Wednesday, April 30, 2014

Wrapping Up M2 - MSU CHM

Yesterday, I attended the last two lectures of my second year of med school - possibly the last *traditional* lectures of med school as a whole; I don't know how much lecturing we get in third year and beyond. I also took a 1-hour clinical skills written exam in the morning, followed by a four-hour practice NBME exam in the afternoon. After which, I and the rest of my class were pretty fried, and thus took most of the evening off.

Today will be a slow day - started off with my last full PBL session ever, and now I'm in the Nerd Nest writing a blog post before doing some more UWorld questions. I've got 33% of my question bank left, which means that I've completed 1478 of 2211 questions so far. I hope to be down to about 15-20% by the time I really kick my ISP (Intensive Study Period) into gear in about a week or so. We'll see if I can pull that off...

Tomorrow night, Hobbes will graduate from Therapy Dog training, finally getting his license. On Sunday, Wife will officially walk in her graduation from Nursing School, receiving her B.S.N. (she technically finished everything in December, but now it'll be OFFICIAL official...). On Monday, I'll take the Gastrointestinal Domain exam, and then it's off to the nerd races for me. Goodbye, World. The intersection of Erkel and Samson, a period of life wherein we force ourselves into a mold whether we fit or not. The mold of the academic, the student with the work ethic that makes most other people shake their heads. We med students will be sequestering ourselves from the world for several weeks to fill every crevice in our brains with all the "knowledge" that the NBME claims is important. Necessary for the real world or not, we've gotta know it.

And that's where I am right now. Getting ready for the biggest test I've ever taken. Mentally and emotionally conditioning myself. Deep breaths. In the next seven weeks, I hope to read a couple thousand pages of information and complete ~4,000 more practice questions. Will it be worth it?

I'll let you know when I find out.

Thursday, April 24, 2014

The Gateway Exam - MSU CHM

Image modified by me from the original at

I have (un)officially completed the Gateway Examination, which is basically a 4-hour experience wherein we, as second-year med students, show that we've learned enough of the physical examination and patient interviewing skills to be trusted with real patients on the wards in the coming clinical years. I haven't gotten my score back yet, but I think I passed. More importantly:

What IS the gateway exam?
I'll tell you, but first - 
Imagine this:

You're a medical student, and you're almost done with your second year of med school. You've completed at least 4 years of undergraduate work, studied for and did well on the MCAT exam, and spent a year applying to medical schools and going on interviews. You most likely took out loans to be here, and at this point (if you're a financially average student) are probably more than $100,000 in debt. You've completed so many classes in med school, it's hard to remember all of their names, let alone their content. Biochemistry, Physiology, Gross Anatomy, Neuroscience, Pathology and more from M1, and now almost all of the Systems/Domains of M2. Last week one of your classmates messaged your class group on Facebook that you've completed your 1,000th hour of med school lecture. That seems like a lot, but you know it pales terribly in comparison to the number of hours that you've spent studying outside of lecture. 

Anyway, you are riding the elevator up to the fifth floor (unless you're in East Lansing, in which case I have no clue where you are) to complete the Gateway Exam. You've practiced all five sections: Cardio Exam, Neurological Exam, Acute Abdominal Exam, Newborn Exam, and you've gone over in your head what you need to do when meeting with a patient with an undiagnosed condition. 

You meet up with several other students, all of you nervously exchanging halfhearted jokes designed to lower the tension, while everyone knows that the tension can't really be lowered. You know you shouldn't feel nervous, but you can't help it. Nobody wants to fail. Nobody wants to do less than perfectly, and so everyone's nervous.

Each student is assigned a room number, and after a 15-minute spiel on what to expect, we file out of the room to walk across the hall to the simulation suite. The sim suite is basically a big grid of fake doctor office exam rooms, each one complete with examination table, physical exam equipment on the walls, and video cameras mounted to the walls with microphones dangling from the ceiling - all the better for the silent evaluators and recording devices to see/hear you with. 

You stop at the room to which you've been assigned. Mounted to the door is a white plastic box with a sliding panel on the front with bold black letters that state, "Do not move this panel until instructed to do so" or something along those lines. Behind the door you know there is a simulated patient and possibly (depending on which experience lies behind that door) a silent physician preceptor with a clipboard, ready and waiting to grade your performance.

You wait. And wait. And wait - until one of the preceptors standing guard in the hallway raises her walkie-talkie to her mouth and says, "Students in North Hallway ready." You hear a crackly voice echo down the hallway from her receiver, "Students in West Hallway ready." Apparently they're only running two hallways at once today, as the next sound is a "Bing BING bing BING" from the speaker in the ceiling above your head, followed by a calm-sounding male voice that says, "Students, you may now access the patient information on the door. When you are ready, you may knock and enter."

Stomach flipping a bit, you slide that white plastic door aside and quickly scan the printed information:

"Mrs. Eleanor Falloway. 55 years old. Chief complaint (from nurse): Abdominal pain."

Until this moment, you didn't know which experience you would be completing after walking through this door. In a couple seconds, you mentally reorder your expectations for what lies on the other side of the door. You're going to be doing an interview with a patient, trying to lightly tease out the underlying etiology of their disease while also addressing their concerns in a caring, supportive manner. Then, you're going to switch to doctor mode, getting all the pertinent positives and negatives, making sure to note all of the important symptom dimensions and risk factors for diseases X, Y, and Z. Throughout the interview, you're doing your best to take detailed notes because you know you're going to need it all when you write your SOAP Note later on. Within a few questions, you're formulating your differential diagnosis, and it never even crosses your mind that even one year ago, what you're doing would have seemed impossible. You've learned a lot.

After the patient-centered and doctor-centered interviews, you transition to the physical exam, specifically tailored to assess the acute abdomen:

1. Inspect the abdomen.
2. Auscultate for bowel sounds. (Patient hands you a card telling you what abnormal bowel sounds their pathologic belly emitted into your stethoscope.)
3. You ask the patient to cough, and she makes a big deal about how much it hurt her right lower abdomen.
4. You make a point to be sensitive of that as you palpate, lightly then deeply, each of the four quadrants of her abdomen.
5. You go on to assess for Rovsing's Sign (+), Rebound Tenderness (+), Obturator Sign (+), Psoas Sign (+), Murphy Sign (-), and you're done. Classic appendicitis. Ain't no thang.

You wrap things up and leave, already formulating the SOAP Note that you'll need to write once you finish up with all of the other examinations. You take the extra time before your next station (you got out FAST! Did you forget something? Did you mess something up?? No, no, you just did a good job. You keep telling yourself that...) to jot down a few more notes before Ding DING Ding DING - on to the next station.

Again, preceptors exchange flat-toned commentary on hallway-specific student readiness, and Calm-Man-Voice tells you that you can access the information behind the secret sliding plastic panel. It's the Neuro exam. Okay - get that vision card ready, you're going to need it. There'll be a preceptor and standardized patient behind this door...


And on and on you go. It would take far longer to type everything out than it takes to actually do it, so I'll just leave you with the steps for each part of the Gateway Exam, in case you're interested. Hats off to all of the upperclassmen who read my blog out of some sort of deranged nostalgia for their preclinical years when "all we had to do was learn!"

A much bigger hats off to all my fellow classmates who completed this milestone with me this week. We're one sizeable step closer to Step 1 this summer, and to the hospital rotations after that. 

Well done.

And now, without further ado, 
click to embiggen any of the below images:

The Cardiac Exam:

The Neurological Exam:

The Newborn Exam:

The Unknown Problem Visit:
For this one, we were evaluated by:
1. The patient we interviewed based on how they felt we did.
2. A miniature 10-15 question quiz we took immediately after the interview, asking us about various features of their presentation to determine to what degree we elicited the most important details.

The Acute Abdominal Interview & Exam:
For this one, the simulated patient evaluated our interview (not shown) separately, then evaluated the physical exam:

The SOAP Note:

So yup. Today was a blur. Four hours of lecture, lunch, the Gateway Experience, a run with Hobbes, then two hours of Therapy Dog Training during which he had his first patient visits in the hospital! Today was just a day full of clinical skills for us budding healthcare workers, hahaha. After several hours, a hefty plate of Wife's Taco Casserole, and a blog post of epic proportions, I'm ready for bed. Today was a complete wash in terms of Step 1 Studying, but I'll remedy that tomorrow afternoon - and this weekend, and every day of the domain afterward...


Tuesday, April 15, 2014

Mnemonic for Nutrient Absorption - Iron, Folate, B12

Image found on a random site, unknown source.

So, I came up with this mnemonic last year, and this seems like as good a time as any (now that we're on the Gastrointestinal Domain) to share it with the world:

That is to say, iron is absorbed in the duodenum, folate is absorbed in the jejunum, and Vitamin B12 (Cobalamin) is absorbed in the Ileum. I imagine a stereotypical "bro" commenting on his friend, who happens to be deficient in one of these metabolites.

Yeah, that's all this post is about.

Monday, April 14, 2014

MER = DONE. MSU CHM Monster Video. Today = Amazing Day.

Officially DONE with MER, and what better way to celebrate than with the above Med Folly, featuring the M1 class (with a little of me thrown in - can you find me?). Mad props to the mastermind of it all (you know who you are, but I don't know if you want me posting your real name on my personal blog, soo...). Bravo! Anyway, the exam this morning went swimmingly - at least, as well as can be expected for an exam where most of the material has seemingly nothing in common other than that it involves stuff that can happen in the human body...

Aside from that, today I also:

- Fixed Wife's laptop by installing a new battery for HALF the price the Apple store would have charged ($60 vs. $120)
- Fixed my iPhone 4s speakers by installing a new set that I bought online for $4.40 including shipping.
- Went to the Omelette Shoppe for some celebratory feasting.
- Took Hobbes to the park and threw the ball around a bit.
- Had some great conversation with Wife about what's really important in life.

Now I'm about to get a haircut and maybe clean my desk. Oh yeah, I haven't written about my new desk! It's pretty awesome. It's this:

Mayline Futur-Matic Electric Adjustable Drafting Table

(click to embiggen)

No more sore back and unworked legs for me. I can now choose between sitting while I study or standing up. I spend about 10 hours per day at my computer/desk, and until now it was 100% sitting. Now it's about 80% standing, which is incredible. Goodbye, increased risk for DVT!

UPDATE: For those who asked, I got the above table used on Craigslist for $350. That is to say, NO, I DID NOT pay the $2,995 retail price out of my bountiful loans. That would be silly. Also, it has an electric motor (operating the switch is super fun!) that lifts it the surface up to 48" tall at the highest setting and down to 30" at the lowest. The surface tilts to be horizontal, vertical, or anywhere in between. The surface measures I think 40" x 32". Something tells me I'm going to write a full review up here at some time about this table, as I had the hardest time finding information about it when I was looking at it...

Anyway, it might be the best purchase I've been able to make this year. I can't say I did this alone - Special thanks to you who helped me fund the purchase - you know who you are. Thank you!

Sunday, April 13, 2014

MSU CHM - Fun Right Now Video

I'm about to enter radio silence until tomorrow's MER (Metabolism, Endocrine, Reproduction) domain exam is over. In the interim, I leave you with Fun Right Now by the MSU CHM Class of 2017.

Well done, M1s.

Friday, April 11, 2014

M3 Clinical Rotation Schedule

A blog post wherein stuff finally seems more real.

So, originally I wanted to write a post about the female pelvic exam experience. You might think this would be awkward (it was a bit - I think that's unavoidable) and nothing more, but I learned a TON. The preceptors were incredible, the patient "volunteers" were very helpful and gave great feedback, and I felt like I learned a ton. Probably more than with any other clinical experience in the second year of med school. That was on Wednesday for me, so two days ago.

Like I said, originally I wanted to write a detailed post on that. Right now though, I'm kind of on a shortage of time. The Metabolism, Endocrine, and Reproduction Domain exam is Monday morning. Time is a commodity. 

Thus, this is a quick announcement to say:

I got my track assignment today.
It's awesome.

What's a 'track assignment,' you say? It's the order in which second year medical students (M2s aka Block II students) rotate through their third year (M3 aka Block III) clinical rotations (aka Clerkships, though I don't like this term for some reason, and thus will be referring to them as rotations).

There are only so many slots in each clinical rotation, so students are split up into groups. We rotate through the clinical placements in 8-week chunks of time, every group going in the same order through the rotations but starting at a different starting point at the beginning of the year.

I received Track D, starting on July 7th after orientation:

That's right. Starting in July, I'll be putting to good use the pelvic exam and many more skills I have yet to learn. My understanding is that I'll even have a quota of delivered babies that I'll need to fill. I ranked this track as a tie for 1st place. I mostly wanted to be able to get as much experience before the Psych/Elective rotation, where we get 4 weeks for Psych and 4 weeks for a rotation of our choice. I'm hoping to do an Emergency Medicine elective, and I want to have as much experience as possible going into that. We won't find out about our electives until later in the summer. Anyway... Yeah.

Med school is definitely getting real.

Wish me luck on Monday's domain exam.

Tuesday, April 1, 2014

How Many Whopper Sandwiches Does It Take to Grow a Baby?

I needed a ten-minute study break, so with the help enablement of Google, a calculator, my love of Whoppers, and the inspiration of a cartoon owl from my childhood, I pondered the question:

How Many Whopper Sandwiches Does It Take to Grow A Baby?

  • Additional metabolic needs, averaged over pregnancy = 275 extra Calories/day
  • Average pregnancy duration, conception to birth = 283.4 days
  • Total Calories To Grow A Baby = 275 Calories/day * 283.4 days = 77,935 Calories
  • Calories in a Whopper Sandwich = 630 Calories

77,935 Calories to grow a baby / 630 Calories per Whopper = 123.7 Whoppers

What does this mean?

It takes 123.7 Whopper sandwiches to grow a baby.

For the classic McDonald's lovers out there, we can see that the unit conversion between Whoppers (630 Calories) and Big Macs (550 Calories) to be 550 / 630 = 0.873 Whoppers per Big Mac. Thus:

It takes 141.7 Big Macs to grow a baby.

If you prefer to eat chicken, and you cook it as healthily as possible, there's 306 Calories per pound of chicken.

This means it would take 77,935 / 306 = 254.7 pounds of chicken meat to grow a baby. According to the interwebs, chickens are about 60% non-organ meat by weight on average, and the average chicken weighs approx. 4lbs. Thus, if a mom-to-be killed all her own chickens and supplemented her diet with only their roasted muscle meats, she'd have to slaughter and chow down (254.7 * 0.60) / 4 = 38.2 chickens to grow a baby.

Finally, my original inspiration leads me to the question:

How many Tootsie Pops does it take to grow a baby?

Tootsie Pops have 60 Calories each. 77,935 Calories / 60 Calories tells us that:

It takes 1,298.9 Tootsie Pops to Grow a Baby Q.E.D.

Disclaimer: Please do not actually try to grow a baby using any of the above dietary plans. You and your baby will probably not be in that great shape at the end of the pregnancy. You might both be dead, so please don't do it. None of this should be in any way misconstrued as pregnancy planning advice for the real world. This is just the result of a random tangent I took thanks to Google's enablement and the power that comes from having the collective knowledge of humanity at my fingertips. To reiterate, please do not attempt to grow a baby by eating a diet consisting primarily of Whoppers, Big Macs, roasted chicken meats, or Tootsie Pops. 


Learning Phlebotomy - MSU CHM M2 Spring Semester


Yesterday, I drew blood from a human for the first time. No, that's not me in the above picture, but that is my arm that you can't see, from which my friend is drawing blood. That's right - after practicing on manikin arms that have fake blood in them, we got to practice on each other.

The preceptors for the experience were great, explaining everything (which I'm sure was as easy as counting 1-2-3 for them, since this is probably the most basic thing they do in their careers) in as much detail as we could possibly want. Since I have pretty good veins (and am accustomed to getting needle sticks due to donating plasma), I ended up being a pretty good practice subject for my classmates.

What surprised me was what ended up being difficult about learning to draw blood. I always thought that getting the needle into the vein would be the hardest part, but it wasn't - at least not for me. It was much more difficult for me to find the vein in the first place, at least on people with no obvious veins. On top of that, holding the needle without moving it once it's inside the vein can also be a bit tricky. Connecting and disconnecting the vacuum tube without jiggling the needle and causing discomfort pain isn't easy, since you have to do all that with your non-dominant hand. Since I'm right-handed, I have to insert and hold the needle with my right hand, doing all the other operations with my left hand. Doable, but not the easiest thing in the world. So make sure to be nice the next time you have to get blood drawn, especially if the person doing it is new to the task.

We practiced with 22 gauge needles. The size of the needle actually decreases with increasing gauge number. The preceptor introducing us to the equipment mentioned that, as a point of reference, the needles used in donating plasma are 16 gauge, while the needles used in insulin injections are 23 gauge. To help clarify this, below left is a shot from when I donated plasma last semester after going through the Heme/Neo domain and getting curious about where "fresh frozen plasma" comes from, and on the right is the needle from yesterday's Phlebotomy session. Click to embiggen:

Above Left: The preceptor compared plasma donation needles to drinking straws. I always thought it was more similar to a bike pump, myself...

Above Right: The needles we used yesterday were pretty thin, which was resulted in very little bruising today. The blurriness of this photo makes the needle seem a little thicker than it was.

Anyway, yesterday was one more step in the direction of actually feeling like a healthcare worker. I understand that as a doctor, I will most likely not be doing many blood draws. Granted, this depends on what specialty I go into and most of all where in the world I end up practicing, but still - I understand I'm not likely to use this skill a whole ton. Phlebotomist technicians exist for a reason. STILL, it was cool to learn another skill so that I COULD do this if I needed to. Some day, I'll know enough information and will have gained enough skills to actually take care of people.

Some day, I'll be a doctor.

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