USMLE-like exam results in Mexico

Here in Mexico there is a similar exam to the USMLE, who is proposed to select those medicine graduated into residents to get a speciality.

This exam is called “Examen Nacional de Aspirantes a Residencias Médicas – ENARM” (National Exam of Aspirings to Medical Residences). This exam was on September 3rd and 4th this year, it consists in 700 multiple option questions, of wich 600 evaluate medical knowledge (clinical vignette questions), and 100 evaluate understanding capacity of english-based medical texts. The results was published yesterday. There were 22,985 aspirings for 4,299 vacant places in 22 specialities.

Public and private institutions offer main specialities as follows (annual and national offers):

  • Anatomic Pathology (54 places)
  • Anesthesiology (420 places)
  • General Surgery (460 places)
  • Audiology and phoniatrics (19 places)
  • Epidemiology-Public Health (25 places)
  • Medical Genetics (16 places)
  • Obstetrics & Gynecology (422 places)
  • Sports Medicine (7 places)
  • Rehabilitation Medicine (56 places)
  • Occupational Medicine (58 places)
  • Family & Primary Care Medicine (724 places)
  • Internal Medicine (607 places)
  • Legal & Forensics Medicine (10 places)
  • Nuclear Medicine(12 places)
  • Ophtalmology (102 places)
  • Traumatology and Orthopedics (229 places)
  • Otorhinolaryngology (73 places)
  • Clinical Pathology (17 places)
  • Pediatrics (531 places)
  • Psychiatrics (86 places)
  • Radiology (156 places)
  • Emergency Medicine (183 places)

That give us a number of 18.7% of selected residents-to be, of the total population of aspirings. That’s sounds BAD. I don’t know the facts and numbers of the USMLE, but i think it’s much easier to get a residency at USA, by far.

Congratulations to all my dear colleagues that had approved this important part of our careers. I’m very proud of you guys!


Jon Mikel Iñarritu, M.D.

technorati tags: ENARM, USMLE, unbounded medicine

Pulmonary tuberculosis: a common diagnosis at INER

A 24 year old woman who presented at INER (Instituto Nacional de Enfermedades Respiratorias) at Mexico City complaining of shortness of breath, weight loss, and chronic cough. This image shows a classic radiographic appearance of pulmonary tuberculosis. An heterogeneous image with alveolar filling pattern and homogeneous opacity are observed at the right apex. Elevation of right hemidiaphragm due to atelectasia is also shown.

Gerardo Morales-Mora

technorati tags: Tb, Pulmonary tuberculosis, tuberculosis, INER, clinical cases, medical images, unbounded medicine

Horrible: Child abuse

Another case of Child abuse was shown today on TV news.

It seems that we can’t stop this and some parents preffer to remain in silence rather than to speak out loud about this impunity.

I think it is time to recognize this cases and report them to the authorities. So today’s matter is to know the facts about child abuse & neglect.

Also know as child maltreatment it is a group of comission, omission and lack of actions, that result in morbidiy and/or mortality.

It is every agression or omission of intentional nature, indoor or outdoor, against child(s), before or after the birth that affects their bio-psycho-social integrity. This actions can be from an individual, a group of people (society), an institution taking advantage of their physical and/or intelectual superiority.

There is a triad of child abuse:

  1. Child: Often a non-accepted (desired) kid, malformation, chronic or acute diseases.
  2. Agressor: Often a parent or caretaker, alcoholic or drug abuse problem, background of abuse.
  3. Triggers: Unemployment, marital disfunction, social and economic problems.

It’s importance: 2,900,000 cases / year on U.S.A of wich 33% is physical abuse. Second leading cause of death in child less than 5 years old.

Burn by iron Circular burn


You should always suspect child abuse when:

Clinical aspects on child: Non-correlated history given by parents, small height, poor hygiene, previous lesions, malnutrition, non-desired/non-accepted child, incomplete vaccination schedule.

Clinical aspects on child’s family: Delayed medical attention, abuse background, step-mother/father, alcoholism, ask for medical attencion by someone else outside the central group of family.

It is required a multidisciplinary team: Primary care Physician, Pediatrician, Social work, Mental Health, Lawyer, Voluntaries.

The action of preventive mesures should include all levels of society: International organizations, Federal instances, Local community (church, school, friends, pediatrician, etc), Child’s family and Child.

Who where ever you are do: Let’s stop this.


Jon Mikel Iñarritu, M.D.

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Concern about appearence

24-year-old male comes to you with the chief complaint that his nose is too big to the point of being hideous. He has been avoiding contact with others and has left his studies.

The patient states that his nose is a constant embarrassment to him and he would like it surgically reduced. He tells the physician that three previous plastic surgeons had all refused to operate on him because they said his nose was fine, but the patient states that “they just didn’t want such a difficult case”. You observe that the patient’s nose is of normal size and shape.

What do you think?

This is a typical manifestation of body dysmorphic disorder (also know as dysmorphophobia), that is an extreme feeling of dislike or concern about some aspect of the appearence in spite of a normal or nearly normal shape The fear of being ugly or repulsive is not decreased by reassurance and compliments and has almost a delusional quality. The social, academic, and occupational lives of this individuals are greatly affected, due to avoidance of social interactions for fear of embarrassment, the time spent in checking mirrors and seeking surgical treatment or cosmetic remedies, and the chronic emotional distress that accompanies the disorder.

Complications: As the presentation of this patient, social withdrawal is common, and patients may be unable to work or to sustain relationships with others. Suicidal ideation is common, and completed suicide may occur.

Treatment: As this patients are loath to consider their pathologic concerns per se, they rarely stay in treatment. Both fluoxetine and clomipramine are effective in reducing the intensity of the patients’ concerns, and there is some preliminary evidence for the effectiveness of behavior therapy.

So, what you don’t like about yourself?


Jon Mikel Iñarritu, M.D.

technorati tags: body dysmorphic disorder, dysmorphophobia, unbounded medicine, psychiatry, medicine

Doctor’s Day

Congratulations to all my colleagues in Mexico, because today is the celebration of Doctor’s Day.

Background & History:

On October 19 of 1833, Valentín Gómez Farías ordered the clossure of the Universidad Nacional y Pontificia and The School of Surgery. Then it inagurated on October 23 of 1833 the establishment of Medical Sciences wich then became in Facultad de Medicina of Universidad Nacional Autónoma de México.

So, October 23rd is our day here in Mexico.

Other dates in other countries:

March 30 – National Doctor’s Day – USA (Anniversary of the first use of general anesthetic in surgery March 30 1842 by Dr. Crawford Long)

December 2 – Doctor’s Day – Argentina, Spain, etc. (Anniversary of the birth of the cuban Dr. Carlos Finlay, who discovered the vector of yellow fever).


Jon Mikel Iñarritu, M.D.

technorati tags: doctor’s day, UNAM, National Doctor’s Day, unbounded medicine

You should never take this chest x-ray

To take this chest x-ray is a common error for those without experience.

Tension-type pneumothorax

The diagnosis of Tension-type pneumothorax is a clinical one. That is because it’s a real emergency (inmediately life-threatening), that should be identified on primary survey.

Basis of Diagnosis:

  • Hyperresonance of affected hemithorax
  • Decreased or absence of breath sounds
  • Tracheal deviation to the other side of pneumothorax is
  • Respiratory distress
  • Hypotension
  • Tachypnea
  • Hypoxia
  • Distended neck veins (this could be absent if your patient is hypovolemic.

Mechanism: The air enters to the pleural space (a virtual one) and cannot escape, then the intrapleural pressure increases and the lung becomes collapsed with secondary shift of the mediastinal contents to the opposite side.

Treatment: Needle decompression (thoracostomy) with large-bore needle in the second intercostal space in the midclavicular line to convert the tension pneumothorax into a simple pneumothorax. This simple procedure can save your patient’s life.

Be aware, explore your patient, establish a diagnosis and give a prompt and proper treatment.


Jon Mikel Iñarritu, M.D.

technorati tags: tension-type pneumothorax, tension pneumothorax, CXR, chest x-ray, x-ray, xray, pneumothorax, thoracostomy, unbounded medicine