University of Oklahoma -- everyone welcome -- Part 4

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So we went to eat at Casa Perico (highly recommended) and bought a bottle of wine. My studying since then has been a little half-hearted. Actually who am I kidding -- it's been half-hearted for the past few months. :D

All I can say is that I'm officially super excited that this is my last traditional test block!! Yay for progress. :banana:
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Doctor Bagel said:
So we went to eat at Casa Perico (highly recommended) and bought a bottle of wine. My studying since then has been a little half-hearted. Actually who am I kidding -- it's been half-hearted for the past few months. :D

All I can say is that I'm officially super excited that this is my last traditional test block!! Yay for progress. :banana:
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+pissed+ :beat: j/k ;) I'm just terribly, terribly, painfully jealous. I'm ready for progress, too. I think I'm going to have to call it quits for the night.... if not for the night, at least for a few hours. I'm running on empty. I took the practice neuro test and only got a 72% :( but most of the questions I missed were on stuff I haven't studied (i.e. the ear) :). So I guess at some point tomorrow I'll have to look at that stuff, too. And Foreman's stuff. His stuff is generally so easy I'd hate to miss those gimmie's. I might rent a movie and add the ear & hypothalamus stuff to my review sheet; that way I can "relax" while still "studying".

Does anyone know if we really need to go back and re-learn the arterial supply from the first test block? cuz I'd rather wait for that til I'm studying for the final. :p
 
Jwax said:
Does anyone know if we really need to go back and re-learn the arterial supply from the first test block? cuz I'd rather wait for that til I'm studying for the final. :p
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I'm at least going to look over it to the point that I can make an educated guess on the exam, since it seems like something he focuses on a lot in his lesion questions.
 
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Jwax said:
Does anyone know if we really need to go back and re-learn the arterial supply from the first test block? cuz I'd rather wait for that til I'm studying for the final. :p
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Arterial supply is HUGE in neuro... you're definitely doing yourself a disservice if you don't look over it.
 
For the neuro slide practical, should we expect to see brain stem sections or just the stuff from the labs this block?
 
WhoisJohnGalt said:
Arterial supply is HUGE in neuro... you're definitely doing yourself a disservice if you don't look over it.
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I recognize that arterial (and nerve) supply are generally the most important things to know for anything related to anatomy, but given the extent of the material they expect us to know for this exam, I'm not inclined to go back and catch back up on last test block when we've not discussed those arteries in 3 months. That's what a comprehensive final is for.
 
Jwax said:
I recognize that arterial (and nerve) supply are generally the most important things to know for anything related to anatomy, but given the extent of the material they expect us to know for this exam, I'm not inclined to go back and catch back up on last test block when we've not discussed those arteries in 3 months. That's what a comprehensive final is for.
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If you didn't cover it this block, it shouldn't be on the exam. I do remember there being a lesion question or two on the exam (can't have a neuro exam without one, I guess), but it was certainly nothing as complex as what you guys did last time with all the brainstem stuff. I think any arterial supply stuff would be pretty big picture -- it's not like the answer would be anterior choroidal artery (is that an artery?) or anything like that.
 
Doctor Bagel said:
If you didn't cover it this block, it shouldn't be on the exam. I do remember there being a lesion question or two on the exam (can't have a neuro exam without one, I guess), but it was certainly nothing as complex as what you guys did last time with all the brainstem stuff. I think any arterial supply stuff would be pretty big picture -- it's not like the answer would be anterior choroidal artery (is that an artery?) or anything like that.
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I kinda got bit by that last year. I had prepared for the first block like EVERYTHING from the not-so-smelly portion of the practical was going to be on there. So then when some of the vestib structures showed up on block 2, I was lost since I didn't go back over it. If you've discussed the function of something at all, the nuclei/tracts/blood supply to it/potential lesions and their clinical presentation are all fair game.

I wonder if an astute PCP can bill for treating derm diseases that typically get referred out of a lack of knowledge. It seems like in trying to educate us to the point we are comfortable managing derm maladies, they are potentially decreasing referrals. I don't know enough about the board-licensure for various specialties to know if you HAVE to refer some things, if they are not in your arena.
 
Doctor Bagel said:
If you didn't cover it this block, it shouldn't be on the exam. I do remember there being a lesion question or two on the exam (can't have a neuro exam without one, I guess), but it was certainly nothing as complex as what you guys did last time with all the brainstem stuff. I think any arterial supply stuff would be pretty big picture -- it's not like the answer would be anterior choroidal artery (is that an artery?) or anything like that.
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Super. There are a handful of ateries we've discussed for this block, but I'm not going to catch on if the lesion is in the brainstem. Internal capsule, basal ganglia, cerebellum... the eye... I accept those as lesion questions. Brainstem questions will annoy me.

Tried to go to bed at 1. Didn't work. Still not tired. I guess two red bulls interspersed throughout the day keeps me up until 4 even though I only got 6 hours of sleep last night. I'm thinking I'll watch the auditory / vestibular lectures again to fall asleep to. :thumbup:
 
Mr. Freeze said:
I wonder if an astute PCP can bill for treating derm diseases that typically get referred out of a lack of knowledge. It seems like in trying to educate us to the point we are comfortable managing derm maladies, they are potentially decreasing referrals. I don't know enough about the board-licensure for various specialties to know if you HAVE to refer some things, if they are not in your arena.
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If you and your patient are comfortable (not egotistical, though) diagnosing and treating their maladies, you can do it to your heart's content.

As far as I know there's no hard and fast rule for referring. The only things I can think of came from the perspectives of the specialists, so take that with a grain of salt. Our psychiatry attending said PCPs should get comfortable with one or maybe two SSRIs and beyond that they should refer for refractory depression (and never prescribe benzos long term for anxiety issues). One of the neurology attendings said he knows PCPs that will try one or two of the migraine medications before referring. I think that PCP physicians should be good at dealing with 90% of the stuff that could reasonable fall within the realm of a specialist. It's the 10% that doesn't respond in the expected way or needs off-label or cutting-edge therapy that gets sent to the specialists... unless the PCP is lazy. ;)
 
Mr. Freeze said:
I kinda got bit by that last year. I had prepared for the first block like EVERYTHING from the not-so-smelly portion of the practical was going to be on there. So then when some of the vestib structures showed up on block 2, I was lost since I didn't go back over it. If you've discussed the function of something at all, the nuclei/tracts/blood supply to it/potential lesions and their clinical presentation are all fair game.

I wonder if an astute PCP can bill for treating derm diseases that typically get referred out of a lack of knowledge. It seems like in trying to educate us to the point we are comfortable managing derm maladies, they are potentially decreasing referrals. I don't know enough about the board-licensure for various specialties to know if you HAVE to refer some things, if they are not in your arena.
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I agree. I ended up sad that I didn't look over it again. But if you've already made up your mind that you're not going to look over it despite what we tell you, why ask the question?

Anyway. As for the referral stuff... you really won't remember all this derm crap by the time you're actually practicing. I got an awesome laminated pocket size page at one of the AMSA conventions that shows you pictures of the most common derm stuff, it's fantastic. I have my derm clerkship next, so I'm hoping that actually seeing some of this in real life will make it stick a little more. Although I did call a shingles patient once when the rest of my team was convinced it was something else... but I kept insisting and finally they started him on acyclovir and it cleared up. But shingles is one of those things you really don't forget... most of the rest of it kinda slips your brain. Anyway, Amx is right... if you feel comfortable treating it, you can definitely go for it; there's nothing you "HAVE" to refer. But part of being a good PCP is being okay with referring what's outside of your comfort zone. You really have to learn to put ego aside to be a good one.
 
WhoisJohnGalt said:
I agree. I ended up sad that I didn't look over it again. But if you've already made up your mind that you're not going to look over it despite what we tell you, why ask the question?

Anyway. As for the referral stuff... you really won't remember all this derm crap by the time you're actually practicing. I got an awesome laminated pocket size page at one of the AMSA conventions that shows you pictures of the most common derm stuff, it's fantastic. I have my derm clerkship next, so I'm hoping that actually seeing some of this in real life will make it stick a little more. Although I did call a shingles patient once when the rest of my team was convinced it was something else... but I kept insisting and finally they started him on acyclovir and it cleared up. But shingles is one of those things you really don't forget... most of the rest of it kinda slips your brain. Anyway, Amx is right... if you feel comfortable treating it, you can definitely go for it; there's nothing you "HAVE" to refer. But part of being a good PCP is being okay with referring what's outside of your comfort zone. You really have to learn to put ego aside to be a good one.
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My PCMII preceptor "missed" a shingles case. She is FM, kinda old school, and "sees" patients sometimes by phone. A lady called and described what to most anyone would sound just like poison ivy, including the back-story, working in the yard, etc. When several days went by on pred or medrol pack, whatever, and it got significantly worse, she came in, and Dr. dx'd before she even got in the exam room. CN V. Lots of scarring, lots of trips to optho, lots of allodynia, too late for zostavax...

The better you learn the neuro now, along with pertinent signs, the easier I think both IHI neuro and your 4!! weeks!!! :thumbup: LOL with DLG during third year will be. Seriously, I bet you guys could have taken the last test we had, and done as well on the neuro portion as any of us. LOTS of lesion q's...
 
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Mr. Freeze said:
The better you learn the neuro now, along with pertinent signs, the easier I think both IHI neuro and your 4!! weeks!!! :thumbup: LOL with DLG during third year will be. Seriously, I bet you guys could have taken the last test we had, and done as well on the neuro portion as any of us. LOTS of lesion q's...
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What's the deal with neuro stuff being so emphasized here? From what I gather, it isn't as intense in other places. Any thoughts?
 
soonereng said:
What's the deal with neuro stuff being so emphasized here? From what I gather, it isn't as intense in other places. Any thoughts?
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I started a thread about this last year in the allo forum, and it seemed like lots of schools have a neuro class pretty similar to our own. Now the move to the 4 week clinical rotation is not as common and is probably a result of the DLG. The rumor I heard about him a long time ago is that he's on the dean track, so yeah, go neuro. :rolleyes:

As for the last test block stuff on this exam, it's not going to be very many questions even if it does pop up, so I personally don't think it would be the most time efficient thing to go back and study the first test block material. I know I didn't and did just fine on the 2nd neuro exam.
 
soonereng said:
Yeah, but you're some kind of genius...and you already admitted that you actually liked neuro.
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Nah, not a genius, but I did like neuro. :oops: The thing about neuro, though, is that most people wind up doing better than they feel like they'll do. It's a class that makes you feel incredibly lost, but the test scores for us were never very bad. The averages were always higher than the phys averages.

Speaking of when neuro gets interesting, I would guess if you don't like the next test block material, neuro and psych are probably things you won't enjoy. You get to the good stuff like strokes, cognition, learning. Believe me, it's much better than learning about the ear.

So I haven't looked at the oral cavity material at all yet. :eek:
 
WhoisJohnGalt said:
I agree. I ended up sad that I didn't look over it again. But if you've already made up your mind that you're not going to look over it despite what we tell you, why ask the question?
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My question was "do you alll happen to recall if there were any questions on the second block that seemed more like they should have been on the first block... i.e. do I need to restudy 1st block material now instead of when prepping for the comprehensive final like I ought to be able to do?". My question was not "what is the most important thing for me to get out of neuro to apply to 2nd & 3rd years?" Once someone actually answered my question, I accepted that there is a decent enough of a chance that something from tb5 lesion-related might pop up on this exam that I will need to at least look it over so I'm not going in blind (despite my irritation that such a question might be on the exam). As far as I can tell, I never said I wouldn't look over it; just that I wasn't inclined to do so... i.e. if I had my way I wouldn't have to study for it until later. I imagine with how well I intend to go over lesions / arterial supply for tb6 that I will be able to at least retain some of it for later years. I am just not pleased about having to do so now. Make sense?
 
soonereng said:
Yeah, but you're some kind of genius...and you already admitted that you actually liked neuro.
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:laugh: Pot calling the kettle black. ;)

(I mean with the genius thing, not the liking neuro thing)
 
Mr. Freeze said:
I don't know enough about the board-licensure for various specialties to know if you HAVE to refer some things, if they are not in your arena.
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you don't have to refer. however, defending yourself in court might be hard when you're asked how many [insert treatment/diagnosis] you performed of the same type in residency when it's something outside your scope of practice. basically, you better be pretty damn comfortable w/ your knowledge before you become the all-fixing doctor that I feel the 1st two years of med school pretends that we are to become.
 
Apparently there's a schedule circulating somewhere that says the IHI test is at 1:30, and this is not true!! It's at 1:00. Just an fyi if you haven't checked your email.

Speaking of ! -- I love how Dr. Kern uses them in almost every other sentence. :)
 
Doctor Bagel said:
I hate this sitting around before the test time. :thumbdown:
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Me, too. I got done with the written neuro at 10am, so I've been waiting for the practical since then. Ugh, 3 hours of waiting = :thumbdown:. I spent an hour and a half prepping for the practical, then I had enough. I've been trying to start on hb but I have a hard time studying on campus most of the time... and now is no exception. Particularly since the boys in my mod are watching you tube videos (what what in the butt?).
 
Studied two or three times as much for neuro this time and decreased my grade by 8 perecentage points. :confused: :thumbdown: I did do much better on the practical, I believe, but that doesn't help. :mad:
 
Doctor Bagel said:
That sucks. :( I'm hoping you'll have the opposite experience for phys.
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It would be the exact opposite, too, since last TB I spent the week before block prepping for phys and still did poorly.

This is the first time that my score on one exam has made me feel so bad that I can scarcely study for the next ones. :( Ash and Foreman killed me on the exam. Between the two, I missed 10 questions. :thumbdown: I actually got all of Thompson's. Apparently, re-watching the lectures right before the exam is a good method for me.
 
Jwax said:
It would be the exact opposite, too, since last TB I spent the week before block prepping for phys and still did poorly.

This is the first time that my score on one exam has made me feel so bad that I can scarcely study for the next ones. :( Ash and Foreman killed me on the exam. Between the two, I missed 10 questions. :thumbdown: I actually got all of Thompson's. Apparently, re-watching the lectures right before the exam is a good method for me.
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So do you have histology tomorrow? At least that's not going to take a whole lot of your focus. That is the definite downside of getting the keys.
 
soonereng said:
Nope HB. But it should still take little focus I guess. I can miss a lot on this one and keep my grade.
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Well, that's even better. From what I remember from that exam, the fetal alcohol syndrome questions were pretty nitpicky, so study those. Duncan's questions were pretty easy, though.
 
Doctor Bagel said:
so I could have studied more for that one. Oh well, glad it's over.
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Oh, I could have studied for quite a few weeks more - don't know that it would have improved my grade much. The nice thing about getting IHI over with is that it's like Phys and Neuro on the same day - we're most of the way home already.

Of course, I still haven't memorized much in pharm. It's gonna be a miserable night and tomorrow...

but, I'm still grateful to have survived IHI. Ugly, ugly, ugly. I didn't see the earlybirds racing from the room after 60 minutes this time.
 
And, of course, while Phys and Neuro grades are reasonably accurate as soon as the key's posted, I have a feeling we'll get a few "poor performers" thrown-out as usual.

I can see the method to Dr. H's madness. I thought renal was so tough it'd kill me. This test was a far steeper hill to climb. I've never ever had to digest and regurgitate (or vomit, take your pick) so much back up at one time. He's toughening us up for Step 1. I have a very passionate love/hate relationship with that man, at both ends of the spectrum!!
 
Non-TradTulsa said:
Oh, I could have studied for quite a few weeks more - don't know that it would have improved my grade much. The nice thing about getting IHI over with is that it's like Phys and Neuro on the same day - we're most of the way home already.

Of course, I still haven't memorized much in pharm. It's gonna be a miserable night and tomorrow...

but, I'm still grateful to have survived IHI. Ugly, ugly, ugly. I didn't see the earlybirds racing from the room after 60 minutes this time.
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I've got to admit I left pretty early just because I was in a mood of extremely not caring (after getting really anxious, of course). I didn't check over my answers and had lots that I wasn't sure of. Still haven't graded it, either. :eek:

And yeah, so much more relaxed now even thought tonight/tomorrow are really going to suck. I've read about half of the pharm syllabus and learned about none of it.
 
Doctor Bagel said:
And yeah, so much more relaxed now even thought tonight/tomorrow are really going to suck. I've read about half of the pharm syllabus and learned about none of it.
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:laugh: And I've thought I was a slacker. ;)

Since I was having such a big pity party, I decided to take a nap. I feel a little bit better now, and I at least feel good enough to race through all the hb stuff a time or two then move of to some physiology. Although I'm starting to feel that the less I study and understand and the more I cram, the better I do. Soonereng - wasn't I telling you this morning that any time I feel confident do poorly? :oops:

I'd like nice big fat A's on HB, histo, and EBM... that way I could feel like a semi-smart person again.
 
It'll be fine, Jwax. (Wait till next year, though - the Holliman awaits! - the only man qualified to get you ready is Dr. Blair). I just got up from a 3 hour nap - mucho help. I'm in the exact same spot in pharm Bagel is - read 1/2 the syllabus, memorized exactly none. But I feel better. Time to do my idiot savant memorize-drug-memorize-drug-memorize-drug routine.
 
Non-TradTulsa said:
It'll be fine, Jwax. (Wait till next year, though - the Holliman awaits! - the only man qualified to get you ready is Dr. Blair). I just got up from a 3 hour nap - mucho help. I'm in the exact same spot in pharm Bagel is - read 1/2 the syllabus, memorized exactly none. But I feel better. Time to do my idiot savant memorize-drug-memorize-drug-memorize-drug routine.
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If I just keep getting worse every semester, I may fail out after all. I'm trying to bring myself back up, but I just can't. This really, really stung, and the fact that no one else is b*tching about it probably means its just me. So I'm the only idiot, and everyone else thought it was fine. This is the most discouraged I have felt since starting medical school.
 
I don't think I've heard "you've got x minutes left" since I've been here, so yeah, didn't just blast out ASAP. Definitely trying to be more methodical. But only because comprehensive exams loom on the horizon, and I'd like to know what I need to hit more. All I did today was pour over things and change rights to wrongs. Although I offset that by changing just as many wrongs to rights. I sat there for a LONG ****ING time trying to remember if BCR-ABL was ONLY marrow, or if you could have a low LAP in ANY other condition. I "spotlighted" "Pagetoid" on my computer, which has ppts, notegroups, and syllabus pertinent to 2008. The only thing that came up was a PDF file from a path qbank I didn't even know I HAD, but glad I found. Derm was not my strong point today...

Silly Bagel, you don't LEARN pharm. You just stuff it in so you can regurg it...

Wax, I'd like to tell you it gets easier. It just gets different. And more interesting. Disease is MUCH more interesting than the bull**** you are going through. But knowing the normal is mandatory, if no one has told you! :rolleyes::D
 
Mr. Freeze said:
I don't think I've heard "you've got x minutes left" since I've been here, so yeah, didn't just blast out ASAP. Definitely trying to be more methodical. But only because comprehensive exams loom on the horizon, and I'd like to know what I need to hit more. All I did today was pour over things and change rights to wrongs. Although I offset that by changing just as many wrongs to rights. I sat there for a LONG ****ING time trying to remember if BCR-ABL was ONLY marrow, or if you could have a low LAP in ANY other condition. I "spotlighted" "Pagetoid" on my computer, which has ppts, notegroups, and syllabus pertinent to 2008. The only thing that came up was a PDF file from a path qbank I didn't even know I HAD, but glad I found. Derm was not my strong point today...

Silly Bagel, you don't LEARN pharm. You just stuff it in so you can regurg it...

Wax, I'd like to tell you it gets easier. It just gets different. And more interesting. Disease is MUCH more interesting than the bull**** you are going through. But knowing the normal is mandatory, if no one has told you! :rolleyes::D
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Yeah, what the flip is "pagetoid"???? I even read the syllabus, and I know I didn't see that, although I added the word "micaetous" to my vocabulary - sparkly! Oh, well, hopefully "pagetoid" is a throw-out candidate... I'm betting there will be some this time!!

Jwax, on the serious, hang in there. I'm doing great but I almost flipped out completely first year from the stress. You'll make it. Remember, C=MD. Ya just have to pass. None of this grade garbage really matters much, and you have a lot of time to get ready for Step 1.

Second year is a lot more work, but my stress level is about half of what it was last year. You get better and better at absorbing material faster - and second year is very definitely more interesting when you're sitting in class and think, "oh God, I have to remember this because a real doctor has to know this!"

We feel ya - it'll be okay.
 
Non-TradTulsa said:
Jwax, on the serious, hang in there. I'm doing great but I almost flipped out completely first year from the stress. You'll make it. Remember, C=MD. Ya just have to pass. None of this grade garbage really matters much, and you have a lot of time to get ready for Step 1.

Second year is a lot more work, but my stress level is about half of what it was last year. You get better and better at absorbing material faster - and second year is very definitely more interesting when you're sitting in class and think, "oh God, I have to remember this because a real doctor has to know this!"

We feel ya - it'll be okay.
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Thanks for that. I was feeling so mopey that I went through and calculated what I need to make a B, and it still isn't difficult at all to manage... so I'll quit freaking out. I thought I had pretty much screwed myself into a C... and as much as I try to utter the phrase c=md to myself, I kept help but feel c=loser=failure=idiot if it is applied to me. But thanks to TBLs and pretests, I think it will turn out okay. So... I'm done flipping out. Thanks for the encouragement.
 
soonereng said:
Nope HB. But it should still take little focus I guess. I can miss a lot on this one and keep my grade.
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I wish I could say the same.

Doctor Bagel said:
Well, that's even better. From what I remember from that exam, the fetal alcohol syndrome questions were pretty nitpicky, so study those. Duncan's questions were pretty easy, though.
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How nitpicky are the FAS questions? I figured they had to be, since there are 16 of them and hardly that much info in the section.

Also, what type of questions does Dr. Duncan ask? 32 questions seems like an awful lot for his stuff, too.
 
Jwax - We medical students, male and female, have this "macho" thing - there seems to be a rule that you have to act cheerful and OK when you're on-campus, no matter what. If you can still pull a "B", trust me, there are quite a few people suffering much worse than you.

In the old days when the official final score was posted in the glass case (I think we were the last class for that due to the test ID disasters), you had to act tough when you saw your final corrected score - BUT, you could also count the number of people who weren't making it - which, I blush to admit, I did on a fairly regular basis (please God, don't turn me in to someone). Getting scores privately on-line is better, but when you could look over everyone's test score and running total, it helped to keep things in perspective.

Think about how hard you worked to get here!! Again, second year does get so much better. I know "more work" sounds impossible right now, but you'll manage it easier.
 
shortitalian said:
How nitpicky are the FAS questions? I figured they had to be, since there are 16 of them and hardly that much info in the section.

Also, what type of questions does Dr. Duncan ask? 32 questions seems like an awful lot for his stuff, too.
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All I remember is getting a few what the hell FAS type of questions. It was one of those topics I sort of skimmed over, and that wasn't the best idea.

Duncan's stuff really is pretty easy. I remember worrying about it because the material he presented in sort of vague, but his questions for us were super basic. He had questions about drug identification -- x person had these symptoms, what did they take? I'm pretty sure we had stuff about what to do with a drugseeking patient. I can't remember much other than that, but I can say it's probably easier than what you're expecting.

And yeah seriously, what's a pagetoid?!! I thought they got pretty sneaky overall with the derm and oral stuff. Of course, I didn't study it anywhere close to enough.

OK, back to cramming (not learning) pharm. :sleep:
 
Non-TradTulsa said:
Jwax - We medical students, male and female, have this "macho" thing - there seems to be a rule that you have to act cheerful and OK when you're on-campus, no matter what. If you can still pull a "B", trust me, there are quite a few people suffering much worse than you.
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I know... that's why I figured I better quit whining. I feel being in line for getting a C is acceptable to whine about, since only a handful of people get C's or below. Faking cheerfulness has never been a problem for me ;). I'm pretty straight-forward. If I did good, I'll tell you I did. If I did bad, I'll tell you I did, and my emotions will be congruent with my situation :p. I think I had a rapid drop in serotonin levels after grading the neuro exam and I'm trying to build them back up since I know I'm not in as bad of a position as I originally thought I was.

HB = so much more fun to study than anything else...
 
Jwax said:
HB = so much more fun to study than anything else...
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OK, so I know that you had to have taken some of these ilicit drugs to get that serotonin level back up. This is confirmed by your making statements about HB that aren't congruent with reality.

Phys is the most fun topic to study for me, just not necessarily the most fun to take a test in.
 
soonereng said:
OK, so I know that you had to have taken some of these ilicit drugs to get that serotonin level back up. This is confirmed by your making statements about HB that aren't congruent with reality.

Phys is the most fun topic to study for me, just not necessarily the most fun to take a test in.
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:rolleyes: And you say I'm on drugs... ;)

Or a better explanation:
Me= BA in sociology/criminology = yay HB
You = whatever degree it is you get for engineering (mechanical, right?) = yay physiology
 
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