Gout is a common inflammatory arthropathy characterized by painful and swollen joints resulting from precipitating uric acid crystals. Acute gout attacks typically manifest with a severely painful big toe podagra and occur most often in men following triggers such as alcohol consumption.
Diagnosis is based on clinical presentation and synovial fluid analysiswhich reveals negatively birefringent monosodium urate crystals. Acute attacks are treated with nonsteroidal anti-inflammatory drugs e.
References:  . Epidemiological data refers to the US, unless otherwise specified. Acute gouty arthritis is not always associated with elevated serum uric acid levels; it can also occur when serum uric acid is normal!
Primary hyperuricemia is aggravated by poor dietary habits! References:       .
References: . References:   . References:   . See differential diagnoses of inflammatory arthritis. References:     . The use of aspirin in acute gout attacks is contraindicated as it inhibits uric acid excretion, thereby delaying the cessation of symptoms. Proton pump inhibitors should be given to patients being treated with both NSAIDs and glucocorticoids to avoid gastrointestinal ulcers. First-line treatment: xanthine oxidase inhibitors allopurinol.
Third-line treatment: recombinant uricase pegloticase. The combination of allopurinol and azathioprine leads to increased bone marrow toxicity! During the first 2 weeks of an acute gout attack, treatment with urate -lowering drugs e. References:          . References: . We list the most important complications.
The selection is not exhaustive. Clinical science Gout is a common inflammatory arthropathy characterized by painful and swollen joints resulting from precipitating uric acid crystals. Gout Deposition of urate crystals into joints Hyperuricemia predisposes to gout Associations : Diabetes mellitus Hypertension Hypercholesterolemiahypertriglyceridemia Anemia Acute gouty arthritis is not always associated with elevated serum uric acid levels; it can also occur when serum uric acid is normal!
Hyperuricemia Uric acid is an end-product of purine metabolism that is renally excreted. Insufficient excretion or increased production of purines leads to hyperuricemiapossibly triggering a gout attack. May be primary or secondary. Primary hyperuricemia Idiopathic extracellular supersaturation of uric acid No history of comorbidities or medications that affect uric acid formation or excretion Primary hyperuricemia is aggravated by poor dietary habits!
Secondary hyperuricemia Decreased uric acid excretion most common Medications e. Uric acid has poor water solubility, even under physiological conditions. The recovering joint may present with desquamation of the overlying skin.
Locations : Peripheral small joints in the lower extremities are especially affected. Podagra : metatarsophalangeal joint MTPJ inflammation of the big toe is the most common site Gonagra : inflammation of the knee Chiragra : inflammation of finger jointsesp.
Imaging Ultrasound "Double-contour" sign representing hyperechoic monosodium urate crystals covering hyperechoic bone contour Tophus a mixture of hyperechoic and hypoechoic structures MRI Excellent measure to detect tophi formation Method of choice to detect spinal involvement CT : can detect bone erosions as well as tophi X-ray Acute gout attack: not useful, as early changes cannot be detected Chronic gout : radiopaque soft tissuepunched-out lytic bone lesions with spiky periosteal appositions References:   .
Test for hypercalcemia esp. Serum uric acid levels are normal. Treatment Asymptomatic cases do not require treatment unless there is an underlying condition e. Symptomatic treatment similar to gout Best initial treatment: NSAIDs Alternatives: colchicine or intra-articular corticosteroids Arthroscopic lavage may also be considered Possible joint replacement References:      The differential diagnoses listed here are not exhaustive.This group, made up of colleagues, friends and study partners, found themselves spending more time on researching medical information than they did on studying it.
Accustomed to spending hours compiling data from multiple sources e. Googlethey wanted to find a way to shift the focus back to actually practicing medicine and not just searching for answers. This team of young doctors, inspired by their own experiences, wanted to help future physicians navigate the journey to their degree with ease.
Our founding team of dedicated physicians has created a platform specifically for English speaking communities of students who are preparing for their USMLE exams.
With a firm belief in a collaborative process, each individual Learning Card and question is developed, checked and cross-checked by a group of physicians to ensure all exam prep material is both clear and comprehensive.
Extensive research and testing is conducted to ensure learning material is perfectly aligned to meet the needs of medical students around the world. At AMBOSS, our objective is to provide global access to a holistic platform for medical students to study and prepare for medical exams. This includes those with limited access to medical education due to socio-economic factors. To meet the needs of medical students worldwide, our platform is continually growing, with regularly added Learning Cards and new subject-optimized Qbank material released weekly.
A third of the Indian population lives below the poverty line, many having to make do with less than a dollar a day. Read their stories here. Medscape, New York, NY To date, very few products combine both raw information sources with a means of testing that knowledge all on the same platform. More thanmedical students and physicians worldwide rely on the AMBOSS platform for test preparation, in-depth studying, and as a clinical companion. Our Story. Our Medical Content.
Our Vision. Our Initiatives. Our Newsroom. Read more.They wished during their studying that they had a combined question bank and reference tool, and so they decided to create one. Amboss combines a large question bank with an equally comprehensive Library feature that contains point-by-point breakdowns of the topics covered by questions.
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More than just a multiple choice question bank, the student can actually choose how deeply they want to delve into the topic.
By doing this, students can compare the parts of the vignette they highlighted to what Amboss recommends should be highlighted. This can be helpful for students who struggle with picking out the most important parts of a section. The question bank itself contains appropriately complex questions, and often has more answer choices than in UWorld: the average seems to be about six choices, but eight is not uncommon.
The former option highlights the most relevant portions of the question stem, while the latter provides additional information directed at the correct answer. The explanation Amboss provides about the correct answer is thorough, and includes pictures if necessary. For instance, a vignette about a thyroglossal cyst had a picture of a congenital neck mass embedded within the explanations as well as picture of an incorrect answer choice cystic hygroma.
This is helpful because the students can see how the two different neck masses can present; not only is it useful for the shelf, but seeing the pictures can be helpful for the wards. The library is a feature with content about the basic sciences step 1clinical knowledge CKclinical skills Step 2 CSand chalk talk. Each of the libraries for this section includes a comprehensive outline of the specific topics covered. For example, the basic sciences section has topics that are outlined by discipline or by system.
Then within each topic, the content is further broken down. For instance, for 1. The formatting of the content within each section is in paragraph form, rather than bullet form. The content is displayed on a white background with black and gray font, which in my opinion is actually a bit dull. It is good for content review but I prefer something more attention-getting for lengthy study sessions. The analysis feature is useful because it shows the session timeline, results, progress, and study recommendations.
The analysis also shows how long the student took to answer a question, which can be helpful to students struggling to finish blocks on time.
There is an option to look at the study summary, which can be for the entire length of having an AMBOSS account, for the previous 6 weeks, or for the previous 2 weeks.
Based on this summary, the study can receive study recommendations. I did not do enough questions to have an example of a recommendation to comment on this more specifically. There are feedback forms all throughout the platform so that users can comment on both good and bad things about a particular feature. This is appealing to me because it keeps the content active and if there is ever an issue with the accuracy of an explanation, the student can immediately report it and Amboss will look into it further.
Amboss is an excellent resource. The only downside is that it is not as firmly established in the U. Brus-Ramer and Dr. Rubin, and an administrative team dedicated to our students' success. All blog posts are Read More. Elite Medical Prep. Dec 18 12 min. Analysis Feature The analysis feature is useful because it shows the session timeline, results, progress, and study recommendations.Account Options Sign in. Top charts. New releases. Add to Wishlist.
No Wi-Fi? No problem. The apps work both online and offline. With its tight integration with the Qbank app and numerous features to help you pinpoint your knowledge gaps, AMBOSS delivers the most complete medical learning platform available.
Take charge of your medical studies. With AMBOSS, you can replace multiple, scattered sources with a single touchpoint that can meet your medical knowledge needs. Utilize the only reference application specifically designed for students on the wards that offers just the right amount of information.
Access thousands of library knowledge cards outlining diagnoses, diseases, and more in just a few taps. Switch on high-yield mode to see the most important information you need to know on every card. Enrich your study sessions with a variety of multimedia elements, from X-rays with overlays to videos. Review from anywhere, including on your commute or between rounds on the wards—even in Wi-Fi free zones. Get a boost when reviewing the information you missed the first time around by turning on the learning radar.
The difficulty of the questions, excellent explanations, and breadth of the Qbank adequately prepared me to perform well on test day! They are a push in the right direction to encourage critical thinking.
This is especially important early in a clerkship when the knowledge base is not that strong Reviews Review Policy. Lots of small bugfixes were made to keep things running smoothly. View details. Flag as inappropriate. Visit website. See more. MediaLab AI. Medical FlashNotes.Classical epidemiology is the study of the distribution and determinants of disease in populations.
Clinical epidemiology applies the principles of epidemiology to improve the prevention, detection, and treatment of disease in patients. They may take the form of case reports, case seriesor ecological studies.Using Lecturio To Excel In Medical School
Analytical epidemiological studies seek to determine the influence of an exposure on an outcome and can be further divided into experimental e. There are a number of factors that influence the amount of clinical evidence epidemiological studies contribute.
Conclusions drawn from these studies can be made more reliable by limiting biasconfoundingand effect modification.
In epidemiological studies, the strength of the relationship between two events is measured using ratiosrates, and proportion tests. This relationship can be presented in the form of a two-by-two table, which helps to visualize the number of false positive and true positive diagnostic test results, as well as the number of patients who actually have the disease and those who do not tested with a gold standard test. A diagnostic test is considered precise if the results it yields are reproducible under similar conditions reliable and if it measures what it was developed to measure valid.
The higher a test's reliability and validitythe lower the amount of random errors it will generate. Also see statistical analysis of data. References:   . Clinical drug trials. Determine the side effectstoxicitypharmacokineticsand pharmacodynamics of the drug. Determine the efficacyeffective dosingand side effects of the drug. Clinical drug trials assess adverse event rates and drug interactions.
They can be used to develop warnings and precautions as well as contraindications for the use of a drug. For example, if the rate of hyperglycemia is significantly higher in the treatment group compared to the control groupit may not be appropriate for use in patients with diabetes mellitus. Randomized controlled trials are considered the gold standard for clinical trials! A case-control study compares a small population group over a short period of time less cost-intensive and determines how multiple exposures lead to one outcome; a cohort study compares a large population over a long period of time more cost-intensive and determines how one exposure leads to multiple outcomes!
In cohort studiesresearchers select individuals based on exposure first and then determine if these individuals develop a disease. This is in contrast to case-control studies, in which patients with disease cases and those without disease controls are selected first to determine if they were exposed or not! The relative riskodds ratioand hazard ratio are usually displayed with a corresponding p-value.
References: . Unlike sensitivity and specificitywhich rely solely on the diagnostic test itself, predictive values are also influenced by disease prevalence! The table below is an annotated 2x2 tablewith additional columns detailing total amounts and their interpretation. References: . Clinical science Classical epidemiology is the study of the distribution and determinants of disease in populations.
Classical epidemiology : the study of determinants and distribution of disease in populations Clinical epidemiology : the study and application of principles of epidemiology to improve the preventiondetectionand treatment of disease in patients Population epidemiology : the total number of people or inhabitants in a country or region from which a sample is drawn for statistical measurement Population pyramid : a way of illustrating the age and sex distribution of a specific population Stationary pyramid: represents a population in which age and sex distribution remain constant over time; equal birth and death rates Expansive pyramid: represents a population in which there is a greater percentage of young people i.
It is matched for baseline characteristics with the study population to reduce confounding factors. Principles of study design Study designs should be tailored to the question that needs to be answered.
A good study design with high levels of evidence increases the strength of conclusions drawn from the results. Types of epidemiological studies Description Example Descriptive studies Studies that try to identify individual characteristics age, sex, occupationplace e.
Example: randomized control trial Observational studies Studies without an intervention The independent variable is not manipulated.AMBOSS is the only platform that covers you throughout all your years of medical school and into your residency. Our Knowledge Library acts as a trusty clinical companion on the wards, ready for you to reference at your point-of-care needs.
Our Step 1 content, as well as the rest of our exam materials, are developed and curated via a rigorous internal peer-reviewed process powered by over 50 physicians who have scored in the top percentiles on their USMLE Step and NBME Shelf exams.
Instead of wasting time between seemingly-related-but-not-really external resources, you can keep your studying centralized with AMBOSS. Every Qbank answer is linked to a corresponding Learning Card that you can open up right beside the question.
Feeling comfortable with the exam format is just as important as knowing the content that will appear on it. Enabling exam simulation mode will replicate exam-day conditions, featuring a timer and NBME-style interface.
The Knowledge Library spans everything you need to know for Step 1. Topics can be approached from two vantage points: by discipline or by system. Always see exam-relevant information first. Enabling the highlighting tool highlights the most essential information you need to know in any Learning Card—the very information that will come up in Qbank questions. Personalized Study Recommendations also provide a breakdown showing how much time to spend on weak areas and with which Learning Cards.
Both the Qbank and Knowledge Library feature a phrasionary, table quizzes, charts, radiological images with overlays, videos, SmartZoom samples and other images that illustrate key points on different topics. Study Information Side-by-Side. Go Through the Qbank. Enable Highlighting and High-Yield Mode. Check on Your Progress.
Take and Share Personal Notes.As you may know, each clinical encounter starts with a patient history and physical examination — which is outlined in the doorway information — and finishes after you type up your patient note.
In each AMBOSS CS caseyou'll find an opening scenario, vitals, and examinee tasks, all designed to get you thinking about differentials from the moment you reach the door.
Each case is unique, with different patient instructions and dynamic, real-life scenarios. During the exam, every patient you see will be instructed to present you with a specific challenge: Some might be forgetful, others might talk too much. AMBOSS CS cases are designed to emulate exactly what you can expect to see on your exam and offer practice patients clear directions on how to act and what to say.
Let's walk through a case. After reviewing the doorway information, you can take a minute to prepare your blue sheet, write down mnemonics to help you remember all the important questions, and jot down patient vitals. After introducing yourself and stating your role, ask the patient the correct series of questions. What brought you in today?
Do you have any allergies? Are you taking any medications? Any past operations? To help you prepare, it is important for your practice patient to check off which questions they are asked during the examination. A detailed list is included in each case, making it easy for practice patients to check your progress as you go through the exam.
After washing your hands and asking the patient for permission to begin, start the physical examination. Your communication and interpersonal skills are just as important as your history taking and physical examination skills.
AMBOSS replicates what you will see on your CS exam, using a patient note form that looks just like the one in the exam, so you can practice in a realistic environment and be prepared on the big day. There is no longer a need to search through multiple resources while preparing for your CS exam.
When reviewing each AMBOSS CS case after you have practiced, you can browse differential diagnosis tables, watch physical examination videos on difficult exam maneuvers, and hover over speech bubbles to see more in-depth information.
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