2nd Term School of Medicine Information and Advice

In term 2, you complete two one credit courses (CPM and Parasitology) in two weeks.  Immunology, Genetics, Physiology, and Neuroscience make up the remaining portion of the semester.  Best advice during these first two weeks is to not fall behind. The courses themselves aren’t too difficult conceptually, but there are still lots of information covered in the time allotted. You do not need to purchase any books for these two classes.

Topics in Community and Preventive Medicine: Medicine in Society II (2 week course)

Just listen to what the professor talks about in class. Soft science is not too difficult but the information is relevant to being a doctor. We had one lab session to attend where we learned how to fill out a death certificate. One exam at the end of week two basically determines your grade for the class. All questions are based off the course objectives. There is nothing to worry about so long you are comfortable answering all of them. Our professor gave a final review on the last day of class. The handout from that lecture was about 80 percent of the questions asked on the final.

This mnemonic helped me remember the order of childhood vaccination:
Homies Really Do Help People If In Major Heat
Hep B, Rotavirus, DTP, Hib, PCV, IPV, Influenza, MMR/VZ, Hep A

Parasitology (2 week course)

This class was pretty interesting. You learn about parasites, their habitat, their life cycle, what ailments they cause, and available treatments. There is a lot of information in this class. You will cover Platyhelminths (cestodes and trematodes) and Nematodes. There are many parasites within each group. Our professor covers a few each day. Best advice is to start studying from either day one or two. That way you won’t be swarmed with unfamiliar names, various lifecycles, what symptoms they cause and their treatment. The best way to study for the final is to organize the various parasites and pictures associated with it that was presented during lecture. Don’t forget to know the intermediate, definitive, and incidental host for each parasite. Make sure you learn the life cycles of all four Plasmodiums. Learn the exceptions to treatments of various parasites. Know which parasite causes foul/fatty stool, bloody diarrhea, and watery diarrhea (G. lamblia, E. histolytica, C. parvum, respectively).

One saving grace is that the final is not too difficult. It’s based on recognizing which pictures belong with what parasite. During the final exam, you read the question stem on your exam sheet and correlate the question with what is projected onto the screen. For instance, you will get a question asking which of the following causes bloody diarrhea. On the screen you will see five pictures and one of them will be E. histolytica.

Immunology

This two credit course is no joke. It takes many hours to memorize the specific numbers/letters associated with some other numbers/letters/cell. There is not much critical thinking in the first half of the course. Most students in my term did not attend class and believed it was a waste of time. I concur with their actions ONLY IF you did not prepare for class beforehand. Our instructor has a different approach to teaching than most are used to. You will receive the pre-midterm note packet on the first day of class. The information in these packets is everything you need for midterms. She expects you to learn the contents of that days lecture on your own prior to attending class. If you did not do this, then I wholeheartedly believe going to lecture is a waste of time. She will use language that you aren’t familiar with and you will get lost, confused, and frustrated in the process. Try to Sonic the lectures where she draws out the various steps/pathways. It was essential for me to get a visual of how everything interacted with one another.

The notes and lectures are not presented in a linear fashion. Since all the information in immunology is interconnected, there will be times when you will be given a new vocabulary/cells/cytokines without the full understanding of what it is they do. This can be frustrating. Just trust in the process and most things will eventually be explained in later lectures.

Try to memorize the list of cytokines early on. You do not want to be cramming that information during the week before midterms when you have genetics, physiology, and neuroscience to worry about.

I believe the midterm was fairly easy. All questions on the exam were first ordered (eg, Which of the following is an example of passive immunity, which of the following is NOT on the surface of macrophages, which of the following cytokines is not related to Th2). There was quite a few “NOT” questions on the exam.

Buying or photocopying the “Purple Immunology” textbook written by the professor is useful for the second half of the course. The practice questions were representative of the final. There is not much new information from this point onwards (new info: Types of Hypersensitivity reactions, lab tests, and some diseases). You will need to integrate all the information into clinical scenarios. I found that drawing out the different pathways helped a lot.

Genetics

First and foremost, DO NOT FORGET TO DO THE QUIZ!!!! You will get two quizzes in total, one before midterms and then finals. These are EASY POINTS!!!! I believe the class worth 120 points and the quizzes are worth 8 points. Many students forgot to do a quiz, including myself. You will be kicking your behind for making a dumb mistake.

This course does not require a textbook. The information is presented fairly well. Some instructors are better than others but overall all the information you need is in the packets. You will need to learn a decent amount of genetic diseases. Organizing the disease and everything associated with it (eg, chromosome, pattern of inheritance, etiology, symptoms, diagnostic test) into tables helped me learn the information.

The other materials presented in class varied from being straight forward to being a bit confusing. Try to understand the ones that give you trouble early on. Just like in biochemistry, you won’t get much new/difficult information towards the end of the term. For our class, we were responsible for the lecture on Thalassemia from the biochemistry note packet. The professors in biochemistry did not lecture on that subject in term one and instead gave the presentation during the last week of genetics.

Physiology

The BRS Physiology book is a great summary of the entire class. I highly recommend getting this book beforehand. I used it for a quick overview and to clarify complicated materials presented in lecture/lab. I also recommend the Pre-Test Physiology book because the questions in each section reinforced what I knew and highlighted what I needed to focus more on. The explanations at the end of each section helped solidify my knowledge.

In this course, you learn about how the various organs in the body work. There are quite a few graphs that you need to COMPLETELY understand in order to grasps the various concepts. Don’t just gloss over them and go onto the next subject. Spend time understanding the ins and outs of the entire graph (x,y axis and their respective values) . Make sure you can draw it out by memory. I had questions that changed certain aspects of the graph and was asked why or how it happened.

You will have a decent amount of drugs that you will be responsible for. We did not get a list of all the drugs we needed to know. Thus, whenever a new drug was presented in both physiology and neurology, I marked that down and made flashcards that same day. That way, I did not have to rummage through the entire note packet to search for the various drugs. Don’t just memorize what the drugs are needed to treat certain conditions. You will need to understand the mechanisms of action for the drugs. This is very important especially for the midterm.

There are labs about once a week for two hours. You will go over certain concepts that are sometimes a bit difficult. You are required to bring your PD kit in some sessions. I believe we used the blood pressure cuff and sphygmomanometer once. The labs require a couple hours of preparation beforehand. Each group consists of about 5-6 students. A different person each week will be designated the moderator of the group. There is not much to prepare for in terms of being the moderator. Your only real responsibility is to keep the lab going by asking your peers questions from the lab assignments. Online quizzes will be posted at the end of each week after all groups finish lab. Some of the quizzes asked questions pertaining to lab. DO NOT FORGET to do these quizzes. They count towards your grade and attendance. You may be dropped from the course if you are missing a certain number. Submit the online quizzes early on in the weekend just in case something happens to Sakai.

A big portion of the exams asked conceptual questions. If you spend the time preparing and understand the lab assignments, then some of these questions won’t be too nerve-wracking. You have to memorize a lot of minute details in this course, but the majority of questions will not ask directly about them (second or third ordered questions). Make sure to integrate all the knowledge you have obtained thus far in your curriculum and apply that to this course. This was by far my favorite course in term two.

Neuroscience

You will need to learn a decent amount of neuropathways in this course. You must be able to draw out each pathway and know where they cross and the exact location of where they are. The questions on the exam will state that you have a lesion in a given area and you need to figure out what the symptoms will be. This will require some effort on your part to learn the pathways.

This course has about 5-7 professors and each with their unique style of teaching. Some were better than others but overall I find that the neuroscience department is organized in terms of how they package (notes) and present (lecture) the materials to you. We had one instructor that was extremely nitpicky when asking questions on the exam. Best advice if you have the same professor (you will know who I’m talking about) is to memorize all the numbers. Just like in physiology, you are required to learn a handful of drugs and their mechanisms of action. Saving grace is that there is plenty of overlap between the two courses in terms of the drugs you need to know. The mechanism of action is important because you will need to know why that drug is having that specific effect.

The BRS Neuroanatomy and High Yield Neuroscience were books that I often referred to throughout this course. BRS did a fantastic job summarizing each topic and had great questions at the end of the chapters testing your knowledge. I found it helpful since it presented the same material in a slightly different manner, much like the BRS for physiology. High Yield Neuroscience was helpful for the second portion of the course because it condenses the material, such as pathways, and presents the information a bit better than lecture.

You are required to purchase the Neuroanatomy Atlas book by Haines. You need to bring this atlas with you to lab, which is one and a half hours, every week. You go over the brain and spinal cord anatomy throughout the first half of the semester in lab. It’s pretty straight forward and the information becomes pretty redundant after the first few times it has been presented. The second half of the semester requires the use of your PD kit. I believe the only big item you need to bring is an ophthalmoscope for one lab session and a reflex hammer for the remaining ones. You will be provided with most of the materials needed to perform the various neurological tests.

METHOD FOR UNDERSTANDING BRAIN STEM LESIONS


This is the method I used to learn the lesions in the brainstem. It’s a good way to approach the subject but there are some exceptions to the rule. Please use this method ONLY for a rough guideline to understand brain lesions.

Everything is divided up into four for simplicity sake. There are four structures in the midline that begin with M. There are four structures on the lateral side that begin with S. There are four cranial nerves in the medulla, four in the pons, and four above the pons (two in the midterm). The four motor nuclei that are in the midline can divide equally into twelve except for one and two. Meaning motor nuclei for 3, 4, 6, and 12 are in the midline, leaving the remainder 5, 7, 9, 11 on the lateral side.

Medial structures associated with deficits begin with M. You have Motor pathway (corticospinal tract – contralateral weakness of arm, leg), Medial Lemniscus (contralateral loss of vibration and proprioception in arm, leg), Medial longitudinal fasiculus (ipsilateral internuclear ophthalmoplegia), Motor nucleus and nerve (ipsilateral loss of CN affected, either 3, 4, 6, or 12).

The lateral structures associated with deficits begin with S. Spinocerebellar pathway (ipsilateral ataxia of arm, leg), Spinothalamic pathway (contralateral loss of pain, temperature), Sensory nucleus of CN V (ipsilateral alteration of pain, temperature of face), Sympathetic pathway (ipsilateral Horner’s syndrome).

Think of the pathways in the brainstem as a map with latitude and longitude lines. If you can figure out where these points intersect, then you can determine the site of lesion.

Medulla has 4 cranial nerves, CN 9 – 12. CN 9 - ipsilateral loss of pharyngeal sensation, CN 10 - ipsilateral palatal weakness, CN 11 - ipsilateral weakness of trapezius and SCM, CN 12 – ipsilateral tongue weakness. CN 12 motor nerve is in the midline of the medulla. The remaining motor components of cranial nerves, 9, 10, 11 are not in the midline. They don’t divide equally into 12.

Pons has 4 cranial nerves, CN 5 – 8. CN 5 – ipsilateral alteration pain, temperature of face, CN 6 – ipsilateral weakness of eye abduction, CN 7 – ipsilateral facial weakness, CN 8 – ipsilateral deafness. CN 6 motor nerve is in the medial pons. CN 7 and 8 does not equally divide into 12, thus they are not midline structures. The vestibular portion of CN 8 is not included to avoid breaking this rule of fours.

4 cranial nerves are above the pons, CN 1 – 4. CN 1 and 2 is not in the midbrain. CN 3 – ipsilateral oculomotor muscles with or without dialted pupils, eyes deviated down and out. CN 4 – ipsilateral superior oblique. Since 3 and 4 can divide equally into 12, they are midline structures in the midbrain.

To sum it up, medial brainstem syndrome will have 4 M’s and the relevant motor cranial nerves, and lateral brainstem syndrome will have 4 S’s and their associated CN. CN 9, 10, 11 will be affected if the lesion is in the lateral medulla. CN 5, 6, 8 will be affected if the lesion is in the pons.

OSPE II

Our class took the OSPE II the weekend before finals. It was similar to the previous OSPE except this time you have 20 questions and 3 of those require you to perform a clinical skill on a patient. The good thing about this OSPE is that you don’t need to study a whole lot for it. I say this because most of the questions should be reflective of what you have been covering in class the past semester. We had 17 multiple choice questions consisting of 9 neuroscience, 6 physiology, 2 immunology, 2 parasitology, and 1 genetics question. This exam is worth 11% of the OSCE (Objective Structured Clinical Examination) that you will take in second year.

Clinical skills example:

Perform ______reflex
Test the extraocular motor muscles
Show the accommodation/light/consensual reflex
Muscle testing for Cranial Nerve ____

Multiple Choice Questions example:

Slide showing ____ parasite. What treatment would you use?
How many days before a newly infected person can transmit malaria?
Slide asking about the various genetic abnormalities
Describe the type of hemorrhage seen on this MRI?
What are the lab values after giving a certain drug? (Na, K, Ca, Mg, Cl)
Which endocrine diseases shown matches with the given clinical scenario?
Interpreting the pulmonary/cardiac function curves and picking out the disease associated with it
Question asking about brain lesions and the specific effects it would have on the eyes
Interpret a positive/negative tests for Weber/Rinne
Interpret the EKG
Determine location of the EEG findings (Right/left, F, C, T, O) that correspond to given symptoms.
Clinical findings associated with HLA____/____deficiency/_____abnormality

BSCE I

By this point most students in my class were pretty burnt out. You take this exam the weekend after finals. You will be tested on all subjects covered throughout the first year of school. We had 495 students sit for the exam and 18 that did not pass, 55% is considered passing. I believe students who fail are allowed to try again the following term. You will be ranked against your classmates however, only a pass or fail is recorded by the Dean of Students and Registrar’s Office. There are 200 questions where each one counts for a point. We had 3 hours or so to complete the test. I looked over the clinical packets for anatomy, histology, and biochemistry. I reviewed parasitology and the pre-midterm materials for all second-term courses. I studied about a day or so for this exam which I personally believe was overkill. Most students in my term did not study for the exam. It’s not difficult if you have made it this far. All questions were pretty straight forward and the questions pertaining to first-term courses were first-ordered or broad concepts. Good luck!