So i completed the USMLE step 1 today. Everyone always asks how i think it went, but i don't have any answers. When you spend so long studying for a certain test, it just is the way it is. You become numb. I was rather surprised that I was able to comprehend most of the questions and either knew how to guess or didn't (and didn't care). Maybe that's the advantage of having done rotations, no wonder the foreign med grads do so well on it. I do know one thing, to study for it, I started drinking lattes, despite my strict no coffee until residency rule. I brought two lattes to the test and drank one after the first section and one during lunch. i was epically focused. I guess that i felt like for all the half-assed studying I did I probably didn't deserve the score I got, because somehow I might have been having a good day.
Watch I'll get my scores back and i'll have to eat my words. (gah. dec 14th!)
Anyhow, study tips for those of you who want to know. Don't worry tooo bad about pharm. Its probably what i'm most rusty on and as long as you cover your anti-arrhythmics and psych meds you'll be covered for most of them. Biochem pretty much focused on those enzymes with an associated disease-- common disease (think Gaucher's and SCID and pyrovate dehydrogenase deficiency). Micro bugs were more fair than the COMLEX- since the COMLEX focused on all the unusals and fungi and my USMLE seemed to cover tons of viruses. I got lots of questions about understanding why-- like if you have a certain immuno deficiency you are more susceptible to Neiserria or how a certain bacteria causes a problem (aka virulence factors)... Immuno was really mixed in with everything else. If you know it its a huge plus but you can figure it out with all the other clues if you know your micro and biochem. I guess focus special on the deficiencies. There really is no more advice i can give, do lots of USMLE World questions. Read first aid at least once.
I guess i will post more later once i have the score back.
EDIT: so scores are back. Passed but didn't do well. Def not the equivalent of what i did on the COMLEX. I don't really know what that means. Am I not smart enough for the things I want to do, did i have a bad day, am i behind? I don't know.
Tuesday, November 22, 2011
Friday, November 11, 2011
IM 2: Fun Fun Fun... study
So I've been pretty busy this month, not with the rotation but with studying for the USMLE step1, I kept flaking out rather than taking it and now its down to the wire. Hello 10 days till my test date. I will try not to completely crazy since I haven't gotten through even half of the material! *hates life*
Anyhow... Yesterday was suddenly really eventful. We had a patient who we talked to because he had fallen down at home and broken his ankle. The doc and I were dicussing why on earth this guy was in the hospital when suddenly he went code blue on us (as in his heart quit beating and he quit breathing). The saddest part is we weren't in the room when it happened, we were down the hall. But I got to be in the room and shouting the past medical history to like 8 residents and 4 doctors and rush around all important-like. The amount of people who respond to code blue's is massive. Its every person on the trauma team, the on call IM residents, not to mention the doctor's whose patient it is and at least 1 ICU nurse. Its like a flock of people who are literally running down the hall trampling people (think medical version of black thursday shopping at best buy). I am so pumped to be on the trauma team at the end of the year. I have ALWAYS wanted to run down the halls.
Anyhow, They told me if i had witnessed it I could have done the CPR compressions. Alas, I was not. I had to settle for calling like every doc on the case on the phone to report the code. The good news: he made it. We were all so close that he came back within about 15 minutes. He went to the ICU and I got to talk to him about what happened. I tried my best not to be all "You DIED but then we resurrected you... how was that?" and I discovered it's harder to be professional that it looks. :D
Hmm. Other cool things that happened this month....
I also had a 39y.o. white lady who insisted she had PVC's (pre ventricular contractions) which means the heart beats randomly when its not supposed to. It can hurt and make you pass out. But the problem was none of her doctors believed her. So when i went in the room I got this big lecture about how doctors should believe their patients. Surprisingly, when I told her I was just a medical student, she cooled down. We talked about all her problems and it was like the longest history i've ever taken, 2 hours. But it was rather interesting and I managed to calm her down. I also discovered she had scleroderma which started as CREST syndrome. Its a really rare collagen problem that causes your skin to be too tight. I got really interested in it and so she took the opportunity to teach me about it. It actually worked really well. She even let me take this really crappy picture. You can see here how smooth the skins looks because its so tight on her fingers she can no longer make a fist. You can also see the clubbing of her fingernail (indicating the lungs have the dz too). If you look really close there is a also multiple white calcifications that you can see on her finger (another symptom). This poor lady ended up being one of my favorite patients. She very calmly informed me that she knew her time was limited because the disease didn't stay in just the skin it was progressing to all her organs. She was very sobering.
Anyhow... Yesterday was suddenly really eventful. We had a patient who we talked to because he had fallen down at home and broken his ankle. The doc and I were dicussing why on earth this guy was in the hospital when suddenly he went code blue on us (as in his heart quit beating and he quit breathing). The saddest part is we weren't in the room when it happened, we were down the hall. But I got to be in the room and shouting the past medical history to like 8 residents and 4 doctors and rush around all important-like. The amount of people who respond to code blue's is massive. Its every person on the trauma team, the on call IM residents, not to mention the doctor's whose patient it is and at least 1 ICU nurse. Its like a flock of people who are literally running down the hall trampling people (think medical version of black thursday shopping at best buy). I am so pumped to be on the trauma team at the end of the year. I have ALWAYS wanted to run down the halls.
Anyhow, They told me if i had witnessed it I could have done the CPR compressions. Alas, I was not. I had to settle for calling like every doc on the case on the phone to report the code. The good news: he made it. We were all so close that he came back within about 15 minutes. He went to the ICU and I got to talk to him about what happened. I tried my best not to be all "You DIED but then we resurrected you... how was that?" and I discovered it's harder to be professional that it looks. :D
Hmm. Other cool things that happened this month....
I also had a 39y.o. white lady who insisted she had PVC's (pre ventricular contractions) which means the heart beats randomly when its not supposed to. It can hurt and make you pass out. But the problem was none of her doctors believed her. So when i went in the room I got this big lecture about how doctors should believe their patients. Surprisingly, when I told her I was just a medical student, she cooled down. We talked about all her problems and it was like the longest history i've ever taken, 2 hours. But it was rather interesting and I managed to calm her down. I also discovered she had scleroderma which started as CREST syndrome. Its a really rare collagen problem that causes your skin to be too tight. I got really interested in it and so she took the opportunity to teach me about it. It actually worked really well. She even let me take this really crappy picture. You can see here how smooth the skins looks because its so tight on her fingers she can no longer make a fist. You can also see the clubbing of her fingernail (indicating the lungs have the dz too). If you look really close there is a also multiple white calcifications that you can see on her finger (another symptom). This poor lady ended up being one of my favorite patients. She very calmly informed me that she knew her time was limited because the disease didn't stay in just the skin it was progressing to all her organs. She was very sobering.
Let's see I also had a patient who had the most massive case of cellulitis I had ever seen. Her legs swelled so much that she and her husband sat around inventing ways to apply compression on her legs so the swelling would go down. (take into account that her body habitus was rather corpulent). However, she was a very nice lady and really patient with me since I had to ask her a million questions about how it felt and she even let me take a picture. I know you can't quite tell how red her left leg really is because my flash is so bright, but i think you can appreciate just how much inflammatory fluid is in her skin. If you touched her leg, besides her screaming in pain, the fluid under the leg sorta moves like a water balloon would. Hello, lymphedema.
Hm. I have a few other stories but they'll have to wait until I have more time. I should probably go back and take more pictures. hmm....
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