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

Second Exam Week Three

There is really no need to say it, but the general consensus is that we are ready for the winter break to be here. The endless hours of review and study are starting to take a toll, unfortunately we still have five more days of exams to push through. This napping station sure looks enticing...

Endurance

Despite my best efforts to study into the next calendar day, I have found that I just cannot do it on my own. Taking time to break away from the books for a short period to shoot hoops, eat a meal or just squeeze in a short nap has fortunately lengthened my capacity to sit for longer periods. On the flip side, I have yet to determine the educational and graded benefits of this approach.

A fellow blogger and former medical student currently in his residency suggested an intriguing method for maximizing his time and efficiency. He calls it the Caffeine Power Nap as it combines the effects of sleep and drink to fuel ones durable energy. From personal observation I don't think my adenosine receptors are as responsive to the methylxanthine as others self-report, but the placebo effect seems to work for now. Ask me how I am holding up by the end of the week, that's the real test.

Board Prep Question of the Week

A 78 year old obese female with a history of bilateral knee arthritis and asthma presents to your office with symptoms consistent with stable angina. You choose to further evaluate her with a cardiac stress echo. For this patient, what agent is the most appropriate method to induce myocardial stress?

A. Adenosine
B. Dipyridamole
C. Dobutamine
D. Metoprolol
E. Treadmill Exercise

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

Giving Thanks

In this season of thanksgiving, I reflect on that for which I am grateful. My supportive family and friends are at the top of my list along with endless opportunities to serve my community. I am usually not grateful for the ability to grow so much hair on my lip, but this month is a little different.

Local Volunteer Opportunities

With the little time we have outside of classes, it is refreshing to give back to the community on occasion. Since we are in medical school, it commonly comes in the form of optimizing health through sports physicals or public screenings. Recently, I joined my peers in a 5k walk for chronic hypoinsulinemia on behalf of the Juvenile Diabetes Research Foundation (JDRF). In addition to raising money for a good cause, we caught a little fresh air and exercise at the same time.

In an ongoing effort to address prostate cancer awareness, men all over the world are "changing the face of men's health" by growing a mustache for Movember. I joined my classmates as Student Physicians for Fuzzy Philtrums, with the goal of contributing our follicular skills to this beneficial cause. If you have a prostate or love someone who does, please contribute to this noteworthy cause by sponsoring my fuzzy philtrum with a small donation. All proceeds go to the Prostate Research Foundation in cooperation with the Lance Armstrong Foundation. (After clicking the above link, you will be able to provide your contribution information online, if you have questions, please leave a comment.) Your generosity is greatly appreciated.

Board Prep Question of the Week

A 29 year old female with type 1 diabetes goes on a trip to the Caribbean and loses her insulin on the way. Three days after her last insulin dose she goes to the hospital. Lab work shows hyperglycemia and increased anion gap metabolic acidosis. Which of the following pathways is mainly responsible for providing the substrate of her acid-base disorder?

A. B-oxidation of fatty acids
B. Catabolism of branched chain amino acids
C. Citric acid cycle
D. Gluconeogenesis
E. Glycogenolysis

Answer & Explanation

Not On My Watch

Iatrogenic (caused be medical personnel) and nosocomial (obtained in the hospital) infections are unfortunately a sad reality in healthcare. When we visit the doctor, the last thing we want is to become more ill than our initial visit from an avoidable cause.

Healthcare Associated Infections

Hospitals are rightfully expected to get you better but that's not always the case. Sometimes people are picking up infections, from pneumonia to antibiotic-resistant staphylococcus (MRSA), while under treatment for other health problems, or even while just in the hospital having a baby. That's a situation that could, and should, be completely avoidable.

The fast pace medical environments such as clinics and hospitals make it easy to understand how healthcare professionals can facilitate the spread of infectious diseases from one patient to another. As simple as it is, hand washing is still one of the most effective means of reducing the spread of infection. Research has shown that alcohol based lotions equally accomplish the task in less time, hence the common practice of their use in medical facilities.

Healthcare associated infections not only have a significant financial impact on the medical system, but they are detrimental to the health of patients everywhere. The global campaign, "Not On My Watch" aims to educate healthcare providers how they can participate in reducing the spread of infection. If we all do our part, we can play an important role in the health of others and our own.

Board Prep Question of the Week

Five days after a mitral valve replacement, a 63 year old woman becomes hypotensive, tachycardic, and febrile. She is rushed to the CCU where an emergent transesophogeal echocardiogram shows multiple vegetations on the new mitral valve. Blood cultures are taken the patient is started on vancomycin and gentamycin. The initial Gram stain shows gram positive cocci. What additional bacterial characteristics are likely to be found?

A. Catalase negative with no hemolysis
B. Catalase negative with partial hemolysis and a positive quellung test
C. Catalase negative with partial hemolysis and no capsule
D. Catalase positive, coagulase negative
E. Catalase positive, coagulase positive

Answer & Explanation

Fertility Institute

With the new block comes new material. In anticipation of next semester's "project prepare," we have started our training of the genitourinary and reproductive systems. In terms of productiveness, we are gaining a fertile education.

Avoiding Educational Infertility

Although fascinating to learn about, the hormones involved in the endocrine system can be quite difficult with the first few passes. In working order, they control normal reproductive functioning and health. When the hormones are imbalanced, disease can easily take over resulting in various health complications.

It extends beyond the hormones into the histology, anatomy, physiology and biochemistry. The more we learn the "cooler" it gets as medicine incorporates so many fields into one.

As medical students we simply try to pack in as much of the information now, let it ruminate and make the clinical connections when the appropriate time comes. A significant part of our education is based off of getting the knowledge now so that we understand the clinical importance later. It may be wishful thinking, but I hope that the clinical experience really solidifies the chaotic sea of information that is floating around in my head. Books, flashcards and lectures can only go so far.

Board Prep Question of the Week

An 18-year-old female presents with abdominal pain determined to be related to ovulation. In reviewing the hormones of the menstrual cycle, you correctly remember that which of the following is responsible for ovulation? (Hint: Shown in the image above)

A. Estrogen
B. Follicle stimulating hormone
C. Luteinizing hormone
D. Progesterone
E. Prolactin

Answer & Explanation

Board Review

As we move forward into our last block of the semester, we often consider the inevitable board exam following our second year of medical school. For those of us who have not already started preparing, there are some very useful tools and programs available to make the most of time and resources.

Step 1 Board Exam Preparation

Whether you prefer reading from a book, listening to a lecturer, or answering thousands of practice questions, this is one test you have to prepare for well in advance. Some of the representatives of the programs have visited our school to share information, but it is important to know what fits you.

Below I have compiled a list of recommended review materials (and pricing when available) from those who have been through the process. As is often the case, the sales happen early, so do not wait too long to make your purchase. If you have suggestions, please leave a comment for others to read.

Books

• First Aid for the COMLEX - ($38) Geared towards the OMM and COMLEX style questioning
• First Aid for the USMLE Step 1 - ($40) Outlines the high yield information for USMLE
• Board Review Series - (avg $30) Various books detailing the important points of each subject (Physiology and Pathology are recommended).

Review Courses

• Doctors In Training - ($700) They are inexpensive, send bi-weekly emails with topics and have a three week online review. The price is lower because they do not include a question bank and use the First Aid book as their text.
• Kaplan - The old standard that provides excessive information at a high price. They offer practice exams, a question bank, and review sessions.
• Northwestern - ($400-$1500) Their emphasis is on COMLEX preparation, but they offer USMLE options. Pricing varies on supplies and package purchased. They offer a range of high yield courses or extended two week sessions.

Question Banks (Discounted prices are often available if purchased early)

• COMQUEST - ($75-$350) COMLEX oriented with 30-365 day subscriptions
• Combank - ($89-$389) COMLEX oriented with 30-360 day subscriptions
• USMLE World - ($99-$399) USMLE format with 30-360 day subscriptions; 2,000+ questions
• USMLE Rx - ($99-$199) USMLE style from the authors of First Aid offering 1 and 3 month subscriptions or until you pass; 3,000+ questions
• Kaplan - COMLEX and USMLE questions
• Northwestern - ($75-$145) COMLEX and USMLE questions with 1-6 month subscriptions

Board Prep Question of the Week

A 58 year old man presents with a past medical history of hypertension presents with a cough. The medical team suspects that the cough is due to one of his antihypertensive medications. Which of the following is a characteristic of the best alternative drug for this patient?

A. Interference with binding of angiotensin I
B. Interference with binding of angiotensin II
C. Reduction of serum angiotensin II levels
D. Decreased production of a key enzyme produced in the lungs
E. None of the above

Answer & Explanation

Second Exam Week Two

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

Medical Knowledge

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

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

Board Prep Question of the Week

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

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

Answer & Explanation