Reader Submitted Corrections

The following is a list of corrections/suggestions that the readers of this site have submitted.  Thanks for contributing.

Miscellaneous

1. P.92, Collagen synthesis and structure
   1. In both Lipp Biochem (p47) and High Yield Histo (ch 5- p 45)say that both hydroxylation and glycosylation occur in the RER as does formation of the of procollagen (triple helix) from pro-alpha-collagen. In First Aid it says Glycosylation and procollagen formation occurs in the Golgi.
2. P. 109, Lipoproteins
   1. diagram of chylomicrons. Shouldn’t have Apoprotein A–A is found only on HDL particles.
   2. On second reading, perhaps CM do contain Apo A, but HDL seems to be the main location of Apo A.
3. P.139, Stains
   1. PCP appears also on page 139, and should be changed to P. jiroveci
4. P.155, Microbiology – Virology
   1. +ss RNA virus mnemonic

                                                              i.      Flava-flav is having a Retro Toga-Corona party in Pico Cali

1.       Flavivirus

2.       Retrovirus

3.       Togavirus

4.       Coronavirus

5.       Picarnovirus (no envelope)

6.       Calcivirus (no envelope)

1. P.158, Viral Vaccines
   1. MMR, with the R [Rubella] being in bold type, is indicated as being an egg based vaccine.  However, measles and mumps are the egg based vaccines, while Rubella is from lung fibroblasts
2. P.171, Protein synthesis inhibitors
   1. I changed the 50S mnemonic to: chloramphenicol, erythromycin, lincomycin/clindamycin, Linezolid. I did this because as you noted, lincomycin/clindamycin are in the same class, and they don’t mention linezolid, which is important as a 50S inhibitor used to treat MRSA.
3. P.201, Tumor nomenclature
   1. Benign: mature teratoma (women)
   2. Malignant: immature teratoma (women), mature teratoma (men)
4. P.250, Cardiovascular therapy
   1. positive inotropes raise cardiac ouput (the + sign and the down arrow are confusing)
5. P.303, Basophil
   1. in TAIL the I is not “Iron deficiency” but is “Iron Overload”
6. P.333
   1. It should mention that PAN is NOT associated with granulomas like Wegeners; also that PAN lesions favor branching points of arteries; Lastly, the last line under Churg-Strauss syndrome stating “often seen in atopic patients” should be followed by commonly has new onset or worsening of asthma preceding symptoms of vasculitis.
7. P.372, Neuromuscular blocking drugs
   1. Everything I have read says there is no pharmalogical antidote to succinylcholine (especially not an acetylcholinase inhibitor like neostigmine, which is what is written under phase II of the depolarizing NMJ blocker succinylcholine).
8. P.426, Lung relations
   1. The figure of the trachea and bronchi is confusing.  The right lung bronchus is shorter, wider and more upright when compared to the left main bronchus.  The figure has this relationship reversed.  See Gray’s Anatomy.

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Brevity is the Soul of Wit

A friend asked in a letter,

Still thinking of being a people doctor? have you switched at all more toward research?

The question has been on my mind a lot, and I guess it had built up enough pressure. My response was disproportionate.

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Therefore, since brevity is the soul of wit, and tediousness the limbs and outward flourishes, I will be brief:It’s funny. I’m applying to transfer into a US medical school pretty soon which means a handful of personal statements. And for all the writing that I’ve done, I still have no idea how to do it correctly. I’ve tried to get to a point in my life where I understand who I am and why I do the things that I do, but I’m just not there yet. Which is fine, it just makes it hard to convince someone else that you’ve got the reigns in your hand, so to speak. It’s always ugly, but whenever you can’t prove or demonstrate something positively, there’s always the reductio ad absurdum. As far as I go, it’s the best I can do.

As it stands, I’m still curious about damn near everything. I have a folder called “million dollar ideas,” one called “essays” and one called “research.” I see problems everywhere and I love obsessing over solutions, and all of these interests pull me deeper into medicine. It’s just so deep and so wide, there’s enough room for anyone to lose themselves or find themselves. That’s why I’m here, I guess.

I’ve always joked with people when they ask me, “So why do you want to be a doctor?” My typical answer is that I’d be too bored with anything else, and that’s a half truth. I only see the rest when I work backwards:

I’d love to be a surgeon, but the malpractice risk and insurance along with dropping pay are off-putting, so I guess I want to be paid well according to my skill and don’t want to enter a field where that may not happen. I’d love to be a pathologist with all the time to write, do research, dissect. But I’d miss the patients. I’m reluctant to admit it, but I would miss the satisfaction that comes from someone you’ve treated thanking you with their eyes. Internal medicine is appealing for the challenge of trying to know everything about everything, but the patient exposure is above what I’d like and the pay seems off the worth. I guess I want to see people, but not all the time. I want to write, I want to teach, I want to cut, I want to cure, I want to be paid what I’m worth and I want time to enjoy the fruits and to share it with a family. I have two years left to figure out if anything fits those criteria, but from here things still look pretty messy.

I still don’t know what I’ll end up doing, but I hold fast to the belief that something fits. I want to transfer because I feel like I’m running out of time to make that decision cleanly. More exposure, more people, more resources and all of it right now would go a long ways to convincing me that I’d seen the field, taken stock, and decided on my future. If it turns out that there’s some unanswered question that I think I can tackle and is worth my life’s efforts, then I want to be exposed to it. I worry, a lot, that I’ll miss that opportunity if I stay with my current school.

The facilities, the people, and the open doors of a US medical school would be an embarrassment of riches for me at this point. In the time that I’ve studied with less, I feel like I’ve used everything available so that now, finally, I know how valuable those opportunities are and I’m ready to make the most of them. I’m praying for the chance.

Until that happens, I won’t know if it’s people or research.

O Tell Me The Truth About Love

Seen on the R subway line between Atlantic-Pacific and 7th street.

When it comes, will it come without warning?

Just as I’m picking my nose?

Will it knock on my door in the morning?

Or step in the bus on my toes?

Will it comes like a change in the weather?

Will its greeting be courteous or rough?

Will it alter my life altogether?

Or tell me the truth about love?

I still don’t know what “it” is. Any thoughts?

How to Prepare for the USMLE: How Early Should I Start?

I have received a version of the following email half a dozen times in the last few weeks concerning when in the first two years of medical school it is best to begin preparing for the USMLE. Here is one response.

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Hello,I wanted to thank you for that information regarding studying for the BEAST!. It is well informed and I loved the reasons behind your study schedule. I am going to start my first term at SGU this coming august. With your experience the past two years is there any advice that you can give me. Does using first aid while studying for exams help to prepare for USMLE. Is it too early to even use it as a reference. Also doing well in the classes help drastically on your performance in the exam. Did you find that having done well made you recall alot of things that you found on the exam or is the details very nitty that it isn’t and needs to be refreshed within the 6 weeks. Wanted to know if it would be a wast of time to use the First aid as a supplement and note margin for my regular classes to be familiar when it comes time too kick but those 6 weeks. Again, thank you for the information.

Knight

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Hey Knight.As far as advice goes about starting early, I have only this: I couldn’t do it. It takes a certain amount of pressure and dread to study effectively for the USMLE, and that’s not just going to be absent, it’s going to be appropriately focused on your other courses. I’m sure you could annotate the FA during these classes, but you’ll soon find that the breadth and depth of your SGU classes will simply dwarf what’s in the FA. The best advice I could give is to work as hard as you can for as long as you can in your classes. While the game of getting A’s isn’t all there is to your education (and you will feel at times that you are learning stupid things to do it), I can think of no better long-term preparation for the USMLE. Those members of my class that have scored the highest were all very strong students from front to end in Grenada and not for being especially intelligent, but instead for their consistent hard work.

The extra mile here is tutoring. I tutored Anatomy, Biochemistry, Neuro and Physio. In this way, I had a full year’s exposure to each topic instead of the four month term. This was invaluable. What many people found while studying for the USMLE, I discovered in tutoring: it’s only the second time around that all the connections fall into place and the interrelationships become intuitive. I was a much stronger student for it.

In a nutshell: don’t buy a First Aid until it’s time (around 5th term, I’d say), do your absolute best in every class, regardless of how innane the material, and tutor with a friend for every class that you can. That, if done, should fetch you a fantastic score.

All the best, topher.

How to Prepare for the USMLE: What Did You Do Each Day?

This comes from an email from two students in my year but a term behind at SGU.

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Hey Toph!
I hear you are having an amazing time on your trip, it is probably coming to an end pretty soon so enjoy the last days! It’s coming close to board studying and Jess and I were wondering how you and Kelly actually studied together. Jess and I are using the same schedule and plan to get together every 3 days or so, and we were thinking about asking questions, buzz words, that kind of thing. We just wanted to see how you boys did it.Talk to you soon, hope all is well.

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We sat across from each other; nothing else. We were on the same schedule, so each day we would open up our books and start reviewing on our own. Any time I had a question about something, I would ask Kelly and vice versa. If either of us found something interesting, we’d share it. If either of us thought of an interesting question to ask the other, we would. It also helped that we were hunting for errors, and this made the work slow but deep as we covered everything in full (since I tried to verify every fact in the FA).At lunch or dinner, one of us might ask the other, “Okay, please explain ovulation to me.” This was always great exercise. At night we would eat with his family and then go our separate ways: me to the basement, him to the study. Throughout the entire process, we were writing our own review notes and inserting them into the FA for quick review in the last week and this has also always been great exercise. Every three days or so we would finish a topic and then go through all of the UW questions on our own. We would mark the interesting ones and include them in our notes. Sometimes we would ask each other how-in the hell-did you answer that one correctly? In this way, we learned the way that each other thought. Kelly goes by instinct; I go by Random Access Memory.But most of all, we did everything that we had always done. Kelly and I had been studying together for two years already and we both did well in school. There was no reason to think that it would be any different and it wasn’t. I was up till 1am or 2am each night and we were both up and at the library by 8:30am, so they were long days. But they were fun days, because you get to see every puzzle piece again only this time (after two years) you know what the fucking picture on the box is supposed to be. It’s amazing how much everything starts sliding into place.

You’ll do fine, just stay on schedule. Never break schedule. Worship the schedule. Hope it helps, toph.

P.S. Kelly never broke the schedule while I broke it all the time. I once spent an entire day on antiarrhythmial drugs, which you just shouldn’t do. I put off viruses, protazoa and fungi, cranial neoplasms, and a host of other topics due to time. Looking at my USMLE summary, these were where I lost all my points.

Back from Vacation

Finally, I am back in the States. I brought back with me custom-tailored shirts, shoes, and suits, a tan (no tattoos) and a few stories. It’s going to take me a while to get back in the swing of things, what with the big move to New York just around the corner.

One great thing that happened while I was gone was the posting of a preliminary errata list by the First Aid folks. After looking through the pdf, I’m thrilled to say that we have been thorough: fourty-three of the the fifty official errors were already listed here. Whether or not we were responsible for submitting them first is unclear, but at least we’re catching them. Five of the errors were added from readers of this site (thanks guys).

I’m going to spend the next few days going through what everyone has submitted and then updating each section, as well as the word documents. I don’t anticipate there being another major update before the July 15th deadline.

For those students asking about my transfer status, the schools to which I applied, etc.. I do not plan on addressing those topics until mid-June. Sorry to put it off.  The remainder of this week will include a few stories from Asia and a few miscellaneous thoughts about the USMLE before I put it behind me.

It’s good to be back.