R.I.P. USMLE

As I made my way to the testing center last week, I wanted to suppress the anxiety with a few tunes. With Queen's "We Are the Champions" blaring, I couldn't think of a better song to get me pumped for one of the most important exams I would ever take. The feeling was short lived when AC/DC's "Highway to Hell" revealed the truth of the situation. All I could do was laugh.



USMLE

Nerves on edge and adrenaline pumping, I finally settled into the exam. Question after question I tried to stay focused and not second guess myself. The barrage of random scenarios and cases certainly kept me on my toes trying not to blur them together. Surprisingly, time went quickly and it was time to call it quits for the day. Unsettled and unsure about my success, I walked away feeling accomplished in taking an exam that few get to experience. And now to wait for the results of all my efforts.

It wasn't until I started celebrating that I realized how keyed up I was for that exam. I lost my appetite and spent the next few days ill as I caught up on some much needed relaxation. Unfortunately, I still have one more exam to face. Fighting off the post-exam-information-dumping-session is difficult to avoid especially when your brain is lacking adequate nutrition. Now somewhat recovered, I am back in the saddle for another week of review to finally put this second year of medical school behind me. Despite feeling champion-like on occasion, I think it would do me good to avoid the highway to hell.


Board Prep Question of the Week

A 24-year-old male with a history of Sickle Cell disease presents to your office complaining of pain in his arms and legs of 12 hours duration. Laboratory tests identify that this patient is experiencing an ‘aplastic crisis.’ PCR tests demonstrate infection by a single stranded small DNA virus. This virus may also cause which of the following syndromes:

A. Burkitt’s Lymphoma
B. Erythema Infectiosum
C. Molluscum Contagiosum
D. Smallpox
E. Yellow Fever

Answer & Explanation

Medical Boards

I had a near death experience today, well more like this entire month. Preparing for the USMLE and COMLEX board exams has finally taken a toll, but the good news is that one test will be done in just a few days.

The Final Push

Two years of medical school, 3000 practice questions, four weeks of intense review, multiple passes through study materials, numerous white board topics and more information than I can fit in my head have come down to this. Working on 5-6 hours of sleep after studying 14-16 hours a day gets difficult with all those facts rolling around in my short term memory. From biochemical pathways and pharmacologic principles to microbiological tendencies and pathologic maladies the pieces are starting to come together.

In just a couple days I will be sitting for the first of two exams and every waking thought seems to bring me back to topics I don't have memorized. Feelings of anxiety and trepidation are fought by the thought of having all of this behind me. I can't decide what I am going to do first when it is all over, take a nap, exercise or celebrate. The catch is that when I finish the first exam and recoup, it will be time to dive back in for another week of COMLEX preparations. As if the sundae were not big enough, its cherry topper is the start of rotations the day before my exam. Fortunately I still have an appetite, does anybody have a spoon?

Board Prep Question of the Week

An aspiring medical student opens up his Step 1 score report and is elated to find that his score is 230, a 92 on the 1-100 scale! The score report indicates that the mean on the exam was 215 and the standard deviation is 15. Assuming a normal distribution, in which percentile is the student's score?

A. 63.5%
B. 77.3%
C. 84.1%
D. 97.7%
E. 99.9%

Answer & Explanation

Preparing for Boards

Before coming to medical school I had no idea what to expect other than a difficult education that would be rewarding. Now, I find it a challenge to truly convey what life as a medical student really entails. My painted picture is probably very different than that of my peers, but it's the only experience I know.

A Day of Board Exam Preparation

The alarm goes off and as I made my way to the breakfast table all I could think was "sodium stibogluconate." Too bad my recall only brought me to the parasitic infections folder in my head and the Leishmania donovani card was nowhere to be found. With my bowl of cereal prepared, it was time to make another pass at the flashcards that have been accumulating over the past year. Some days the cards are nice to me and other days they seem to be retaliating for my reluctance to review them more frequently.

After a quick shower to really wake me up, it's time to sit for the next eight hours plowing through copious amounts of information mostly guided by First Aid, the medical student's bible. In an effort to solidify the information, I found it worth my while to review the information through question banks. The results of which were not always pleasing, but usually ended in learning something new about the topic and how to incorporate the information.

On a good day, my legs would only fall asleep two or three times and I wouldn't fall asleep until after midnight. Depending on the material and how long it took to get through it, I might actually be able to get in a little exercise thus avoiding the effects of Virchow's triad and potentially deadly clots. (Who knew med school would be so dangerous?) Other times, I just needed to see the light of day by taking a walk to the mailbox or going for a drive to reward myself with ice cream. Then it was time to focus again for another few hours hoping my brain would not be too active to let me sleep. Fortunately by that time, it was willing to shut off in preparations for tomorrow's marathon of education.

Board Prep Question of the Week

A 67-year-old woman is started on warfarin to prevent embolic events from her atrial fibrillation. Four days after taking warfarin, she starts developing well defined, erythematous, indurated, and purpuric lesions on her thighs. The inhibition of which component of the coagulation cascade is likely responsible for these lesions?

A. Factor II
B. Factor VII
C. Factor IX
D. Protein C
E. Protein S

Answer & Explanation

Things I Wish I Knew - Second Year

It's that time again to take a look at what I've learned from the last year and roll it into a bite-sized post. At first glance it may not seem much different than last year's report, but with a side-by-side comparison I'm surprised I am alive to tell the story.

Looking Back

Somewhere between peaked exam weeks and the troughs of vacation, I actually found time to breath. For what it is worth I have learned a few things along the way and would love to hear from others what you have gleaned from your experience. Without further ado, he is my small list of things I wish I knew before my second year of medical school.

1. Proper repose - Some people have a knack at getting sleep and lots of it. I have never been that fortunate, but learned that a regular sleep schedule was important to staying on task during the day. I must admit though, there were days when I just had to find a spot on the floor and take a quick nap. If only our brains could burn as much energy as a full workout, now then I would be set. Make sleep a habit and take short naps when needed.
2. Staying current - I am still convinced some professors do not communicate with the others and actually understand how much information is being thrown at us. Letting too many lectures and reading assignments go unattended can lead to undue stress before exams. Pacing is crucial to really understanding the concepts despite how well you "cram." It might be difficult, but getting things done now will save the pain of not having it done later.
3. Two heads are better than one - Normally, I am not one to study in groups, but I have found this to be fundamental to my success in medical school. Where I misunderstood a point or did not have the background knowledge to comprehend, my study partners were often able to fill in the blanks. And for all those times when the stress really got to me, a quick game of HORSE was sure to do some good. Study partners help you understand what you do and do not understand really fast, get some.
4. Practice makes perfect - After being in the classroom for so many hours, it is easy to lose sight of why we are there in the first place. For some of us, it really is about helping the patient. Be sure to take advantage of opportunities that permit exposure within the community. These help make the light at the end of the tunnel a little brighter along with gained experience in practices you may intend to be doing for the rest of your career. Be an active participant outside of the classroom.
5. Surmounting the challenge - Without hesitation, I can honestly say this is the hardest thing I have ever done. Having said that, it is also one of the most rewarding. High stress conditions, little sleep, poor exercise, sparse family time and a constant query of knowledge has kept me on my toes much longer than imagined. The best part is that it is fulfilling a goal that I have had for so long, which makes it all worthwhile. Take time to enjoy one of the more difficult hurdles life has to offer.

On another note, if you are interested in what other students are saying about their experiences, my Life as a Medical Student has been showcased along with theirs in this list of 42 Medical Blogs Written Entirely by Med Students.

Board Prep Question of the Week

A 3-year old child has dyspnea, severe cough, and a fever. A chest X-ray and laboratory tests lead to a diagnosis of Pneumocystis jirovecii pneumonia. Further laboratory tests indicate abnormally low levels of the IgG, IgA, and IgE immunoglobulins. However, levels of IgM are far above normal. This patient's immune deficiency is caused by a defect in which cell surface molecules?

A. CD40 ligand
B. CD86
C. Fas ligand
D. TCR
E. TNF receptor

Answer & Explanation