How to Prepare for the USMLE: Cardiovascular System

My ass has been handed to me and these are not happy days.

I went through the Anatomy in Rapid Review: Gross and Developmental Anatomy. This book is so much fun that my roommate (after hearing a few examples of the clinical correlations therein) left to buy his own copy from the bookstore. I recommend this book twice on Sundays.

Later that day I went through Costanzo’s Physiology BRS. It’s fine, but it’s really lacking in detail. It’s a review book (I get it) but it’s a review book for the Boards. It could have brought a little more to the table (at least in Cardio). Other than claiming that baseline MAP should be 100 mmHg (instad of 93), showing ventricular volume changes on a graph during isovolumetric relaxation (wrong by definition), and showing no ventricular volume change with atrial systole (accounts for last 10% of EDV), there were no major errors. The questions are cookie-cutter and do not ask you to think a single order above the basest level of detail. I judge this section as “adequate.”

Day two was Schneider and Szanto’s Pathology BRS. I wrote about this book before and think that the chapters on basic pathology are good, and the sections on Heart and Vascular System are “okay.” Again, review book, I get it. But come on. The coverage of topics is pretty superficial and for the time I spent trying to find reasonable detail in Pocket Robbins and Merck, I could have just as easily skipped this book. While so far some sections have been better than others, the questions in the Path BRS are universally weak.

I was pretty excited to finish Anatomy, Physio and Path in two days and was scheduled to begin Pharm, but I stopped. Instead, I opened up Merck and started reading. I skipped over epidemiology and treatment regimens, but I lingered over clinical symptoms and pathology for each entry just to have a fighting chance of redoing the Cardio Pathophys in a day. I didn’t make it. It took two solid days but I don’t regret it.

The next day was for questions. First, I went to WebPath and worked through their tests. I did very well. Next I opened up Robbins Review of Pathology for their questions and, too my surprise, did well again. Feeling pretty cocky, I walked up to the 116 Phys, Path, and Pathophys questions in the USMLE WORLD qbank.

If you’ve seen Fight Club, then you’ll understand the following scene:


In the basement of a dank bar, the men are circled around each other and in the center, two are fighting. USMLE WORLD grabs Medstudent by the collar bone and drives his head into the student’s nose. He falls. Standing back up, he is able to land a few blows against USMLE WORLD’s jaw. He should be down, but he’s not. He’s smiling. USMLE WORLD proceedes to knock Medstudent to the ground, letting his fists drop into student’s face with a sick, wet, smacking that hides the student in his own blood. The faces of the other men hang slack, each of them uncomfortable with this particular show of brutality. The fight should have been over seven blows ago. USMLE WORLD stands up, shrugs his shoulders, and walks away. Medstudent coughs up a tooth through his nose.

“What got into you, Psycho-boy?”

“I felt like destroying something beautiful.”


It was the Pathophys questions that did it. I’ve learned all about Pressure-Volume loops. I thought I understood the pathogenesis and sounds of every valvular disease. And I was completely wrong. Throughout the entire, horrible experience of getting question after question incorrect, I began to realize that there was a level of detail simply lacking from what I understood that was essential to tackling these problems.

I’m reminded of what Bobby Jones said about the young Jack Nicklaus. “He plays a game with which I am unfamiliar.”

Thanks to google, I finally found the rules to the game. I could kiss Richard E. Klabunde on the mouth for creating his Cardiovascular Physiology website. It is through him that I discovered that there were not just direct effects on the PV loop due to Preload, Afterload and Contractility, but there were INTERDEPENDANT EFFECTS as well! It’s the missing move in the Rubicks Cube!

He has a book! He has another site for Cardiovascular Pharmacology!

Excuse my enthusiasm, but you have to understand: this was like Ignorance prison and I’ve just let the Physiology Jesus into my life. I’m parolled!

So not such a bad day after all. After spending two hours internalizing the PJ’s message, I took the remaining questions and fared much better. Tomorrow is Pharm, and I will let the PJ’s site be my guide (PBUHHN).

Return to USMLE Step 1 page.


3 Responses to How to Prepare for the USMLE: Cardiovascular System

  1. One of my sons brought your comments to my attention. It brought a smile to my face. I’m glad that “Physiology Jesus” (a.k.a. “PJ”) enlightened your thinking as Jesus has enlightened this physiologist’s thinking for almost 40 years.

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