Osteomyelitis is an inflammatory bone infection that can be acute (days to weeks, responds to antibiotics) or chronic (months to years, requires surgical debridement). The most common organism across all age groups is Staphylococcus aureus (MSSA more common than MRSA), with specific variations: Salmonella in sickle cell disease, Pseudomonas in IV drug users, Group B strep in neonates, and polymicrobial in diabetics. Clinical presentation includes fever, localized bone pain, and decreased mobility. Diagnosis involves CBC, ESR, CRP, blood cultures, and imaging (X-ray first-line, MRI gold standard). The probe-to-bone test is highly specific for diabetic foot osteomyelitis. Treatment requires 4-6 weeks of antibiotics (6 weeks for vertebral involvement), with surgical consultation for exposed bone, abscess, or neurologic compromise.
MCCQE Osteomyelitis + Review of Medbuddy Question bank
Added:gives learners a clear starting point, readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep. Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams. The home dashboard gives learners a clear starting point, readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep. Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams. The home dashboard gives learners a clear starting point, readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep. Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams. The home dashboard gives learners a clear starting point.
Readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep. Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams. The home dashboard gives learners a clear starting point, readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep. Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams. The home dashboard gives learners a clear starting point, readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep. Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams. The home dashboard gives learners a clear starting point.
Readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep. Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams.
Heat. Heat.
Heat. Heat.
Hello, hello, hello, hello everybody. Dr. Brun here. I'm excited tonight because I have a gift for everybody. We have a gift for everybody. So, please make sure that you invite all your friends. Tell them, tell them, tell them to join the stream right away. Tell all your friends to join the stream because tonight is going to be a great night. And um as we promised in the WhatsApp group, we're going to give access to everybody to our question bank. Everybody, whether you're a medcognito student or you are not a metcognito student, you're going to get access. So, please hang in there till the end of the class because we're going to do a demonstration. Going to show you how to use the question bank and then look, let's get going. I'm excited. I'm getting to the end of the class. I'm going to invite our administrator to join us to do the demonstration. So, today I'm going to just jump in right away so we can start studying. Please let me know. Can you hear my voice? I want to know whether you can hear me clearly. Just type Dr. Brun, I can hear you clear. Clear. I can hear you clearly. Just let me know. Let me know.
Let me know that I can hear you clearly, Dr. Bernie. And then we start the game because it's going to be a powerp packed night. Please, can you hear me? If you can hear me, just let me know that I can hear you, Dr. B. I can hear you, right?
I can hear you. Yes. Yes. Good. Let's go. Let's go. So, we still doing the free MCC questions and Oh my goodness, the room is hot. Too much fire. Let me put on the fan, please. Let me put on the fan. Too much fire, right? Too much fire. So, yeah, we're still going through the free MCC questions and um awesome time to be alive. Um I need to check the MCC website whether they've released the 230 questions which you can buy for just $1. $1. But I think the announcement was July 20th, but I need to check the time the dates very well.
Okay. So, please be on the lookout. If it is today, I will let you know and then you can just go there. pie, buy $1 and we're good to go. So, we're going to do something today. We are launching the question bank, okay? Which everybody, everybody, whether you're Medco student or you are not, you're going to get access for a period for the Med Cognto students, you'll be getting an email blast tonight for you to log in. So, don't worry about that. And even if you're not a metcognito student, so far as you join the class right now, the live class, you're going to get access and the administrator will be joining me at the end of the class to do that. But we're going to go through a quick lesson on osteomiitis. We will try the flash cards on osteomiitis in the question bank. Then the admin will join us to finish everything up. So let's do this question quickly. You have a 5-year-old boy who is brought or somebody saying, "How are you doing, Dr. Brun?" I'm fine, Dr. Atric. Hey, Dr. Atric, I need to do something for you. I remember. I'll do it for you, please.
Okay, I'll do it. I'm not going to say it here, but I'll do it for you. Don't worry. Okay. So, you have a 5-year-old boy who is brought to your clinic with an oral temperature of 39° C and a normal temperature is between 35.5 to 37.5 and localized tenderness just above the right knee. He was previously well with no recent illness. He's unwilling to bear weight on that leg. Which one of the following is the most likely diagnosis? A. Osteomiitis. B.
Osteocyoma, C. Juvenile idiopathic arthritis, and D transient sinovitis. What is the correct answer? Let's get into it. Let's get into it. Is it A, is it B, is it C, is it D or is it E? Doctors, please don't forget, send this link to all your friends. Tell them to join this class.
If you have been looking for a question bank you can use, tonight is the night.
Look, it is built on the MCC question um the MCC objectives. So look, everything you need is here tonight. We are doing the launch, but we preceding it with this particular topic. So I see a lot of doctors going for a a a which is osteomiitis. Osteomalitis and the rale is this from the medical council. The presentation strongly suggests osteomiitis. So now you have to ask yourself if you are presented with any of these options osteomiitis, osteocyoma, juvenile idiopathic arthritis and transient syobitis you should be able to tell the differences right based on how the question describes them. So for this one the MCC says that the presentation strongly suggests osteomalitis. Why?
Because osteomiitis is an infection of the bone and it is often caused by bacteria and it is characterized by localized pain.
Localized pain, fever and an inability to use the affected limb due to pain.
Okay. Now the acute onset of symptoms and the specific location of the tenderness align with the diagnos of osteomiitis.
And why is it not osteocyoma? you realize that osteocyoma is a malignant bone tumor and it is rare in this age group. So that's something you need to pay attention to. The medical council wants you to link various bone abnormalities with significant age groups. Right? And is usually it usually presents with more chronic cause and possibly a palpable mass. So that is something for tonight please I need to review the features of osteomiitis the features of osteo saroma the features of transient sinovitis and the features of juvenile idiopathic arthritis these are things the medical council wants you to master right good now juvenile idopathic arthritis could cause joint pain and reluctance to bear weight but it usually involves mult multiple joints and a longer duration of symptoms. So doctors, please pay attention to the way you know the various nuance things that the medical council wants you to know. And then what about transient sinovitis? It is a common cause of hip pain in children and it typically presents with less severe symptoms and the clue with transient syitis is that usually it is preceded by a viral infection.
So know the difference between osteocyoma, osteomiitis, trans um um transient sinovitis and last but not the least idiopathic juvenile arthritis.
Know the difference. Know the difference in their clinical characteristics. This doctor says something here. What what is the doctor saying? She just typed something here. She says access to question bank is going to be for how long? Please don't worry. We'll talk about all that. Okay? We'll talk about all that. So, you don't need to worry about that. But tonight, everybody on this call is going to get it for free because we want you to really, really be able to get it. So, this is osteomiitis.
This is how osteomiitis will present on an x-ray, right? So, I'm showing you how it will present on an x-ray. Let's get into it. So, what is the definition of osteomiitis?
What's the definition? Osomiitis is basically an inflammatory condition of bone secondary to infection that may be acute or chronic. So that's something you need to really remember. Osteomiitis may be acute or it may be chronic. Most of the time for many of us when we thinking about osteomiitis we think about it in its chronic form. But you must also know that you can easily confuse osteomalitis the acute form with other differential diagnosis. And we will look into all those things as the class goes on. Now what is the mechanism? What is the mechanism by which people develop osteomiitis. So you can have a hematogenous spread and you can also have a nonhematogenous spread. So a hematogenous spread means the bacteria is implanted in the bone through the bloodstream. Hematogenous hea talking about blood right and it is with when you come talk about hematogenous spread most of the time that is the most common in children so long bone metaphysis and older children and vertebral bodies usually um non-microbial so most common in children you find otomyitis in the long bones okay and in older adults you find otomyitis which is spread by the hematogenous route that is so maybe the patient has some blood infection and then it deposits some um organisms in the bones but in children remember that hematogenous spread of osteomiitis usually is in the long bone metaphas meanwhile in older adults it is in the vertebral bodies and then we also have non-hematogenous spread where maybe there was a surgery being performed on the bone or something or there was trauma, right? And there is spread from adjacent soft tissue and joint infection. And usually when it comes to the nonhematogenous spread, usually it is it can be more polyicrobial. So different organisms can be involved. Now you remember that I talked about acute and chronic osteomiitis.
With acute osteomiitis, the organism or the the features present within days to weeks. And how will they present?
They'll present with pain. They'll present with fever. They'll present with edema.
And they will not usually present with any bone necrosis in the acute one, right? And they can respond to antibiotics alone. That is acute osteomalitis. And I'm saying it again for many of us. The kind of osteomiitis we've seen is the chronic osteomiitis.
But then there is the acute form as well. Now what about the chronic one? So the chronic one develops over months to years and usually they are characterized by necrotic bone which we call sequesterum and invoculum which is a new bone which is forming around the dead bone and draining sinus tract. So these are usually the three characteristics of chronic osteomalitis that many of us know. There is the necrotic bone which is called the sequestrum and there's the invoke in in involucum which is you know the new bone which is forming around the dead bone and then usually you will see that there's a draining sinus tract as well and usually with chronic osteomalitis it requires surgical debridement if there's going to be cure. Okay. Now, another thing I need you to master for your board exam, the MCQE, is that you need to know the microbiology of osteomiitis.
You need to make you need to really really um understand, you really need to understand, okay, various organisms for various situations. And I'm going to show you something.
When in your board exam, you forgotten everything. Remember for all age groups always remember that common things are common. Common things are common. The commonest organism which causes osteomalitis for all age groups is stafalucos orius.
The commonest organism which causes osteomalitis is stafylocus orius. Now in the staflocus orius group we have the metisline sensitive stafloccus oreos and the metisline resistant staflucocus orius. You will realize that the metisline sensitive stafloccus oreus is more common than the metisline resistant stafluclocus oreus. So let's look at it this way. Stafloccucus orius is the most common and under staflucose orius we have the metisline sensitive and the meticuline resistant and the metellinine sensitive is more common in causing osteomiitis than metisline resistant.
Now after stafilocucose orius the next common organism which causes osteomiitis in all age groups is sudominous erogenosa. Doctors please let that sink in.
I want to allow you to allow that to sink in very well.
So if you are asleep and someone asks what is the most common cause of osteomiitis met um staflloccus orius in the staflocus orius group which organism causes more cases of osteomalitis? It is the metellin sensitive.
Then we have metellin resistant. Then after stafylocucus oros group which organism also causes um osteomiitis more commonly it is seduminous erogenosa. Now if you are quizzed on neonates neonates neonates please remember that stafloccus orius is more common in all age groups right? So but in neonates after staflucocus orius which is common you go to group B strep which is strep a galacti and then ecoli and then stafalucos orius okay so please remember this very well staflocus orius is common in all age groups but in your board exam if they are going for specific things if they ask you what's the most common cause of um osteomiitis in a unit go for group D strip What about in a child who is less than four years go for stafilocus orius and then after that you can think about kinga kingi but please remember staflocus orius staflocos orius even if you forget everything staflocus orius okay what about children who are more than four years still staflocus orius leads then this time instead of kinga kingi it comes to strep pneumoni and then strep piogenous Okay, for this table, you just have to remember certain things. Then after this table, I'm going to show you some simple tricks for specific organisms that you just have to know. Okay, what about infection drug users? Infection drug users, which organism causes osteomalitis more commonly? It's sudomonus erogenosa. Then from sedominus you can go to candida and then you can go to siraia.
Okay, good. Now what about patients with cickle cell disease? Cle cell disease the commonest cause of osteomiitis in cle cell patients is salmonella.
Salmonella please this one is very important. Salmonella very very important. What about patients with diabetes? Usually the cause of osteomalitis in diabetics the commonest cause is polyicrobial and then it can go to staff orius then strep and then others please just learn the first two you are good to go okay what about people who develop otomalitis in their vertebrae what is the commonest organism staff orius I need you to pay attention to this because I'm going to quiz you at the end of this class like what we do all the time right and then it can also be micropopplasma um tuberculosis. So also remember that that's why they develop what we call the POTS disease, right? Spinal tuberculosis. And then um what about if you are told that the patient has a prosthetic valve, a prosthetic valve, think about coagulous negative staflocus stafloccus and then you can also have staflocus orius as well. Okay. So please know the various ones sickle cell neonates all age groups right patients with prosthetic val uh prosthetic um joints. So I kept it very simple I made it very simple for you. The commonest organism which causes osteomiitis in all age groups is staflocus orius. Sickle cell disease the commonest organism is salmonella.
Salmonella. What about IV drug use?
Sudomonus.
Sudomonus. What about neonates? It's group B strep. And what about children who are less than four years after you talked about um um um staff or don't also forget about Kella Kingi. So I just used various colors to represent them.
Right doctors, this one you just need to know it by heart and you're good to go.
But if you forget everything don't forget about stuff orius. And when it comes to cle cell don't forget about salmonella.
All right. Okay. Good. Now what's the clinical presentation of osteomalitis?
Remember we talked about acute oalitis and chronic osteomalitis. So now let's deal with acute osteomalitis. Usually they'll present with fever, chills, malaise and this usually presents or reflects the bacteria the patient is going through right because we said that most of the time it is from a blood source and then it is seated into the bone and then we also have localized bone pain in acutomalitis.
There can be tenderness, there can be swelling and there can be arythemma and you realize that there is decreased range of motion in the adjacent joint and usually in infants there will be pseudo paralysis where the child is refusing to move that limp.
In children, the classic presentation of acute osteomalitis is fever, pain and diminished mobility. You see this in about 50% of cases of acute osteomalitis in children. Okay, good.
Then when it comes to chronic osteomalitis, you realize that it is often a very vague presentation and there is lowgrade fever and the patient may have chills. And one unique thing about chronic osteonalitis is that there'll be drainage from the sinus tract and that is very pto pathognmonic right drainage from the sinus tract and there can be arythmia as well as swelling and they may have periods of quietense and flare so where it everything gets quiet and then there's flare up of the symptoms again.
What about diabetics? diabetic foot osteomiitis as well. diabetic foot osteomiitis.
So you want to suspect that in your board exam in anyone with chronic foot ulcer especially if that foot ulcer you are told that the foot ulcer is deep is wide and it is over a bony prominence you want to be very careful it may present with what you call a sausage toe.
So that's why I showed you that example and usually the question may describe it that you know you see a bone underneath the skin and you need to do what you call a probe to bone test. I'll show you a picture of how to do the probe to bone test for you to confirm that this is diabetic foot osteomiitis.
So if somebody has osteomalitis what is the diagnostic workup? Get your CBC, get your ESR, get your CRP, get your blood culture and also get your proalcetonin.
Why are we getting CBC? Because luccoytosis may be present in acute cases, right? But in chronic cases, the luccoytosis might have resolved. So please be careful in your board exam.
Don't just look for luccoytosis because you have to look for luccoytosis in the context of the presentation. If it's acute osteomiitis, sure. But if it's chronic osteomiitis, you may not necessarily see a luccoytootic picture and then ESR is elevated as well as CRP will also be elevated and for blood cultures especially if there is hematogenous seeding okay blood culture may be positive in about 50% of cases.
And then proalcitetonine is sensitive but it is very very expensive and so for most centers when they able to do their CRP their ESR and their CBC and they see the features on X-ray they are good to go and they able to confirm it. So this is the probe to bone test that I was talking about right this is the probe to bone test. So you get a sterile blunt metal probe. You insert it into the wound and it is positive if there's a hard gritty feeling um gritty structure felt beneath that hole you see.
Okay. So if you have a patient who has a positive probe to bone test and the ESR is also elevated that is highly predictive of osteomiitis very highly predictive.
So if you have a patient with a positive probe to bone test and you get the X-ray and it also shows the features of osteomalitis then the diagnostic accuracy is very very high and you can compare that to even somebody who went to get an MRI to confirm osteomalitis.
So let's look at the various imaging modalities we can use for osteomalitis.
you can get your plane radioraph usually that is the first line right and the findings usually appear two to 3 weeks after the onset.
So um in very very acute osteomalitis you may not be able to pick it up very well with the x-ray unless it takes about two to three weeks then you can see it clearly. Now the gold standard remember in your board exam the gold standard for diagnosing osteomiitis is MRI with or without contrast. That is the gold standard.
Now if for any reason maybe the patient has some metals in the body or something and you cannot get an MRI then get a CT scan.
Okay. So remember when can you use X-ray? Usually if it's been going on for two to three weeks. What's the gold standard? Your gold standard will be an MRI. Some can also do a bone cintigraphy test but usually um the bone cintigraphy is used if the symptoms are not well localized.
So for me I would say do your initial plane radioraphs and then confirm with your MRI. That is simple. That's very simple. And the teaching point I want you to know is this.
A normal plain radioraph does not rule out acute osteomalitis. Why? Because we learned today that usually osteomalitis may take two to three weeks to appear on x-ray. So the patient starts having symptoms right now. You do your x-ray, it looks normal. Please don't close your eyes. It could still be osteomiitis.
Doctors please I want to know is the class making some sense like in terms of the microbiology in terms of the evaluation in terms of acute and chronic osteomalitis is it making a lot of sense please I want to know is it making sense let me know does it make sense so far in terms of classification the organisms you know um the investigations the blood invest investigations and the imaging investigations as well. Does it make sense? Beautiful, beautiful, beautiful.
People are poised for the question bank.
So, but the definitive definitive um diagnosis is with a bone biopsy and culture. Okay. And boon biopsy with culture remains the gold standard for definitive diagnosis and guide targeted antibiotic therapy because with osteomiitis you want to give antibiotics and you want to give specific antibiotics in specific situations.
So what is the management of osteomalitis?
The general principle is that antibiotics are the primary treatment and should be tailored to culture and susceptibility results. That is why this this this this slide is very important.
Bone biopsy with culture remains the gold standard.
Bone biopsy with culture remains the gold standard. Why? Because we need to culture to help us to know which antibiotics to choose.
And you want to delay empiric antibiotics until cultures are obtained.
Unless the patient has you know very bad sepsis or maybe it has extended into the the vertebrae or there are some neurological complications that is when you want to start your empiric antibiotics. If not you want to wait.
Now the standard duration is usually four to 6 weeks standard duration for management. But if in your board exam you are told that it is vertebral osteomiitis doctors go for 6 weeks. 6 weeks.
I said that the standard treatment duration is between 4 to 6 weeks. But in your board exam if you are told that it has affected the vertebrae.
If it has affected the vertebrae please go for 6 weeks. Okay. Now yes we need to do parental treatment. at some studies and remember I I'm quoting studies because from all the past free questions we've reviewed if you look at the resource that the medical council sorts them from they usually sort source or get their questions from articles right and so the there was a trial demonstrated and the trial showed that oral antibiotics are not seen to be inferior to IV antibodies when it comes to the management of osteomalitis, right? I know it can be controversial in some circles but that's the teaching point. So remember that we talked about the fact that staflucos orals is the commonest cause of osteomiitis and the staflucos orals group the metellin sensitive staffor causes more more cases of osteomiitis than metisline resistance. So assuming in your question stem you are told that the organism which is causing the osteomiitis is metellin sensitive stlucos orius what antibiotics can you give you can give cloaseline you can give nfiscellin or you can give keazolin or septriazo okay I'm just going to deal with first line stuff because remember this is an exam at the level of medical student you're not expected to reason at the level of a college of physician like a a royal college person it is at the level of medical student let's learn first line treatment what about metellin resistance taporius usually you want to use vancomyin ivy vancomyin ivy that's what you want to use what about sudonus pseudomonus if your question talks about sudonus go for cipm or meopenim go for keipm or meopenim what about salmonella By the way, who can remind me which group of people does Salmonella usually cause um osteomalitis?
Which patient group do you usually see salmonella as the cause of osteomalitis in them? Which patient group please? Who will help me?
Beautiful sickle cell disease. So if I say if if I put a question and I'll say oh patient has um cle cell disease and I don't mention osteomiitis but I describe you know sinus tract I describe all the x-ray features of osteomiitis and I ask you remember I will not say the name of the organism but I will say the condition the patient has and I'll describe osteomiitis The first line you want to go for will be cyproluxin and then you can go for septriazone. If cyproluxin does not work and if the ostealis is also caused by entrocus then you can use penisellin giv orin or second line you can use vancomyin daptomyin or linosled. Okay good. So in which patients will you want to call the orthopedic surgeon right away? In which patients with osteomiitis will you call the orthopedic surgeon right away?
Number one, if there is exposed bone, if your question is describing exposed bone, call orthopedics. If it's describing compartment syndrome, call orthopedics to come down right now. If it is describing unrained abscess, please call auto to come and see the patient. As well, if there's extensive gangrine or necotizing infection, please call autoopedics. If there's also severe lower limb eskeemia, call autoedics.
Don't waste time at all. Call auto. Call auto. Call auto. Call auto. Call autoopedics.
Right. So that that is indications for urgent surgical consultation. Now what are the indications for surgery in osteomalitis?
The indications can be chronic osteomalitis with sequestrum where there's dead bone. You need to usually do surgical debridement of the dead bone or else healing will not occur. If there's also presence of orthopedic hardware and there's the osteoporosis on top of that osteomiitis around it, you want to get surgery involved.
If there's also absess which requires drainage, get surgery involved. And if you tried antibiotics and it did not work as well, please get surgery involved. as well as if there's neurologic compromise like epidural abscess in the vertebral invertebral otoitis then you want to get both um um orthopedic surgery and neurosurgery you want to get both okay so know when you're going to call surgery because remember I always say in the MCCQE there are six things you need to know about every case the way the case will present physical exam features investigations management complications and indication for referral. Every topic whether it is eye pain, nose pain, abdominal pain, chest pain. Learn each of the topics under these six umbrellas. Case presentation, physical exam features, investigations, management, complications, indications for calling someone with specialized skill. If you notice these six things, whatever topic you are dealing with, just use these sixprong approach and you'll be good. Okay. So, you have a patient with osteomalitis. What are the complications? What are the complications of osteomalitis?
Number one, there can be chronic osteomalitis.
Okay, there can be chronic osteomalitis.
Number two, there can also be pathologic fractures especially through the places where there is weakening of the bone and there's infection of the bone. Number three, there can be growth arrest cuz in children if there's damage to the faces of the bone from the infection and it crosses the growth plate then it can cause a growth arrest and osteomiitis can also lead to septic arthritis.
So where there's spread from adjacent metaphysicial e infection especially in infants and then there can also be subparostial absess where there's pass which is tracking beneath the loosely attached perostium in children and this can lead to bone eskemia. So you want to be very careful.
And then there can also be sepsis and bacteria and it can also lead to amputation and in very rare cases it can even lead to squamos cell carinoma.
In very rare cases osteomiitis can lead to squamos cell carinoma.
So doctors, we are about to solve some questions and then we will go into the question bank and then the flash cards and everything. Okay. So by the way, don't forget that the med drill is coming on. I want to just remind you um the crash course is coming off for cardiology on July 31st and we are still taking enrollment. You can still use the 67% off and still get access. So if cardiology is a weakness and you want to join us, you can just register for $99 to attend that class alone. It will start at 5:00 a.m. Ontario time or you can become a metcognito student and because you're medto student you can get access for free. I'm going to just drop the link to the um to the to to that class. If you like to join can just click on it and join. Use the code 67% off. Okay, use that code.
Now, let's try some questions right away. Let's try some questions. So, you have a seven-year-old boy who presents a three-day history of fever, right leg pain, and refusal to bear weight. On examination, he has point tenderness over the proximal tibia with overlying warmth and swelling. Blood cultures are drawn. Which one of the following is the most likely location of infection within the bone? A. Diaphysis, B. Epithesis, C. Metaphysis, D.
Perryostium, E. Fisus.
I see a lot of doctors going for C, which is metaphysis. Is metaphysis. The answer.
Correct. Correct. Correct. Correct. So that means that what I thought people are picking it up. So the most common location for hematogenous osteomalitis in children involves the metaphysis.
Please remember that the metaphysis.
The reason why the metaphysis is the most common site is because there's slow flow of sinosoidal nutrient vessels and it creates a very good environment because of the slow flow of the blood.
The slow flow of the blood. The slow flow of the blood. So it creates a unique environment for organisms to brew in that location.
Okay. Good.
Next question. You have a three-year-old girl with cickle cell disease who presents with fever in left femoral pain for 2 days. X-ray of the feur is normal. Blood cultures are pending. Which one of the following organisms is classically associated with osteomiitis in this patient's underlying condition? A e.coli Colli B. Grubby B strep C. Kella King D.
Sedonus Ainoa E. Salmonella.
What's the correct answer?
What's the correct answer?
What's the correct answer?
What's the correct answer?
What's the correct answer? K. So everyone is going for E which is salmonella. Salmonella salmonella right and salmonella is the correct answer.
Salmonella is the correct answer. Okay because salmonella is associated with osteobalis in patient with cle cell disease. Even though as I said staff orius is the most common overall pathogen when you are given some of these specific conditions in the board exam the examiner is expecting you to think in a particular direction and salmonella is the commonest cause of um osteomalitis in cle cell disease because they are not able to deal with encapsulated organisms. Okay, good.
You have a 55year-old man with poorly controlled type two diabetes. He presents with chronic non-healing ulcer on the planter surface of his right foot overlying the first meta metatasal head.
The has been present for 8 weeks. There is surrounding iththema and mild swelling. Which one of the following bedside tests is most useful to evaluate for underlying osteomiitis?
A. Allen test, B. Monofilament testing, C. Probe to bone test, D. Seisenstein test, and E tuning fork test.
Good. So, probe to bone test. Why are we getting it correct? We've been taught in class today, right? Okay. Good. So, the probe to bone test, remember, is the most useful bedside clinical examination to detect diabetic foot osteomalitis and it has a sensitivity of 87% and a specificity of 83%.
So if you get a positive probe to bone test, it is defined by you know you feel a hard gritty structure when a sterile blunt metal probe is gently inserted into the wound. That is the probe to bone test for you. Okay, next question.
You have a 45 yearear-old man who presents a six week six week history of right tibial pain which is which followed an open fracture repair 3 months ago. X-ray shows perostial reaction and a radolucent area within the bone. MRI confirms osteomiitis with esquestro.
Now which one of the following is the most appropriate management? Which one of the following is the most appropriate management? A antibiotics only for six weeks? B. Hyperbaric oxygen therapy alone. C. Observation and repeat imaging in four weeks. D surgical debridement plus antibiotics. And E surgical debridement without antibiotics.
So the correct answer is D which is surgical debridement plus antibiotics.
surgical debridement plus antibiotics because we learned that chronic osteomalitis with sequestrum that's dead bone you need to surgically debride it with and then you need to cover the patient with antibiotics right and the sequestrum harbors you know a bofilm protected bacteria that are inaccessible to antibiotics and the immune system so you need to debride that so that antibiotics can work and usually you give you antibiotics for four to six weeks but I have a Question. If the osteomalitis is in the vertebrae, how long do you give your antibiotics?
Doctors, please. Who can help me? If the osteomiitis is in the vertebrae, how long do you give the antibiotics?
Who help me? Who help me? Who help me?
How long will you give your antibiotics?
6 weeks. If it is in a vertebrae, it's 6 weeks. Okay, good. Next question. A 70-year-old man with diabetes presents with chronic foot ulcer. The probe to bone test is positive. Plain x-ray of the foot is normal. Which one of the following is the most appropriate next step? A begin emperic antibiotics and reassess in 6 weeks. B CT scan of the foot. C discharge with wound care instructions. D MRI of the foot. And E plain X-ray in two to three weeks.
So I see a lot of doctors going for D. A lot of doctors are saying D.
Remember it says 70 year old man with diabetes presents with a chronic foot ulcer.
The probe to bone test is positive.
Plain X-ray is normal. Which of the following is the most appropriate next step? Are we going to go for A? Are we going to go for B? Are you going to go for D? Are you going to go for E? And the correct answer is E. When and we learned this the last time that in osteomalitis usually plain X-ray is your first line. And usually you also have to understand how the Canadian healthare system works, right? Um if you've done if you've not done an X-ray for a particular condition, unless it's very very severe, the result will request that you get an X-ray before you jump to an MRI. Right? And we know that MRI is for definite um to to help us to make a concrete diagnosis and a definitive definitive definitive investigation is bone bone culture, right? But if your initial X-ray is normal, we learned that it takes about two to 3 weeks for you to see oalitis on X-ray. So you just want to repeat it, right? So I just want to read what the um explanation here is that when initial plane X-ray is normal but clinical suspicion for osteomaly is high. You need to repeat the radioraph in two to three weeks as it is more likely to reveal osteomalitis at a point right and there are a lot of guidelines which recommend using a combination of the prone to bone test plane x-rays ESR and CRP as the initial diagnostic studies.
If the diagnostic if the diagnosis remains uncertain after repeat X-ray then you can get the MRI then you can get MRI. Okay. Then you can get the MRI.
Then you can get the MRI. Okay. So think we are done. So this is what I would do if I were you and I have MedBody. Right after I finish studying, what I would do then is to go to the Medco Cognto portal and I'll go to MedBody.
That's what I'll do. I'll go to MedBody and review some concepts with MedBody.
So that's exactly what I'm going to do right now with you. Okay? Let's review some concepts with MedBody.
Let's review some concepts with MedBody right away. So this is how MedBody looks like. So but admin will join me and then we will go through the rest of it. But this is just the flash card portion.
This is just the flash card portion. So in your med Cognito medy, you have your home screen. Admin will take us through everything. You have the question bank, you have the flashcards, you have mock exams, and you have progress. And you also have a study plan. Admin will take us through that. But for me, I'm just going to focus on the med buddy the the flash card because maybe I've come to class, I've learned something, I want to just review it in 10 simple points. How am I going to use the metcognito flashc card system? So the first thing I want to do is this. So I just studied osteomalitis, right? Okay. So I go there, I just type in osteomalitis.
I just type in osteomalitis. Or if you want me to create a new deck, I'll just type in osteo myitis.
Okay. And then I'll just tell it generate flashc card. So it is going to generate a flash card. And then we will see whether the knowledge we have we can apply to this flash card. So that is the first thing I really really really really really want you to apply so far as your med cognto medbody is concerned.
Okay. So it's just generating it's going to take its time generate it for you and then quickly we go on. Okay. So osteomiitis flash card is ready. So let's go. So let's go to the study get deck. So the first thing is this define osteomalitis. So osteomalitis or define osteomalitis and distinguish between acute and chronic forms of osteomalitis.
So doctors, we just finished a whole class on osteomiitis and now your med body is also quizzing you in 10 simple steps. Okay, so I'll flip my card.
Osomalitis is a bone infection usually is bacterial. Acute osmalitis is usually less than two weeks. Supative inflammation. Chronic osteomalitis usually more than four weeks where there can be necrotic bone which is a sequist and a new bone which is the involucum formation. Simple. Then I go on to the next thing.
Acute oimalitis in a child typically presents with what? What? And what?
Because remember you are trying to do active recall. Doctors please are you following me? You are trying to do active recall with your flash card. And so now I turn it and what am I seeing?
Atosmalites in a child will present with fever, localized bone pain, systemic inflammatory markers which will be elevated which are ESR and CRP. Simple simple stuff. then I go to the next one and oh okay so the medbody aside the fact that I'm going through so if I say I've really mastered my osteomiitis even as part of the flash card as well it is going to give me an MCQ question so this is the question I'm going to read the question out loud for you so you have a 35 year old man with poorly controlled diabetes his hbaw1c is 9.2% 2%. He presents with non-healing foot ulcer over the metatasal head. He reports four weeks of progressive pain and drainage.
Plain radioraphs show bone erosion.
Which one of the following is the most likely organism?
So, which one of the following is the most likely causive organism in diabetic foot osteomiitis?
A. Staflocus orius. B. Strep piogenous.
C. Sudedonus aerogenosa D microbacterium tuberculosis. Doctors what was the correct answer? So this is your med body. You are just testing your hands on you know the concepts and now while you go while we're going through the concept it is giving you a quiz.
So please what's the correct answer?
What organism is usually the cause of oalitis in diabetics? Is it a staff orius b strep pyogenous cedonus aerogenosa or e microbacterium tubaclosis? What's the correct answer doctors?
Okay, so I've seen a couple of people go for a which is staporious. Does someone have a different answer?
So this one will ask me to choose my answer first before it will reveal the answer to me.
So please are you all sticking with a diabetes and osteomalitis?
You sure it is a? Okay, let's see if you think it's a let's see. So all of you are saying a. So I'm just going to choose what the group is saying. I'm choosing what the group is saying. Okay.
So if I flip the card, what does it say?
A staflo orius. Now you also realize that even in the flash card you can get explanations and the explanation is very succinct. So you don't need to read too much. You don't need to read a whole thesis. So staff orius is the most common cause of osteomiitis overall and in diabetic foot infections including metin resistant staff or strains in healthcare settings.
Simple. This is it. No long talk. Then we move on to the next question in the flash card.
What is the gold standard imaging modality for confirming osteomiitis in a child? What is the gold standard imaging modality for confirming osteomiitis in a child?
What is the most Oh, somebody's asking for what is the price tonight. Doctors, it is free. Tonight it is free. Tonight it is free. We're going to on board everybody. That's why I'm saying please tell all your friends to join the class right now. Everybody on the class is going to get it for free tonight. It's free tonight. It's free. Okay. So, what is the gold standard imaging modality for confirming osteomiitis in a child?
Please answer my question. Forget about how much you're going to pay. We do a lot of things in met cognto for free, including spending time with you previously on Sunday afternoons and now on Monday evenings. We've already done one hour and we are taking you through a whole med dealing with osteomalitis.
Tonight it is free. Tonight it is free.
So what I've seen some doctors going for MRI and the answer is MRI. MRI gadolinium contrast. It detects narrow edema, soft tissue involvement and absess formation earlier than CT or plane radioraphs. That is why MRI is the best doctors please. This is what medbody is about. And remember this is just the flash card portion.
your mocks have not come which admin will take us through your um actual question bank has not come. It is also going to even give you insight to which areas are your weak points.
So the medbody is like you know your companion who is telling you that doctor you are a cardiologist in your home country. So it looks like you're getting a lot of questions correct in cardiology go and try your hands on public health and as you are doing your mock exams in the medbody the medbody will realize your weak points and it will be giving you signals that doctor you are not doing well here. So it's not just a generic thing but I'm not going to get into that. Let's continue with our our flash cards. doctors remember this is just a flash card. We've not gone through all the other features and that's why I'm for me I'm very excited about it. So you see instead of sitting down for a whole lecture from Dr. Brun on osteomalitis med is just breaking everything down with you for you quick questions quick MCQs that is just the flashcard portion.
So next question is a 45-year-old woman with chronic diabetic foot ulcer and suspected osteomiitis is being worked up. Blood cultures are negative. Which diagnostic test is most specific for confirming bone infection? A bone culture which is needle aspiration or biopsy. B elevated ESR and CRP alone. C plain radioraphs showing a bone erosion.
D positive blood culture alone. What's the correct answer? Is it A? Is it B? Is it C or is it D? Doctors, tell me. Tell me. Tell me something sweet. Type your answer in the comment section. Type your answer in the comment section. Is it A, is it B? Is it C? Is it D? Which one of the following diagnostic test is most specific for confirming osteomiitis?
Okay, I've seen a couple of doctors going for A. They're saying A. A. A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A. A lot of doctors are going for A. So, let me choose my A and let me flip my card. Boom. Bone culture. So, bone culture is the gold standard for diagnosing, confirming infection and guiding antibiotic selection doctors. So, you can type in any topic whatsoever so far as it is in the MCC objectives.
Boom.
MedBody will be there for you.
Med will be there for you. Okay, good.
Let's go to the next one.
What is the recommended initial antibiotic regimen for acute hematogenous osteomalitis in a child with metisline sensitive staff orius?
What is the recommended initial antibiotic regimen for acute hematogenous osmalites in a child with metisline sensitive staff orius? And the correct answer doctors, what's the correct answer?
What's the correct answer?
Okay, so I'll pick this question.
Someone says, does metcognito have an app? Admin will answer that when he joins us. Admin will answer that when he joins us.
Okay. What is the recommended initial antibiotic regimen for a child with hematogenous acute osteomiitis which is M MSSA and the correct answer is IV keazeline or clogeline and you do that for four to six weeks you do that for 4 to 6 weeks and then you can transition to keileexin or clogazeline after there's clinical improvement and you've controlled the source Next question. Next question. Next question. Next question. Next question.
Doctors, this is it. This is it. This is it. So, you have a 28-year-old man with chronic osteomiitis of the tibia due to previous open fracture and is being cancelled on treatment expectations.
Chronic osteomiitis often requires dash dash and dash to achieve cure. So, this one you should have known. Okay. So it will require surgical debridement, removal of the sequestrum, prolonged antibiotics for about four to six or 6 to 12 weeks or longer if necessary.
Okay, next one. Name two serious complications of untreated or inadequately treated osteomalitis.
So you have a 16 year old with untreated acute osteomalitis of the proximal humorus is presenting with worsening systemic symptoms. Name two serious complications of untreated or inadequately treated osteomiitis. Who can help me? Who can help me? Who can help me? Two serious complications of untreated or inadequately treated osteomiitis.
Two serious complications of untreated or inadequately treated osteomiitis.
Okay. So I've seen some answers. Septic arthritis. Someone just typed in septic arthritis. Someone also typed in amputation. Are we going to get more answers, doctors? Are we going to get more answers? We have more than 70 people on this live stream right now.
Septic arthritis, Meline ulcer. Well, Meline ulcer we learned is very rare, right? Meline ulcer we learn is very rare. So what is the answer? It can lead to sepsis, bacteria, pathologic fractures, chronic osteomiitis with sequestrum formation, growth disturbance in children and septic arthritis if infection spreads to adjacent joints. So all the answers a lot of you put there is or are correct. Okay, next one.
A 10year-old presents with two weeks of right knee pain, fever and elevated inflammatory markers. MRI shows metaphysicial maro edema without joint eusion. Which diagnosis is most likely?
A. Acute hematogenous osteomalitis. B septic arthritis of the knee. C.
Transcenditis.
D. Leukemia with bone pain.
Two weeks of right knee pain, fever, elevated inflammatory markers, MRI shows metaphicial marrow and edema without joint eusion. What's the correct answer?
Is it A? Is it B? Is it C? Is it D? Is it D? D for daddy. So, what's the correct answer?
So, I see a lot of you going for A. I'll let me go with the group. Let me just click A and let's see.
So, A is the correct answer. That is acute hematogenous osteomiitis.
Next one.
What are the main indications for surgical drainage or debridement in acute osteomiitis? So doctors and remember you can create another set of flashc cards on osteomiitis. So after your first 10 if you want to even go deeper but hey if I am going for osteomalitis like I'm preparing for my board exams and I go through these 10 questions I think I'm done. Literally I am done. I'm done. Any topic medbody got you I'm done.
I'm done. So what are the main indications for surgical drainage or debridement in acute osteomiitis? The correct answer is if there's failure to improve clinically within 48 hours of antibiotics. If there's a large absess on imaging, if there's a pathologic fracture or involvement of adjacent joint, then you want to do early surgery which will improve the outcomes.
Doctors, ladies and gentlemen, this is what MedBody offers. This is just a flash card option.
Right now, I'm going to invite admin to join us right now and he's going to help us. So, admin, thank you very much for joining us um tonight. The people want to hear from you. They want access to the medbody right now. So, how do they get access to medi?
>> All right. Um thank you Dr. Bronny and I think the whole team is excited to make this available to um our students as Dr. Brony mentioned um you know you can access MedBody for free. you get a set of you know questions that you can try your hands on. Um and we're building this you know as as a solution to um you know a problem that we found with you know a lot of um our candidates preparing for the MCCQE right you know typically your your your your preparation is spread across you know a number of tools and at medcognito what we are trying to do is you know build an ecosystem that once you come in you have everything you need for your exam preparations. So what BitBuddy is is basically um you know a one-stop shop for your um MCCQE prep and you know we are building this not to just serve you know the MCCQ community. We also going to expand this across you know other exams but for tonight I think what we're going to show you will be for you know >> admin please can you raise your voice please we can't hear you clearly >> sorry I think for tonight what we're going to show is for the MCCQE exams um so I think you know Dr. Brun has already shown um what the you know the flash cards um portion of the of the of the of the application will look like. One thing I want to point out is um you know the system I'm going to show is connected. So you know if you're doing something like question banks and you're missing some questions the system automatically pulls it into your flash cards and then once you go to review your flash cards you know you can review questions that you've missed as part of your Can you raise your voice? We can't hear you.
>> Um, can you hear me? Can you hear me now?
>> Yeah, it's a bit better. Yeah.
>> All right. Yeah. So, what I was saying was, um, you know, we're building this to be an interconnected, you know, system where, you know, you you're not just generating flashc cards on a specific topic. If you're doing a mock exams and you miss some questions, some of the concepts will be pulled into your, you know, your flashcards experience and um, you know, you see some of those concepts as you review your due flashcard. So, you know, I'll stop I'll stop the talking and take you through what the application looks like and, you know, also answer any questions that you have. But, um, Dr. Brony, I think, you know, we are very excited to to to share this with, um, with the entire, um, you know, >> let's do it, buddy. Let's do it.
>> All right. Okay. So, please let me know when you can see my screen. Um >> so what he's saying is that you know there are a lot of question banks in the system right and most of the question banks are specific it's like okay you do this you are done these are the questions however what we have built at medco with our group of engineers and um our consultants is as you are solving your questions so you realize that each candidates's um experience with met is different >> it's dynamic it it is suited towards somebody. So for example, if you get MedBody and you share with a friend, what is going to happen is that MedBody is going to it's going to get it's going to put your experience and your friends experience together >> and so it will not be giving you the >> signal.
>> It will not be giving a true reflection of what you are doing.
>> Yeah. So as you are solving questions maybe you are doing well on public health you are doing well on ethics but you are not doing well on cardiology you realize that when you go to your flash cards because cardiology is your weakness medbody will then be quizzing you more on cardiology. So as you do mocks and as you do your question banks it is now building a profile for you. So admin please you wanted to share something?
>> Can you can you see my screen? Um are you able to see my screen?
>> Yes. Um let me see.
Yes please. This is your screen.
>> All right. Awesome. So um you know for everybody this will be your homepage.
This will be what you see when you have full access to meduddy right. Um so once you know you get full access this is what you're going to see your initial dashboard you know gives you some metrics around your readiness as you do more mocks as you >> admin please can you raise your voice a bit please?
>> Hello can you hear me? I think >> I'm speaking as loud as I can. Um but yeah, um this will be your initial dashboard. You know, you have we have a readiness score that we are basing on the um you know the MCCQ's MCCQ's sorry the MCC scoring you know mechanism um and that's how >> so the readiness score will tell you whether you are really ready for the exam or not. So if your readiness score is say um um so admin the readiness score what's the total it will give you >> not over 100 um >> it's over 100. So if you doing if if your readiness is 13 that means doctor you are not ready for the exam right okay good hear you so I'm the one who is who is not able to hear you so I'll keep it that way so the readiness score so part of this whole thing is that it also tells you as you solve the questions it will then tell you doctor are you ready for the exam or not so you can't just solve cardiology questions and then the the thing will tell you you are ready for the exam no because it will know that you've not done questions in public health. It will know you've not done questions in ethics. It will know you've not done questions in nephrology. All right. Okay. Good. Admin, please continue.
>> Um so yeah, you have your readiness score. Um again, I want to caveat that this is not an um you know, it is not an MCCQ MCC um you know score, but we are using the MCC MCC scoring mechanism to calculate your score. So you know it gives sort of a good reflection of what you are doing. Um also um this is something that I think Dr. Bon has pointed out that you know the system itself based on what you're doing across you know the various objectives and because this is also rooted in the objectives um by the MCC MCC as you go through different mocks as you go through you know different questions um it understands and it's able to recommend to you that hey you know you're you're lacking a bit in cardiology so maybe you need to go do some practice in cardiology so you know the system is intelligent enough to make these recommendations to you. So you know you're not skewing your preparation towards one specific um you know area as Dr. said you know some some because you know we are specialists in some fields sometimes you know we we we tend to you know skew our preparation towards where we where we feel the most confident. But what medbody does is it exposes you know those um skewess and tells you hey you need to change course and go into this direction. So this is one feature that we are really excited about you know >> so so admin so what you're saying is that as I practice the thing is intuitive enough to tell me hey Dr. Brun you are weak in cardiology go and practice some cardiology questions.
Yeah. Yeah.
>> Meanwhile, the system will be telling another candidates that hey, you are weak in public health. Go and prepare on public health.
>> Correct. Yeah.
>> Beautiful. Correct. So, yeah, there there are specific signals that you know are being sent as you go through the system, right? So, yeah, this these recommendations will be very different for different people. Um, so I I think you know, Dr. what what you were saying was it's it's better for you to just you know use this system and get the correct signals as you prepare for your exams. So you know that this is sort of um your your your your home dashboard. We also have you know as you go through it the systems that you know you are either doing very well in um and the systems that you're not doing so well. So, so for this user, you know, you can see that they're doing so well in gastroenterology, dermatology, and you know, some um you know, general um practice questions.
They're lacking in ethics, um you know, public health and infectious diseases.
And we also have like, you know, some non-specific system topics. So, they've not done any questions across these systems. So, the system is flagging that. Um on your we also have like this trick that you know encourages our student to always come back and practice at least for a day. You know one thing we believe at Mecognito is you know you need to be consistent in your practice >> even if you're not doing like you know a whole study session a day. We encourage you to you know come in and do maybe 20 flashcards or you know maybe five questions in your question bank. So we have this streak that you know encourages that. I'll just step through the other features um on the question bank. I know Dr. Brun has already spoken about flashcards. I will go into our question bank. So admin please can you go back go down where it says lower retention systems. What what what is it really going to tell me to do?
>> So the this is part of the signals that you know um are being sent to your focus next. So you know the systems that you've not practiced enough in will eventually pop up in your focus next and you know you'll be recommended to go try >> um you know either a question or a mock on that particular system.
>> Okay.
>> Yeah. Okay. So, stepping into um you know the the the the the meat of the actual application, we have our question bank and currently as of today we have about 3,000 questions or about you know 2500 um to 3,000 questions in um you know the question bank and one thing that is you know as as we do at Medcognito all our teachings all our classes are rooted in the MCC's objectives right that is where we specialize that is where we focus and you know make sure we are getting our students ready for the exam. So the same way we structured the question bank it's based on the MCC's objective. So um if you come in the question bank you know you can select which area you want to you want to um you know you want to specialize or focus on for today. if you leave if you leave it if you don't select any of the specialties it will just produce like a mixed um you know system question bank um and then you can you can go in and you know review so for this example I'll just do you know five questions I'm not going to select any specialty I'm not going to select any difficulty level and I'm also not going to select any of the you know unseen or seen questions I'll just leave these blank because this is one thing that we've also added right um if you just want to focus on new questions and you don't want to see any of your old um any of the old questions you've done, you know, you have the option to do that. So, I'll just start a five, you know, five um question question bank and just go through it. So, I'll just click through this. Please forgive me. Um you know, we're not doing this for perfection. Oh, I actually got it right.
So, yeah. Um I just want to show you the experience and how this looks like. So you have your question, you have your um your question stem, you have your you know your answers and immediately you submit, you get to explanation. The question bank is sort of your tutor mode, right? So this is where you want to study a particular topic or you just want to try your hands on some questions. Um this is where you come to do that. Um so I'll just click through that. Um and you know just try to get through this as fast as possible. So once you finish you know you get um your score it gives you the breakdown by system and how you did across those systems and then you can also review um you know the questions that you did and one other feature that we've put into this is you know outside the the quick explanation that you know the system itself gives you we have this dive deeper um that is sourcing from you know academic papers you know all it's it's sourcing from a lot of you know medical um um you know information systems to give you a deeper understanding of this particular question. So we're not just giving you you know like a twoline explanation >> admin before you continue listen to what someone is saying finally I have a buddy to keep me on track with pointers.
Awesome. This is great news.
>> Yeah. So you know we have the deeper explanation that gives you it it gives you like a deeper dive into you know why you know this answer is correct or this answer is wrong. So you know we're not just giving you you know a resting tumor that's the correct answer. No we're telling you why and giving you you know some academic references as to why you know this answer. So if you really want to dive deep into a topic you can always use the question bank feature um to do that. Uh okay >> Dr. Brun I don't know if you have any questions or if there are any questions in the chat.
>> No so look it's and you know so where did we get these sources from? You realize that as I said the medical council has books and um actual references on their website not just Toronto notes. No they have actual books. So for example public health they want you to use EFMC primer you know um ethics they want you to use CMPA choosing um doing right. So we have built our entire system based on all the recommendations from the medical council of Canada right and that is why after I taught um osteomiitis I just went into medbody just typed in osteomiitis and the very concepts I taught because I sourced my information from tintenali from up to date from dynamed medbody look at the way medbody was also quizzing me focusing on the various things that and you saw it. I generated Medbalid live. It's not like something I already had hidden somewhere and I just brought it up. So if you want something which focuses on what the medical council wants you to know.
>> Yeah.
>> Not just fluff knowledge, not some ch GPT or claw thing. No, this is built tailor made for you for the MCCQE exam.
Okay. Good.
>> So yeah, just just also mention you know this is Another question here says, "I'm a new user and I want to have a twomon course and some information. Can anyone please share me in private?" Yes, doc.
Please send me a WhatsApp right now on plus one. My number is what is scrolling at the bottom of the page. Plus 1 306891-5649.
Plus 1 3068915649.
Another doctor says if someone is isn't a metcognito student can he or she will be able to use medbody if he has how yes we'll talk about it and so for now we are testing so it will be open to both metal and non-medcognito students but as time goes on we'll see we may add it to the main metcognito program or we'll still keep it separate whichever one works we will see then someone is asking does the med body address the two new objectives every new objective MedBody covers.
Okay. Every new objective MedBody covers. So, for example, um I I don't know which two new objectives you're talking about, but maybe you can type it in the comment section and then I will I will I will look into it for you. Admin, please continue.
>> So, going into the next one, Dr. Brun, >> we ch all the resources as per med MCCQE guidelines strictly. Yes. That's why I'm saying this is not some random AI thing.
No, it is focused on MCC objectives and MCC resources only. All the books that the MCC recommended tint and everything we are focusing on that only nothing more nothing less. Okay, moving on to the next one. Um so we have this you know when you come to your flashcards um experience you have two features right?
you have this flash cards due and where that is sourcing from is you know let's say I did a question um you know I went through the question bank I got some questions wrong you know that sources those um you know mixed missed questions those missed concepts are pulled into my due card so when I come in the morning I can I can quickly say hey um um you know because I missed these questions I just want to quickly review them and you know make sure getting those concepts right from a mock that I did or from a question um that I did through the question bank. So that is how the review or sorry that is how the you know the due cards work. The next one is also like you know being able to generate new set of you know um decks um for space repetition through this you know generate new deck functionality right so it's it's it's twofold what you're doing the qu the questions and the concepts that you're missing whilst you're doing a mock and also going into the question bank those are sourced into your due cards and then you can always come in and generate a new card for any any topic that you know you want to um review as Dr. Bony you know demonstrated with osteomalitis and as you generate them you can generate as many as you want for a particular topic and you can see all those decks here. So that is how our flash card um feature works and you know as I said this is integrated across your whole experience.
So it's not like you're doing one thing here and you're coming to see a different set of questions here. No, it's all based on MCC objectives. based on the signals that you're sending as you go through the experience. And we also have this um mock feature. So this is where you have like your more timed, you know, mock experience or you're you want to put yourself in an exam setting, right? So let's say you've you've gone through, you know, you've gone through Cognito for, you know, five months. You you have you're in your last month preparing for the exams. You can do some timed mock experiences or you can take some timed mocks and currently we have um you know three handpicked mocks in the system. These are you know mocks that um we've used in the past. These were paid mocks that we've made free for medical cognto students in the portal.
Um you can also generate your own mock right based on the based on the different um you know MCC objectives or based on the different specialties. So you can go into the the handpicked mocks. That's one option. Or you know if you want to do um you know mock on urology, you can always come in and say I want to do maybe a 20 a 20 set mock. I want it mixed. I want it across just urology or maybe you know a number of other systems. Um you know you you tell it to build you a mock and then it builds. The difference between this and the question bank is this is timed, right? And as you get closer and closer to the exams, you want to put yourself under these exam conditions as much as possible. You know, you can highlight, you can flag questions as you go through them. Um, and you know, this this doesn't give you the answers immediately. you know, you have to go through the whole thing before um you know, you see sort of the the the your performance and you know, how much what what you did. I just want to click through this as fast as possible and show you the analytics that you know this pushes for you after you're done.
Um so just bear with me. Let me just do this. Hopefully I score above you know average.
>> Remember admin is not a medical doctor.
He's an actuary scientist. So, we got a group of engineers together to build it.
>> So, he's just going to, you know, click click click and then we'll see how much he scores.
>> So, forgive him. Okay. Please forgive him.
>> All right. So, for for this experience, you know, I got 15%. It's telling me it's below standard, which is true. I got just three correct. I missed about 17 of them. Um, it tells me my pace, right? And this is one thing when we used to do the timed mocks, we usually encourage students to you know make sure at least they are spending not not more than a certain amount of time on a question and you know we put this metric here to help you continuously evaluate how much time you're spending whilst you're going through you know these questions because Dr. Bruno, I think what we realized was um you know people don't feel the MCCQ because you know they don't know what they're doing. Most of the time it's you know from fatigue you know because it's a long exam and also like people just don't finish the exam right so um you know we've we've put this pace here to help you understand that hey how how am I doing you know when it comes to answering questions and as I said you know the the the concepts that you miss here they go directly into your flash cards.
So for the 17, you know, or so questions that I missed, if I go into my flash cards, you know, you realize that they are there for me to, you know, review as part of my due decks. Um, what else do I even want to point out?
>> Please, someone has a question. Someone says, "Is MedBody operational yet? I'm a med cognto student. I'm on MedBody presently. I'm not seeing all this experience now."
>> Yes. So for for for our med cognto students um after this you know after this um webinar we are going to make it available to you. So um the s what you have in your system currently is you know the outdated meduddy >> is the outdated version. Yeah.
>> Yeah. We are going to make this available to you um Dr. Dina.
>> Okay. Um so yeah that's sort of our mock experience and you know for those who sign up sign up sign sign up and use metuddy um you know we're going to continuously load the handpicked mocks which you know are curated you know questions um based on you know the signals we are getting as to where people are you know are not performing and all that good stuff. So um you know be on the lookout for the handpicked ones but as I said you can also build your own mocks around you know specific systems >> and admin the beautiful thing is that now we can use this system to help us to know which areas the candidates are struggling with then we can decide on the crash courses we are going to do for them >> right >> so it's not just oh oh this month what do we do do we do cardiology no no no no we come to the dashboard we see the performance of both met cognitive and non-metcognito students. The system will tell us where the students are doing well and where the students are failing and they will go like okay this is the weak point this month this is where we're going to focus on remember you're also going to get your live classes you're going to get you know the Monday classes so doctors this is a whole soup everything is in there you know and we are just cooking we are just cooking we're just cooking so admin where do we go from here tonight where do we go from >> I think you know Dr. Brun what I what I want to point out is you know at Med Cognto what we're doing is we're trying to build this ecosystem where you know >> your your preparation is not scattered right >> yes >> you have you have you have well seasoned you know professors or professionals who are taking you through you know guided lessons you have your notes in your portal and you have this added resource as you know a study buddy as you as you use all the all the tools in in our portal as well. So that is the that is the ecosystem we're building. That is what we are building for the IMG community and you know we hope that everybody on the call you know jumps on this and you know joins the metcognito um train but yeah um for me cognto students within the next hour we're going to make this available in your portal and you know you can start using it. Actually Dr. Brun maybe we should just share the link so you know people on the >> Yeah let's share a link. Let's share a link. So so what what are we doing? I just want to know exactly is this link for the non-metcognito students or >> everybody can use it. Um so for nonmetog students what they need to do is they just need to um log in with the same email address they use when they logging into their portal.
>> You mean the metcognito students they should use the same email they use when they logging into >> Yeah.
>> their portal.
>> Yes. When they're logging into like you know their study portal they should use the same email address. And for non-medcognto students they can log in and you they can log in with any email address and they will get you know a view of medbody.
>> So will the non-medcognto students get all these features? Yes.
>> Or they will get some features?
>> No.
>> Or what?
>> So for for medcognito students we've they unlock a six they unlock six month access of meduddy for free as part of their subscription. And for nonmetbuddy students, sorry, non-medcognito students, they get, you know, access to a view of MedBuddy um and they can unlock, you know, um sort of the additional features as um behind the pay wall. They can pay for it and just unlock the additional features. Yeah.
>> So, so how much does Medio cost?
>> Um I mean for your monthly subscription, you know, it's it's it's it's a cool $99. Um >> it's $99 for a month.
>> Exactly. for non-medcognito students but for medcognito students for now it is part of your subscription >> correct yeah >> it is part of your subscription yeah >> yeah yeah and if you want a three months um a three month subscription I think that's 269 >> so if you want three month access to medbody if you are not a med student is just 269 uhhuh >> yeah and for um for sorry for full um for for six month access it's 36 69 I believe.
>> So for just 369 you get 6 months access if you're not a metcognito student. But if you're a medical cognto student you get access till your time expires.
Ladies and gentlemen, doctors of the noble profession.
So admin please can you share the link so that we can um um um we can get it for them? Yeah it's free tonight. It's free for everybody.
>> Dr. How do I can I can you can you add the link to the chat? It's app.
>> Okay. So, I'm sharing the link right now. app uh >> app.medcognito.com.cognito.com.
>> So, doctors, I've shared the link for the MedCto students. Please use the same email address you use when you are logging into your Medco Cognto portal because we are using that to unlock the whole experience for you. For the med non-medcognito students, you can use whichever email address you want. It is going to give you some parts of the medbody and then you can take it from there. Doctors, I've shared the link.
It's app.mmedcognito.com.
Okay. So, start using it tonight. Thank you very much. Um, yeah, for if you even a medcognito student who is paying monthly, you still have access for free.
So your access ends app.mmedcognito.com.
Let's go. So doctors, thank you very much. It's been a wonderful evening.
Don't forget if you want access to the entire experience, just become a med cognto student for even just $420 every month or 6 months is only $2,200 Canadian. Remember, it also gives you access to the six-hour cardiology class on July 31st, right? If you don't want everything in Med Cognito and you want only that class on July 31st, it's only $99.
But if you want MedBody only, it's also only $99 every month. And if you want three months, admin mentioned it. If you want six months, admin mention it.
Remember, there's also the free version as well. And that is open for everybody.
just clarity on the on the pricing. So yeah, monthly 99 bucks.
>> Um for a three month pass it's 269. For a pass it's 399. Yes.
>> Beautiful.
>> Yeah.
>> Beautiful. So doctors, there's something for everybody. Those who want it for free, you can have it for free. I don't have a problem. app.cognito.com app.medcognito.com I'm putting it there again.
app.medcognito.com.
Okay, get app.mmedcoto.com.
Click on it. Start using it. Start sending me your reviews. You can send me video reviews. You can text some reviews to ask. app.medcognito.com. If you're a medcognito student, use the same email address you use when you are logging into your portal so that we can open everything up for you. If you're not a Medco student, you'll get access, but some portion limited. Okay, thank you very much. For just $420, you get access to everything in Medco, the live classes, replays, notes, um access to the crash course, access to this question bank, doctors, the soup is too much. The soup is too much. The soup, the food is too much.
QE1 MCQE just got easier with metcognito. So let's not take your time and oh yeah admin someone was asking does it cover the new objectives I want to just share my screen for the doctor to see something here just so that you know you will see what it's all um let me see how do I share this screen okay let me share my screen so I think the new objective that doctor was talking about was clinical informatics okay clinical informatics So let's just go here just let me just type just so that you'll see that yes so clinical informatics and then I'll just go to generate flashcards this is just an example so clinical informatics study deck boom define clinical informatics and its primary goal in healthcare boom it gives me the answer right I go to the next one what is an electronic health record and what are its core functions beautiful boom An EHR is a digital record of a patient's health information across multiple care settings. Next one, the high rate of clinically relevant alerts in an EHR system is an example of da da da. Then you flip it, boom, alert fatigue, decrease patient safety. Next one.
Which one of the following is the most important consideration when migrating patient data to a new EHR system? So doctor, whichever new objective the MCC introduces, we capture it for you. We capture it for you. Every objective is captured in Med.
So thank you very very very very much admin. You and the team have done a yman's job. We want to say thank you. Um yeah. So when you register, you'll also realize that it will send you a code to your email, the email you use to register.
Just um use the code, put it in the in the in the in the in the web browser you use and then it will open everything up for you. Okay. So app.medcoto.com.
Let me put it again. app a.mmedcognito.com.
Okay. And those who are having trouble um you can just send me a message on WhatsApp and then admin and I can help you there. My phone number is + 1 3068915649.
plus 1 306891 5649.
Doctors, thank you very much for your time. God bless you. All the best. Good night. Bye-bye.
Meet MedBuddy, an adaptive study workspace built for medical learners preparing for high stakes exams. The home dashboard gives learners a clear starting point. Readiness, streaks, do flashcards, weak areas, and the next best action. In tutor mode, each question becomes feedback. Learners see why the right answer works, why distractors are tempting, and what to review next. On mobile, MedBuddy keeps recall moving with quick flashcard reviews, progress streaks, and spaced repetition built into the flow. The progress view connects question accuracy, mock activity, flashcard reviews, and readiness into a plan learners can act on. Instead of jumping between disconnected tools, MedBuddy brings practice, recall, mocks, and recommendations into one study loop.
We're inviting MVP testers now. Try MedBuddy. Pressure test the experience and help shape exam prep.
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