Life as a Medical Student

Objective Structured Clinical Exam

2009-12-20T08:00:00.002-07:00

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

2009-12-13T08:00:00.002-07:00

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

2009-12-06T22:37:00.004-07:00

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

2009-11-29T09:59:00.006-07:00

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

2009-11-22T10:44:00.003-07:00

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

2009-11-15T12:36:00.005-07:00

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

2009-11-08T10:16:00.006-07:00

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

2009-11-01T17:43:00.009-07:00

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)

Combank - ($85-$385) COMLEX oriented with 30-360 day subscriptions
USMLE World - ($99-$400) USMLE format with 30-360 day subscriptions; 2,000+ questions
USMLE Rx - ($70-$300) USMLE style from the authors of First Aid offering 1-12 month subscriptions; 3,000+ questions
WikiTestPrep - (Free) USMLE type questions to get you warmed up for the tougher ones; 600+ 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

2009-10-25T11:43:00.005-06:00

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

Medical Knowledge

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

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

Board Prep Question of the Week

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

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

Answer & Explanation

Medical School Training

2009-10-18T12:17:00.006-06:00

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

Objective Structured Clinical Examination

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

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

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

Board Prep Question of the Week

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

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

Answer & Explanation

A Breath of Fresh Air

2009-10-11T22:26:00.003-06:00

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

2009-10-04T09:45:00.005-06:00

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

Medical Training

2009-09-27T17:45:00.001-06:00

We are slowly making progress through the body systems and their related pathologies. Fortunately, the curriculum is set up to permit a significant overlap in material so that most courses are reinforcing concepts of an important nature. This repetitive exposure has been helpful to build working knowledge of how differing subjects can contribute to a comprehensive understanding.

Medical Program

All of our courses, during the second year, relate in some way to the health of the human organism. The learning process at Touro Nevada has been made simpler by combining topics from the multiple courses to coincide with one another to some degree. For example, this week in Pharmacology we covered Non-steroidal anti-inflammatory drugs (NSAIDs). At the same time in the Clinical Systems course we learned about various rheumatologic diseases that employ the use of NSAIDs to treat symptoms. Additionally, the Osteopathic Manipulative Medicine staff presented lymphatic treatments that could be used to aid in the recovery process.

The combined efforts of each course is to develop a well-rounded understanding of the approach to various body systems. So while studying for one class, I am equally reviewing material for another. The pieces of this "human puzzle" come together quite nicely to paint the whole picture.

Board Prep Question of the Week

A 40 year old female presents to her physician for worsening joint pain. She has had joint pain for many years in both wrists, MCP joints, and PIP joints. Her DIPs are spared. Her pain is always worse in the morning and improves as the day goes on. Lately she realizes both knees also hurt her and she is more tired than usual. Examination reveals her painful joints to be mildly warm and her PIPs are flexed, while her DIPs are extended. Laboratory testing reveals high titers of rheumatoid factor (RF), an elevated ESR and C-reactive protein, and a normocytic normochromatic anemia. Examination of the synovial fluid at the involved joints would most likely reveal which of the following?

A. Clear fluid; 125 WBC/mm3; 20% PMNs
B. Clear-yellow fluid; 1,800 WBC/mm3; 20% PMNs
C. Cloudy-yellow fluid; 6,000 WBC/mm3; 60% PMNs
D. Turbid, purulent fluid; 50,000 WBC/mm3; 80% PMNs
E. Reddish fluid; 1,500 WBC/mm3; 20% PMNs

Answer & Explanation

Wireless Mobile Phones

2009-09-20T18:00:00.002-06:00

As technology advances, similar improvements can be seen in the medical field. The possibility of having communication devices at our fingertips has changed our approach to simple tasks. With smartphones now available in all shapes and sizes, technology continues to maintain its "coolness" with the added bonus of simplified communication.

Smartphones

Knowing full well that in less than a year I will be working in the clinics and hospitals among physicians and patients, I wanted to ensure that I had one of the most helpful tools in my pocket. Where a Personal Digital Assistant or book may have useful applications they still lacks in communication. The smartphones, on the other hand, are all encompassing with everything from internet and wireless communication to user friendly applications that make life easier.

Within the last few years the smartphone market has become increasingly saturated with new brands and models to meet diverse personal needs. In my recent hunt for the right phone I was able to narrow my search with the help of Top Ten Reviews. With so many options, it was helpful to have one place with customer reviews and technological differences.

In the end I chose to purchase Apple's iPhone for a number of reasons. A large portion of the purchase cost ($400 to be exact) is covered by AT&T making the initial out-of-pocket cost more affordable. To my surprise, the technology is rather easy to use and navigate, even for a beginner. With an expanding collection of applications, the iPhone has a versatile array of uses for many settings including the medical field, which was a critical deciding factor in my case. Although it may be a little more expensive than some of its counterparts, I felt the iPhone was the best fit for my particular medical student needs and will be an indispensable tool in my professional aspirations.

AT&T Gift Card

I have also recently learned that with a new AT&T account you can receive a $25 dollar gift card when referred by an existing user. That said, if you are planning to switch to AT&T or have recently joined AT&T, leave a comment on this post to that effect and I will provide you with the information needed to get your $25. Just be sure to leave your name and a means to contact you. Consider it your bonus for getting to the end of this post!

Decompressing

2009-09-13T17:10:00.005-06:00

Block week certainly took its tole on me. Little sleep, difficult exams, and copious amounts of information culminated in a rather challenging week.

Overload

Coming into medical school, I knew the curriculum would be a feat to overcome. The change from undergraduate training to graduate level was no piece of pie, but I learned to cope and make the most of the situation rather quickly. The change from first to second year, however, was a curve ball I was not expecting. From the beginning of this year, we have been running at a sprint just to keep pace. Block week was no different.

I thought by studying in greater detail, for longer hours, from numerous sources that this year's courses would be surmountable. Unfortunately, there was little relationship between the amount of study and the resulting grades, which means I have to review the way I study. I felt that I already made a change for the better this time around, but it is apparent that I review my approach.

Needless to say, this weekend has been a much needed recovery. Catching up on sleep, missed errands and emails has been a great break in the action. It sure is a good thing I like the medicine.

Second Exam Week One

2009-09-06T09:00:00.000-06:00

Let the fun begin. Although it seems like we've just begun the year, block weeks are here. That equates to a lot of late nights, little sleep, and excessive stress.

Student Syndrome

Fortunately, by this time we have been "around the block" a number of times and we are starting to feel comfortable with the flow. The sense of shock that was once there is more of a nagging feeling to get back in the books and make the most of our time. With one week to show what we have gained over the past month, why not drive hard?

Now the exams are not necessarily "old hat" just yet. In addition to revisiting the grueling routine again, we still have a lot of new subject material. Where there is one normal physiological function for everything, there are multiple pathological occurrences. That adds up really quick, leaving a substantial amount of material to cover.

The school has become my second home...for better or worse. The two most appreciated feelings are 1. Doing well on an exam and 2. Jumping into bed at the end of the night. Did I mention how much I love medical school?

Clinical Corner

Student Syndrome

This refers to the art, skill or habit of procrastination commonly employed by students to hold off their most important tasks to the last minute or wish there was more time to complete their work. Although I would like to say I do not actually have this syndrome, I am of the opinion that if you are a student, you likely exhibit it to some degree. Avoid cramming and use your time efficiently, even if it is at the last minute.

Pathology Education

2009-08-30T19:59:00.005-06:00

The second year of medical school certainly has a lot of information compared to first year. Fortunately, it is focused on the pathological abnormalities, which make learning the material much more fascinating. [Image provided by the National Cancer Institute]

Pathology

This field of study often associated with autopsies and coroner's investigates both the abnormal macroscopic and microscopic findings in anatomical tissues. Learning a subject that takes years to master is quite a challenge for the novice pathologist.

It has been difficult to narrow my study of the subject as there are so many sources to pull from. The professor has his way of disseminating the information and pathology review books are quite different from that style. I have learned that with more exposure to the subject, the better it falls into place. As with anything, repetition is bound to make a connection sooner or later. Since there is a grade at the end of all this, in this case I am hoping for sooner.

We started the year with cellular pathologies and more specifically when cells get out of control. One of the leading concerns today is cancerous growth whether on the skin, in an organ or rampant throughout the body. Although I certainly do not have a cure for it, I am just starting to appreciate what causes cancer and how it is manifested. Often times it is the result of a genetic deviation from normal that no longer suppresses rapid cell growth. However, there are environmental factors that contribute to the development of cancer too.

Examples of carcinogens include UV light, occupational chemicals, and even hormones. We are exposed to them in various amounts depending on our habits, environments and genetic vulnerabilities. There is little that can replace healthy eating, regular exercise, and minimal carcinogenic exposure. So until next time, don't get too much sun and stay away from those asbestos infested workplaces; it could mean the difference between life and death.

Clinical Corner

Asbestos Exposure

Despite workplace safety measures, exposure to asbestos has been linked to mesothelioma, a malignant cancer affecting the lining of the lungs and/or abdomen. Where pleural mesothelioma can cause difficulty breathing due to fluid in the lungs, peritoneal mesothelioma affects the intestines causing weight loss, pain, and fluid accumulation in the abdomen. The latter is also associated with bowel obstructions, anemia, and fever.

It is most commonly seen in individuals who work closely with asbestos or their families, but may not be symptomatic for years. Mesothelioma is diagnosed by a pathologist who obtains a biopsy for histological examination. It is treated by surgical removal of the organ involved, radiation or chemotherapy. It is difficult to treat and therefore has a poor prognosis. For this reason there are clinical trials being performed in an effort to find better outcomes.

Neck Pain Treatment

2009-08-23T16:55:00.004-06:00

One highlight for osteopathic medical students is obtaining hands-on training in Osteopathic Manipulative Medicine (OMM). Cervical spinal manipulations are among the most anticipated of techniques and thankfully have successful outcomes.

Neck Therapy

With the Hollywood stigma and the spine tingling sound of cracking, it is no wonder that we have had to wait this long to learn the mechanics associated with such treatments. As students we are just as nervous performing the technique as we are to be the patient on the table. The risk of severe damage is reported to be rather low, nevertheless, attention to properly performing these treatments is critical.

There are numerous resources available for learning the art of OMM and the American College of Osteopathic Family Physicians' website outlines a few of the more common treatments performed by osteopathic doctors. Although it is needless to say, there is more available than we students have time to consume. After learning it in the lab, we have to take it upon ourselves to make the time to practice our new skills.

In cases of somatic dysfunction, when a diagnosis is obtained, a trained DO can perform these treatments which relieve unnecessary pain and muscle imbalance. Because it is so sensitive, the neck can have a significant amount of dysfunction. Osteopathic cervical treatment is a quick way for the patient to find relief from their symptoms, and it is an enjoyably unique part of most osteopathic medical students' curriculum.

EKG Training

2009-08-16T09:47:00.004-06:00

While working in the Emergency Department, I saw a lot of electrocardiograms (aka ECG or EKG) but did not have the training to read them correctly. Now in our second year of medical training, we are learning the basics of a somewhat complicated art.

Electrocardiogram

An electrocardiogram is a medical tool that provides an electrical reading of the heart's activity. Once you get past placing the leads in all the right places, it is a matter of understanding what the data is trying to say. With lines, spikes, bumps, depressions and what seemingly looks like cat-scratch, they can appear quite daunting to the amateur like myself. Careful observation and study of the markings can reveal a lot of pertinent information about the patient's anatomy and cardiac condition.

EKG training has branched out from the classroom to include online resources and texts that provide a quick reference to normalcy and abnormalities. As both an educational tool and reference book, Dale Dubin has published an easy to read book, Rapid Interpretation of EKG's, which I would recommend to any student of the art. Once there is a foundation of the principles, it is useful to consider a number of unique readings to see how they actually look. Dr. Wes, an electrophysiologist and cardiologist, occasionally shares EKG's on his blog for reader interpretation before posting his diagnosis. In this way, readers are exposed to various rhythms that demonstrate critical findings.

Being competent enough to know what you are seeing is a significant task when reading an EKG. With time and practice, I could be well on my way to understanding it a little better than before. Pathological indications will be jumping off the screen giving vital hints as to what treatments are required, and it's my job to recognize them when I see them. Fortunately, they will not be on living patients for another year.

Bicycle Transportation

2009-08-09T09:45:00.006-06:00

We've only had three days of class and I already feel behind in my work. Between previewing lecture notes, reviewing lecture notes and reading the texts, I seriously wonder if I will have enough time to do anything else. At least getting to and from school will now be beneficial in relieving some of that stress. Check out my new wheels!

Scheduling Overload

Somewhere between the end of first year and the start of second year I lost a lot of important information mentally. As we cover certain subjects again, I can feel that sense of lost recognition. The professors certainly did not wait to open the flood gates and started in full force. After pharmacology and pathology were introduced, I felt my time would be well occupied. But it didn't stop there, they tacked on behavioral medicine, medical microbiology/immunology, clinical systems, osteopathic manipulative medicine (OMM), and objective structured clinical exams (OSCE).

On top of all that, I plan to squeeze in time for work-study in the anatomy lab, tutoring, several interest groups of which I'm an officer for two, and act as a "big sib" to a couple of the first year students. I smell burnout in the near future.

Stress and Anxiety Relief

In an effort to reduce some stress and use my time efficiently, I purchased a great bike at a great price thanks to Craig's List. Last year, I was in the worst shape of my life due to classroom inactivity. I'm hoping this year will be different. Amid the busy schedule, I don't see a whole lot of time for exercise and plan to ride my new bike to school instead of taking the car. Surprisingly, it takes almost the same amount of time to travel due to an abundance of traffic lights. At least this way I will be getting some movement into my otherwise sweat-less chair routine and burning useless calories in the process.

Sports Physcial

2009-08-02T13:04:00.004-06:00

Not only is school starting in a matter of days for Touro University students, but high school students too are getting ready for the coming year. In conjunction with a local sports medicine clinic a few of my classmates and I teamed up to provide pre-participation exams for students trying out for various high school sports.

First Patient

Although our cadavers may have been our "first patients" as medical students, they were not breathing. So my first patient would have to be among the students I examined this last week. Each of the medical students were assigned an exam room where we obtained vital signs, medical histories, and performed sports physical exams.

After talking with some of my colleagues, I don't know who was more nervous, the medical students or the highschoolers. During first year, we were never instructed how to perform genitourinary exams. Given this responsibility among other tasks, we were expected to be professional and lead the exams in a timely manner. Looking back on it, it really wasn't so difficult. I assume at this point in my education, there are going to be a lot of firsts. Fortunately, this one was a positive experience.

I can tell there is a lot to be learned as the flow seemed a little choppy. In all, it was great exposure to the physical exam, younger patients, and my weaknesses as a learning student. It gives me something to work towards the next time around.

Healthcare Reform

2009-07-26T12:59:00.005-06:00

Political propaganda just keeps rearing its face in lieu of the healthcare debate. Making sense of it all is an entirely different story and I am no where near understanding.

Healthcare Debate

With the new president and political party, we are soon to be introduced to a new form of healthcare. As medical students we may not yet be intimately involved in the business aspects yet, but we certainly will be in the future. Medicine as we know it today will change to adapt to the new policies decided in Washington.

In March, the largest gathering of osteopathic students and professionals held a conference in Washington D.C. to share their voice with politicians concerning healthcare reform. Considering the task before them, politicians may take a while before coming to a consensus, but the August deadline remains.

It is exciting to imagine how things will change by the time I and my colleagues graduate. Nevertheless, the majority of physicians are not content with the way things are moving. Understandably, the idea of doctors doing more and getting paid less is not an appealing alternative to their current standing. Perhaps if doctors were to be sponsored like professional athletes, there would be no need to worry.

Online Preparation

2009-07-19T17:51:00.006-06:00

As new books are coming in, old books are being sold. The cycle seems a little ridiculous when we have so much technology available. How long will it be before there is an online medical degree for physicians?

Online Medical School

Although it may not be too far into the future before medical degrees come via online schools, at least online resources are a great place to study for such degrees. Whether a student or simply intrigued you can get a feel for questions that are asked on board examinations at WikiTestPrep. It is a free question bank composed to help students prepare for Step 1 (after second year) and Step 2 (near fourth year) board exams.

It doesn't take much time to answer a couple questions making this a simple addition to board prep exercises. Detailed explanations help to give a better understanding of difficult concepts. Add this to your routine as early as possible and reap the benefits when boards come around. Question banks are useful but can have expensive subscription fees which is why the above link is provided. Below are a few qbank offerings:

USMLE World - ($185, 3 months, 2000 ?s) Good reviews
Kaplan - ($189, 3 months, 2400 ?s) Most popular
Exam Master - ($99, one month, 7900 ?s) Commonly free through school libraries
USMLERx - ($129, 3 months, 3000 ?s) Similar to the Kaplan service but with a free trial
Score95 - ($59, 3600 ?s) Poor reviews
Scrub Notes - Blog post with an insightful qbank opinion

There may be other question banks available, but these tend to be the standard. I have been using Exam Master through Touro's library in addition to the WikiTestPrep just to get started. Getting in the right mindset to approach the boards has been a challenge, and the little time spent using these programs has been helpful in exploring the process. It may not get me a degree, but the internet has been my online medical school this summer and definitely keeping me busy.

Early Board Review

2009-07-12T15:17:00.007-06:00

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

2009-07-05T08:00:00.008-06:00

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.