unique1 wrote:
GOGETA, which topics would you advise to read from Step2 internal medicine ?

Scareless Johan wrote:
I am an IMG. I don't work at all and dedicate all of my time for study.
I start study in March until now.
I take Kaplan prep course and complete 1 reading.
I do UW 3months and my score is only 50%.
I score 50% from the beginning until now.
I try to improve my score but it doesn't work

I am so upset and depressed.(I am typing with tear!!)
How can you give me any suggestion?
Thanks

Fyred-up wrote:
hey gogeta.. this is goku. am too a huge fan.. its good to know that youre helping alot.

Im getting somewhere in 60-70 in uw but am very panicky and feel like i dont know anything. If i think about immuno.. then i feel i dont know anything about it and when i think about personality disorders, same thing. however, when things are put together and given enough clues.. i manage to do lil ok. I guess my question ultimately is how would you suggest that i study in these last 3 weeks. i went through each subject but its as if i forgot em as days pass by. what would be a good consistent review. Im telling myself to do one subject/day and lets say im GI today.. i would start the day w/ 100-150 q from the subject i studied day before.. then GI kap. anatomy/histo/embryo, then brs phys, then goljan path, then FA, then FA pharm. It seems overwhelming everyday and im burning out(7am-9pm) and gerd is making me miserable. any input? and im weak on pharm too..

cutekity wrote:


GL with step 2 ck ...may god bless you and give you the residency you want in coming yrs !!

For a recent string of emails, I conclude that the reason so many smart med students fail the Step 1 is because mainly their study "technique" is ineffective and wrong. Most students HAVE the right ingredients: Brains, Effort, Materials, etc. However, many are studying incorrectly. So many have, Dr. Goljan's Notes, Kaplan, First Aid, etc., but they are reading the material like a magazine or a mystery novel. NO! You MUST ATTACK each concept. Many just report that they "memorize questions". That may have worked wonders in high school and college and even medical school since many teachers REPEATED QUESTIONS almost word for word on tests. But the NBME is very powerful. They charge literally an ARM and a LEG for the test so they have so MUCH MONEY to ask people (professors and doctors) to write an "ENDLESS STREAM" of questions so students do not have any "short cuts".

You cannot just read these Hy Concepts like a newspaper like the New York Times. You must attack them and dissect them…make up flash cards, make certain guesses BEFORE looking at the answer, quiz friends with them, make up a “board game” with them, etc.

But that is why this message board is SO KEY. We can ask each other for their exam experiences, and then make up legal questions/concepts to help others.

However, know that you need that key ingredient of TIME and MONEY to give yourself adequate preparation. You NEED a SOLID window of studytime to pass.

If you do not have it, ask for it and beg your family and friends for it. Live with a friend/family in their basement to save money and buy time to study UNINTERRUPTED w/ TOTAL CONCENTRATION.

If you cannot find time and money to study, it may be a waste of time and cost you your mental health. Please ask others to pray for you. However, know that you are not alone and many of the students I knew who finally reported passing did so even after more than TEN ATTEMPTS at the USMLE Step 1. Seriously, I called the NBME to verify it! OVER 10 ATTEMPTS! If they could have the dedication and finally passed, they achieved a dream even if they don't even go on to practice medicine! Abandon your dreams of doctoring only after ALL LIFE SUPPORT measures are taken.

I think of it if I am caring for an ICU baby. I won't give up my efforts at saving his or her life until there is no heartbeat for an hour or more!

Sincerely,

Tommyk

*** LACK OF CONCENTRATION ***

Another reason called to my attention is that suffering students often have LACK OF CONCENTRATION. The Step 1 is about understanding yes, but more importantly... can you memorize??!!! You need "total concentration" (like Bruce Lee said in the movie, "Enter the Dragon") to memorize effectively. If you are distractable, you can not memorize the ROTE information like what disease is on which chromosome, etc.

Again, I knew many students who completely BOMBED the MCAT, which is MORE a test of comprehension and understanding than the USMLE Step 1. Then, then went on to SAIL past the Step 1!! When I tested a few of them, I noted that they HAD SUPERIOR MEMORIES. I would test them with picture recall, story detail recall, numbers+letters recall, etc. They were superior. But, some of them could NOT write a poem or compose a serious argument on paper!

I see the Step 1 as mainly a test of recall. If a person can function effectively in society, then I believe it is a matter of needing time AND CONCENTRATION to absorb all the MASSIVE MOUNTAIN of information.

Intelligence alone cannot do it. As I wrote so many times, I knew of even Ivy League level students from University of Chicago, Harvard, Brown, Yale, etc. that had SERIOUS numbers of failures in the Step 1. It is a closely guarded secret that medical schools love to protect. But there are failures all around. If you doubt it, just really ask around...

Make sure you have a strategy for memory with concentration. We often recall if we are in an altered state of excitation. For example, in the movie "Kingdom of Heaven", the actor Orlando Bloom was slapped in the face after a quote by actor Liam Neeson and was told, "This is so you will remember it..." That IS true. Look back on things you remember. You can often note that there was some level of distress, anxiety, or pleasure... basically a HEIGHTENED sense of awareness during that time. You may remember the name of the first boy or girl you kissed, the time you were so anxious due to an embarrassing moment, and so on.

Use that strategy in your studies. You could SHOUT OUT YOUR ANSWERS so that you can "pair a loud" angry noise to help RECALL. Or you could DRAW PICTURES... which I read helps A LOT. You could explain each concept to another whom you are studying with to SOLIDIFY. You could pair a concept with a MUSICAL PIECE which I read helps. You of course "could" pinch yourself or hurt yourself after trying to memorize a difficult concept (BUT I WOULD RATHER CHOOSE ANOTHER WAY)... it would leave ugly marks on your skin. There are MANY other strategies. But after you study for a day, you must ask yourself not just "How many hours did I study?", but rather, "Did I study EFFECTIVELY during that time?"

By all means though... Rid yourself of ALL distractions! I get constant feedback on this board about the distractions that destroy "CONCENTRATION". Movies... TV... The telephone... Googlesearch ... YouTube ... Novels ... Girlfriends ... Boyfriends ... Unrelated work at a job ... Email...

BLACKOUT ALL THE BACKGROUND NOISE. Stick to your schedule. Make sure you are NOT TIRED while studying. Those times you are nodding off will yield absolutely NOTHING. If you have to, drink lots of coffee or tea.

Go and CONQUER!

Sincerely,

Your friend, Tommyk
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Neurology IMG SURVIVOR style

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So you have a 58 year old guy that comes to your private practice because of a shaking in his hand. You notice that when he shakes your hand the tremor stops.
Now my question to you is the difference between a cerebella tremor and the tremor from Parkinson’s?
Cerebella tremor: The patient is at rest and has NO TREMOR, when the patient start to move then the tremor starts. Not cool is a very bad disability disease.
Parkinson’s: The patient is at rest and has TREMOR, when the patient start to move then the tremor stops.

Now you know the difference between these 2 types of tremor
My question is Do you know a tremor disease that part of the treatment is drink alcohol? No I’m not kidding.

Now what substance is deficient in Parkinson’s disease?
Dopamine you say, ok Is Dopamine.
Now where Dopamine is created? Do you know?

Now why people get Parkinson’s?
Trauma could be a cause, drugs could be another cause. Now about drugs what drugs and why?
So lets rewind a little here people with parkinsonism have low levels of dopamine, now the question is what medication will lower dopamine in the brain or what disease give you high levels of dopamine?
What about antipsychotic medications
What about the patient that is diabetic and they just give a story of a guy with diabetes and now has Parkinsonism symptoms? And you need to fill the blanks in this case for the diabetic patient you can say that is because of the use of metoclopramide.
Do you know for what is use metoclopramide?
A tumor can give you Parkinson’s
What about MPTP? Can this drug give you Parkinson’s? Yes
Carbon monoxide poisoning can give you Parkinsons

So ALWAYS, when you have a patient with signs and symptoms of Parkinson’s think what medication could be responsible for this sign and symptoms. And if you find it then ask yourself can I change the medication so he gets better.

Listen EVEN STROKE can give you signs and symptoms of Parkinson’s

Now what about the treatment?
There is so many drugs out there and you need to know the MOA= mechanism of action and you need to know the side effects.
Know that the BEST DRUG for Parkinsons is levodopa and carvidopa.
You remember Levodopa is a dopamine agonist and is able to transform into dopamine in the brain, and carvidopa will prevent that the drug transform into dopamine before it reach the brain.
What will happen if this levodopa transform into dopamine before it reach the brain then you will get Sympathetic stimulation. Not cool
So here I will make it short and sweet because this is the part you guys will not find when you are reviewing for step1

How do you answer the question: what is the best initial treatment for this patient?

This is how it goes ok
If the patient is younger than 60 and is able to do his every day activities meaning he can function, and then the initial treatment is what are you thinking levodopa and carvidopa?
That is the most common wrong answer the correct answer is anti Ach.

If the patient is older than 60 then you give Amantadine

So you will say wait wait you just said that the best treatment is levodopa and carvidopa why don’t we give that to ALL the patients with Parkinson’s well because of the side effects its side effect are worst than the other drugs and also the what will happen to a patient that has an excess of dopamine in the brain? They become psychotic yes psychotic AAAAAAAAAAAAAAAAAA, do you understand my dear future ECFMG CERTIFICATE friends?
Also remember that the patients that use this drugs for a long time get what is call the ON/OFF phenomenon presentation.


I will stop here so you can digest this part and then I will do a second part, I will like to thank Gogeta for telling me about this finding to help people in step1.