Prolactin mnemonic

Hello.

Prolactin is pro-lactation hormone. It aids in breast development during pregnancy and milk secretion from the breast during nursing.

It's regulation is kind of complex which is why we'll be learning about it today. I'll also be sharing a few mnemonics that will help you remember these facts!

I have no idea about USMLE Step 1

I have noticed that some of my readers haven't spoken to anyone about USMLE step 1 exam and ask very basic questions about the preparation so I decided to write a separate post on it.

For those who have started preparing for the exam and have a general idea
- You'll find most of this post useless and redundant.
- I have marked asterisks (*) for important points you might wanna look at :)

Lastly, most of these are replies from conversations that I've had with real people so
- I haven't sequenced them in order.
- Ignore grammatical errors that I may have overlooked.
- Some of them have shout outs to Indian medical students (Simply because I know the Indian system better and it's hard to separate those points and write em again. Please don't mind that. I love you all equally, medics of the world!)

Okay, let's begin!

I just started. Which books do I get?
Kaplan notes and Goljan pathology.
* Don't buy First Aid initially since you'll be requiring a new edition in the last 3-6 months of your prep.

How do I start preparing?
You'll have to start with Kaplan videos. Supplement them with notes. Add extra points, stuff not mentioned in the videos to it. Hear Goljan audio while travelling, cleaning the house. Read the book and know it cold.

What is Goljan audio?
Recorded lectures of an absolutely amazing pathology professor, Edward Goljan.

What all is encompassed in Step one? Which subjects?
Anatomy, Biochemistry, Physiology, Pathology, Microbiology, Pharmacology and Behavioural science.

* It has a lot of clinical questions as well so it's hard for me to restrict the syllabus to basic sciences. For a hypothetical example, say, a question on burns was asked on my Step. In India, it is taught in Forensic Medicine and Toxicology and Surgery. So you get the idea? You require an over all comprehensive knowledge for Step 1.

Behavioural science?
It's Biostatistics from Preventive and Social Medicine (3rd year minor for Indian medical students) and Psychiatry from Medicine (3rd year major for Indian medical students).

If there are minor and major subjects, won't I score better if I give the exam after I am done with MBBS?
Yes, I think people who give the exam after they complete final year score better than those who give it in their basic science years simply because people from first year and second year lack clinical knowledge essential for Step 1.

I must say, my opinion is biased on my experience. I know of a senior who gave his exam before final year and scored a 265 on his Step 1 (So that's pretty awesome and you should go ahead, give the exam without doubt in your basic science years!)

Umm so why give Step 1  early?
- You're utilizing your time efficiently.
- You'll need the score to apply for electives in certain colleges.
- You get "done" with the exam and you can chill out.

When and how to register?
You'll need an ECFMG id to give the exam. That requires college stamp. You'll get the instructions online. If you can't figure it out, email me.

When do need to get the id? ASAP?
3-6 months before you feel like giving the exam, you make the id. It takes approx 1 month to make.
The thing with ECFMG id is that you need to pay a certain amount of money to make the id. That's why, I recommend you to make it when you're absolutely sure about giving the exam.

What is uWorld?
It's an online question bank. They are questions which are similar to those on Step 1 and essential to get an idea of what the exam is like.

When do I start with uWorld?
It is a resource you would like to use in the later months of your preparation because it is difficult (You can't do it without having any knowledge) and because it trains you for the real exam.

Are there other questions banks that I can do?
Many. Kaplan Q bank, USMLE Rx to name a few.
* Unlike uWorld, you can start with other question banks well before the exam because they are not very similar to the real exam, they scare the shit out of you with facts you don't know and motivate you to study.

What is NBME?
Mock exams created by examiners who write questions for the test. They predict your score.

I've heard you need to do research stuff in the field you are interested, is that right?
Yes. Research and electives are required for residency.

How do I become a part of some research?
That is later. In USA. Give your step exams first.
For Indian medical students - You can do research in India as well but it has no value. You'll get experience but that's about it. No credibility.
Procedure in very short: You'll need to contact the HOD of that department, get permission from ethics committee and contact a professor who would like to mentor you for research.

No advantage of research in Step 1?
Nope. They help you in residency match. Just get a good score for now and worry about the other details later.

(I'll keep updating the post with recent questions as and when I can.)

Related posts:

Preparing for the USMLE Step 1 exam

http://medicowesome.blogspot.ae/2015/01/preparing-for-usmle-step-1-exam.html

USMLE for Indian medical students 

http://medicowesome.blogspot.ae/2015/01/for-indian-medical-students.html

Giving the test you failed in while studying for the next exam

I'm a third year med student and today I just got my result for the annual exam and I flunked in biochem :'(
It's been like the end of the world to me today. I feel so hopeless and helpless.
I really have no idea how I'm gonna retake the exam while having the 3rd year classes side by side... I really really hope that I can do as what you did and be just awesome as you are in the future but right now I don't have a clue. Any suggestion about how to manage things side by side? - Asked on Tumblr

I'm sorry you have to go through this :(

It's not the end of the world even though you feel like it is. There is so much ahead of you.

Although I have never been through it, I had a friend who had failed and had to give the exam again in the next year.

This is what we did -

Regret and forget:
You can take a few days off to cry, feel bad about it. Regret, hate, feel guilty and blame whoever you want to. But be done with it. Once your few days of sadness are over, you have no right to complain, feel hopeless EVER. You're not allowed to feel like this again. It's very similar to what they show in movies - write on a piece of paper and burn it.

This is important because you can't feel bad for yourself while you're preparing, you can't have low energy or blame others in that phase. It's going to be very hard and you have to be strong.

Get your spirits up: Believe that you can do this. Half the battle will be in your head - the previous failure will haunt you and the anxiety will try to take over. Make sure your winning the battle in your head. YOU CAN DO IT.

Plan: Now, you have new syllabus to study and give the re-exam, right? How many months for the re-exam? How much time do you have to study for the new exam?

Tips: You wanna study the very important and parts you were weak again very throughly.

You can do it side by side, you'll need to discipline yourself to study one particular amount of time for the re-exam and one slot for the new syllabus. You can give less time for the new stuff and then study over time for it later. Passing this subject is your priority.

I love this part, telling the success story - My friend did it. She passed the exam the second time and did good in the next year subjects as well. If she can do it, you can do it too!

You will do great and you'll be much more awesome than me in the future. I believe it! :D
(The fact that you spoke about it and aren't giving up is evidence of the same.)

Just work really hard and keep fighting your way through it. All the very best!  Drop by and update us on your progress sometime later :)

Avoiding negative thoughts

Low self esteem is a challenge I'm also facing. I can ignore it while I'm studying or doing something but it's always in my thoughts during transportation times. - Tumblr

I know ignoring negative thoughts can be really hard, especially when your mind is free to wander while traveling. I listen to motivational tapes or audio lectures to keep me occupied when I wish to ignore these thoughts while transporting myself.

Long QT syndrome mnemonic

Hey guys!

We'll be talking about congenital long QT syndrome today!

Short story: Surviving Diabetes

Hi, readers.
I am Sakina aka “M”

Lead poisoning mnemonic

Hello everyone! 

We'll be learning about lead poisoning today! 

The mnemonic for lead poisoning is, "LEAD BATTERY"

L: Lead lines
E: Encephalopathy (Common in children)
A: Anemia (Pallor is earliest sign)
D: Drops (foot drop & wrist drop)

B: Basophilic stippling, Burtonian line (on gums)
A: AminoLevulinate (ALA) Dehydrase and Ferrochelatase (Heme Synthase) affected
T: Toys (Lead toys cause toxicity in children)
T: Tremor
E: Encephalitis
R: Renal Tubular Acidosis (Fanconi syndrome)
Y: Young children affected

That's all! 

-IkaN

Related post: Chelating agents mnemonic

Self doubt and low self esteem

"When med students ask you about whether they have what it takes to get through med school or if they deserve to be here - You tell them that they made it this far, they were already good enough to even get into a med school, they have the skills. But what if you never deserved to be at med school and got in because you paid money to get the admission and belong go a well off family? What if your scores were just average?

I always had dreams of being a doctor. I want to work hard and I want to help people. The thing about not deserving to study medicine, low self esteem and self doubt is getting me down so bad.

How do I deal with that? Please help me, looking forward to your honest reply." -Asked on Tumblr

Inability to concentrate before exams

"I have exams in less than 2 weeks and I'm unable to concentrate. Thought of sending you a message."

At times, our concentration does begin to taper right before exams. Maybe it's because exams are pressurizing and we don't want to learn while we are stressed.
Here's what you can do, with varying success -

Read out loud: It's just a way of making sure you are studying something. If your mind starts wandering, you'll won't understand what you are reading out and you'll alert yourself.

Write: Fill up pages with words that are important. It helps you stay on topic and concentrate. Whenever I am unable to concentrate, I make mini notes on what I will write in the exams. (I also write extra points that others are not likely to write in the exam, pretend my answer is going to be the best - Just to boost my spirit and make myself feel better!)

Pathophysiology of symptoms in anemia

Hello!

I'm answering some questions asked by readers on anemia. They asked -

Why does anemia cause insomnia?
Iron is vital to the brain’s dopamine system. Dopamine is a neurotransmitter that plays a role in neural networks including sleep activity. Hence, iron deficiency causes sleep disorders like insomnia.

Why does iron deficiency cause chest pain?
Reduced oxygen supply to the myocardium causes angina.

That's all!
-IkaN

Related post: Total iron dose infusion formula (Haldane and Ganzoni) mnemonic 

New year

Here's something written by a friend as motivation for new year.

Thanks for letting me publish this, Raman! -IkaN

So many years have passed and you kept making resolutions every year, same ones year after year just to keep them for few  weeks or may be months.

But this year, it's time to stop making resolutions and start making decisions; decisions firm enough to make this year the absolute best year. 

And while doing so, promise yourself not to fall back on your old ways, and affirm yourself every morning that these decisions ate the ones that are going to help you make new rituals in order to change your life in a positive way forever. And additionally, after a span of some 5 or 10 years you will be looking back at 2015 with a sense of satisfaction and gratitude.

USMLE for Indian medical students

What is the best time to start preparing?
As soon as you have the slightest gut feeling that you might wanna go to the US. It's better to start preparing early and then change your mind than to start late.
I started in March of my third year. Ideally, you should start in your early second year.
It's never "too late" to start. I have a friend who started in internship and nailed the exam within a few months. Preparation time varies.

Preparing for the USMLE Step 1 exam

"How do I prepare for the USMLE Step 1 exam?" -The most requested post ever!

The essentials - Kaplan videos & notes (for basics) + Goljan book & audio + uWorld + First Aid is the general way to go for most IMG students.

Kaplan videos and notes: They are a good start. If you are time restricted, you may want to skip stuff, fast forward through it.

Anxiety and depression before exams

"How do you manage stress before an exam? I study a lot, but I stress too much and I usually forget everything before the exam. I have anxiety and depression because of this." -Asked on Tumblr

Sounds like you need to believe in yourself a little more. You study a lot. There is no reason for you to worry so much! 

You should start your day with positive thoughts. Affirm this to yourself every morning, "Today is a great day to study and be productive." Clap your hands while you do this. It'll flip your mood right around! Before exams, "I have studied enough and I will do well."

Trust yourself, you've got this. You are a medical student. Getting into medical school ain't easy, but you did it.  You can do this too. 

We have different reasons for getting stressed out -

When you get tired of studying

"Sometimes I get the feeling that my brain can't take more information. Can this be? What can I do when I have this feeling?" -Asked on Tumblr

Yes, it can be! We often get exhausted and feel like we can't take any more information.

In my experience, taking breaks is the best solution for this. I read a research a while back (Don't remember where!) that your performance deteriorates after 45-60 mins of studying depending upon your capacity. If you take a 5-15 min break, however, you do much better.

You can exercise, eat, mediate, dance, listen to music or an inspirational tape if you want in this mini tape. Closing your eyes and lying doing for a while is very relaxing.
Do not use your phone. Your phone has text all over and reading does exhaust you.

I usually get really distracted if I take mini breaks after studying for an hour and don't return to books for another hour. If you have the same problem, you can study for 2-3 hours straight and then take a longer break like a shower, have a long lunch break or a walk around the park.

Change

I spent a lot of time thinking over the name and the logo of the blog, before I even started!

It had to be related to the medical field with a tinge of young enthusiasm. It is a student's blog after all! After a  lot of pondering and questioning, the eureka moment happened. Which word makes us awe in amazement? Awesome! Medicowesome!

If you have a good idea, do it. You don't need to be perfect.

Why does hypophosphatemia cause an increased affinity for oxygen in the blood?

The mechanism for this is very fascinating.

Remember the reaction that generates 2,3-Bisphosphoglyceric acid (2,3-BPG)?

Submissions: Endocrinology notes

Here are some more!

Submissions: Fever with rash in childhood mnemonic

Mnemonic for fever with rash in childhood is, "MEEK SCREAMER"

Dealing with stress and studying before exams for medical students

"I am overwhelmed with exams. I have an anatomy exam coming up. I am slowly beginning to lose hope. Advice would be very much appreciated, thank you!" -Asked on Tumblr

Medicine does get overwhelming. Mostly because no matter how much you study, you will always feel under prepared. It's normal to feel this way.

But don't let it get to you. This part is important because if you feel hopeless, you won't work as much as you should and the guilt will feedback. You need to break the cycle and focus on what's in front of you. There is always hope.

Take a deep breath. Say this aloud - "I've got this. I can do this."

Exercise. Exercise gives you endorphins. Endorphins make you happy. Happy people kill exams!
(Do 20 jumps right now and then read further :D )

Laugh. It's a mature defense mechanism. You'll learn it in psychology. (Another reason for you to survive anatomy right now - so you can read new things next year!)

Acknowledge that you're stressed, laugh about it and be okay with it. Or pretend to be. Fake it till you make it. (PS: If you fake laughter, you'll end up laughing for real.)

Smile. Look at this smiley (:

It's smiling at you, please smile back!

Laughing and smiling alone is a HUGE stress buster.

Tissue plasminogen activator mnemonic

Greetings people!

Tissue plasminogen activator is an enzyme that catalyzes the conversion of plasminogen to plasmin, the enzyme responsible for clot breakdown.

It is used in the treatment of embolic or thrombotic stroke.
Contraindicated in hemorrhagic stroke and head trauma. The antidote for tPA in case of toxicity is epsilon aminocaproic acid.

Mnemonic is, "TPA"

T - Thrombotic and embolic stroke (Use)
P - Plasmin (Mechanism of action)
A - Aminocaproic acid (Antidote)

The dose mnemonic is, "TPA" again!

T for ten:
10% of dose given as bolus.

P mirrored looks like a 9:
0.9 mg/kg dose, maximum 90 mg.

A for an hour:
Rest of the dose is given as an infusion lasting for 60 minutes.

That's all!
-IkaN