will provide some protection against further UVR-induced damage. You will have more melanin (which is what you have more or less of depending on your skin color; if you are dark skinned you have more melanin and if you are light skin, you have less melanin; more melanin = more protection). BUT REMEMBER, you should always, ALWAYS wear sunscreen. Even when you want to get a tan.

Is it true that if I wear clothing do it will protect me from the sun? Not always. UVR can transmit through clothing, especially if it is wet. Look into what clothing is more protective.

My recommendation: ALWAYS use sunscreen and use it 15 minutes be for leaving your house. Be good at reapplication after 2-3 hours or after getting out of the water (pool or beach, etc).

Prevention: Use sun protection factor (SPF) of 30 (there hasn’t been an indicating that states using higher SPF is more protective). SPF 30 is more than sufficient. And as long as you are using it prior to 30 minutes to sun exposure and reapplying every 2-3 hours or after swimming, sweating or toweling off, you will be well protected. Avoiding the sun during the period of peak solar radiation can help prevent sunburns (10AM-4PM). Let’s be honest, when we go to the beach, we want to swim during these hours, I usually avoid going outside between 12-2, because this is when its the strongest. However, when I go to the beach, this is the best time to be swimming because it feels so good to be under the hot sun and in the cool water. Just be good about reapplying sunscreen. Have an umbrella with you and get under the umbrella after you get out of the sun and apply your sunscreen. Let it set. Protective clothing includes wide-brimmed hat or sun visor.

Treatment: Naproxen, this will inhibit inflammatory reaction and pain by decreasing the activity of cyclooxygenase, which decreases the production of prostaglandins which is what is causing the pain.

Aspirin, ibuprofen can also be used. Ibuprofen is usually the drug of choice for mild to moderate pain. If you have hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), then acetaminophen is better, especially if you have GI or renal issues or are on oral anticoagulants. Elderly will do better with acetaminophen to avoid any GI and renal adverse effects. Acetaminophen will help with the pain but it doesn’t have an anti-inflammatory effect.

The best thing to do for your sunburn is taking cool baths or showers, using NSAIDs for the pain and to decrease the inflammation and avoid further sun exposure.

Medical School/

OnlineMedEd Case X Review

If you are a fourth-year medical student you are very much thinking this: “Omgosh, I am forgetting all that I have studied for the USMLE exams!!”

Dude, I get you. I am struggling to get the motivation to get back to studying mode (USMLE Step 3).

I don’t want to lose all that I have learned! One of my biggest pet-peeve as a 3rd year was hearing 4th-year med students excusing themselves from not remembering concepts because they are done with taking USMLE exams. True that while one is studying it is fresh on your mind, but just because exams are over, it shouldn’t mean you can become stupid — (harsh words, Mursi). It just bothered me so much because we need to know medicine for a living… With that said . . . here I am after just finishing my fourth-year, I am becoming stupid. LOL. Well, at least it feels like I am slowly getting my knowledge drained out of my brain cells.

THIS NEEDS TO STOP. NOW.

My plan to get my shit back together and not be a hypocrite: I have started doing Case X, a newly added study material from OnlineMetEd. Case X is good for 4th years, new residents, older residents, even attendings (why not?). As I am studying for Step 3, I will be adding Case X by doing 1-2 cases a day on weekdays. I want to go thoroughly through each case — this is the plan, for now.

I have done several and here are my thoughts so far on Case X by OnlineMedEd:

Honestly: this is absolutely great so far. This is the real deal. This is the real world studying, no more multiple choices. This is you getting your brain cells working and coming up with reasonings based on your knowledge and problem solving. This is your favorite resident/attending during clinical years making you think by asking you all the right questions. This is you being challenged and then learning from your mistakes. This is you reading well-explained reasoning behind the thought process. It is easy to follow and does not feel overwhelming.

Not all of us can open a textbook and read page to page and feel accomplished. Most of us, I included, can’t even get a textbook opened, let alone go through so much material. Case X allows you to take a case at a time. No overload. Just a section at a time with questions to go with each case.

Let me show you a case here, plus a cool perk.

OME provide videos with each case. This is a great tactic because this gives you that visual to trigger your recall when you get a similar real case in real life. You will remember the steps to make the right diagnosis, go through the right management steps, etc.

This is a Case under Cardiology section of Internal Medicine (PS. you will see the diagnosis).
A history of present illness provided after you have watched the video.
You get the full history to go through, including physical exam.
You get questions, but you can only see a question at a time. Once you have thought about the question and answer it to yourself you can click on it to see the answer. This will then unlock the next question.
These are all the locked questions that will only unlock once you have answered the previous questions.
You can click on the icon in the right lower corner to open up a note section to take notes to look back on later. You can exit out and it will save it for you there.
I exited out… look at next screenshot.
Clicked on the notes again.
Woot, woot! I like this.
Then it ends off with key points at the end. And you can give a feedback as well.

OME is doing it again, bring great content!

You can check out their website www.onlinemeded.com. Let me know your thoughts and how you are going to schedule this in.

Much love,
Mursi

Women's Health/

Bacterial Vaginosis

“I have itching, burning, irritation and/or abnormal discharge DOWN THERE!? What is HAPPENING to me?! This is so embarrassing!”

Let’s break it down and see the possible causes; what you need to do now and what you need to do in the future. Ultimately, this post is guidance and to give you a better understanding of what may be happening and why. You need to see your primary care to get the proper diagnosis. My goal is to teach and help you understand about certain infections.

If you have been itching, burning or having an abnormal discharge, you might be suffering from a type of vulvovaginitis, which is inflammation of the vulva or vagina. It could be mild or severe. It could occur for the first time and not come back again, or come back again often. In order to treat it appropriately, the type needs to be identified. Is it a yeast infection? Is it bacterial vaginosis? Is it trichomoniasis?

The most common cause of vaginitis is bacterial vaginosis (BV). The next common cause is candidiasis and then it is trichomoniasis. They affect the vulva and the vagina, but other infections can also affect these areas, such as sexually transmitted diseases like herpes, syphilis, chalmydia, gonorrhea. Often when women have vulvovaginitis, they do not have symptoms (70% of the time).

If you are having the symptoms for the first time, you should see your doctor without doing any self-treatment based on what you have read on the internet. Get it diagnosed. What is the cause? If you do self-treatment with nonprescription medications, it may compromise the evaluation. I highly recommend going to your primary care and getting it evaluated not to a blog or youtube channel that gives home remedies.

What will happen during the doctor visit? You will be asked a series of questions then have a speculum examination done to obtain a sample to do various tests on. Then a diagnosis is given and a treatment.

Let’s talk about the normal vulva and vagina:
The vulva contains hair follicles and sebaceous, sweat and apocrine glands. While the vagina does not have these things but is made up of nonkeratinized cells. The vagina is influenced by estrogen stimulation. After puberty, the vaginal tissues will react to estrogen and it will increase glycogen levels which will favor the growth of specific bacteria, lactobacilli, which are the good bacteria. They break down the glycogen into lactic acid and brings the pH at a range of 3.5 – 4.5. This pH level is normal after puberty and before menopause. So, if you test the vaginal pH and have anything above 4.5, this would be abnormal.

Discharges:
There are normal discharges from the vagina. So, do not freak out when you have a discharge. You can have mucus coming from the cervix, exudates from accessory glands, exfoliated squamous cells from the vaginal wall. It could lead to white or off-white color and provides an increased consistency. This is normal. The amount varies depending on many factors, which includes your hormones, hydration status, pregnancy, immunosuppression, and inflammation. Normal vaginal secretions do not have an odor. So, discharge can be normal, but if you ever have an odor — THIS IS NOT NORMAL. No, you won’t normally have a perfume like smell, but you shouldn’t have a bad smell. Pay attention to the smell and if it seems different, bad, then this could be a sign of an infection.

Let’s talk about bacterial vaginosis.
This is due to low levels of the normal bacteria (lactobacilli) and an overgrowth of anaerobic organisms. I know this might be a bit much, but the lactobacilli (the good bacteria in the vagina) produce hydrogen peroxide that breaks down glycogen, which is produced by the vaginal tissues. This causes the pH low to be low (between 3.5-4.5). So, the normal vaginal pH should be between 3.5-4.5. And in bacterial vaginosis you have lower than normal amounts of the lactobacilli, the pH will be higher than normal. This causes overgrowth of the bad bacteria in the vagina. In BV there is this musty or fishy odor and a gray-white to yellow discharge and a pH above 4.5. When you visit your primary care, they will take do a speculum exam and take a sample to check pH, look for clue cells under the microscope (clue cells are epithelial cells with clumps of bacteria clustered on their surfaces).

So, in BV you have abnormal gray discharge, pH level of greater than 4.5 and positive whiff test and presence of clue cells. They are treated with metronidazole oral or topical, or you can be treated with clindamycin. If you are pregnant, you can still be treated with these drugs as they are not teratogenic (these drugs won’t affect your pregnancy).

Vulvovaginal Candidiasis
This is caused by airborne fungi, 90% of it is Candida albicans. This is NOT an STI and they do not generally coexist with other infections. This is more likely to occur in pregnant women, patients on broad-spectrum antibiotics, diabetics, obese, immunosuppressed, those on OCP, those on corticosteroids. Wearing tight clothing or keeping a warm and moist environment can increase candida infection. the most common symptom is itching. But up to 20% of women are asymptomatic. Burning, ezxternal dysuria and dyspareunia are also findings. There is a discharge that looks like cottage cheese. They have a pH of 4 to 4.5. It is odorless. You can have a reliable diagnosis based on history and physical exam alone. OTC treatments are safe and effective but if they do not respond to OTC treatment or they have recurrence soon after treatment should have a definitive diagnosis. If you are self-treating, before visiting the doctors, you need to stop the treatment for three days prior to visiting the doctors. Diagnosis will require visualization of blastospores or pseudohyphae on saline or 10% KOH microscopy or a positive culture in symptomatic woman. Latex agglutination tests may be used if it is a non-Candida albican strain because they do not demonstrate pseudohyphae on wet prep. Treatment requires the topical application of imidazole (miconazole, clotrimazole, butoconazole or terconazole in cream or suppository form placed intravaginally. Or a short-term oral therapy with low0dos *150mg) of fluconazole. Pregnant women should be treated with topical agents due to an increase in the risk of birth defects associated with high obese (400-800) of fluconazole. Although it has high cure rates, there is still a 20-30% chance of recurrence after 1 month. There is an option of weekly therapy with fluconazole for 6 months, which has been shown to be effective in preventing recurrent candidiasis in 50% of women. Intermittent therapy with topical agents weekly or twice weekly can be used as preventative care. When a patient is given antibiotics for systemic inflammation, they should be prescribed antifungal for ppx.

Trichomonas vulvovaginitis
This is an infection that is transmitted through sexual contact but can occur from fomites (poop) and oht tubs. It is assoicated with PID, endometritis, infertility, ectopic pregnancy and preterm birth. It often coexists with other sexually transmitted disease and BV. It has also been shown to facilitate HIV transmission. It can present with itching, burning copious discharge and an odor, as well as pain during urination and during sex. The discharge is often frothy, thin, yellow-green in color but even gray in color. pH is above 4.5. There may be edema or erythema of the vulva. On exam there could be strawberry patches in the cervix, but this is not often seen in every case. The diagnosis is confimred by microscopic examination of vaginal secretions in normal saline. THis wet smea will show large mature epithelial cells with WBC and trichomonas organisms. Those that are diagnosed with this should be screen for other STDs esepcially gonorrhea and chlamydia. It is treated with oral metronidzaole or tinidazole. Their sexual parter needs to be treated as well other wise it will lead to reinfection due to the partner not being treated because they stil lhave it. When on this medication, abstaine from alcohol because it will lead to disulfiram like reaction. Trichomoniasis is assosited with preterm delievery, PROM and low brith weight. Pregnant patiens should be treated and metronixazole is considered safe for use during pregnancy. However, treatemtn may not prevent these pregnacy complications. They do not need to be followed-up to see if it is gone. it is not cost- effective.

BV and trichomoniasis can be hard to distinguish so if you have symptoms, it is important to get it diagnosed. If it is trichomonias, you have these protozoans in the vaginal that need to be eliminated by metronidazole and also your partner needs to be treated for it.

Women's Health/

Complete a​bsence of menstrual cycle (Amenorrhea)

There could be a complete absence of bleeding, called amenorrhea. In this post, I will only talk about the absence of menstruation. Then in another post, I will talk about abnormal bleeding (abnormal bleeding could be in the frequency, duration and the amount). You can skip to the paragraph that highlights your concern by looking at the bold writing of the first line.

My daughter is 15 years of age and has not had her period and looks to have developed breasts, armpit hair, and pubic hair.
Your daughter seems to have primary amenorrhea. Make an appointment with their primary care physician, pediatrician or OB/GYN specialist.

My daughter is 13 years of age and does not have signs of breast development, armpit hair, pubic hair nor her menstrual cycle.
Your daughter seems to have primary amenorrhea. Make an appointment with their primary care physician, pediatrician or OB/GYN specialist.

I haven’t menstruated regularly for the past 3 months and I usually have regular cycles!!! (or) I haven’t menstruated for the past 6 months and I usually have irregular cycles!!
This is secondary amenorrhea. You have had a menstrual cycle before, but now it doesn’t seem to be occurring. Usually, it is due to pregnancy. Grab a pregnancy test or go to your doctor and see if you are pregnant. The chances that an absence of menstrual cycle is caused by something other than pregnancy is 5% or less in these situations. If you have noticed that your breasts are fuller, you have gained weight and you feel nausea and possibly been vomiting lately, then this suggests you may be pregnant. You will need to have this confirmed with a pregnancy test which checks your level of hCG in your urine or in your blood.

You are not pregnant and are not having your periods (look above for timeline).
You need to be evaluated further by your doctor. Your doctor will do further tests to see why you aren’t getting your period. They will check your FSH, LH and prolactin levels in your blood to see if that tells a story about why you aren’t having your normal menstrual cycle. If you have low levels of FSH and LH levels, this may indicate you have a decrease in the production of these sex hormones, possibly due to your hypothalamus or anterior pituitary (both located in your brain). Don’t get too overwhelmed hearing that. Just relax. This is all potential talk. If the LH and FSH levels are normal but you have high prolactin levels, this could be the cause of your menstrual cycle abnormality and it may be due to an adenoma in the brain that is secreting prolactin in excess. This excess prolactin may be messing up with the sex hormones. Again, stay calm. Nothing is being diagnosed here. You would need to get the actual work up to get the actual diagnosis. There are a variety of causes of amenorrhea. You are learning some causes and when you go to your doctors you will have a better understanding of what high FSH and LH levels could mean. Or high prolactin levels. Let’s just discuss this without stressing. If your FSH and LH levels are high, then this could mean the ovaries are not being stimulated by the FSH and LH, which may be due to the ovaries not properly working.

History of dilation and curettage from a previous pregnancy and now you are not having regular menstrual cycles?
Then there could be a chance it is due to scarring of the uterine cavity, called Asherman syndrome. This is the most frequent anatomic cause of secondary cause of the absence of menses. If you had a history where you had D&C to remove retained pregnancy due to pregnancy, this has a risk of developing scarring of the endometrium. This then could lead to abnormal menses.

So what next?
You need to make an appointment with your doctor. Your doctor will ask you a variety of questions to establish where the problem could be. Then they will decide what steps to take, which is most likely taking some blood after initially checking for pregnancy with a urine test. Even if you say you are not sexually active, it is mandatory to rule out pregnancy. It isn’t because they don’t trust you, it is because it is protocol. They may do a progesterone test to see why you have an absence of menses and go from there.

I hope this gives you some understanding of what may be going on. Please, leave a comment below if you have any questions and I will be sure to answer it the best I can. My intention is to only teach and not make a diagnosis. You need to see your doctor for the appropriate diagnosis and next step in management.

Medical School/

Elective Clinical Rotation In the UK

My medical school recently added an elective rotation in a small town in England called Corby. There is a massive family medicine practice here called Lakeside Healthcare. You can do a 4-week elective rotation, which is what I did. Medical students from Cambridge and Leicester medical schools rotate here, and now students from my school can as well. Let’s just state it here and now, you are exposed to so many patients in this rotation, AND the most impressive part is that Lakeside Healthcare takes it to another level with their teaching: Medical students have their own rooms and system access to see patients by themselves before the general practitioners (GP) see them. Read on for schedule and experience.

As a Caribbean Medical student, you can be exposed to multiple hospital/clinic practices and I have traveled from NY (Richmond University Medical Center, Kingsbrook Jewish Hospital), to Michigan (Pontiac General Hospital), to Maryland (University of Maryland Medical Center). And now I have just finished my medical school career with my very last rotation in United Kingdom. All of which were my own choosing. This has multiple advantages of seeing how different hospitals run and it brings different exposure that you might not get by being in one single medical practice. Lakeside Healthcare was the first rotation where medical students are a huge part of the practice. It felt good.

A typical day in this elective: Come at 7:45 AM, log on to the medical record system and open the first patient’s chart. Call the patient in and grab history and physical exam. Then document it on their chart. Then present it to the attending either in front of the patient or before the patient is seen by the attending. After the presentation, we are asked about the potential diagnosis and indicate the next step in management. The physician then agrees or corrects. Then they talk to the patient for any further information and provide the final diagnosis and management. The patient then leaves the room and the physician briefly talks about the topic with the medical student. Then repeat! The medical student gets a full 15 minutes consultation time and then the attending gets 15 minutes of consultation time, which totals to 30 minutes with the patient. This is beneficial both for the patients, medical students and the general practioners. The patients get more face time and do not feel rushed; the students get the practice; the physicians get more information. Then after seeing patients for the morning, you go out for lunch, then come back and have a lecture on a topic.

During one of my patient encounterance, I went full Dr. Mursi, MD mode, where I counseled a pre-teenager whose mom had brought her in for depression. Initially I was in medical student mode, getting the history. However, realizing their intentions, I took full control of the appointment while charting everything that was discussed for the general practitioner (GP) to see. It felt really good to know I helped open doors to better conversations between mom and daughter. I was confident in my diagnosis of grief, provided some counseling and indicated the next step in management (of course, I informed the patient that the GP would make the final decision). This along with many of my other patient encounterance reminded me where I belong in the world of medicine. I am really excited to practice and have my own patients. I feel very content. It was also always fun to have the patient ask me where my accent was from.

Side note: In just about all of my rotations (especially fourth year) the patients I encounter, I indicate what I believe their diagnosis may be. Then tell them the next step in management. However, I always state that the GP will confirm this. This way, as a student, I am practicing diagnosing disease/conditions. I am practicing confidence, and also simply showing my knowledge to self and my patient. Often the patients will point out, “oh yeah, that’s what the medical student said”. This also makes you look good with the resident or attending you are working with.

Things I really appreciated:

  1. The patient exposure and student involvement. Rather than simply being asked to just observe patient and doctor interactions and then sometimes get asked to see a patient and present on them, students are expected to take history and physical and make a diagnosis and write up notes on the patient. Then they are expected to present it and indicate the next step in management. This is intimidating but you gain so much from it including confidence, knowledge and more efficient style of approaching patients. You are part of the schedule. It is always nice to be wanted as a medical student (doesn’t often happen)
  2. The coffee breaks! I think this is such a good idea to integrate into practice to allow for a breather for the physicians and the students.
  3. They provided access to a taxi cab company, which allowed me to travel within Corby. I just had to ring up the cab company and within minutes the cab was waiting for me! This was really convenient and it allowed me to venture out into the town center and etc. It definitely made it more comfortable to be there.
  4. They provided access to the swimming pool and the gym. This was great because I have been wanting to tone up and get healthier and it is located right by the practice. I simply walked over to the gym after work and then called the cab from the gym to get to the housing. It felt like a very productive day after work and the gym. I didn’t use the swimming pool so much, but it is one of the biggest one I have seen (it is an olympic size swimming pool).

Overall, it was one of my favorite rotation experiences. I do wish that I didn’t have two weeks of observation. This was due to my start date. I started with one set of students, who were on their last week of their 12-week rotation. Then I began with the next set of group. I ended up doing 2 weeks of observation. I was waiting to see patients on my own. I think it will be different for the next set of students as it will most likely be coordinated differently.


I definitely have to add that I am really grateful to have gotten this opportunity to see what medicine is like in the United Kingdom. I don’t think I can begin to explain how exciting it has been and the amazing opportunity I have been given. It was a pleasure to meet new people and get to know their thoughts in medicine and just as human beings. I have more thoughts and that will come in more blog posts.