There's No Homework Like No Homework

Rotations are finished. Residency is on the horizon. I am basking in the space between...vacation-land. Although there is plenty to do in preparation for the next steps, this time is just as precious as it sounds. Letting go of the time schedule, burdens of major responsibility and trivial concerns is more relieving than I imagined it would be.

Recapturing Lost Time

While I could have been intently studying for my next board exam, reviewing the pharmacokinetics of anti-microbials or rehashing the Kreb's cycle, I chose to rest the organ I've exercised intensely for the last four years. Traveling here and there, sometimes without a phone or computer to really dive into the organic "R and R" so badly needed. Mother's Day was no exception. With no prior commitments and time to spare, I made the trek to surprise my mother even though it was the week before graduation where I would see her again. Why would I do it? Because I could. Time allowed and it makes for a better story than going to the arcade for a day.

With only one week remaining before graduation the obvious excitement has somewhat worn off since starting vacation. As it stands now, only time is between me and a degree. No more exams, interviews or documents need my attention. My vacation time seems more valuable at this point than a 4 hour meeting of name-calling and black robes. Yet we are required to attend the event, perhaps for the school to maintain its public appeal of graduating x number of doctors this year. Attending graduation will be the public culmination of all this hard work put to rest. An opportunity for close friends and relatives to say, "I know that guy, how on earth did he become a doctor?" I suppose deep down inside I want to be there too, because it is a proof-giving ceremony validating the last 25 years of my life. Something few events can do.

Here is to a lifetime of dreams, four years of hard work, relationships made and kept, mothers and fathers who support, being a medical student who experiences bipolar highs and lows, and most importantly to the years ahead. The next time I post here will be as a doctor, not that far removed from the student, but across the line a marathon winner.

Question of the Week

Was it hard?

Answer & Explanation

Anti-Medical Meanderings

All this humid weather has kept me under a fan, in the air conditioning and rarely outside. The times when I am exposed to the elements are usually reserved for travel to my clinical site, exercise and exploration. Here in Miami Beach there is plenty to explore especially since I am coming from a desert.

Beautiful Exploration

Taking time out of an already busy schedule to investigate a new location is not always easy, especially when time is limited. When traveling to rotation sites out of my home city, I like to get an idea of what the community has to offer and what attractions may be in the area. On a day off, I drove to the Florida keys. I've always been curious about the tropical environment there with its long stretches of road linking numerous islands. Beautiful skies were complemented by the temperate waters and lush greenery. It was a short lived getaway that I needed. Upon my return to the mainland I pit-stopped on one part of the seemingly never ending beach. The entire coast is Atlantic Ocean beach front covered with tourists, towering resorts and one of the nicest boardwalks I've experienced. City life is bustling and the art deco facades a glimpse of times past. This is definitely a colorful place to experience medicine as the hospital caters to those who live and play here.

Traveling to places unknown is a challenge when adjusting to the newness of lifestyle and environment. If the residency match places me here, it's nice to know what I am getting myself into. To me that makes the exploratory day trip worth the effort. Getting a sense for the people and their mentality in and outside of the medical setting is key to making what will be a life influencing decision. On the flip side, this is Miami and summer, I don't know how I could have come here and not experienced what this place has to offer! Living among the locals definitely helps get an idea for what there is to do and see. In exchange for all of this I have to learn to live with the humidity which has been tougher than I imagined.

Question of the Week

An 8 year old boy with rapidly deteriorating cognitive function is not oriented to time, person, or place. On exam he has nuchal rigidity and a high fever. His mother tells you that he has been swimming in a lake at a campground in Florida. You diagnose the boy with meningoencephalitis. Which of the following represents the most likely infectious agent?

A. Neisseria meningitidis
B. Haemophilus influenzae
C. Streptococcus pneumoniae
D. Naegleria fowleri
E. Mycobacterium tuberculosis


Answer & Explanation

COMLEX Level 2 Performance Evaluation

This "vacation" month has been quite useful. I started with an extended hospital stay, added a little at-home recovery time, and will shortly be taking my practical board examination. This test, known as the COMLEX 2 PE, is just the next hurdle on my path to becoming a physician.

Board Exam Number 2

The COMLEX 2 PE tests students' ability to obtain a patient history, conduct a physical exam, and write a patient note within an allotted time of 23 minutes. We are graded in two domains: biomedical/biomechanical and humanistic. The former is a conglomerate of skills performed with the patient, information gathering and written communication of associated findings, while the latter is derived by the patient/actor in response to our interpersonal skills and professionalism. Students must pass both domains to effectively pass the examination. We will interact with 12 patients throughout the seven hour day. Although this is an exam we have prepared for in school and on rotation, it is a standardized board exam and that means high-stress.

Normally, with enough practice an examination such as this should be second nature. In fact, most students return with the feeling that it was not a difficult process at all. The stress comes in the details surrounding the exam. From here in Las Vegas, I must travel 2,500 miles across the country as there is only one test site. The exam itself is expensive, a small investment of $1,100. Then there are the airfares, lodging, and travel expenses to include. The time commitment is not too overwhelming, but requires a couple days off for traveling. It's easy to see why we want to pass on the first time so badly. This is not an exam anybody wants to repeat for a number of sound reasons. In one week's time, it will be behind me and hopefully for good. Unfortunately, I will not know my fate for another two months when scores are reported. In the meantime, I am thinking positive thoughts and trying to enjoy the remainder of my so-called vacation.

Question of the Week

A 46-year-old woman presents with complaints of feeling as if she
has "sand in her eyes" and reports difficulty swallowing such foods
as crackers or toast. Which of the following pairs of tests would
likely yield positive results in this patient?

A. Anti-centromere antibody and rheumatoid factor
B. Anti-Scl-70 antibody and anti-Smith antibody
C. Anti-Smith antibody and anti-double stranded DNA antibody
D. Rheumatoid factor and anti-double stranded DNA
E. Rheumatoid factor and anti-SS-A antibody

Answer & Explanation

Dreaming of Paradise

While most students are gearing up for spring break, good weather and time off from their workloads, I find myself in a little different scenario. I am spending my "vacation" recovering from surgery and preparing for board examinations...a whole new kind of fun.

A Breath of Fresh Air

Always wanting to take advantage of school vacations and explore foreign environments, I think I am a little bitter this time around. What was intended to be a month of nothingness, quickly became a month of hospitalization and due diligence for the practical portion of board exams. I made it out of the hospital alive, but somehow could not bring myself to study much. That was a good thing, because it was about the only real vacation time I experienced. Now to get back to the books and practicing to be a student doctor on the other side of the country. It has to be done, so I would rather get it behind me early, but I was hoping it wouldn't eat up so much of my vacation.

Why is it that when breaks come, it is so easy to choose the masochistic approach of work and little play? As a medical student, there is always the next step and the next hurdle. When we have time to sit back and get some R&R, we try to do so, but have anxious tendencies about getting things done. Maybe I am the only one that feels this way. This is certainly a Type A personality trait; always on the go, wondering what's next and overboard about everything. I need a real breather. I'm thinking something on a beach; away from this, away from reality and not tied down to a checklist of things needing attention. Maybe when fourth year is over.

Question of the Week

True or False: You can be on vacation and not feel like it is vacation at all.

Home for the Holidays

Being in the hospital days before Christmas it was clear that patients really didn't want to be there. It's not their bed, their decorations or their roommate. They likely don't feel well and simply would rather be ill on their own terms in the comfort of their own home.

Deck the Halls

It was sad to see so many who were aching to be discharged from our care to be sent home for the holidays. They understood their illness was severe enough to warrant continued medical care, but like Dorothy said, "there's no place like home." For what it was worth, the halls were decorated with sparkling ornaments, holiday wreaths were hung near each door, and festive music echoed for those close enough to hear. The hospital staff were directly influenced by the trimmings and hopefully some of their holiday spirit spilled over into the patient rooms.

It made me reflect on the importance of relationships among friends and families. Being surrounded by strangers that have only known us for a few hours or days is in no way as fulfilling as family members and good friends. Cherish good health and loved ones because it is too easy to take them for granted. Despite being hospitalized, I hope those patients felt the holiday spirit even if it was briefly shared by a nurse, house keeper, medical student or other provider. May you and yours have a festive holiday season.

Question of the Week

A 26-year-old HIV-positive woman is brought into the emergency room after she is found lying unresponsive in the street. She has no recollection of what had occurred. She reports sensing a smell "like burning hair" and then blacking out. A medical history reveals that she has had a fever and a headache for the past week. An MRI of the brain shows multiple ring-enhancing lesions. Which of the following is the most likely cause of her symptoms?

A. Cryptococcus neoformans
B. Cryptosporidium
C. Cytomegalovirus
D. Pneumocystis carinii
E. Toxoplasma gondii

Answer & Explanation

Holiday Festivities

(Click image to view Doctor Fizzy's medical cartoons)

Just in time for the holidays is the spread only a physician could love. Textbook descriptions of anatomical abnormalities may not be a popular thing to talk about, but somehow they always seem to make it to the dinner table. For an explanation of these rare delicacies consult your local medical student or physician.

Holiday Cheer

Medical students usually dream of this special time when they get extra time to sleep in, experience a comatose state in front of the television, or just simply not think much at all. That is of course if you are in your first two years of medical school. The clinical years are not as relaxing; resembling something closer to a paid profession. We work all the way up to the holidays and sometimes on those special days just chugging along trying to keep pace. It continues to be rewarding, but does it really help in the long run to have one extra day of clinic...really? The break would probably be better for us mentally than stressing about a few hours of scutwork.

The cartoon depicts the feast well and I could imagine a dessert platter offering the following: cafe-au-lait spots, peau d'orange, cherry hemangiomas, or berry aneurysms. As long as you don't have any of these questionable entities yourself, your holidays are already off to a good start. So whatever your plans this holiday season, elaborate or simple, I hope you take some time to enjoy the finer things in your life - even if you have to work on a supposed day off. I hope you all enjoy the beauty of the season and stay in good health. Bon appetit!

Question of the Week

A patient is admitted to the hospital with shortness of breath and found to have a pleural effusion on chest X-ray. Thoracentesis is performed and the fluid is sent for laboratory testing. Results of the fluid analysis are: pleural protein 8.0, serum protein 6.5, pleural LDH 500, serum LDH 100. Based on these findings, which of the following is the most likely etiology of the pleural effusion?

A. Bacterial
B. Congestive heart failure (CHF)
C. Cirrhosis
D. Nephrotic syndrome
E. Pulmonary embolism

Answer & Explanation

Third Year Begins

With the board examinations behind me and fingers crossed tight for passing scores, I can finally look forward to beginning my third year of medical school. The word on the street is that the clinical years are undoubtedly better than the first two years of basic sciences.


Rest and Relaxation

For the first time since spring break I was really able to kick back and relax. Fortunately it falls on a holiday weekend that offers a little more meaning to my time off. With the stress back to controllable levels and a foreseeable future on the horizon, I am reveling in the lack of planning every moment. Soon I will be back on a schedule and studying again to fulfill my clinical duties, but this is a much needed break that will not be wasted.

Before sitting for the COMLEX exam, I started my rotation in Family Practice. I was such a breath of fresh air to see patients again. It didn't take long for me to realize just how much learning I have ahead of me. On more than one occasion I failed to give the correct answers to posed questions by my attending physician. I suppose those particular questions will be burned into my memory out of embarrassment. Nonetheless, the practical learning grounds beat any classroom lecture. Getting myself ready for a late night shift may take a few days, but I'm up to the challenge.


Board Prep Question of the Week

A 31-year-old man presents to the clinic for his yearly check-up and is found to have a blood pressure of 158/94. At a re-check two weeks later, his blood pressure is still elevated even though he has no risk factors for the development of hypertension. Further evaluation reveals a potassium level of 3.3 meq/L. Proper medical therapy for this man's most likely condition would involve which of the following mechanisms?

A. Agonism of the aldosterone receptor in the distal renal tubules
B. Antagonism of the aldosterone receptor in the distal renal tubules
C. Inhibition of sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule
D. Inhibition of sodium and water reabsorption in the proximal tubule and the loop of Henle
E. Inhibition of carbonic anhydrase activity

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

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

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

Watch Medicine

In lieu of the holiday season and the thought of possibly having a little time to kill while on vacation I have sought out forms of digital entertainment that are sure to keep you amused while feeding the inner medical monster.


Medical Media

Fortunately, I do not own a television. Despite the shock this might cause, it is really a blessing considering how much homework I have. Every now and then, however, I just need a respite from the books and take advantage of the offerings provided by the World Wide Web. Below are links to free medical television shows, movies and procedures for your downtime enjoyment (if you have other suggestions, please leave them in the comments):

Medical TV

• House - An arrogant physician and great diagnostician takes on intricate cases
  
• Grey's Anatomy - Resident and veteran doctors dramatize their medical lives
• Mercy - Television drama at Mercy Hospital
• Private Practice - A drama about a neonatal surgeon practicing in California
• Trauma - Paramedics from San Francisco race to save lives
• Scrubs - A comical show about healthcare providers at Sacred Heart Hospital
  
• Emergency! - Los Angeles paramedics respond to emergencies in this older series
• St. Elsewhere - An 80's look at health providers in a Boston hospital
  
• Nip/Tuck - The dramatized life of plastic surgeons
• ReGenesis - Episodes about a team of anti-bioterrorists
• Chicago Hope - A healthcare team provides treatment to those who have lost hope
• Doogie Howser, M.D. - A young physician's approach to healthcare
  

Medical Movies

• Lorenzo's Oil - A moving story about parents who race to save their dying child
• Patch Adams - A comical view of humor in medicine
• Sicko - Comparison documentary between socialized medicine and American medicine
• Awakenings - New treatment permits catatonic patients to return to society
  

Medical Procedures

• ORLive - Watch recorded or live surgical procedures
• MedlinePlus - Various surgical videos available online

Board Prep Question of the Week

A patient presents to your clinic with a complaint of visual difficulties. On physical exam, you notice that when the patient looks to the left, only his right eye moves. The rest of the exam was within normal limits. The nerve responsible for this patient's problem travels through which of the following structures?

A. Internal auditory meatus
B. Foramen ovale
C. Foramen rotundum
D. Optic canal
E. Superior orbital fissure

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

Early Board Review

More than halfway through summer vacation and I can't seem to stop thinking about preparing for board exams and the second year of medical school. Despite being a year away, they loom incessantly in the back of my mind. It's time to start warming up the memory centers I turned off a while back.

Board Review Books

Since pathology is taught predominantly during the second year of medical school, it is wise to know the normal characteristics and actions of the physiological processes. Many students before me have suggested a self paced refresher course focused on physiology. For a relatively inexpensive price, I was able to procure the Board Review Series text. I figure with a couple hours every day I can at least review the important concepts so they are less foreign when we get into the material this coming year.

Many students have also recommended comprehensive books, such as First Aid for the COMLEX, First Aid for the USMLE, or question banks that will guide the study sessions towards board material. These are often used in conjunction with course materials throughout the year. In any case, there is more material available to prepare for boards than anyone has time to consume. As for enjoying summer to some extent, I think I have plenty of materials to work with and expect to see an improvement in information retention.

Clinical Corner

Home Medicine

Who isn't a fan of self-diagnosing? Admit it, you always try to guess what you have before asking the professional. I had an experience this past week where I was headed to the clinic and stopped at a book stand before arriving. To my surprise they had available a home edition of the Merck Manual. After a little thumbing, and I have to admit a selfish desire to have it on my shelf, I found a detailed description of the ailment, symptoms, treatment and more all in understandable English. For a quick reference, an abbreviated online Merck Manual is also available.

Matriculating Year Two

Hoping everyone had a great independence weekend, this blog comes to you while I'm actually out of town on vacation...enjoying every moment of it. Meanwhile back home, the school registrar is signing me up for the second year of medical school.

Registering

Registration has to be one of the simplest homework assignments I've had all year. With a quick signature, I was on my way to 45 more credits of graduate education. From what I have gathered, the first year of medical school is the most tedious as it concerns everything normal. Second year may have less credits, but a lot more material to cover in the way of pathological systems. Third and fourth years are just plain great due to the clinical experiences and freedom from the classroom.

Fortunately, some of the courses will be continued from last year so the terrain will not be foreign, but the rest will prove to keep me busy without a doubt. If Pharmacology and Pathology don't have me buried in a book all the time, I'm sure Clinical Systems will. (This comprehensive course, for example, touts a cumbersome set of notes and a lot to learn.) At least the information is becoming less dry and more interesting to learn as time goes on.

Assuming all goes well, I will be starting classes as planned in early August with adequate funds and supplies. In the meantime, I'll be enjoying vacation and honoring those who serve our country to protect our freedoms, thereby supporting my education.

Summer Exercise

We've already had a few days with temperatures above 100 degrees and Summer is officially here. It's time to enjoy this summer vacation before school starts again.

Mental Exercise

With some free time on my hands and in an effort to avert the quickly growing student loans I currently have, I tried out for the game show Wheel of Fortune. As exciting as it would have been to tell everyone I won thousands and a vacation getaway, my Wheel experience ended in the second round of auditions. Phrase, only vowels remain... B_TT_R L_CK N_XT T_M_. Left without much money and a stubby pencil as a souvenir, I am grateful for the mental workout.

Physical Exercise

High on my list of priorities for this summer has been eating nutritionally and getting in shape. Exercising right is time consuming and physically demanding. With the right tools and knowledge, workouts can be fun and rewarding.

In my search for exercise tools I have come across a fantastic website that crawls the web for the best deals in online stores. They provide definitions and guides in choosing the right product that meets your needs without the bias of commercialized businesses. With filters to narrow your search, it could not be simpler to shop the internet.

I have been looking for heart rate monitors for a while now, because meeting or exceeding 60-90% of your maximum heart rate is a significant part of an effective workout. Using a heart rate monitor will provide instant feedback that helps determine your level of exercise intensity, a major component in physical training.

When exercise intensity is not elevated, pedometers serve well to be riding your waist. They help track steps taken throughout the day which correlates with overall daily activity. Using a pedometer can help you reach the recommended amount of 10,000 steps per day by taking the guesswork out of counting the steps yourself.

What better way to model your new electronic wear than with a new pair of trail running shoes. Whether your in the gym or on a nature hike, your feet are often the most important part of your training. Recommendations are to replace your old shoes every 300-500 miles to avoid injuries from lost shock absorption and uneven tread wear.

With luck and a lot of effort, by the time second year comes around I'll be a little healthier and more prepared to take on the new year as long as I keep moving.

Things I Wish I knew - First Year

After becoming a second year medical student two days ago, I looked back at the last year and gave each week a point value between 0 and 10 signifying my interpretation of medical school intensity where 10 is the greatest. Low points were often vacations (with the next few weeks prorated) and tallest peaks represent block weeks. Call me a geek if you will, but I think it's pretty cool to see the year in graph format.

Things I Wish I Knew

This last week of exams was not difficult academically, but was more so in anticipation of summer break. With one year behind me I have come up with a list of things I wish I knew before my first year of medical school.

1. Not all the textbooks were necessary - In addition to presentations and notes, the textbooks added a valuable resource, but there was simply not enough time to read every assignment. Occasionally, books were not even used. Contact current students and find out what they recommend. If possible, get used or discounted books. Often times they will already have markings of the material that is important and you save a little money too.
2. Much of the day is spent sitting - Time management is crucial to success. With excessive amounts of lecture and self study, there is little time to exercise. Elbows become sore and dry from hours at the desk, the back sore from pore posture, and the neck aching from constantly looking down. Exercise can be difficult to fit into the rigorous schedule, and it will make a great difference if included on a regular basis.
3. Organizing study habits takes time - It seems like a moot point because most people who get into medical school have some experience in studying. As one who has never used a laptop during class in undergrad, it took some time to learn how to organize my notes. When I realized that wasn't for me, I had to move back to paper. Transitioning between school and home is a challenge that requires attention. Having specific times dedicated to studying and following them will help significantly. Do what you are comfortable with, and most importantly how you learn best.
4. Associations are everywhere - At first it seems like you are struggling to get the fire-hose out of your mouth as far as information goes. Whether it is anatomical structures, terminology, or concepts it can quickly become overwhelming. For example, if you have experience with a condition you are studying (clinical, family or friends), it makes it a lot easier to remember and understand. Making associations to things you are familiar with personalizes the same message in a way you can comprehend.
   
5. Get involved - At first it was hard to imagine that there would be time to do anything but read. Initially, I was going to avoid the groups and activities until I could handle more which was not wrong thinking, and permitted proper time to habituate. Study groups are vital to bounce ideas and thoughts around. Student organizations are a great way to participate in community events and gain more experience. There is no better time to become a team player than in your first year class.

I am but one medical student in the sea of many. If you have something you wish you knew before your first year of medical school, please share.

Starting Refreshed

The taxes are filed, financial aid has been requested and the groceries have been purchased. It sounds like spring break has been a success, not to mention sleeping in once or twice.

Back to School

It was hard to stay away from the books for a week knowing full well that the next six weeks will be building upon previous information. Gearing up for the last block of the first year of medical school has taken some effort as the tank of enthusiasm was reading empty.

Fortunately, the last set of exams went well and only one exam week remains. We are on the verge of starting two new subjects Renal Physiology and Immunology. From my understanding both are rather challenging subjects. I will take their word for it as I have learned professors know how to pack a lot of information into a few weeks of lecture.

Clinical Corner

Sleep

Sleep, it does a body good. Sleep disorders can make getting the rest you need very unpleasant. Circadian rhythms help to cycle our sleep patterns which induce relaxation and waking affects. No less than 7 hours of sleep are recommended to maintain optimum health and cognitive functioning. Thanks to spring break, I think I am back on schedule.

Technology and other methods are available to help individuals who suffer from the lack of a good night's sleep. If you are having trouble sleeping or getting your child to sleep, check out the Marpac SleepMate and the Conair Sound Therapy Clock.