Second Exam Week Two

Other than missing out on the Black Eyed Peas and U2 concert up the street, studying for our exams this time around has been similar to those in the past. Thank goodness, it is starting to become a familiar process that has an end in sight.

Medical Knowledge

Knowing that after the last exams I realized a need to change the way I approach my studies, I am hoping that the change for the better has occurred. In the last few weeks we have had enough quizzes in class to "force" the information in our heads early. For better or worse, it leaves us with a simple review of the concepts at this stage, thus allowing more time for novel material and difficult concepts.

After talking with a few of my colleagues, we were happily surprised by how far we have come. One year ago we would not have been able to carry on a conversation concerning our current material with an understanding of the terminology or concepts. During this second year of medical school there has been a significant increase in vocabulary and conceptual development that builds a stable foundation for medical comprehension. We are only beginning the year, so I imagine there is a lot more to learn, but for the time being we enjoy knowing that all this studying is paying off.

Board Prep Question of the Week

A 44 year-old obese woman who has been recovering from a knee sprain develops sudden shortness of breath and left-sided chest pain with inspiration. On exam, HR is 110, RR is 24, Temp is 37 C, the pulmonic portion of the second heart sound is accentuated, 3 cm of JVD is appreciated, and the right leg is slightly swollen and tender. Trachea is midline and lung sounds are equal bilaterally without wheezes, rales, or rhonchi. The remainder of physical exam is unremarkable. If pathological examination was performed, what would be seen in the affected lung tissue?

A. Caseating necrosis with acid-fast bacilli
B. Exudative consolidation with numerous Gram-positive cocci
C. Hemorrhagic wedge-shaped infarct
D. Loss of alveolar septa
E. Pale infarct at the periphery of the lung parenchyma

Answer & Explanation

Medical School Training

Fortunately, medical school is not solely based on bookwork. Labs are intended to solidify the knowledge we get in class and clinical experience are used to tie everything together. This last week we had our first patient encounter.

Objective Structured Clinical Examination

Also known as OSCE, this course provides patient encounters by local actors who give us an opportunity to experience patient clinical interaction. The session can be monitored and recorded by faculty to help the medical student hone in on the challenging aspects of their experience. The exam rooms are equipped with everything we would need to perform a basic exam and we are timed to simulate the practical exam two years from now.

I enjoyed my first OSCE experience as it took me back to my days as an EMT gathering a medical history and executing a physical exam. For the purposes of OSCE, we performed a brief history and physical in 12 minutes to be followed up with a 10 minute SOAP note documentation of the encounter. Overall, time went much faster than I expected, hence the reasoning behind preparing us well in advance for this important exam.

This unique part of the curriculum is used to help us develop an understanding of patient communication, the importance of a complete history, and proper clinical examination. All these points are reinforced by the documentation of our impressions and plan. It is essentially an "ice breaker" into the rest of our career. For now, I think I am still afloat.

Board Prep Question of the Week

A 72 year old woman presents to her physician with the complaint of loss of vision. Visual field examination reveals anopia of her right upper quadrant visual fields bilaterally. What is the most likely location of the lesion responsible for this defect?

A. Left optic nerve
B. Left parietal lobe
C. Left temporal lobe
D. Right optic tract
E. Right parietal lobe

Answer & Explanation

A Breath of Fresh Air

I wonder if doctors have the privilege of prescribing vacations among other things. As a medical student, feeding the urge to enjoy oneself is often confronted with a looming need to study, thus rendering vacation a physical attribute that is rarely shared mentally.

Psychiatric Relief

With the extra day off last week and an opportunity to get out of town, I was sure not to pass up a potential vacation. Nonetheless I still have a quiz upon my return Monday. With some study behind me, the hours of travel time to come, and the mountain pass closed ahead there is a little time before I can consider myself fully prepared for the upcoming knowledge assessment.

From the beginning, the idea of boards has haunted me as the ultimate test of knowledge. In the interim, there is always something that needs to be studied. This unending progression of curriculum makes weekends and vacations difficult to enjoy completely. Although, I must say, studying for my quiz at a mountainside resort was not the worst experience ever, despite the urge to enjoy local amenities. My kind wife made an attempt at helping, but when it came time for the “anti-pyretics” and I had to point out they have little do with “pirates,” I finished the investigation on my own.

If for nothing else, this weekend getaway provided a mental respite from the monotonous page turning that fills most weekends. I would definitely suggest taking the time, however minimal, to regroup and stay at the peak of your game. Do yourself a favor, consider your mental health too and maintain your sanity once in a while.

Board Prep Question of the Week

A 43-year-old woman presents with bone pain, joint pain, and fatigue. Further history reveals blood in her urine and difficulty moving her bowels. She denies recent weight loss, poor appetite, and night sweats. She has no chronic medical conditions and does not take any medications or use drugs. Her family history is negative for malignancy. Physical examination is negative for lymphadenopathy or hepatosplenomegaly. Laboratory values include serum calcium 11.2 mg/dL, serum phosphorous 2.0 mg/dL, urine calcium 410 mg, and increased levels serum 1,25-hydroxy Vitamin D, and parathyroid hormone. Which of the following medications would most likely help in treating this patient?

A. 1,25-hydroxy Vitamin D
B. Calcium gluconate
C. Furosemide
D. Hydrochlorothiazide
E. Magnesium sulfate

Answer & Explanation

Organization Learning

Once again the Jewish holidays Yom Kippur and Sukkot have come around offering a respite in our studies. The extra time off has made life a little more bearable.

Time Management Strategy

When the school year started, I had no idea how much more difficult this year would be in relation to first year. I spend a great deal of my time at school late into the night preparing for exams, quizzes or simply studying recent material. The environment provided there helps to maintain focus, where the home environment can easily become distracted...especially if the refrigerator has been recently stocked.

I have found that spending a little time organizing oneself for a few minutes makes a significant difference when it comes to accomplishing the necessary tasks. It may be a simple check list or a detailed breakdown of how each hour is going to be spent. In any case, time management is critical to our success as medical students. Unfortunately, we sometimes forget to plan in the important things such as family, sleep and exercise. They all have their place and need to be considered into the equation. Thus when the days off come around, there is much rejoicing.

It is important to find what works for you. I break down my material into subject matter and then what I feel can be accomplished with the time I have. Commonly, it is by deadline prioritization - if the due date is coming, it gets top priority. Occasionally, I will complete a task simply because it can be done quickly, thus leaving one less thing on my list to worry about. Whether you make a spreadsheet with all your tasks, create an online task list that can be accessed anywhere or just write it down on an index card, being organized from the start will maximize your time and lower your stress.

Board Prep Question of the Week

An otherwise healthy 10-year-old boy develops blotchy areas of erythema that are pruritic over the skin of his arms, legs, and trunk within an hour every time he eats seafood, followed by diarrhea. These problems abate within a few hours, and physical examination reveals no abnormal findings. Which of the following immunologic abnormalities is he most likely to have?

A. Cell mediated hypersensitivity.
B. Hypergammaglobulinemia
C. Immune complex deposition
D. Localized anaphylaxis
E. Release of complements

Answer & Explanation