Family Medicine Shelf

I got my scores from my Family Medicine rotation. I didn't study nearly as intensely as I did for Step 1, but I did fairly well. Looking at how I did based upon my score as compared to the national average for U.S. medical students and the standard deviation, I did better than I did on the Step. This is motivation to study even harder for the OB/GYN shelf in six weeks!

PASS!

I passed my first licensing board, USMLE Step 1. As usual, I'm not 100% pleased with my score, but I passed!!!! Goodbye USMLE Step 1, hello really becoming a doctor.

USMLE Step 1: Check

Yesterday was the day: USMLE Step 1. I've been dreading this exam since before I was accepted to medical school. I always thought that if I could pass that exam, I can do anything. Well, I've at least finished it. I barely sleep the night before (or the night before the night before). I was up at 6:45, got ready, and headed out the door. We had to drive north on the Palmetto past Miami. Luckily, it went okay. We arrived at the center to take the exam a half hour before our slot. We checked in and headed to the back. They take your picture, fingerprints, review your ID and your paperwork. After all of that, you are assigned to a computer and are allowed to start your exam. You are given a tutorial about the software, then you start the seven blocks (one hour each) and 45 minutes of breaks. If you finish a block early, than that extra time goes to your break time. Break time also includes the time it takes to check out and recheck in (check ID, check finger prints, and sign in and out). I'm really glad that I had done four full length practice exams because this day was just something else. I've never been so tired. It is shocking how tiring it can be to think all day and obviously the questions were very difficult and there is a lot on the line with this exam. Anyway, I think it went okay. I'm really glad to have it behind me and I'm really glad to sleep and relax.

Geez Louise

Yesterday we decided to our testing permits for USMLE Step 1. First we went to the Internet cafe in our condo, but the computers were down. On a side note, it really isn't a cafe--it is a room with computers and free wireless Internet for the tenets to use along with a printer and fax. There are some tables and couches and the room has a view of one of the courtyard gardens. It is a nice area but no one has ever offered me a Café con leche so I don't think it qualifies as a cafe. In addition to it not really being a cafe, I don't really think the computers are down. There is new management at the condo and I think that the new management just doesn't know the passwords as the computers and wireless Internet looked to be working, but the computers needed someone to log onto them.

Anyway, after finding out we couldn't print out our testing permits at the condo we decided to make the two block walk to school. We grabbed our IDs and waited until after 5:00pm (because you have to be dressed up to go to school during working hours). Neither Farley nor I had a print card, so first thing we went to the print card vending machine. Luckily for us, you had to had a one dollar bill to buy the card then you could add money to the card. Neither of us had a one dollar bill and the machine was not accepting credit cards. We went upstairs to the main offices (which frankly can be a scary place) and our favorite office worker, Mrs. Kind was still at work. She didn't have change for a $5.00 and refused to let us pay her a $5.00 for the $1.00 dollar bill that we so desperately needed. I think she is probably one of the most helpful and genuinely caring people that our Caribbean Medical School has to offer. She is like a surrogate mom to any student in need, while maintaining her professional boundaries of course.

After obtaining the elicit dollar bill, we bought the card and then put $5.00 on it to purchase copies. We headed right to the computer lab and logged onto our respective computers. Farley hopped right on and had his permit printed quickly. I, on the other hand, ran into some troubles. I logged onto the website a few weeks ago to check the permit and make sure it was correct--it must match your ID exactly or you are not allowed to take the exam and if there is a problem you must correct it a few weeks before your exam. Obviously, I knew my password three weeks ago, but I could not get logged on yesterday. I tried retyping my password several times. I tried a different password. I tried everything I could think of. Nothing was working so I decided to click the "I forgot my password" link and have them send me a temporary password. We waited and after five or ten minutes, I thought that maybe I didn't fill out the "I forgot my password" information correctly so I did it again. About three minutes late, the temporary password arrived: It didn't work. We thought maybe another email would be coming since I did the "I forgot my password" thing twice. We waited for about a hour and kept trying to use the temporary password to no avail so we headed home.

I was worried about this password thing all night. I knew that I would be able to contact the medical board people and figure out my password in the morning, but it was weighing on me. I kept thinking to myself, thank goodness you decided to print this out two days in advance rather than one day or you would be in trouble.

This morning at 9:00 EST, I got online and tried one more time with the temporary password. It worked. After all of that, it worked just fine. I logged in changed my password, copied the permit into an email in case I had any other problems then headed back to school.

School was a ghost town. It is Wednesday so all of the third year students were enjoying a great day of lectures in Downtown Miami. I was alone in the computer lab, so alone I even turned on the lights. I tried to log onto the computer and it wouldn't let me. I was contemplating trying to find one of the IT guys, but on the fourth try, I got onto the system. Besides, the IT guys are also in Downtown Miami for the all day lectures, lucky them. So, once I was on the computer system, I logged onto my email to get my account number so I could then log onto the medical board web site and print out my testing permit. Failure. I could not get onto the medical board website. I tried to print out the testing permit from the email, but the formatting was completely different so I didn't think it would work. Security for these exams is extensive--they finger print you every time you take a break and leave the test room in addition to taking your picture and probably your first born child. But, it is a good thing security is so tight as these are medical boards and it is essential that medical students meet the minimum marks before moving forward with more extensive patient care.

Anyway, I ended up calling the medical board. I spoke with a very helpful lady. After telling her my life story to prove that I am who I claim to be, I she gave me the password that I had typed into my computer less than an hour before. In my rush, I neglected to read that passwords should be 6-9 characters and mine was much longer. So yes, I typed it in correctly that morning but the computer only picked up the first 9 characters and when I typed in my full length password which was longer, the computer caught it as an error. I felt so stupid. But, I now have three copies of my test permit just in case I lose one before tomorrow morning!

Happy Birthday!

It is a special person's birthday today: Farley! Unfortunately, Farley and I have both had big tests near our birthdays this year. I had the comprehensive exam the day before my birthday and obviously we are taking the USMLE step 1 next week. Thus, we don't get to go out to dinner or do anything fun today for Farley's birthday.

Since his birthday is so close to the exam, I bought his present a month ago. Regrettably, it was delivered while we were eating dinner and he signed for it. He didn't know what it was, but he got to shake the box. I intended on hiding it in my room until this week, but the day it arrived I put it on my bed and went back into the kitchen. I heard a strange noise and looked out into the living room where he was shaking and listening to the box. A little while later, I joked that I should put it under the banana tree and we could call it the birthday tree. (The banana tree is a holder to keep the bananas from getting those yucky black marks on them). Later, I went to open the box to make sure that his present arrived in one piece, and it was missing. I was a little panicked until I looked under the banana tree--Farley moved it while I wasn't looking. I grabbed the and opened the box, wrapped up his presents, put them back in the box, wrapped the box and put it back under the banana tree where it sat until his birthday. I was going to get a picture, but Farley wanted to open it a little earlier than I thought he would. It has been sitting there for a month so he opened his present a few hours early (before I had time to bake the brownies and sing "Happy Birthday"... perhaps it was the thought of my singing that made him want to open the present early). Since he loves reading, I got him a couple of novels for after the exam.

Happy Birthday Farley!!

More motivation

"Some give up their designs when they have almost reached a goal; while others, on the contrary, obtain victory by exerting, at the last moment more vigorous efforts than before"--Herodotus

At this point in my preparation for USMLE step 1, I'm needed to exert more vigorous efforts than before. I'm trying really hard, but sometimes I need a little extra motivation to keep me going. Since I'm part Italian and a full time jazz lover, I've found just the motivation that I need: the Jazzed up Rocky Theme. Yes, you read correctly. Not only is it an amazing version of the Rocky Theme, the orchestra is wearing the most fantastic 1970s suits ever. If you ever need a pick me up, just listen to this and you too will be ready to take on the world.

Relief

One of our professors, Dr. GoodAdvice, advised us to take a practice exam from the NBME (National Board of Medical Examiners, the people who write the boards), which will estimate your USMLE step 1 score, ten days before you plan on taking the Step. Dr. GoodAdvice told us that if you want to go into an extremely competitive speciality like dermatology, you need to get a score of X ten days before the exam. If you want to go into something less competitive with more residency programs, like internal medicine or pediatrics, you need to get a score of Y. Dr. GoodAdvice also told us that if do not meet a score of Z ten days before the exam, postpone your examination. The USMLE step one exams is extremely important in residency applications and if you pass the exam, you cannot retake it to increase your score. Basically, this is a one shot deal.

It is ten days before I plan on taking USMLE step one. I've always had a bit of test anxiety, but since starting medical school I've noticed a pattern of my test anxiety. I usually get really, really nervous two to five days before an exam. Then by the time I take the exam, I'm still nervous at the start, but I'm okay once I get going. Well, today was completely different. I've been dreading taking the USMLE practice exam all week. I was really afraid that I wouldn't be ready. However, I knew I had to take the practice exam because if I wasn't ready, I needed to know 7-10 days before the exam so that I could move the exam. I think I've talked about the scheduling of the exam, but is is a process. Moving the exam is doable but you need at least a week to do it. When you apply for the exam, you are given a three month window to take the exam. If you move the exam, you must move test date within your three month window. If you need to move out of that three month window, I think you might have to start the whole process from scratch, but I'm not certain.

Anyway, there was a lot riding on this practice exam and I think it is the most nervous I've been taking an exam. This exam was four blocks of fifty questions and each block lasts sixty-two minutes. After you complete a block, you cannot go back and change any questions. This is the format of the USMLE step one, except that the USMLE step one is seven blocks rather than four. I started my first block yesterday and I wasn't sure of the first question. No big deal. After being unsure about the first five or six questions, I started to get more nervous and was planning for the worst case scenario. Then the next fifteen to twenty questions I felt much more confident about. It is amazing how every question you are not sure about stands out and is easily remembered, but all of the questions that one feels confident about just fade into the background. I kept checking my pulse during the exam (since there is a clock at the top of the screen to let you know exactly how many seconds you have left). I usually have a resting heart rate of about 60 beats per minute. During this exam, my pulse ranged from 120-150 beats per minute, but my mind remained clear. I felt like I still could reason my way through things fairly well especially when I took 10-20 seconds to just stop and breathe/relax. Nonetheless, by the time I clicked the button to see how I did on the exam, my hands were shaking. Then relief: I did okay. I met the marks that Dr. GoodAdvice gave us. I didn't do as well as I hope to do next week, but I put so much pressure on myself for this practice exam that doing well on it is a huge confidence boost. This probably sound strange, but I'm grateful I was so nervous today. This practice exam gave me a chance to practice stopping to take a few breaths, centering and then concentrating on my task at hand, despite being nervous. I am really lucky that I had a chance to practice and gain confidence in myself. Those four hours today, hopefully, will pay dividends next week and later in my career. There will always be times that I get nervous (everyone does), but having the ability to calm myself, focus and be successful are necessary skills that I've proven to myself I possess.

Now, I've got ten days to practice taking more exams and review errors I've made so that I can reach my goal USMLE score!

Sprinters train by sprinting. Medical students train with multiple choice questions.

I finished watching the 160 hours of Kaplan lectures at the center yesterday. Today I'm finishing the USMLE world question bank. Between the questions in my Kaplan course and the questions in the USMLE world question bank, I've done at least 4,000 questions since September. Since everyone I've spoken with that has recently taken USMLE step 1 says that the USMLE world questions are very representative of the types of questions that are on the actual step, I am planning on taking a few full day practice exams using the USMLE world question bank next week (hopefully, I'll be able to go though the whole question bank at least twice). I know academically that it is a good idea, but the thought of spending 7 hours doing question every day for the next week or so doesn't sound like fun. There is an analogy between sports and training for standardized exams. An Olympic sprinter does not just run around the tract and lift weights to prepare for the 100 meter dash, she practices the 100 meter dash. USMLE step one will not ask if I can read and understand the text book as well as the next medical student; they want to know that I can answer multiple choice questions, so I will practice as many multiple choice questions as I can from now until test day. I hope I'm ready!

Fall Back

The fall back weekend couldn't have come at a better time for me. I've been getting up at about 7:30 every day, but the day of the Step I'm going to have to be out the door by 7:30. It is so light and bright in my room that despite my sleeping eye mask, I am up and alert by 6:30-6:40. Falling back has made moving my get up time, so much easier. This is one of those times I can thank Uncle Sam! Just a couple more weeks then I will kick some USMLE butt (or so I hope!).

Lentil Soup and Beef Stew

On Mondays, I try to do most of my cooking for the week since Mondays are our day off while we are studying for Step 1. Farley is fairly easy to cook for because when he decides he likes something, he will eat it every day. I, on the other hand, like some variety. Recently, he has decided that he wants lentil soup and beef stew. The beef stew I can understand because he loves meat, but I was a bit surprised about the lentil soup. I asked him why he wanted lentils so much this fall and I thought his response would be something like, "My mom made it when I was a kid." I was wrong. One of our Kaplan video lecturers said that fiber inhibits the uptake of cholesterol from the gastrointestinal tract, which is basically how drugs known as bile acid sequestrates work. Farley decided that we should eat more fiber and lentils are extremely high in fiber. I wanted to do something different this week but he really wants to make sure that our cholesterol is kept in check, so we are having lentil soup again. He was so excited to get more lentil soup and beef stew that he chopped veggies, beef and helped me cook for an hour. I took a few pictures, but I don't know if the pictures look as good as it tastes.



Above: Double batch of Beef Stew
Below: Lentil Soup (many lentils were at the bottom of the Tupperware)

Berkeley

This morning when I was looking at flights heading home, I noticed that Southwest is having a super sale (though tomorrow). I wish I knew exactly when and where I'll be heading to in January, as I could have booked the ticket to the east coast for $100.00!! Isn't that crazy? As a coincidence, the other day I was thinking that it's been over two and a half years since I last saw one of my closest college friends, Mary. When I called to tell my parents that I booked my flight home after the Step, I mentioned the great sale and how long it's been since I've seen Mary. My Mom suggested that I call Mary to see if she has time for me to come down (My Dad, on the other hand, misses his little girl so much that he doesn't even want me to meet up with friends for coffee let alone go to California for a weekend). I assumed that Mary wouldn't have time for me to come visit as she is up to her neck in her lab work for her PhD dissertation. But, to my surprise, she said to plan the trip because she can arrange her schedule so that she doesn't have to go to lab much on the days I'm in town. In less than 24 hours, I went from not knowing exactly when I'd be coming home after the Step to booking my flight home and making a surprise side trip to see a friend.

I've been doing fairly well on the Step prep questions and feeling more and more confident the last couple weeks. But, the last two days haven't been so super, which can be at the same time discouraging and motivating. I also have the motivation of all the excitement after the Step. Assuming no two-day flight delays, I will be home for two Thanksgiving dinners (one at my Aunt and Uncle's house and the other at our neighbor's house) and I get to see one of my most beloved friends. I'm so excited about the fun to come after the exam that I feel like Popeye after eating spinach--I'm recharged, excited and ready to study!

I'm coming home!

Farley and I just booked our flights home for November 24th. Farley is heading home a couple hours before me, so I'm sure I'll be sad and crying at the airport (I hate to see him leave and this will be the longest time we've been apart in two years), but it is also going to be exciting to be home for Thanksgiving. I just hope that our flights go smoothly and that we are able to get all of our odds and ends finished in Miami before heading out. Speaking of things to finish up, I have a little test on November 19th so I should get back to my studies. See you soon!!

Two months, two weeks, and a number two pencil

To become licensed as a physician in the United States, one must pass the USMLE steps 1, 2, 2CK and 3. That is just to be eligible to apply for a license; it doesn't include all of the testing that physicians do to be considered board certified in their respective speciality. That is a whole other set of hoops to jump through and the process varies depending on the speciality. Obviously, one must complete a residency (and fellowship if sub-specialized) to be eligible to take the boards. I'm years (of if I go into hematology/oncology close to a decade) away from those exams, so I'm not as informed about all of the nuances involved.

Anyway, there is a little saying that to prepare for Step 1 you need to study for two months, for Step 2 you need to study for two weeks and for Step three you just need to bring a number two pencil. I've also heard that generally if you study for more than 2-3 months for Step one you will start to become inefficient and things will go downhill. Farley and I scheduled 2.5 months to study just for that reason. Today, I was grateful that I only need to keep up this pace for another month. No matter how nervous I am to take this exam, since it is such a monumental aspect of the early part of my career, I know that I couldn't keep up studying at this pace for more than 3-4 months. Many physicians have told me that they are not sure they'd go back to medical school again if they knew what they'd go through. Most of them said that the first two years are the worst, culminating with USMLE step 1. They added that the third and fourth years are better because you spend more time with patient, rather than just book learning, but that the intern year and the rest of residency are extremely challenging. I know that I have some of the most toilsome aspects of medical training ahead of me--clerkships, intern year, residency and maybe even fellowship--but I know exactly what those physicians were talking about. I'm glad I went to medical school, but if I had to start again from scratch knowing what I know, it would be a more difficult decision. Medical school is mentally, physically, spiritually, emotionally and even financially exhausting. It isn't going to get any easier from here, maybe more rewarding, but not any easier.

M.D.

During one of my USMLE Step 1 video lectures, the professor some funny things. He started out by declaring that MD does not stand for Medical Doctor (or Doctorate of Medicine) as we have been told. In reality, you earn your MD once you become a walking Medical Dictionary. He added that you must be able to describe the medical term using a normal vocabulary in 30 seconds or less--not 30 minutes and definitely not using 5 dollar words. Next, he proceeded to spend twenty minutes explaining why fat is yellow. Theoretically, I could have fast forwarded; but I was rather enthralled. I didn't know that if you get butter from cows at different time of the year the color changes based on the cow's diet. Nor did I realized that human vegetarians have brighter yellow fat than non-vegetarians. I especially enjoyed the end of the yellow fat discussion when he declared, "What you eat is what you are...everybody worries about what they look like on the outside. You're more interesting on the inside. That is what makes medicine interesting!" I only wish I could transmit his excitement in my typed words. And to answer your question, yes, he is a pathologist. Next he proceeded to say that, "Cellular Injury and Adaptation may not look sexy, but on an exam it will be. Trust me." Interestingly, I think I know what he meant; however, I'm pretty sure sexy isn't the correct word to use. But heck, he has already earned the title of Medical Dictionary and I have a couple years to go before I earn that honorific!

Cold Front

Yesterday it was 60 degrees for the high in South Florida. Now, I know 60 degrees doesn't sound too bad to all of you up north, but I've grown accustomed to the 90s with about 99% humidity. It felt downright frigid. Today, our study day off, I was planning on going to to pool to read One Hundred Years of Solitude by Gabriel Garcia Marquez. However, mother nature had another plan: it was in the lower 70s. Now, I know I can't really complain too much, but I look forward to getting outside and enjoying Miami every Monday afternoon for a couple hours, so I was a bit disappointed today. I'm sure it will be back to the normal 80-90s the rest of the week--when I'm indoors studying for the USMLE step one exam. Speaking of the Step, I've put in my final date (the step is an application process in and of itself, which I started in July). It's getting down to crunch time!

Pharmacology Nomenclature is NOT fun

For the last few days, I've been doing my pharmacology review for the USMLE step 1. I know it doesn't exactly sound exciting; nonetheless, I'm excited about it. I think this is the third time I've reviewed pharmacology. The first was, obviously, on the island. The second was last semester (5th semester) during the UMBR course (University Medical Board Review course) that was offered in the evenings. There is a lot of memorization in pharmacology and I think multiple exposures are helping me remember the classes of drugs and the little unique things about each drug.

In medical school lectures, exams and the licencing exams, pharmacological agents are known by their generic names. At times last semester, I felt really dumb because patients would name off their medications and I wasn't sure what class some of the drugs fell into. The reason is that most people know drugs by the trade name (brand name). For example, other than a health care professional, who would know that Benadryl (trade name) is also known as diphenhydramine (generic name)? Honestly, who is going to refer to Benadryl as diphenhydramine--it's too hard to spell let alone pronounce. However, one advantage to the naming system of the generic drugs is that classes of drugs sound similar. Let's consider beta blockers, which are drugs that can be used for several different cardiovascular problems, such as hypertension and some types of heart arrhythmias. All of the generic beta-1 blockers end with -olol. If the drug is a non selective beta blocker (meaning, for example, it blocks beta-1 and beta-2 receptors), it has a slightly different ending, such as -ilol. As far as I know, the trade names, have no rhyme or reason. For example, some beta blockers:

• Acebutolol's trade name is Sectral
• Atenolol's trade name is Tenormin
• Bisoprolol's trade name is Zebeta
• Carvedilol's trade name is Coreg
• Metoprolol's trade name is Lopressor or Toprol XL
• Nadolol's trade name is Corgard
• Nebivolol's trade name is Bystolic
• Propranolol's trade name is Inderal LA

One day last semester, a patient told me he was taking Coreg. I felt so dumb that I didn't know what it was. I knew it was a heart medication because of the commercials, but I didn't realize it was a beta blocker. I sure as heck know what a beta blocker is! This is just one example of how confusing all of these drug names can be, especially when you are still learning. Thank God for pharmacists! It is a bit ironic that I'm finally feeling really confident with my pharmacological knowledge and in a few months I'm going to have to start seriously learning all of the trade names. Up until now, I've left learning the trade names on the back burner, as it isn't on exams and there is only so much room in my brain for information. However, next semester when I see patients full time rather than part time, knowing trade names will be more important since, as already mentioned, most people know trade rather than the generic names. I'm also going to start learning some important economic information--which drugs are available generically and which are not yet available generically. As obvious as it sounds, if patients can afford their medications, they are more likely to stick to the treatment plans and drugs available generically are much more affordable than those that are not. Thus, over the next few years I'll have to start learning what is available generically so I can suggest those medications when applicable. However, some of the newest and best drugs are those that are still under patent and therefore not available as generics yet. Oh, and every hospital has a different formulary (drugs they keep in stock)! It seems in health care, whether you are trying to learn medicine or receive medical care, you can't win for losing.

Name Game Anatomy Answers

Last week, I posted a question:

In the following list of words (lettered A-H because supposedly we get up
to 7-13 answer choices on the USMLE) try and guess which word is NOT a name
for something found in the adult human body (I'll do an embryo quiz later):
A. Olive
B. Lumbricals
C. Pyramid
D. Chordae Tendinae
E. Kasseri
F. Pylorus
G. Supinator
H. Gastrocnemius

I suspect that some of you might have thought the answer was olive or perhaps pyramid, but you'd be wrong. Now, I know that those aren't really fair as there are olives outside the body and there are pyramids outside the body, but they are also found in the body.

A: The olives are found in the brain stem. There are superior and inferior olives. The superior olivary nucleus is involved in hearing and the inferior olivary nucleus is involved in transmitting information to the cerebellum. The cerebellum helps your brain coordinate movements (like walking in a straight line or touching your hand to your nose with your eyes closed).

B: The lumbricales are little muscles in your hand that help the fingers abduct and adduct. To abduct your fingers is to spread them out and to adduct is to push them together.

C: The decussation for the pyramids are the part of the lower medulla (part of the brain stem) where approximately 80-90% of the corticospinal tract fibers cross sides of the body. Basically, this meas that the primary motor cortex in the cerebral cortex sends down a signal for something to move (this is voluntary movement of skeletal muscle). This signal travels down the brain, but when it reaches the brain stem (lower medulla), the signals from the right side of your brain cross over to the left side of your brain stem and continue to travel down the left side of the spinal cord to control muscles on the left side of your body. Obviously, this happens on both sides of the body. This is one of the reasons why people have contralateral (opposite side of the body) problems after having a stroke. Also bear in mind, different spinal tracts that carry different information (like tracts that go up the body with sensations of pain, vibration, pressure, and proprioception) cross at different places and some things even cross twice in the brain. I have the upmost respect for anyone who can be a neurologist because I think it is incredibly, incredibly difficult and I really don't know much since I'm only in medical school.

D: The chordae tendinae are found in the heart. I think they might be my favorite part of cardiac anatomy. They are cord like projections (Farley says they look like floss) that are found on the mitral and tricuspid valves, which attach to papillary muscles. In other words, the chordae tendinae help close the mitral and tricuspid valves and prevent regurgitation of blood (basically, you want blood to flow in one direction and the chordae tendinae help the valves close so that blood can flow backwards).

E: Ah, the answer to the question is E! Kasseri is a Greek cheese of medium consistency made with unpasteurized goat's milk. From what I've read, it has to be unpasteurized because that ensures the correct flavor of the cheese. Kasseri is suppose to be similar in texture to Parmesan, but not as creamy. I've never thought of Parmesan as creamy, but I guess I'm just not an expert on cheese.

F: The pyloris is bottom part of the stomach that leads into the small intestine. It has different cells which secrete acid and enzymes to breakdown food. It is also very famous (at least amongst medical students) for pyloric stenosis, which is when newborn babies have projectile vomit. Pyloric stenosis is when the connect between the stomach and the small intestine is too tight and the little baby cannot keep food down and they are always hungry. Apparently, the term projectile vomit is very serious as babies with this problem have been known to send vomit several feet across the room! Babies are usually diagnosed at about three weeks old (although it can be up to about 5 months old). I can't imagine a three week old causing such a mess!

G: The supinator is my favorite muscle in the upper arm because the name tells you the function: it supinates! To supinate the arm is to bring the arm and hand into a supine position. Or you can think of it as twisting, like to open a bottle of wine.

H. The gastrocnemius makes up the majority of the calves. It is the biggest muscle in the calve and is involved in helping us stand and walk. It also contracts and looks shapely when one wears high heals. It sometimes can cause involuntary, painful contractions (charlie horse)--I had one a couple weeks ago when I didn't stretch well after working out.

So that is the end of the first Name Game. I'll post another couple in the next few weeks. I hope you got the answer correct and that I was able to tell you something new and interesting about the anatomy!

Let's Play the Word Game: Anatomy

This week I've been reviewing anatomy for the Step. When I say I'm reviewing anatomy this week I really should elaborate. I'm reviewing microscopic and macroscopic anatomy and development, which really means that I'm covering histology, anatomy, neuroscience and embryology. It has really reminded my why I have no desire to become a neurologist. I feel like neuroscience is a language that others speak fluently and I do not. It is like someone understanding enough Spanish to go on vacation or study abroad, but that person doesn't feel like they know enough about the language to understand all the nuances of Spanish poetry. That is how I feel about neuroscience. I understand, but unlike many of my peers, I'm not all that excited about it. I think part of my distaste for neuroscience is that all of the anatomical names are really big and hard to pronounce or it sounds more like a little girl's name and than anatomical name. In fact, Farley and I have noticed a trend across all medical nomenclature: some of it just doesn't seem to fit in. Thus, I've decided to do a series of blog posts that I'm going to call the word game. I'll give you a set a words and I want you to try and guess which word is NOT part of the medical nomenclature. Basically, which one of these is not like the others.

In the following list of words (lettered A-H because supposedly we get up to 7-13 answer choices on the USMLE) try and guess which word is NOT a name for something found in the adult human body (I'll do an embryo quiz later).

A. Olive
B. Lumbricals
C. Pyramid
D. Chordae Tendinae
E. Kasseri
F. Pylorus
G. Supinator
H. Gastrocnemius

I'll post the answer and explanations to all the answer choices in a few days! Let me know which you think is NOT found in the body.

I'm getting into a groove...

Studying has been going better. I think I'm starting to get into a groove and getting the habit down. I know I posted a little about my 10-12 hours of study schedule before, but here is a little more detail about what my everyday life is like right now.


I wake up about 7:00am, put on make up, get "dressed" (usually into sweats), and enjoy some coffee and breakfast while reading the newspapers online (either on my laptop or on my I-pod). At about 8:00am, I start 100 questions in whatever subject I am studying. The USMLE is comprised of 7 blocks of 50 questions each so I do two blocks 6 days a week to get into the habit of taking 50 questions at a time. That takes me until approximately 10:00am at which point I get to correct all of those questions and review why I got them wrong or why I got them correct. At noon, I take a lunch break and actually get dressed. We leave for the Kaplan center at about 12:45 or so and the drive is 10-15 minutes. From about 1:00-5:00, I watch video lectures at the center and take copious notes. The videos are pretty good. My school videotaped the first two years of medical school so some people would watch the videos on line, but I never like it (it was helpful if you missed something or got sick though). These Kaplan videos are made for the sole purpose of students studying on their own, so they are better (in my opinion) than just watching a lecture from my medical school on video (since lectures at my medical school were intended for you to actually attend). Anyway, after we leave Kaplan at 5:00, we get to take a few hours off. Usually we head down to the gym for 30-40 minutes, shower, have dinner and maybe watch a t.v. show online (remember our giant t.v. and that we choose not to get cable). We are usually back to the books by 7:30ish. In the evenings, I try to review what I've covered in the videos at the Kaplan center and take the recall quizzes at the end of the chapters. I generally study until 10:00 or 10:30 and then try to be asleep by 11:00 so that I get a full 8 hours of sleep before doing it all again. This is my life six days a week.


On the seventh day, we "take the day off." That really means that we only study for 4 hours or so. I don't schedule anything and use this as my catch up day. This last week, I had way to much to do because I had a hard time focusing during my evenings study session (the 7:30pm-10:00pm). I was beginning to get worried that I'd never catch up, but in the last two days I've almost done it. I promised myself that I would put my studies first, especially while preparing for the boards, so since I was feeling so far behind this week, I didn't get to go down to the pool with Farley to relax in the Miami afternoon sun. Rather, I got to sit in front of my computer and books and read more about lipid synthesis and storage. This is one of those times that I reminded myself, that I have an "enviable opportunity to learn".


By the time Farley returned from the pool, he said that I looked as burnt out as I felt. We decided to get out of the house, so we went to Target. I've been wanting to get an apron since we returned to the USA, but I always forget to look. Well, it was my lucky day on Monday because Target was having an apron sale and I got one!! However, I didn't get my apron soon enough. Did you know that watermelon can stain clothes if you get the juices on you? I've cut a lot of watermelon this summer and I have two t-shirts that can attest to this fact. After Target, we headed to the grocery store and I got everything I needed for some almost homemade chicken pot pie (I didn't have time to make the dough so I used crescent rolls, but the rest was from scratch). I even had an excuse to use my apron on the first day!!


I think it is time I get back to my studies...It's 7:35pm!


I couldn't decided which picture to post. I like the top picture more, but in the bottom picture you can see the apron better. I love to cook and bake (and dislike laundry) so I think I'm a little more excited about an apron than most!

"I know the price of success: dedication, hardwork and an unremitting devotion to the things you want to see happen." --Frank Lloyd White

It's only a week into my USMLE Step 1 preparations and I'm already starting to feel tired. I think it is easy for people doubt themselves and question, "can I do this" whenever one starts working to achieve a new difficult and challenging project. Last night, I started feeling overwhelmed with the amount of work to do and started wondering if I can do it. There are times that it is really easy to sit down and study for hours and other times when it is not so easy--last night and this morning, it hasn't been so easy. I took a little study break last night and while looking around online I found a few words of encouragement:

"The greatest danger for most is not that our aim is too high and we miss, but that it is too low and we reach it."--Michelangelo

"Don't bunt. Aim out of the ballpark. Aim for the immortals"--David Ogilvy


When I started doubting myself last night, I thought something on the lines of "don't make your goal so high--then you won't feel overwhelmed." Then I saw the above quotes. It really made me think twice about lowering my goals. I've set my goal so high that realistically, I might not be able to reach it. But, who cares? So what if I don't reach that extremely high goal? Even if I miss my goal, I'll still score higher than what I thought I could initially score when I started making goals last May. I've decided to keep my goal sky high and do everything I can to reach it.


"First say to yourself what you will be and then do what you have to do."--Epictetus.


This really describes my medical school path. I first wanted to be a physician at age six when my maternal grandmother was dying of colon cancer. I didn't get into medical school right after college so I gained priceless experience as a clinical researcher. Then I took a huge risk and moved to a third world Caribbean nation that I'd never heard of before. I didn't just survive the experience, I thrived. I never expected that I would have done so well in Dominica--heck I don't even go camping! I really don't want to move back, but overall, life in Dominica was pretty great--excluding the bugs, brown and cold water and lack of groceries. If you want something enough, you just do what you have to do to reach your goals. Sometimes I think about the future--such as the USMLE, moving to Chicago, Washington D.C. or New York City (most likely New York)--and I get overwhelmed. But, I have to remind myself that I've done it before and saw success in my first two years of medical school. Besides, I decided I'm going to be a physician and now I'll do what it takes to get there--I've already done so much!


"Some give up their designs when they have almost reached a goal, while others, on the contrary, obtain victory by exerting, at the last moment, more vigorous efforts than before"--Herodotus


Strangely enough, just admitting that I feel overwhelmed at times has already made me feel more confidant. I know I can do great on these boards and I know that I have the motivation to work hard to achieve my goals. Speaking of hard work, it is time to exert "more vigorous efforts than before!"