Post-COMLEX Step 1

Well, that was a long test, that's for sure. So, I took COMLEX on Monday, it is a 400 question test, separated into sections of 50, no real theme to the sections, they feel like pretty much random collections of topics, and you get 60 minutes per section and a 40 minute break for lunch after the first 200 questions. Took BART into San Francisco, arrived at the Prometric testing center at 7:30am, started the exam around 8:15am after everyone got checked in, pockets checked, scanned with metal detectors... at least cheaters have a difficult time. They also do rounds in the testing area every 10 minutes.

Anyhow, there were quite a few repeat questions - what bug is causing this infection, what does this slide indicate, it's all a bit of a blur right now. I kept tabs of how many I was "guessing" on, and by the end it felt like maybe 40% of the test was my best estimate? But the questions are each weighted between 0.5 and 5 points, so it's really hard to know about how many you need to get right to pass or get a proper score. My practice COMLEX exam had me at slightly above average, and my question bank percentages were fairly respectable, so I almost certainly passed and most likely have a score acceptable to most Family Medicine, maybe some Internal Medicine, residencies.

I also got some information about my General Surgery rotation which I am starting on 7/18/11 - clinic days are Monday, Wednesday, and Friday - where he will have me practice taking patient histories and then we will do physical exams together; Tuesday and Thursday are surgery days.

The surgeries I can expect to see performed include:

Inguinal hernia

Umbilical hernia

Lap Chole (Laparoscopic Cholecystectomy)

Excisional breast biopsy

Appendectomy

Injecting hemorrhoids with a sclerocing agent

Port a cath placements

Pilonidal cyst excisions

So... lots of stuff in the future! I'm glad the clinic days are so short, as it'll leave me a lot of extra time for studying and personal time =)

One more week to go...

One more week until I take COMLEX, going to have to step up and really study. Took a break the last day or two, just been stressed out. Plus after I take the test it is off to Oregon, then the day after I get back it's time to jump into the general surgery rotation and patient interviews and scrubbing-in and all that fun stuff. I've gotten my badges for the two hospitals I'll be at for now, and have a surgery rotations book to review while I'm in Oregon. It's getting really hot now in the bay area, so it's getting harder to focus. Must stay strong! Time to do some practice questions...

Finished BLS and ACLS

Since I shall soon be starting rotations in hospitals, I had to go through BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support) training and certification. Didn't take too long, and BLS was a recertification so that was no challenge - ACLS was a lot of new material and new sequences of information, along with a refresher course on EKG reading so that was fun! I particularly liked the instructor, as he had 42 years of experience as a paramedic and emergency department (ED) technician so he had lots of case examples to share with us.

Some take-away points for normal people which I feel I should mention - as it may save you or a loved one one day:

3 main things to know for CPR

1. Are they breathing? Do they have a pulse? (if no...)

2. Have someone call 911 and tell them to try to find an AED (often in hospitals, schools, major office buildings, gymnasiums) - no use doing CPR if no one is coming to help.

3. Chest compressions - fast and hard - at a rate of at LEAST 100/minute, so we're talking about 2 compressions per second. When you do compressions, middle of the chest (approximately between where the nipples are), compress about 2 inches into the chest. On kids, 1/3 of the way. *FYI: If you are doing compressions properly, you may very well end up breaking their ribs - don't let that stop you - keeping heart circulation going is much more important than a broken rib or two*

If you are comfortable doing mouth-to-mouth on this person (child, husband, etc.) do only 2 breaths, head tilted back, covering nose, and then go straight back to compressions -compressions are WAY more important, so alternate 30 compressions then 2 breaths.

Another take-away note about Strokes...

If you or someone else starts having signs of a stroke (one sided muscle weakness, face drooping on one side, difficulty speaking) - CALL 911 - DO NOT DRIVE THE PERSON OR YOURSELF (unless you are less than a block from a hospital MAYBE). Reason? You may feel well enough to drive yourself, or you may think you can drive your family member, but if an ambulance picks them up, then not only will they get en-route care, the hospital they deliver the person to will be completely prepared, with the neurologist, cardiologists, etc. all notified and ready to take care of the patient. It can take 45 minutes of assessment and evaluation once you get to the hospital before they decide it's a stroke and can do any therapy - by then, it may be too late.

Why is this so important? Fibrinolytics - you basically have a 3 hour window where you can be given a medicine that will essentially dissolve the clot in your brain. I have known people who drove themselves while having a stroke, or who started having a stroke in the middle of a golf course and played through to the end before going to the hospital - if you want that shot at a Fibrinolytic, which will GREATLY INCREASE your chance of restoring brain circulation, get to the hospital ASAP.

Bottom line: If you have a loved one, pass on this information so they get the fastest possible care, or so they know what to do if this happens to you. Time makes a MAJOR difference when it comes to blood not getting to your brain.

Enough with the public service announcements though - time to get back to studying for board exams! Wooh! Diuretic medications.

Mostly done with 2nd year

Finished all our normal curriculum classes - feels like it's time for a break but alas, must start really hankering down on preparing for boards. I moved my board exams to later, since I will be doing a vacation first, so I have a bit more time but my prep program has a live lecture series that begins at the end of May so I need to get cracking!

As far as the last few weeks of school, they went by rather quickly, with lots of studying and crossing fingers that I wouldn't have to re-mediate anything. It's getting warmer, so perhaps I can take a break to collect insects again soon, but a medical career sure does eat up your time. I'm also trying to adopt a healthier lifestyle, incorporating more exercise and diet changes. We'll see how long that lasts.

Got back from Monterey recently, went for a week-long vacation with most of the family - I say most because my dad recently had a hernia repair complication and had to stay home to recover from that. Funny how you learn things in practical settings that they don't really discuss in medschool - like how to approach a patient who comes in with an internal bleed. Solution? If their H&H doesn't drop too low, and if the bleeding stops on its own, even with tons of swelling, you can expect the body to resorb a certain amount, and it is usually less risky than surgically draining the fluid or going in to repair a small bleed.

On another note, I've discovered I have a very particular allergy, to two products produced by the Estee Lauder parent company (Brands are Origins and Clinique). The brands are significantly different and the two moisturizers I used only share a handful of ingredients - I've narrowed it down to butyloctyl salicylate (but this is common in a lot of sunscreens that I think I have been exposed to before) and micrococcus lysate (an ocean-microbe's dissolving organ enzyme). My money is on the micrococcus lysate, because it is used in very few products and is relatively new on the market (2009) so I am curious to see if that's what it is. There is one more product out there that I know of that contains the micrococcus lysate but not the other compound, so if i test that on some skin it should produce a reaction if I have the right compound isolated. Kinda fun to experiment on oneself, but I kinda want my face and neck to stop being all inflamed and itchy. And my test arm.

Nearing the End of 2nd Year

Well, in a few short weeks my core classes will be finished and I will be mostly studying for Board Exams (USMLE, COMLEX) and gearing up for rotations. My third year rotations will mostly be taking place around Fairfield and Napa, with two rotations out in Stockton (psychiatry and hospital-internal medicine). That isn't until the end of year 3. My schedule only permits one month of vacation, which I intend to take right at the beginning so I can extend the time that Itake USMLE and COMLEX by a month - an extra month of studying will make a big difference, especially since that is ALL I will be doing. I am leaving a week between the COMLEX and the start of rotations to go on a vacation though - it's my only vacation, I should try to do something!

The unfortunate thing about Touro University is they do not let us finish school very early. We are in actual classes up to April/May, many mandatory, while other schools have already finished second year to give students time to study for boards! No wonder Touro students perform more poorly on boards. It's hard to keep up with boards and classes at the same time. Luckily a lot of the boards review is starting to overlap with what we are currently studying, so hopefully that'll help out a bit.

I also had an interesting extra-clinical experience - we are required to do a visit and then 6 month follow-up with a geriatric patient at a nearby retirement community. When I went to visit, it so happened that my patient had fallen in a parking lot that day and did not feel up to visiting the clinic, so the head nurse told me to make a house call. In a way, it's kind of ironic that my first "house call," once a traditional type of doctor visit, is probably the only one I shall make in my career. It was a little awkward, but kind of cool to examine a patient with an acute injury in the comfort of her home (in case you were concerned, she was barely injured - extremely lucky considering she is an 83 year old female with history of osteoporosis and is on anti-coagulation medications - she could have easily broken her hip, leg, or wrist, or ended up bleeding a ton).

On another "fun" note, we get to do rectal, breast, and vaginal exams on paid "patients" this week...not particularly looking forward to it, but at least I have experienced all three, so it's not an entirely foreign concept. We are getting into the genitourinary and pediatrics sections now so ... time to race to the finish line. I still have some fun stuff planned - next week double date to Sattui Winery for complimentary tastings, thanks to being wine club members. Anyhow, back to boards review...

Spring Semester and Boards

Well, just finished the 3rd week of Spring Semester - this unit is gastrointestinal, endocrine, reproductive, and dermatology - or GERD. Just signed up for our "Project Prepare" time slots, where we get to practice breast, prostate, and vaginal exams on hired "actors". We always kind of wonder what kind of people choose to do this sort of work, but hey, in this economy, why wouldn't they?

At any rate, the first week we covered mostly dermatology, and the second and third weeks have been focused on the endocrine system (so the pituitary, adrenal glands, pancreas, etc.). I am also getting geared up with my boards review program. I am taking Boards Bootcamp, where we get video lectures, as well as a study plan in the mean time. Near the end of the program we attend some live lectures locally. We got a super discount because at first we committed to the comprehensive program which was supposed to have weekly live lectures and cost 1700 or so, but we were going to get it for about 1300, then when we didn't get the minimum number of students to sign up, they upgraded those who did sign up to the elite program which normally costs 2200 (but we still only paid 1300). It's a lot to work on, but frankly I enjoy studying for boards more than Touro material - it just feels like it's better organized and more relevant. Anyway, I devote my Sundays to studying Boards material - works out well because my boyfriend works essentially all day on Sunday, and Monday-Thursday, so I don't feel like I'm neglecting him too much.

I have been managing to have a little fun on the side - spending time with my boyfriend, hosting a New Year's Party, heading out to a brewery here and there, a movie or two, played nearly all the way through Fallout: New Vegas. Even trying my hand at some new dinner recipes. Now I just have to re-incorporate an exercise regimen...

Oh, I also got all two of my wisdom teeth out a couple days ago - first time going under anesthesia. But there was barely any after-effect and I'm recovering quite quickly. It sucks not being able to eat much solid food, but because I only had wisdom teeth on my left side, I can still chew a little bit on my right without disturbing my stitches. The whole procedure was only about 25 minutes, I was surprised.

Fall Semester: Finished

Well, the Fall semester of OMS 2 has come and gone - it was rather intense, neuro-musculoskeletal-other stuff. Next up is Dermatology, Gastrointestinal, Genitourinary, etc. Should be interesting - this is all the neat stuff. I think I will actually attend lecture this time because a lot of it is interesting stuff to me and I'd kinda like to get back into that. Right now it is Christmas time, and I'm home for a bit but mostly school is still on my mind. Board exams are coming up, so I have to take a diagnostic Step 1 for my boards prep course, which starts in January. Also, our 3rd year we start rotations so we had to rank and send in our requests for certain rotation locations. I'm trying to stay local, but so is most everyone else - most people are in relationships or have kids so it is a challenging position. We hear the results shortly after class starts again.

So...what with rotations, boards, end of fall semester, board prep courses, and trying to have some semblance of a social life, been quite busy. My other blog has been sorely neglected of late...hopefully I can get back to it soon. It seems I never have a spare moment to think even. For now, just trying to enjoy a few days off and plan a New Year's Party.

Season's greeting, everyone - stay warm and safe this holiday season!