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

Playing Doctor

Anticipating the start of clinical rotations, we were oriented to hospital procedures and scrubbing techniques this week. They made for long days...thankfully there won't be a test.

Sterile Technique

Despite having classes behind us and the board exams ahead of us, we couldn't quite crack the books until we were oriented properly for our rotations. This particular exercise gave us an opportunity to "scrub in" from fingernails to elbows and donning a sterile gown and gloves. It can be a challenge the first few times trying not to contaminate oneself, but the no-pressure environment was perfect for learning this skill. We may not be as proficient as some, but at least we know the basics of the surgical scrub.

It is hard to believe that the second year of medical school has passed so quickly. By keeping us busy all the time and always preparing for the next exam or quiz, we didn't have much time to really slow down. Fortunately, all the grades have been posted and I am still in "good standing" with the university. It's just a matter of time before I can say the same about board exams. In the meantime, the morale boost we get from doing doctorly things will have to feed our fires for this career we have been working hard to achieve.

Board Prep Question of the Week

An 8-year-old boy presents to your clinic with a history of nonproductive cough and recurrent opportunistic infections. His mother claims that the symptoms first arose about 2 years ago and previous physicians suspected an immune deficiency disorder. A chest X-ray reveals patchy infiltrates and diffuse clouding. Bronchiolar lavage identifies numerous neutrophils arranged in isolated conglomerates. Nitroblue tetrazolium dye reduction test is negative. Which enzyme is most likely deficient in this child?

A. Alpha-ketoglutarate dehydrogenase
B. Dihydrofolate Reductase
C. Glutathione Reductase
D. NADPH Oxidase
E. Topoisomerase

Answer & Explanation

Easing the Pain

Like something seemingly out of a torture camp the Transcutaneous Electrical Nerve Stimulation (TENS) unit is actually designed to relieve pain and discomfort through a small portable device. 

A New State of Comfort

Finally able to breath again and catch up on my sleep, I still find my back and neck sore from the long hours of hunching while studying for exams. A good night's rest and a session of yoga at the gym quickly helped ease some of the tension that built up over the last couple weeks. For some people, however, pain can be an ongoing problem that limits their daily functioning and even compromises optimal health. Recently, I heard about muscle stimulators and their non-invasive approach to easing sensory and motor deficits. Despite their evil look, some people swear by their effectiveness as adjunct to common medicine.

Although not effective in all cases of chronic pain, TENS Units are an alternative approach to the use of medications and more invasive methods of treatment that aim to reduce neuropathic pain. By stimulating nerves to release inhibitory (GABA) signals, the sensation of pain can be reduced. Among the research is a case that shows there may be some benefit to the use of such systems in restoring sensation where it has previously been diminished. For additional information about LGMedSupply's products visit their online customer blog. Otherwise, if you have used a similar device, I would be interested in hearing your feedback on the subject.

Board Prep Question of the Week

An 18-year-old girl from Southeast Asia presents with symmetric ascending weakness below her knees. She has been unable to walk for 3 days. Physical exam reveals mild hypotension and papilledema. Upon respiratory support and administration of IV immune globulins and plasmapheresis, her condition resolves after 2 weeks. Which of the following is the most likely etiologic agent of her condition?

A. Acid sphingomyelinase deficiency
B. Arylsulfatase A deficiency
C. Infection with C. jejuni
D. Infection with JC virus
E. Microsatellite instability on chromosome 4

Answer & Explanation

Second Exam Week Six

Now that our classroom career is over and the last set of exams are here, it is time to study. Fortunately for us, the first tests last week were in Osteopathic Manipulative Medicine. This meant one good corporal realignment before a week of uncomfortable postures and mental torture.

Final Adjustments

"...Take a deep breath." I then waited as my study partner dropped his weight on my upper body and we both felt the audible release of a vertebral segment that was misaligned. In no time the pain was gone and we moved on to continue our studies. As this was our last set of exams, we had the task of performing a full body evaluation and applying a specific treatment of our choice aimed to restore function. Since we were successful in treating each other in practice, our partners the next day had little to correct during the test. I think I am going to miss these little "corrective" sessions.

The thought of being finished with school is really exciting. It doesn't take long, however, to remind myself that as soon as this week is over, it will be time to dig deeper in preparation for board exams. (So much for having a vacation between school and rotations.) One thing is for sure, this experience has been so much better than I could have ever imagined. Sure, it has been difficult, but it continues to pique my interest and lift my thoughts to a better future.

Board Prep Question of the Week

A 13-year-old figure skater botches a quadruple lutz and falls on her right outstretched hand. Several weeks later a cast is removed for a healed scaphoid fracture. She begins having episodes of intense burning pain, sweating, swelling, and redness that begin in her right hand and moves up her forearm, sometimes up to her shoulder. These episodes often occur when she is angry or upset. On exam her arm shows no visible abnormalities. Which of the following nerve types are involved in the pathogenesis of her disorder?

A. General somatic afferent
B. General somatic efferent
C. General visceral afferent
D. Special somatic afferent
E. Special visceral afferent

Answer & Explanation

Fetal Development

I remain in awe that a body can reproduce its genetic code and create life as seen in this video.

The Making of Mothers

Preheat the oven to 98.6 degrees, place it in the endometrial wall and let it slowly rise over the next nine months. If only fetal development were that simple. Below are some of the highlights of embryologic formation with which most people never really become acquainted. Welcome to life as a medical student.

First Trimester - Weeks 1-14

• Week 1: Fertilization, morula, blastocyst(Day 5), endometrial implantation(6) and hCG from the syncytiotrophoblast
• Week 2: A bilaminar disc forms(8) and uteroplacental circulation starts(13)
• Week 3: The primitive streak is evident and the central nervous system begins via the notochord and neural plate; appearance of somites(20)
• Week 4: The neural tube closes leaving cranial and caudal neuropores(23), limb buds develop(28), and the heart begins to beat
• Week 5: Facial development, pharyngeal arches and clefts take shape
• Week 6: Fingers start to appear(38), endodermal derivative development (lung, stomach, pancreas, intestines, liver, gallbladder, urinary bladder)
• Week 7: Toes develop, maxillary and medial nasal swellings fuse to form upper lip
• Week 8: Fetus has the appearance of a baby and begins to move; heart sounds can be heard
• Week 9: Eyes and ears form as face and other organs continue development
• Week 10: Male and female genitalia are identifiable
• Weeks 11-14: Fine hair (lanugo) starts to appear; muscle and bones develop

Second Trimester - Weeks 15-27
The bones begin to harden, finger and toe nails form while the fetal organs continue to develop. Movement can be felt during this period as the fetus kicks, rolls, sucks its thumb and learns to swallow.

Third Trimester - Weeks 28-40
The fetus will double or triple in weight from now until birth. The skin thickens with a layer of fat to maintain body temperature. The senses of hearing, vision, touch and taste are developed and used. Repositioning in the womb is not uncommon in preparation for delivery.

Birth
All I can say is that without it, I wouldn't be here. Thanks Mom, Happy Mother's Day.

Board Prep Question of the Week

A male infant has a cleft lip on one side that does not involve the alveolar process or the hard palate. A unilateral cleft lip results from the failure of which two facial prominences to merge?

A. Lateral nasal and maxillary
B. Left and right medial nasal
C. Maxillary and mandibular
D. Medial nasal and maxillary
E. Lateral nasal and Medial nasal 

Answer & Explanation

Medical School Family

Time management is definitely an issue in medical school. Finding a balance between the books, upcoming tests and family has been more of a challenge as time goes on. Last week, one reader asked how it all comes together on the family front. Rather than imply that I know exactly how it is, I asked my wonderful wife to share her thoughts.

Life as a Medical Student['s Wife]

Without blinking an eye I'll say it's tough.  Worth it?  Of course.  Before this experience, I remember talking to a friend whose husband had just finished dental school.  She said, "I proudly wear my wife's badge for having gone through that experience."  I laughed in ignorance.  Now familiar with the battles waged through this medical school experience, I fully support her honorary wife's badge.  While Josh and I have chosen not to have children in school, (heaven help those courageous couples who do have kids) there are plenty of battles we endure.  The two struggles that seem most prominent for me this year are time/patience and emotional connection.

Last year I wrote about adjusting to the first year. This year has been most trying on my patience and I've felt like my life has had to take a backseat to his career. I've been offered many opportunities to advance in my career which I've had to turn down due to his current position and our location. I've been supporting Josh from day one of our marriage. I take that back...after our amazing honeymoon in Paris and Eastern France, I've been the sole provider. This year we will celebrate our fourth anniversary. During these four years I've worked full time as a graphic designer, part time as a yoga instructor, freelance designer, painter, letterpress designer/printer, photographer and figure skater- simultaneously. Even with all of that, Josh manages to stay busier than I and buried in books for longer hours than I work. That means when there is down time I also feel obligated to take care of everyday chores. Usually, this is what Josh and I fight about - the chores - when we're both exhausted. I think we once argued for 30 minutes about our pantry door being closed vs open until we realized the absurdity of the situation. 

This year I've felt more distance between us also.  Because of our clashing time schedules, it's difficult to connect. Last year I embraced every moment of time he had available and dropped whatever I was doing to have some time with him. My responsibilities this year are more demanding and I can't always do that. That also may have been a bad habit I enabled Josh to expect. It is difficult to feel emotionally detached due to our schedules, but even more demanding to feel compelled to switch the emotions on whenever it's convenient. In the question posted last week on the blog, the fear of affairs during long hours of study after school was addressed. Josh's study partners are two Mormon boys, so it hasn't been a direct fear I've had to face, but it would be if he were studying with the opposite sex. We've learned to put each other on our daily lists of things to do. It's important to make some sort of connection in whatever time you share, to keep the pilot light on. We recently watched a NOVA documentary called "Doctors' Diaries" that followed the lives of seven medical students through medical school. It addressed the reality of divorce, the difficulty of relationships through school and the experienced perspective of the doctors after school. I would recommend watching their stories and being honest and real about what your unique relationship requires to stay healthy.

Thank you for your thoughts Willow. I agree that this has been a trying process with moments of joy. One of the most important things I learned before coming to school was from a doctor friend. He said that as a student we can set our own schedule and if we want our family to be a priority then choose it to be such. It is crucial to work with groups, patients and other classmates, but most importantly to know that our families are standing behind us. If it were not for my wife, I would not be where I am today. Thank you for your support and encouragement, you certainly deserve a part of my degree.


Board Prep Question of the Week

You went to visit your friend from college who recently had a baby. She named him Johnny. As the mother was gently letting you hold Johnny, he appeared really anxious and started crying once you reached to hold him. Johnny's age is most likely to be:

A. 2 months
B. 3 months
C. 5 months
D. 7 months
E. 4 years

Answer & Explanation

Hands On Training

Hands on training always seems to draw more interest than lecture and books. Despite the risk for injury or mistakes, it is likely we actually get more out of it than a textbook could ever offer.

Clinical Skills Lab

As I walked back to my lab station with a pig's foot cut in half, I admired the piece of anatomy and questioned how this was deemed appropriate for a Jewish institution to support. Apparently, it is "Kosher" as long as we are not eating it. Pig's feet never had the same appeal as bacon, so I don't think that will be a problem.

After creating a laceration in the foot, we learned various suture styles to close the wound. It was more of a crash course in instrument handling as I quickly learned how clumsy my rookie hands performed this common clinical task. Nonetheless, it is a skill I will be needing in the future and any exposure is good exposure.

The next station, phlebotomy, was old hat. While my partner fretted the experience, I couldn't wait to get my hands on a needle again as it had been too long since my last stick. To my surprise there were quite a few in the class who have drawn blood in one form or another. On the other hand, those who attempted it for the first time would shake at the thought of hurting their partners. Learning new skills in the classroom has obvious benefits over learning them in the clinics, fortunately it leaves room for mistakes. Even though my partner impaled me twice before striking gold, he did a great job for his first experience.


Board Prep Question of the Week

On your rotation in the intensive care unit, you follow a patient with advanced sepsis from a central line infection. On exam you notice marked petechiae on his extremities as well as some large clots around his mouth. Concerned about disseminated intravascular coagulation, you check his labs. What would you expect?

A. High platelets, low bleeding time, high PT, high PTT
B. Low platelets, high bleeding time, high PT, high PTT
C. Low platelets, high bleeding time, low PT, high PTT
D. Low platelets, low bleeding time, high PT, high PTT
E. Low platelets, low bleeding time, low PT, low PTT

Answer & Explanation

Student Loan Debt

The start of our last block sure feels good. Soon enough we will be seeing patients and interacting with physicians in the community, unfortunately that comes with a price.

Student Loan Repayment Options

Just as we are preparing to file our FAFSA for the next year we received the bad news that there will be a 5% tuition increase! Apparently this figure is low, but it still adds up. The AMA reports that the majority of medical students have more than $100,000 of debt. Ask a student and after performing the math they will tell you that their debt is closer to $200,000 or more. We have no idea how the health care reform will affect future medicine and the financial concerns it carries. From my understanding, it is difficult to be a physician and not be bothered by the monetary repercussions of business. In fact, many practicing doctors are still paying off student loans.

A growing concern is the dwindling number of family practice physicians. For many students the pay alone is a deterrent that promotes interest in medical specialties. Fortunately, there are some specialties that are eligible for loan repayment opportunities. Here are a couple resources worth investigating if you are looking to get that student loan monkey off your back and you are not interested in the military scholarship:

• National Health Service Corps - Family Medicine, Obstetrics/Gynecology, General Internal Medicine, Gerontology, General Pediatrics, General Psychiatry
• AAMC - Loan repayment/forgiveness and scholarship opportunities by state

Board Prep Question of the Week

A 6-year-old child is brought by ambulance to the emergency room following an automobile accident. She is covered with blood and unconscious secondary to hemorrhagic shock. Her parents urge the physician to do everything possible, but implore that no blood products be used to treat their daughter. What is the best course of action for the physician to take?

A. Administer blood without delay and contact child protective services
B. Convene an urgent meeting of the hospital ethics board
C. Engage the parents in a discussion of why they hold these beliefs
D. Transfuse blood as needed, explaining the situation to the parents
E. Treat the patient without using blood products, per the request of her parents

Answer & Explanation 

Basic Life Support

Nearing the commencement of our clerkship rotations, we eased our way back from spring break by receiving training in basic life support (BLS) also known as CPR.

Cardiopulmonary Resuscitation

You never know when you are going to need CPR. For that reason alone, it is wise to at least have some understanding of what to do in an emergency situation. Despite learning the skills, I always seemed to have a difficult time counting the 30 compressions in a real situation. Fortunately, when there are other providers available, the actual count is not as significant as when you are alone.

My experiences in the emergency department have prepared me well for this sort of training. Looking back, I would say that working in the health care setting before coming to medical school has helped more than anything else. Exposure to real situations, with real people makes a significant difference when learning the skills needed to succeed. For this reason, we spend a large portion of our time in the clinics honing clinical protocols and learning the standard of care. As we said in boy scouts "Be Prepared." CPR is a skill that is never to late to learn.

Board Prep Question of the Week

A 70 year old man was brought in the hospital by ambulance subsequent to chest pain that lasted 40 minutes. In order to assess the degree of stenosis of his coronary arteries, he underwent coronary angiography, a procedure during which a contrast dye was injected in his coronary vessels. To which phase of the ventricular action potential does visualization of the stenotic lesion correspond?

A. Phase 0
B. Phase 1
C. Phase 2
D. Phase 3
E. Phase 4

Answer & Explanation

Spring Boarding Into the Future

Despite the obvious enjoyment of our spring break from medical school, we are also gearing up for the most important exam of our life...boards. Translation: very little vacation and lots of time to study.

Vacation vs. Study

Call me crazy, but I have a feeling that I am not the only student spending my vacation reviewing concepts, exploring question banks and preparing for the months ahead. I have taken time to enjoy the time off and even managed to reproduce my annual farmer's tan in the meantime. Nevertheless, I was compelled to dedicate a portion of my time to catching up where the routine studies made me lose ground.

I think the simple fact that so many have gone before and there will be more to come is reassuring. This metaphorical med school sandwich means there is hope yet. In the back of my mind I pretend that just by registering for the board exam and enduring classroom lectures, the examiners will congratulate us all and send us happily on our way. I know the reality is that these exams are in place to protect the public from incompetent practitioners. This is a roundabout way of expressing my fear, but I would be lying if I said I felt confident at this point. When it just becomes too much to handle, I stop and follow the advice of my high school algebra teacher; Count to ten...in Roman numerals and things usually start to feel better. I, II, III, IV...

Board Prep Question of the Week

A 6-year-old child is brought by ambulance to the emergency room following an automobile accident. She is covered with blood and unconscious secondary to hemorrhagic shock. Her parents urge the physician to do everything possible, but implore that no blood products be used to treat their daughter. What is the best course of action for the physician to take?

A. Administer blood without delay and contact child protective services
B. Convene an urgent meeting of the hospital ethics board
C. Engage the parents in a discussion of why they hold these beliefs
D. Transfuse blood as needed, explaining the situation to the parents
E. Treat the patient without using blood products, per the request of her parents

Answer & Explanation

Spring Break

Spring break is finally here, I just wish that truly meant time off and possibly an exotic location. Alas, one more block to go and then it's time to buckle down for board examinations. Spring break = head start on board prep.

A Breath of Fresh Air

I am not really certain if it was the excitement of break or the fast paced material, but this last set of exams was tough. Now, I am mustering all that I can to collect my mental capacities for the final chapter of a 25 year career in classroom education. That means extra sleep, exercise in any form, and semblances of healthy nutrition. Finding a way to create extra memory in my noggin and not lose too much of what was learned before will be a challenge. Crunch time is here.

In the meantime, when I am not stressing about the next three months, I like to imagine the cabana I hope to one day use in the Maldives. Believe me, I have already started saving for that trip years ago. Nevertheless, while my financial resources sort themselves out, I think I might stay close to home for a while. Perhaps a visit to the local state park, but nothing too costly; after all, student loans have already sent me out to drift.

Board Prep Question of the Week

A 28 year-old male of Jewish descent presents with abdominal pain, diarrhea and fever. Physical exam reveals a tender abdomen and a perianal fistula. A biopsy reveals chronic inflammation in the small intestine involving all layers of the intestinal wall. This patient may be treated with a monoclonal antibody which blocks which of the following cytokines?

A. IL-3
B. IL-5
C. IL-8
D. IFN-Beta
E. TNF-Alpha

Answer & Explanation

Second Exam Week Five

We are on the verge of having one more set of exams behind us. With some quick arithmetic, that means spring break is almost here, and it's time for board studies to kick into full gear.

Lifespan

Somewhere along the way, one of our teachers mentioned that just by choosing to become a physician and going through the process, we would be decreasing our life span a significant number of years. Finding enough research to support this claim, on the other hand was not easy. Now, more than ever, I think I understand it's foundation. The never ending struggle to be on top of things and keep up with all the stress has had a deleterious effect on me mentally as well as physically.

Although this week's block exams may not lead to my demise, this profession might. Considering the alternatives, I am OK with this. As for life expectancies related to health conditions, World Life Expectancy has broken down the statistics to map out diseased counties. Unless you live in the middle of nowhere, it seems that we are all geographically at risk for something. My interpretation; eat healthy, exercise regularly and live happily.

Board Prep Question of the Week

A 4-year-old girl came home from day care and developed fever, abdominal pain, and diarrhea containing flecks of bright-red blood and pus. The girl did not ingest any food at day care. Which is the most likely causative organism?

A. Enterotoxigenic Escherichia coli
B. Campylobacter jejuni
C. Shigella dysenteriae
D. Vibrio cholera
E. Yersinia enterocolitica

Answer & Explanation

Medical Fraud

This posting comes as the 100th, marking almost 100 weeks since being accepted to medical school. Time has gone faster than I could have imagined. Thankfully it wasn't any slower!

Never Give Up

With Spring Break around the corner, professors have scheduled quizzes and midterms to query our knowledge. Normally this is not a problem, but with a block only four weeks long, there is a lot of information to cram in there. As a result, after last weeks barage of graded interrogations and late nights, I was flat out exhausted. Thinking I was the only one having difficulties focusing and reviewing materials, I didn't say much to my peers. A few days later I was surprised to learn that the majority of us have had similar experiences.

I have heard this called the impostor phenomenon. We feel as though we are the only ones who are not pulling our weight, making advances, or in plain terms...frauds. It is not until we see our achievements and learn that our peers are in the same position that we begin to feel a sense of belonging. Now that I know I am not alone, or at least the only fraud in the class, it's time to get ready for the exams next week. Medical school is relentless - if it's truly where your heart is, you have no reason to give up.

Board Prep Question of the Week

A 25 year old from Massachusetts complains of increasing fatigue and pre-syncope. Upon further questioning, he admits to having had a rash on his arm a couple of months ago. He denies joint pain, photophobia or a stiff neck.

An EKG is taken which shows 3rd degree heart block (complete heart block). His laboratory tests are within normal limits. Blood cultures are pending.

What is the most appropriate treatment?

A. Ceftriaxone
B. Doxycycline
C. Implantable defibrillator
D. Penicillin G
E. Rifampin

 Answer & Explanation

Cranial Osteopathy

A unique component of Osteopathic medicine, osteopathy in the cranial field, aims to treat the structural dysfunctions of the skull through manipulative techniques.

Osteopathy in the Cranial Field

Whether due to birth trauma, accidental injury, or abnormal strains, insults to the head can cause anyone distress. The cranium has numerous bones that move in an organized fashion to maintain optimal health. Like a dislocated joint, when one of these bones is forced out of alignment, somatic dysfunction ensues. This may present in the form of headaches, sinus congestion, neck pain, agitation, vertigo and a host of other complaints.

Initially difficult to comprehend and palpate, cranial alterations are smalll displacements of bones within the skull. Through diverse techniques the trained practitioner can treat everyone from neonates to elderly. As a student I am excited to be able to palpate the cranial rhythmic impulse (CRI). Apparently it can take hours and days before the CRI is appreciated. Despite making a step in the right direction, I find the cranial methods difficult to employ consistently as a beginner. Forty hour courses are available for extensive training, but the way tests keep coming my way, I don't think there will be much time to dedicate to this detailed study. For those who may be interested in learning more about this treatment The Cranial Academy has set up a website with course offerings and more.

Board Prep Question of the Week

A 50 year old woman with a history of headache presents with complaints of chest pain. She described the pain as pressure, and tightness in her chest. She said that the pain occured after taking a drug, the name of which she forgot. The most likely mechanism of this drug is:

A. Antagonist action at serotonin receptor
B. Agonist action at serotonin receptor
C. Release of nitric oxide
D. Inhibition of calcium channel opening
E. Decreased levels synaptic levels of catecholamines

Answer & Explanation

Industrial Health

Among the books, papers, and anatomical models in my office I have a small collection of medical art hanging. In the bottom left corner is an industrialized piece by Fritz Kahn that depicts the body as a machine. "Der Mensch als Industriepalast" has recently been given new life in this video animation, "Man as Industrial Palace."



Body Systems

Our newest adventures follow the gastrointestinal tract from top to bottom. Like the chocolate morsel in the animation we are developing an understanding of the chemical breakdown of foods in healthy and diseased individuals. At first, I thought there was no hope of grasping the workings of the liver and this complex array of tubes (If only it were as simple as the animation). Despite its complexity, there are occasional "aha moments" when the on-turning light above my head illuminates a concept I've known before, but never truly understood. Compared to days of confusion, those are usually what constitutes a good day.

We have not yet finished our systematic approach to the body. Looking back at my second year of medical school, however, I feel there has been a significant amount of progress. We are constantly developing a new vocabulary and a working knowledge that were non-existent only months prior. This process definitely has a steep learning curve and it is no wonder that doctors are considered to be among the top 1% of the world's most educated professionals. A daunting reality that is appropriate, considering we are expected to care for the life of another individual.

Board Prep Question of the Week

A 46-year-old female with a history of painful spasms of the fingers in the cold complains of 2 weeks of fatigue, pruritus, and abdominal pain. Her exam is notable for scleral icterus, right upper quadrant pain, and a liver span of 11cm. Her laboratory values are as follows:
AST: 110
ALT: 102
Alkaline Phosphatase: 256
Total Bilirubin: 2.8
Direct Bilirubin: 1.9

An abdominal ultrasound shows no obstruction. A liver biopsy is taken and shows destruction of small interlobar bile ducts. What antibody test will likely be positive?

A. Anti-Scl 70
B. Anti-ds DNA
C. Anti-mitochondrial
D. Anti-smooth muscle
E. P-ANCA

Answer & Explanation

Second Exam Week Four

Thanks to the help of a few classmates, I came across an understandable metaphor for medical school. It might go down well, but the repercussions can be awful.

Pancakes

Eating pancakes is not normally considered a difficult task and may even be quite enjoyable. Equating five pancakes to a day in school does not seem like much to swallow. From day one you know that is all they ask you to do, eat your five pancakes a day. Things get tough when you decide to put off what you could have done today. As one of my classmates said while preparing for our exams last week, "Eating two weeks worth of pancakes in one night. Can't wait to regurgitate them tomorrow."

It is definitely a feasible task, but along comes all the distractions and enjoyments of life outside of school competing for that pancake eating time. Do we grab a fork or find that comfortable spot in front of the TV? Decisions, decisions... One thing I know for sure, this last week was one of the hardest yet and I couldn't be happier that it is behind me.


Board Prep Question of the Week

A 20-year-old female sees her physician for diarrhea and fatigue with a 20 pound weight loss over the past 6 months. On exam, she is afebrile and has mild muscle wasting, but her strength is normal. Stool studies do not reveal blood, ova, or parasites. A biopsy of the jejunum is taken and microscopically reviewed. The patient is placed on a special diet with no wheat or rye products. The change in diet produces a dramatic improvement. Which of the following microscopic features is most likely to be seen in the biopsy?

A. Crypt abscesses
B. Foamy macrophages within the lamina propria
C. Lymphatic obstruction
D. Noncaseating granulomas
E. Villous blunting and flattening

Answer & Explanation

Human Network

Rummaging the internet for a bit of entertainment to break the monotony of studying for our exams this week, I came across one of the latest installments of the TED talks and wanted to share it here.

Patients Like Me

Medicine does not have all the answers. Clinicians and researchers continue to investigate how the body functions and how to make it better. Despite decades of data, we are still plagued with devastating illnesses that affect individuals and families alike. Jamie Heywood, after losing his brother to Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Disease, has developed a network for sufferers, families and providers afflicted by various prevalent and rare diseases.

Patients Like Me permits users to create a profile that depicts their illness in measurable terms. In the way a social network functions, one can compare their symptoms, treatments and journey with others who suffer from the same complication. The site functions as a tool for encouragement, but has the potential to help with future outcomes and treatment. The more patients contribute their data, the better the reports become. One can see a spectrum of their disease in a way not possible before. Patients and clinicians can integrate disease progression with the current situation in an effort to find the best approach to treatment. Although it is not solid science, it is a model for clinical data developed by the people who know the disease best, the patients.

Board Prep Question of the Week

A 32-year-old woman with no significant medical history presents to the clinic with visual complaints. On a recent trip to Arizona, she suffered an acute episode of visual impairment. She experienced blurred and double vision, which made it difficult for her to drive. On visual examination, her vision is 20/20 in both eyes. When she is asked to look to the right, her left eye only reaches midline while her right eye shows a beating nystagmus. Testing for visual convergence is intact. Based on the clinical history and physical examination, what is the most likely cause of her complaints?


A. Amaurosis fugax
B. Cataract
C. Multiple sclerosis
D. Optic neuritis
E. Panophthalmitis


Answer & Explanation

More Than Meets the Eye

Infectious mononucleosis, when symptomatic, you really don't want it unless you are trying to get out of your day job. The image here is a kit for performing the MonoSpot test.

Laboratory Diagnostics

Although we may not be performing the laboratory procedures ourselves in the future, it certainly helps to have an understanding of the equipment available. This week we tinkered with the MonoSpot test, rapid strep test, and Gram staining. The first two are specific indicators of illnesses that can be performed quickly to rule out other causes. The Gram stain is used to narrow down the possible organisms that may be leading to illness.

In a matter of minutes these simple tests can aid in the diagnosis of disease saving time and resources. If for nothing else, it was nice to get out of the classroom for a couple hours to get a change in scenery. After getting through the gag reflex, it was quite reassuring knowing that I don't currently have strep throat.

Board Prep Question of the Week

A 9 year old girl presents with 2 days of sore throat and fevers of 102ºF. Physical exam reveals an erythematous pharynx with a white, creamy exudate covering the left tonsil. Palpation of the neck reveals an extremely tender left submandibular lymph node. Throat cultures were taken and reveal beta-hemolytic colonies on blood agar. Susceptibility analysis show growth is not inhibited by amoxicillin, and erythromycin. Growth is inhibited by bacitracin. Which of the following is the mostly likely causal organism?

A. Rhinovirus
B. Streptococcus pyogenes
C. Streptococcus agalactiae
D. Epstein-Barr virus
E. Candida albicans

Answer & Explanation

Anatomy of a Stethoscope

The signature tool of the trade, stethoscopes have heard it all. Despite being a well crafted instrument, their versatility makes them a "must have" in the field of medicine.

Stethoscopes

Originally a device made of wood, stethoscopes and their evolution have given diagnosticians enhanced hearing capabilities. Ranging from drug store knockoffs to professional Littmann stethoscopes, pediatric to cardiology, short or long, there is certain to be one that will meet your needs. Through the years I have used many, never really understanding their differences...at least until a few weeks ago.

I was recently gifted my first Littmann stethoscope. From experience, I know having eartips in for extended periods of time gets uncomfortable after a while, and draping the tubing around my neck can be awkward if it is stiff. My new stethoscope has extremely soft earpieces and tubing which permit greater comfort than I previously knew. As for auscultating breath, heart, digestive and vascular sounds, my lack of experience at this stage limits my judgment. Nonetheless, I like what I am hearing. Now I just have to find willing subjects for more auscultatory practice.

Board Prep Question of the Week

A 48 year-old female presents with progressive shortness of breath and anxiety. She has no notable prior medical history, and on physical exam, auscultation reveals an opening snap over the cardiac apex followed by a mid-diastolic rumble. The most common cause of her disease process is which of the following?

A. chronic hypertension causing dilatation of the left ventricle
B. repeated attacks of Streptococci causing valvular lesions
C. primary pulmonary hypertension causing atrial dilatation
D. a congenital atrial-septal defect causing chronic hypoxemia
E. a congenital bicuspid valve causing increased afterload of the left ventricle

Answer & Explanation

Kidney Health

The latest installation of my Objective Structured Clinical Exams are now available. With practice, I felt much more comfortable and actually proved to be more efficient in my use of time. Although we will continue to have simulated patient encounters, our study of body systems is not yet complete and continues to flow...yes, cheesy pun intended.

Nephrology

It always seemed a bit confusing to have a urologist and a nephrologist until just recently. The former bases their practice on gross structures and specializes in surgical interventions while the later concentrates on the medical aspects of kidney disease. The smallest functioning unit of the kidney is called a nephron, to think there is a doctor who focuses a career around this structure is mind boggling.

When we started learning about the detailed pathology of nephrons and the kidneys it became clear why these specialized physicians exist. The kidneys are critical to our survival as they filter our blood. When malfunctioning, numerous other body systems are affected leading to a patient's compromised health status. The field of nephrology has not drawn great appeal from my side of the table, which is likely due to the fact that I have not yet come to a solid understanding of the material. Who knew such a small part could be so complex?

Board Prep Question of the Week

A 42 year old black woman presents to clinic complaining of swelling around both her eyes. The patient also adds that she recently has been only urinating twice a day which is much less than her usual. Further questioning reveals a few months history of subjective fevers, malaise, and non-focal arthralgias. Vital signs show a low-grade fever and a blood pressure of 155/90. Urine analysis reveals moderate proteinuria (3g/day) and RBC casts. Blood tests reveal a hemoglobin of 9.6g/dL, BUN of 29mg/dL, and a creatinine of 2mg/dL. What is the most likely cause of this patient’s symptoms?

A. Glomerulonephritis caused by anti-GBM antibodies
B. Congestive Heart Failure caused by uncontrolled hypertension
C. Glomerulonephritis caused by immunocomplex deposition
D. Glomerulonephritis caused by T-cell production of cytokines
E. Nephrotic syndrome caused by immunocomplex deposition

Answer & Explanation

Health Education

As medical school progresses, so do the milestones along the way. From our first cut into a cadaver, to the first successful osteopathic treatment, they contribute to the degrees we will one day hold. This last week we incurred yet another set of milestones in cooperation with the program Project Prepare.

Reproductive Health Services

Project Prepare, and other programs like it, trains medical models to educate students in the proper techniques and skills needed for clinical breast and pelvic examinations on both the males and females. Each educator works with a small group of three to four students at a time. After providing an overview of the exam, each student gets the opportunity to perform the exam on the educator. From experience, the teacher is able to direct the students to the proper structures and guide them from start to finish. It was not only observed learning, but permitted a beneficial hands on approach.

I was personally very impressed by the professional demeanor and first class education that was offered. There are many schools that do not provide their students with an opportunity to learn these skills on a responsive patient. Some use rubber models, cadavers or even surgical patients to teach. By empowering our educators, they were in control of the session and the experience we received. I am grateful for their knowledge and willingness to provide skills that I will need for the rest of my career while maintaining a safe and comfortable environment. Now on to the next milestone...board exams, only five months to go.

Mobile Blog Access

On a different note, Life as a Medical Student has gone mobile! To check it out or get mobile access to this blog on your internet capable smartphone you can visit medicalstudent.prohost.mobi. Simply insert your phone number in the space provided and the link will be sent to your phone for bookmarking.

Board Prep Question of the Week

A 23 year sexually active woman presents with a right upper quadrant pain of one day duration. Her pelvic exam is remarkable for purulent vaginal discharge and cervical motion tenderness. Speculum exam reveals a greening material coming out of a reddened cervix. What is the explanation of her RUQ pain?


A. Distention of the liver capsule
B. Choledocholithiasis
C. Cholelithiasis
D. Pyelonephritis
E. Bacterial vaginosis

Answer & Explanation

Mangosteen Juice

Every now and then I have the opportunity to investigate new products on the market. With energy drinks in every store and super juices making their way to the shelves, our beverages can get a bit overwhelming. The makers of Xango, a competitive nutritional fruit juice company, have developed the recently popularized mangosteen juice.

The mangosteen fruit comes from Southeast Asia and has no relation to mangos. It is a small purple fruit about the size of an apple that has a white tart core. Chemical analysis suggests the fruit contains various xanthones and tannins which may have anti-cancer properties in addition to being an anti-fungal, antimicrobial, and anti-inflammatory compound. It is no wonder that mangosteen juice has been used medicinally for generations.

Although this post has been sponsored by Xango, it certainly sounds to be a healthy alternative to the growing energy drink brands that boast more caffeine and sugar than your mother is willing to give you. As with any medication, too much can be a bad thing. Recommendations suggest smaller doses to avoid sedative or abnormal clotting effects. I assume it is for this reason that Xango promotes mangosteen juice as a supplement. So if you ever get the chance or have already tasted this unique blend, leave a comment and let me know what you think.

Medical Diagnostic Lab

In an effort to broaden the scope of clinical understanding, each student provided urine specimens for gross and microscopic urinalysis. I felt rather fortunate to only find calcium oxalate crystals, a sign of dehydration. Considering the alternatives, it could have been worse.

Lab Diagnostics

The new, and last classroom, semester has begun and we are starting with an all encompassing look at the endocrine and renal systems. The two converge when considering the hormones involved, or the lack thereof. Our laboratory diagnostics course is intended to provide exposure to the procedures that are routinely performed when samples are needed (e.g. phlebotomy) or obtained. Despite knowing there will be staff who commonly accomplish these tasks, it is important for us to have an understanding of the protocols involved. Besides, how often do you get to analyze your body chemistry anyway?

The results of collecting various samples from wounds, vessels and orifices will be the determining factor in the care we provide as clinicians. Having a solid understanding of the results could very literally mean the difference between life and death. I will admit that there are so many values and tests that it can become overwhelming for the beginner, but in due time it will be second nature. Until that time, I intend to take a drink from the fountain at every opportunity, at the very least to protect my kidneys.

Board Prep Question of the Week

A 45 year old male presents to the Emergency Department of his local hospital coughing up blood. He reports a history of a dry cough for the past couple of months, but this is the first time that he has coughed up any blood. He denies any smoking history. On further questioning he notes that he has had episodes of blood in his urine recently.

A metabolic panel shows:
Na: 140
K: 4.9
Cl: 105
HCO3: 25
BUN: 30
Cr: 1.9

Urinalysis shows blood 2+, protein 1+, neg leukesterase, neg nitrites
Urine microscopy shows red blood cell casts

A kidney biopsy is taken and is stained (above). What is being stained in the slide?

A. Anti-glomerular basement membrane Ab
B. c-ANCA
C. C3
D. IgA
E. p-ANCA

Answer & Explanation

Scheduling

In addition to overindulging in my extended vacation, I spent the last week preparing for the upcoming semester. The ultimate goal is successfully passing board exams, but there is a lot of time between now and then that I have to stay on track.

The End is in Sight

Perhaps anxiety driven or possibly in excitement, I managed to sit myself down long enough to work out a schedule for the next six months. In addition to coursework, I intend to be actively reading review books, utilizing question banks and sitting for mock exams. A weekly plan covering six months is laid out, and for the last month before the boards a daily routine is in place. I don't intend to have much time then and thought it would be best to plan well in advance.

Despite registering for the exams a little late, I have successfully signed up for the COMLEX and will shortly be adding the USMLE to the calendar. Don't make the same mistake I did, sign up for these well in advance as it makes scheduling much easier. Either way, I am facing the reality that I only want to take these exams once due to both the financial expense and the time investment required. At least for now, that's the intention.

The plan, though daunting, is bringing me one step closer to seeing the end of lecture halls and experiencing more clinical interaction. Once again, I am still not certain where exercise and relaxation will fit in, fortunately there are still a few holes in the schedule.

Board Prep Question of the Week

A 6 year old child is brought into your clinic for evaluation of right hand weakness. The mother is unsure of the onset of the weakness, but has been noticing that her child rarely uses his right hand and that the right arm looks unusually limp. Physical exam reveals atrophy of both the thenar and hypothenar eminences, atrophy of the interosseous muscles, and sensory deficits on the medial side of the forearm and hand. Which of the following is the most likely location of the pathologic finding in this patient?

A. Carpal tunnel
B. Medial epicondyle
C. Shaft of humerus
D. Supracondyle of humerus
E. Costoclavicular space

Answer & Explanation

Holiday Vacation

The holiday floor strewn with gifts both adult and child reminded me of days with less stress and responsibility. This year we were fortunate enough to have three such weeks between semesters.

Prescribed Relaxation

Using vacation to get away seemed like such a good thought at first and it did the job to some extent. With upcoming board examinations, there is a lot of preparation that merits some planning. Whether finding the right question bank, registering for appropriate exam dates or making the perfect study plan I cannot let all of the vacation slip away to misdirected productivity.

In the meantime, vacation is here, classes are just around the corner and boards will be here in no time. If you happen to have a well organized study plan for boards and don't mind sharing please let me know.

Board Prep Question of the Week

A 32-year-old woman with no significant medical history presents to the clinic with visual complaints. On a recent trip to Arizona, she suffered an acute episode of visual impairment. She experienced blurred and double vision, which made it difficult for her to drive. On visual examination, her vision is 20/20 in both eyes. When she is asked to look to the right, her left eye only reaches midline while her right eye shows a beating nystagmus. Testing for visual convergence is intact. Based on the clinical history and physical examination, what is the most likely cause of her complaints?

A. Amaurosis fugax
B. Cataract
C. Multiple sclerosis
D. Optic neuritis
E. Panophthalmitis

Answer & Explanation

Objective Structured Clinical Exam

Despite the likelihood that I am actually making a fool of myself rather than providing a form of enlightenment, I have posted my personal OSCE experience for your viewing pleasure.

Medical Training

In preparing for the exam, I searched the internet for similar scenarios and was surprised that there are no amateur versions around. Perhaps that makes this the first student version available to be mocked, ridiculed and berated. It is in no way flawless, especially since it was our first OSCE experience. Nonetheless, I rather enjoyed the opportunity to "act" the part and play diagnostic detective if only for a few minutes.

For this exam, the patient was assigned to have strep throat, so it makes me chuckle in embarrassment that I submitted him to the Romberg test. In my defense, I was trying to stall with the last couple minutes to make sure there were no other exams I wanted to perform. Once we leave the room, early or not, we are not permitted to return. Fortunately, my assessment and plan were on target with the premeditated ailment.

Anxiety driven exams certainly test us under pressure, and we tend to make irrational decisions as a result. I did not have enough time to test for somatic dysfunctions as I ran out of time. If I was better prepared, I could have finished the physical early with a few less tests in order to leave time for the SOAP note. Not realizing how long the written portion would take, I learned the hard way that 9 minutes is not much time at all.

In time I have learned to hone in on the critical findings and tests to maximize the use of my time. The SOAP note information rolls out of my pen with greater fluidity and I now have a little more confidence than is portrayed above. At least this was an educational and preparatory experience, the real thing this early in the game could have been much worse.

Board Prep Question of the Week

A 48 year-old female presents with progressive shortness of breath and anxiety. She has no notable prior medical history, and on physical exam, auscultation reveals an opening snap over the cardiac apex followed by a mid-diastolic rumble. The most common cause of her disease process is which of the following?

A. chronic hypertension causing dilatation of the left ventricle
B. repeated attacks of Streptococci causing valvular lesions
C. primary pulmonary hypertension causing atrial dilatation
D. a congenital atrial-septal defect causing chronic hypoxemia
E. a congenital bicuspid valve causing increased afterload of the left ventricle

Answer & Explanation

Health Care Training

And it's over. All week long I thought for sure I would be looking for a new career path as the exams seemed to get tougher and tougher. One thing is for sure, your doctor has gone through a lot of tedious training to get where they are, more than likely they have some idea of what they are doing.

Allied Health Programs

When researching schools, I was happy to learn that Touro University Nevada supports a variety of health care professions such as nurses, physical therapists, physician assistants, and occupational therapists with the intention to expand into other fields of similar interest.

If you are considering health care careers there are many to choose from that may fit your personal interests. Whether you want to learn a new skill or need a complete career makeover, it can be done. A number of health care programs, online training, and trade development courses can be found with the click of a button.

The growing demand for health care professionals has shown a dramatic increase in nursing schools, radiography training, and various other allied health certification opportunities. Although there may be a shortage of physicians now and in the future, without the support staff, there is no way a physician could safely manage a patient's care.

Nonetheless, I am happy to say that when I reviewed my grades this time around, I was very pleased with the outcome. Despite contemplating other professions in case the exams had a poor outcome, physician is still at the top of my differential for future careers.

Board Prep Question of the Week

A 25-year-old professional cyclist is diagnosed with testicular cancer and undergoes chemotherapy. One month after beginning treatment, the patient complains of difficulty hearing. Which of the following chemotherapeutic agents is most likely responsible for this side effect?

A. Bleomycin
B. Busulfan
C. Cisplatin
D. Cytarabine
E. Doxorubicin

Answer & Explanation