Tuesday, December 14, 2010

Exam Time

Had two exams yesterday. One at 0900h and one at 1600h. Nothing like having a 5 hour break in between to feel nauseated, anxious, and exhausted while trying to decide if cramming if futile or beneficial. 

Turns out in this case it was beneficial. 

I knew I'd be too frazzled to concentrate on studying (and the nagging voice of 'should I even be doing this?') so I went for a run right after. A totally killer-hill-interval-one in a desperate attempt to flush my body of all the adrenaline of the morning (as well as some of the junk food I've been eating this past 2 weeks). 

I went back to my study pit and tried to focus, despite the workout I was having a pretty hard time looking over stuff and keeping it in. In the morning we'd had our EMQ exam--for those of you not cursed with this type of exam I'll give a quick example (my apologies to the non-med readers, you can skip the boring blah blah blah and head to the bottom):

For each clinical scenario below, give the most likely cause for the clinical findings. Each option can be used one, more than once, or not at all.  

B-Hodgkin's Lymphoma            
C-polycythaemia vera         
E- chronic lymphocytic leukaemia           
F-Waldenstrom's macroglobulinaemia       
G-acute lymphoblastic leukaemia
H-Burkitt's lymphoma
I-paroxysmal nocturnal haemoblobinuria
J-essential thrombocythaemia
K-chronic myeloid leukaemia
L-antiphospholipid syndrome

1. A 25 year old man presents with enlarged painless lymph nodes in the neck. His peripheral blood film shows Reed-Sternberg cells.

2. A 45 year old man presents with fever, weight loss, tiredness and gout. On examination there is splenomegaly. WBC 112. The Philadelphia chromosome is detected. 

3. A 70 year old woman complains of weight loss, headache, blurry vision, lethargy and hematuria. Positive findings on exam include cervical lymphadenopathy, splenomegaly, and numerous retinal hemorrhages. Bone marrow biopsy shows lymphoplasmacytoid cell infiltrate. 

4. A 27 year old man presents with haemolytic anemia after surgery. He reports a history of recurrent abdominal pains. Ham's test is positive. 

5. 60 Year old man presents with headaches, blurred vision, and itching over the whole body (the last after a hot bath). Positive findings on examination include plethoric facies and moderate splenomegaly. Hct: 65%. *

Yeah, so that wasn't a question from our exam but it was a sample of the EVIL that is EMQ. The whole idea is that by giving many answers the 'posible right answer by guessing' amount is decreased to an insignificant amount. 

I usually feel pretty strong about my ability to perform on these, and don't get AS stressed as I do about the long answer exam or the anatomy spotter. The thing that scares me about the long answer is that if I get a question that I have no idea about then suddenly I see a barren desert in my mind. Tumble weeds blow by and the soundtrack to a western movie starts playing in the background. I'm sitting at the desk, in the middle of this desert and it a tumbleweed bumps into me on its way by.

[Cue scream of mortification at the thought of one of my profs marking my exam!!!]

Well yesterday was a little different. I felt like I got spanked by the EMQ compared to the long answer. Out of 100 questions on the morning exam it seemed like well over half were pure pharmacology questions. There was ONE, I repeat ONE thread on bone physiology and that was it for physiology. I have a pretty decent grasp of pharm but some of the questions were ridiculous--like knowing length of action verses T1/2, etc. It is simply not possible to memorize those things for every drug when you're expected to know a couple hundred meds. GAH!

In the in between as mentioned I was faffing a bit but just before leaving I picked up my USMLE book to look something up regarding estrogen (this school has proven to be OBSESSED with sex hormones). Just by chance I saw the summary of polycystic ovary disease. I looked at it, remembering vaguely having a case of PCOD last year in the fall.

YEP. It was one of the 6 long answer questions!! YIPPEEEE! I would have gotten ZERO on that question if at about 20 mins to exam time I hadn't chanced on that little box summary (bad pun intended).

So I don't know.  I am of two minds now on the whole last minute cramming thing? Thoughts? Experiences? Cited journal articles telling me I should or shouldn't do it?

Tomorrow is my last exam. Anatomy spotter.

We meet again!! (dun dun dunnnnnnnnnnnnnn) 


*Ok you nerds, the answers to the EMQ are in the comments.


Albinoblackbear said...

Answers: BKFIC

(Questions taken without permission from my "EMQ's in Clinical Medicine" book by Irfan Syed. A good EMQ book if you're in the market.

ulyssesthedog said...

For a long time, I avoided cramming right before tests because it made me feel stressed. I started doing it again since my friend swears by it and now I almost always spot at least one thing at the last minute that ends up being on the test. So it's worthwhile even though it stresses me out a bit.

Sean said...

Hahaha, as a recent grad of pharmacy school, I couldn't even tell you some of the pharm information on drugs (mainly half lives, it's something we ALWAYS look up when questioned!). HOpe you did well, love your blog!

ertwro said...

yeah, pharmacokinetics it's a pain in the ass. Just barely I'm able to say clopidogrel (instead of copidrogel, which sounds more intuitive for me...don't know why)

Oh, and thanks for reminding me of how badly I need to study hematology. 2/5 sigh!

Keet said...

CRAM! Your short term memory is always better than your long term when it comes to detail.
Love you mean it, glad you're a turbo smarty!

Albinoblackbear said...

Liv--yeah it definitely stresses me out a bit too but seems like the stress is less than the gain, maybe?! :)

Sean--Hahah, exactly! I mean really, is knowing the 1/2 life of bismuth chelate ever going to be clinically relevant?! Probably not. Don't get me wrong, I appreciate the importance of memorizing certain ones and the implications (you know like having to double port adenosine with a flush because it's half life is like 2 seconds!) But bismuth chelate!??!?!? Argghh. Come ON! hhaha Glad you enjoy the blog!

ERT--I didn't even do those sample questions yet because I needed higher self esteem to tackle them! hahah Don't worry, they are questions for final exams in 4th year anyway. :)

Keet--Good point! Though let me remind you that YOU are in fact the turbo smarty who only had to study for 40 mins the night before every exam in Uni to get good grades. :P

gabbiana said...

How an ER doc answers these questions:
1. heme-onc consult
2. heme-onc consult
3. heme-onc consult
4. heme-onc consult
5. heme-onc consult
I love my job

Albinoblackbear said...

Gab--exactly! =)