Boards Studying, Days 9 & 10

May 25, 2008
1) started reading cardiology notes in First Aid. Read all of the cardiology chapter of Rapid Review Pathology. OH PATHOLOGY, I have missed you so much!
2) 9 questions on histology, 20 questions on immunology (YUCKY), and 10 questions on cardiology = 39 questions.
3) finished Goljan audio #7, 45 minutes.

May 26, 2008
1) finished reading cardiology notes in First Aid.
2) read some Molecular and Cell Biology notes — I got a question wrong on ELISA on Sunday, and that just pissed me off because I’m usually good at questions on lab techniques!
3) 35 questions on cardiology.
4) 10 minutes of Goljan audio #8.
5) One of my favorite episodes of House, “The Socratic Method,” which ends up being about Wilson’s disease. This episode (and an unrelated story about Roommate Rebecca from college) made it easy to remember Wilson’s disease during school. Also watched an episode of Good Eats, because the universe loves me and somehow our week-long “trial” of Food Network has lasted 3 weeks. (We didn’t used to get Food Network, which is a TRAVESTY, because I do not need Fox News or 3 kinds of HBO if I don’t have Food Network, okay?)

Total number of hours spent studying: 9.5, which is pretty good, especially considering it was a holiday and the library was closed (ALSO a travesty), and so I had to study mostly at home. Studying at home is always a problem, because the bed is right there for napping, the TV is right there for watching, and my laptop is right here for checking email obsessively.

To do today: respiratory system! WOOHOO!

Boards Studying, Days 7 & 8

It’s the one-week anniversary of studying for Boards! Ugh, I’d like to break up with Boards. I think this relationship has already run its course.

May 23, 2008
1) read some notes on microbiology (viruses!)
2) did 50 questions on microbiology
3) listened to 45 minutes of Goljan audio (finished #6 of 37)
4) hit the JACKPOT of House episodes with s1 episode 4 “Maternity” — it was about an outbreak in the maternity ward! Totally money, because I’d just finished reading about all these crazy infectious diseases, and what you do to test them and treat them. Watching the episode consisted of a lot of pausing the DVD so I could look up the latest bug on the differential diagnosis. It was AMAZING, because the list covered bacteria and viruses, so it was like my entire day, encapsulated in an hour-long TV show.

Total number of hours spent studying: I dunno, around 9.

May 24, 2008
1) read notes on immunology
2) read notes on some pharmacology (drugs)
3) 20 questions on microbiology, 30 questions on pharmacology
4) no Goljan audio today
5) watched the season finale of Grey’s Anatomy instead… Grey’s is really, really light on the medicine, but I guess it was the season finale so I couldn’t really expect much in the way of actual content. Also, they mis-described the IRB. Internal Review Boards, or Institutional Review Boards, are formed by each hospital or research facility. There is no single national review board for clinical trials.

Total number of hours spent studying: around 9

Boards Studying, Day 6 – May 22, 2008

What I did today:
1) did 26 more USMLE World questions on embryology — no more embryology questions left!
2) started microbiology and immunology notes
3) did 30 microbiology (but not immunology) questions on USMLE World.
4) 20 minutes of Goljan audio (part of #6 of 37)
5) no House, but did spend 1 hour at the Medical Student Research Committee’s journal club meeting, talking about a pretty short paper in Science testing the use of farnesyltransferase inhibitors in treating progeria, a genetic mutation that causes premature aging in children. The hour was totally made worth it when the professor leading the discussion mentioned that one of the enzymes used by the disease is also known as HMG CoA reductase, the enzyme that statins work on to lower high cholesterol. And then he went through a quick sketch of cholesterol synthesis, and I was totally grateful for that tiny tie-in to Boards studying. I know, I’m super lame.

Total number hours spent studying: approximately 8 (YIKES, I’m falling behind).

Boards Studying, Day 5 – May 21, 2008

Accomplished today:
1) read notes on Embryology
2) 25 questions on USMLE World (need to do more embryology questions)
3) 45 minutes of Goljan audio (finished #5 of 37)
4) no House, but rather, spent nearly 2 hours watching the American Idol finale. Oops.
5) Registered for a practice session at the Prometric center. Unfortunately, the only date available was June 3, which is earlier than I wanted. But at least it was available.

Total # hours spent studying: about 8

What happened to Days 1 and 2?

On Days 1 and 2 of Boards studying, I skimmed and half-assedly read the entire First Aid for the USMLE Step1 book. And by that, I mean that I daydreamed while reading bits and pieces, perfected my study schedule, took a lot of breaks, and moaned a lot about having to study for 30 days straight.

It was a pretty good 2 days.

Exam date is currently scheduled for Wednesday, June 18. I’m not planning on pushing the test date back, and at this point, I probably can’t, since I booked my plane ticket to go back to LA on Thursday the 19th. However, there is a testing site in Diamond Bar, of all places, so if I really wanted to… But that’s kind of crazy talk. The sooner this test is over, the sooner I can go back to being a real person.

Boards Studying, Day 4 – May 20, 2008

Done today:
1) finished reading biochemistry notes
2) 45 questions on USMLE World
3) listened to 50 minutes of Goljan audio
4) uhhhhh…

No episode of House today, because I spent a few hours going into New York City to look at an apartment I’m subletting for 6 months, in lieu of renting my own apartment and getting into a year-long lease for a ridiculous amount of money. The apartment is on East 13th Street and 2nd Avenue, in the East Village. It’s also about 1 mile, or 3 subway stops from St. Vincent’s Hospital, where my 3-month medicine rotation is. It’s going to be awesome. Even better is that now that my living situation is mostly squared away (I have a sublet lined up in Westchester in January & February 2009 for my surgery rotation, and I have housing in May & June 2009 for my pediatrics rotation, so all I need to find is a March & April sublet in the city, which can wait), so now I can seriously, honestly, fully focus on Boards studying. Hooray!(?)

I’m doing practice test questions from a “question bank” (or QBank, for the kids in the trenches), and I’ve chosen to use USMLE World. Generally, most people pick USMLE World or Kaplan QBank. Kaplan’s been around longer and better known, but USMLE World supposedly better simulates the real Step 1 exam. USMLE World doesn’t do anything besides USMLE (Medical Licensing Exam), whereas Kaplan has its hands in every kind of test prep imaginable. This is probably why the USMLE World website (www.usmleworld.com) is kind of ghetto-looking. When I was signing up for the QBank, I wasn’t even sure I was at the right website. My favorite part of the website has to be this picture on the left, though:

Look at that mustached man! There is a man who knows test prep questions and WILL make you LEARN THEM!! I’d trust him and any question bank he endorses. That Blue Steel look must have taken eons to perfect.

Boards Studying, Day 3 – May 19, 2008

Accomplished today:
1) biochemistry notes in First Aid
2) 60 questions on USMLEWorld
3) looked up tubulointerstitial nephritis (TIN) and colchicine (anti-gout medication) after watching House s1 ep3 “Occam’s Razor.”
4) listened to 60 minutes of Goljan audio

For the next 30 days, I will be studying for the USMLE Step 1 Board Exam, or “Boards,” as we generally call it. It’s like taking the Bar for lawyers, except we have three exams (well, two and a half) and this one is most important and taken during school.

I’ve taken to watching an episode of House per day, with the caveat that I have to actually look up the final diagnosis and any other diseases significantly listed in the differential diagnosis. It’s worked out pretty well — the “Pilot” episode had neurocysticercosis, which I have written about! Episode 2 (“Paternity”) was fun when they thought it was multiple sclerosis, but then it turned into long-standing measles, which is rare these days and probably won’t come up on the Boards. Boo. “Occam’s Razor” turned out to be kind of boring — colchicine overdose is kind of mundane, AND they got one of the symptoms wrong! You can’t get heart failure from colchicine use, because colchicine stops only the cells that are dividing, and heart muscle cells do not divide. OH SNAP, HOUSE!

CHOOSE!

My roommate Aubrey and I enjoy (“enjoy”) picking diseases we’d suffer from, if we had to. We also like to list diseases we’d rather die from than get treatment for (usually because the treatments are awful), and diseases we’d never ever want to get.

This is a variation on the old game of “Gun To Your Head” or “CHOOSE!,” which is Grace’s succinct summary of the rules.

So, if I had to have a worm infection, I’d pick Taenia saginata, the beef tapeworm.

Why? It causes loss of appetite or an early feeling of fullness — hello, weight loss! It sucks out nutrients, so you have to eat more just to stay nourished. It stays only in the GI tract, and does not invade other tissues the way Taenia solium, the pork tapeworm, does (this is called cysticercosis). The pork tapeworm can invade your brain and cause seizures, and eventually kills.

The beef tapeworm is like a real version of the Food Wormhole or Hollow Leg we have so fondly wished for when faced with a mountain of delicious food and limited gastric capacity. The beef tapeworm is the organic, all-natural answer to Alli or laxatives or whatever gross things people medicate themselves with to lose weight.

And finally, you can’t get the beef tapeworm unless you eat beef, so this means an exponential increase in steaks and burgers for dinner!

More Self-Diagnosis

Things I’ve diagnosed myself with, using Robbins & Cotran: Pathologic Basis of Disease, 7th ed.
From the week of April 27, 2008.

Iron deficiency anemia
What: Lack of iron, causing lowered levels of hemoglobin.
Why I totally had it: Had a spoon-like dip in my thumb’s fingernail (koilonychia) — a sign of iron deficiency.
But actually it was: A little dip in my thumb’s fingernail that I’ve had since forever.

Hashimoto’s thyroiditis
What: Underactive thyroid, caused by autoimmune destruction of thyroid.
Why I totally had it: Weight gain, fatigue, memory loss, intolerance to cold temperatures.
But actually it was: Poor eating habits (potato chips and Diet Coke are not real dinner), sleep deprivation, and New York’s shitty “springtime” weather.

Easier than taking a final exam

Medical Specialty Aptitude Test
From http://www.med-ed.virginia.edu/specialties/Home.cfm

Rank    Specialty             Score
1 	general surgery       39
2 	plastic surgery       39
3 	pathology             38
4 	ophthalmology         38
5 	gastroenterology      37
6 	emergency med         37
7 	orthopaedic surgery   37
8 	occupational med      37
9 	urology               37
10 	thoracic surgery      37
11 	otolaryngology        36
12 	nuclear med           36
13 	neurology             36
14 	hematology            36
15 	radiation oncology    36
16 	nephrology            36
17 	endocrinology         35
18 	cardiology            35
19 	colon & rectal surgery 35
20 	anesthesiology        35
21 	allergy & immunology  35
22 	pulmonology 	      35
23 	infectious disease    35
24 	neurosurgery 	      35
25 	radiology 	      35
26 	rheumatology 	      34
27 	dermatology 	      33
28 	general internal med  33
29 	obstetrics/gynecology 32
30 	med oncology 	      31
31 	preventive med 	      31
32 	aerospace med 	      31
33 	physical med & rehab  30
34 	psychiatry 	      30
35 	family practice       29
36 	pediatrics            25