I thought this was lost forever to Microsoft’s stupid Publisher format, but thanks to PDF Online’s awesome and free Convert-to-PDF program , I’m able to pass it on to the future generation. (Ha!)

Since this is about the time that I technically started preparing for boards (translation: I taught myself biochem, nothing else), and I was talking to my friend John, I figured I might as well post this before I forget about it. The basic deal: during our “prep for clinics month,” I would casually review subjects I felt the least comfortable with for a couple hours a night. For my 5 weeks of boards studying, I’d spend 8-12 hours a day studying the subject listed on the calendar. I spent two weeks reviewing everything by system, and then I reviewed everything a second time for the next two weeks, re-learning it by subject again. 5 weeks is the clear maximum. My sweet spot was 4.5 weeks, as I started to lose it at about day 30 or 31. The motivational crap at the top was just to try to push me that extra little step–we took a family trip to Mexico the week after I finished boards, which was really great.

And now, without further ado (and please forgive the language, which I’ve blocked out):

Graham’s Boards Step 1 Calendar!

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In two common infections of the vagina, bacterial vaginosis (and sometimes in trichomonas vaginalis) your doctor may do a “whiff” test, where he or she takes some discharge, drops some potassium hydroxide on it (a base, KOH) and smells it for a fishy, foul odor. The base causes some foul-smelling amines to be released: cadaverine and putrescine . What great names.

Interestingly, some women will complain of foul odor after intercourse, and the reaction is the same: semen is basic, and when it mixes with the discharge, you get the same release of cadaverine and putrescine. Cool.

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Okay medical blogosphere, let’s figure this one out (comments are open!). Is there a physiologic mechanism to “breaking the seal,” or is it just a drinking myth? ( Breaking the seal, if you’re not familiar with the term, refers to the idea that if you’re out drinking, once you start peeing, then you’re going to have to go urinate every 10-20 minutes after that. “Don’t break the seal!” means don’t start peeing, ’cause then you’ll never stop! )

From Goodman and Gillman’s Pharmacology:

Alcohol inhibits the release of vasopressin (antidiuretic hormone; see Chapter 29) from the posterior pituitary gland, resulting in enhanced diuresis (Leppaluoto et al., 1992). The volume loading that accompanies imbibing complements the diuresis that occurs as a result of reduced vasopressin secretion. Alcoholics have less urine output than do control subjects in response to a challenge dose with ethanol, suggesting that tolerance develops to the diuretic effects of ethanol (Collins et al., 1992). Alcoholics withdrawing from alcohol exhibit increased vasopressin release and a consequent retention of water, as well as dilutional hyponatremia.

Vasopressin (ADH, antidiuretic hormone) causes your kidneys to reabsorb free water molecules, to maintain your sodium osmolality, so knock that out and you’re going to be peeing lots of dilute urine, making you hypernatremic. Combine that with ethanol’s peripheral vasodilation, making your kidneys think you’re hypovolemic (even though you’ve been drinking lots of fluid), and they’re going to try to clamp down to reabsorb all the possible sodium they can… aaand that’s all I’ve got. Maybe it’s just a feed-forward positive feedback relationship with the continued filtering of the kidneys, since they don’t realize ADH isn’t being released? I don’t think it really matters if you stop drinking or not.

I swear I experience this all the time, but maybe it’s just the drunkness and rapid passage of time. I’m stumped.

(Excuse: Was reviewing phys today for Anesthesia which starts on Monday, and boy can my mind wander.)

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It’s Step One of USMLE Boards season , and Rumors Were True has a nice writeup that I pretty much agree with. I did 5 weeks of studying, 10 hours a day, and ended up doing well. The key is to go in confident and rested, and be able to sort questions into 3 categories: I know the answer, I think I know the answer, and I don’t have any freaking clue. Answer #1 immediately, mark #2 and come back to it if there’s time, and educated guess #3 and move on.

Do. Not. Over. Study. It will only hurt you.

Good luck to all the 2nd years–take boards and get into clinics, it’s much more fun!

(And don’t push back your test date, that is stupid!)

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I just got some requests for information on how to prep for the Boards (Step 1), so I figured I’d supply this to all you new second- and first-years. (If you’re a first year and you’re already prepping for the Boards, you’re a gunner. But the Boards books are really useful for getting through second year Path, Pharm, Micro, and Phys, so I’d buy these before I start any of those classes.) A note of warning: these will definitely help you prepare for boards, and will also help you prepare for your classes, by helping organize information and provide mnemonics, but likely won’t be in-depth enough for you to ace your class’s final exam.

Your bible: First Aid for the USMLE Step 1 . You will, essentially, compile all information from every other board review book into this one. (This one already has a ton of information.) You will study from this every day. You will memorize every word of every page of this book. And if you do, you will probably do okay on the Boards. It has some good mnemonics you won’t find elsewhere, and some people say if you start studying from it from day 1 of med school, you’ll be better off, but I didn’t really use it until I started studying for Boards. I’d hold out until 2nd year to buy it, as you can get the latest edition, which has been updated for what the authors have learned about the previous year’s board exam and its subject material. Expert tip: go to Kinko’s, get the binding cut off, three hole-punch it and throw it in a binder. Much easier to study with. Example pages with my chicken scratch everywhere:

If you buy any other review books, make them BRS Pathology and BRS Physiology . I don’t think I could have handled the sheer amount of information in med school without these two books. They’re essentially bullet points of every body system and disease. They help you organize the information in your head, and give you the really high-yield facts you’ve gotta know. I think most, if not all of our class owned a copy of each. They’re that good.

Because Developmental Biology just sucks monkey balls, you’ll want a copy of High-Yield Embryology for yourself.

The rest of my suggestions, you can really just get used, or get a group of friends together and share. Pharm and Biochem were big challenges for me, and I really liked Lippincott’s for both of them–very complete, and very easy to read: Lippincott’s Illustrated Reviews Pharmacology and Lippincott’s Illustrated Reviews Biochemistry .

Finally, the rest of the High-Yield series are good short reviews, but not worth buying full price. Borrow from a friend or get them used.

And then there’s always the question of the dreaded, way-too-expensive Kaplan Q-Bank. I used it, probably everyone in my class used it. It’s not necessary, but I guess I have to recommend it. It gives you an insane number of questions, and does a number of things:

• Forces you to practice taking computer tests.
• Forces you to get used to not knowing the answer. (There are a ton of really random questions in Qbank that are totally minutae and worthless, but as a med student, it’s good to practice not freaking out when you have no freaking CLUE as to the answer to like 5 questions in a row.)
• Helps you get really good at eliminating bad answers and guessing.
• Gives you some feedback on what sections you are doing okay at and what sections you need more work on.

So there’s my little Boards talk.

Oh, and one more thing: Make a calendar for yourself and stick to it! Give yourself breaks during the day, and reward yourself: “If I finish this section today, I’ll go get a Frappacino,” or “I’ll go to the gym,” or whatever you like doing. And give yourself the illusion of choice. Sure, you have to study for 10-12 hours a day for weeks on end, but ask yourself, “Hmm, do I want to study in the library today or the study lounge?” So many choices. It makes it more fun tolerable. Really.

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I don’t know who these guys are , but posting a practical joke involving a cadaver with a full view of the face is incredibly unprofessional. As a former anatomy TA, I know I’ve had my share of laughs in the dissecting lab, but it was among classmates in a closed setting, not posted on the Internet for all to see.

If that was my father, brother, or friend, I think I’d be pretty pissed. Those that donate their bodies give us the privelege of using them to learn, not for the whole world to see us play around with.

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The cure for canker sores in two paragraphs, but first, a little education: I’m talking about canker sores , also known as apthous ulcers, found inside your mouth. I’m not talking about herpes sores, which are usually found around the lips or on the genitals, or syphillis chancres, or chancroid, yet another similar-sounding STD. Canker sores probably have an unknown viral or bacterial cause from what I’ve read, and are not STDs , for the damn record.

If you get canker sores recurrently like I do (mine are generally from stress), you’ve probably tried every possible cure. I’ve tried vitamins, amino acids, yogurt bacterial cultures that you have to keep in the refridgerator, mouthwashes, toothpastes, numbing agents, and anti-viral drugs, with absolutely zero success. When I was in high school, I had 17 in my mouth at one time. I’m not kidding. (Thankfully I’ve learned to de-stress since then.)

But I’ve finally found a cure (for me at least), thanks to the doctor at the student health service: triamcinolone paste (it’s a corticosteroid). The stuff works wonders. Spread the gospel, please. Dry off the canker sore, put the paste on the canker sore just before bed, fall asleep, repeat for a couple days, and it’ll hurt less and heal much faster. Your doctor can easily prescribe it, and it’s a generic, so it’s cheap.

Please appreciate this advice, I’m probably sacrificing my kissing-attractiveness by posting this one.

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In an interview with Stephen Colbert , we find out he’s deaf in one ear. Acoustic schawnnoma, anyone?

Colbert is forty-one, a native of South Carolina, one of eleven children, the father of three, a suburban guy, and deaf in one ear. “I had this weird tumor as a kid, and they scooped it out with a melon baller.”

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A Pixar movie based on the human body, with different cell types for different characters, could be both incredibly cool and educational. Antigen presentation and B-cell isotype switching would never be the same.

Pixar, if you’re reading, I’d be happy to consult on the film.

Anyone else, if you’re still reading, this is clearly a cry for help. I’m in major Loserville right now.

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Kylie Minogue was just diagnosed with breast cancer at age 36. She’s huge in the dance music world; her stuff is always on the radio. If you still don’t know who she is, she sang Locomotion in the 80s.

The average age of breast cancer presentation is usually post-menopausal early 60s, so I’m wondering if she has the familial form of breast cancer, caused by the BRCA1 and BRCA2 genes. Breast cancer usually presents much earlier in those women. If so, Kylie’s sister may be at risk, too.

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