Endo/Repro II

Hello!

I had to take a break during our last block (GI) for personal reasons. Which is why I didn’t put anything up study-wise for it. But I’m back into the swing of things and trying to grasp how to best tackle this information. I’m trying some new study techniques this time around! Although honestly, it feels like I’m always changing up my studying style with each block…

Path is always my worse subject. I don’t normally understand it. There is histopathology and small random facts/clues that don’t seem to correlate. They don’t solely test us on histo pictures anymore in second year, but in general it is a difficult subject that I need multiple exposures in order to start grasping.

Here are some ways to go about it:

1. Reading Robbins. I personally hate this one. I don’t absorb what I’m reading. Even if I feel like I understand that half page I just read, I will completely forget it when I move on. But if you absorb well from reading, this is one way to get the material into your head.
2. Previous outlines of Robbins. We have a prior KCU student that outlined the chapters in Robbins. Complete with fancy charts, some highlighted information, bolded important information, and sometimes they go back and add in prior high yield test/quiz topics. This is what I have started using as my first pass.
3. Lecture. Now, I dislike this method, but it does give me another pass and I use it to point out what the professor deems important. Sometimes the professor will actually teach, other times they just say “know this” and list a bunch of crap. It’s up to you how you best learn, but I have heard from many of my classmates that they at least listen to lecture on 2x speed just to star the topics the professor highlights in lecture; especially if they don’t really teach. Unfortunately, there are some professors who don’t touch on some topics in lectures. But because they are in the book, they write questions on it (even if they didn’t go over it…)
4. Pathoma. I recommend if you are having trouble understanding the basic concepts or even just getting a good organizational start on the material to go with this. They are short, sweet videos with accompanying high yield points. It does not always correlate in order with Robbins though.
5. You can use sketchy path as another way to get information in. I know classmates who prefer using this since they already have it from micro and pharm. I personally don’t like using this for path, but it presents information in the same way it does for micro.
6. Learning objectives. I’m hit or miss on this. Sometimes in path I will use this to help fill out the information; others I don’t. For path, basically every learning objective is a header in the book or a chart. So you have to know all of it anyways. But for other disciplines I find learning objectives helpful.
7. Practice questions. In general is usually helpful. But sometimes you get too used to the way questions are written by the authors of the practice questions instead of your professors. Just be mindful of this!

My way:

1. I first use the outlined notes. I print them out and underline, re-write, whatever it is I need. I go in smaller sections and have my book open if I need clarification or need to write it slightly differently for my brain to understand it.
2. I then go over this section of notes, either by writing it out or using a write board. Can I make associations with the material? Can I define the disease? What are the prominent features I need to know? Buzzwords? You get the idea. I don’t do this for all the pages, but it does help with some of my sections. Occasionally I’ll make a chart if there is a lot of information that I need help picking details out between. But I have not been doing as many charts as I did originally for GI. I may also decide to make organizational flow charts or “mind maps” as well. What’s the main, overarching subject, and what falls under it? Sometimes just reading the book or reading the outlines it is not as apparent.
3. I then listen to lecture to get the points of what the professor deems important. I either have the lecture up or the book open, and take notes either in my margins & highlight in the book, or I put it on my iPad.
4. Notecards. I don’t normally do well with this, but I’m finding that I personally need to increase my exposure to remember it. Just because I understand it before bed the night before doesn’t mean I will remember much the next day. There is a deck that a previous KCU student made that I am modifying/using in Anki. I also add my own cards as well. But you could use any prior deck, make your own, or use a Zanki deck. A lot of students recommend running notecards before bed. I have trouble with this as either the notecards aren’t finished, or I don’t feel confident enough in the material to start using notecards and it causes more confusion for me. If this helps you, then utilize going through them before the end of the day.
5. Pathoma. I use this basically if I am super confused or want to test my own knowledge. It is just another way to expose myself and see if I am making those connections.
6. Practice questions. Really a crucial part in seeing if you understand the material. I’ve mentioned in other posts what practice questions can be helpful. In general, Robbins questions, university of Utah path questions, and/or Truelearn (COMBANK) questions can help.

For Clinical Medicine & Pharm:

I am doing something completely different than what I have ever done for these. Simply because I need to get more on top of the material. Again, if you are like me and you need to see the material 8,000x before the exam, then see how I am doing it. Otherwise, do what you are doing boo.

1. Pre-reading lecture OR filling out objectives the night before. I am doing this basically to set my notes up and to help get exposure. I then print them out so I can write all over them.
2. I actually go to class for clin med. Or as many as I can get up for. I really enjoy the repro clin med lectures, so it is fun to go for me (I know, weird). I am more apt to pay attention if I have an inkling of what is going on (hence the notes the night before). I add in anything to my paper notes that I missed from the night before, that the professor deems super important, or any questions they give us in class. There was a few times I didn’t go to clinical med lectures. In which case I still did my notes before hand and then just watched the lectures.
3. Reviewing this by both reviewing my LO’s and flash cards. Same principle here; I need to see it a lot.

In a previous course I would make giant charts for pharm. I still have charts in my notes, but they are based on the learning objectives.

Is this a lot of work? Yes. Absolutely. Do I want to pass? Yes. I’m finally a bit more motivated and want to do well. I feel like I have wasted my time in medical school not being able to fully grasp the material. Which is due to a multitude of things, but I digress.

As you will see, a lot of second year is learning on your own. You and Robbins are going to be the best frenemies you’ve ever had in your life. It’s a love/hate relationship that you will be ecstatic to be rid of after boards. But until then, trying to find a good way to synthesize a lot of the material and connect the dots is key in second year.

Another big thing (which I can’t help you determine) is:

  • Are you a fast or slow learner?
  • Do you synthesize well by reading or do you have to write it out?
  • Can you just look over the powerpoint and grasp information or do you need to put it in a different format?
  • Do you do better with learning new material in the morning when you first wake up or reviewing when you first wake up?

All of these things will help determine how you will be able to best learn the material and approach it based on your brain and your learning style. There are more questions you could ask yourself, but these are some of the ones I’ve come across while attempting to figure out my learning style.

See, in first year, everything is very piece-meal. You either know it or you don’t. You can easily break it up by discipline or by LO’s and not a whole lot interrelates with each other. In second year, you don’t get that luxury. So it is a bit harder. It also seems like the professors teach less second year than they did in first year. So there is that too..

TEST 1: Repro

  • 64% clinical medicine
  • 27% pathology
  • 9% pharmacology
  • Total: 100 questions

Overall, I would say it was a fair exam. There were some very easy first order clinical med questions, and some very difficult questions. Pharm was if you knew it, it wasn’t that difficult. But if you didn’t you would have to guess. Most of what I felt I got wrong was on the path side, simply because I didn’t have enough time to learn all of the very nitpicky details. But that’s okay! I’m overall very very happy with my raw score for once. I will have to wait for our official scores to come back and to see my specific exam breakdown to see what areas I may need to spend more time on in the future.

Average: 76%. Much higher than our other exams! Our clinical medicine average was pretty high. However our class path average was around a 66%. So ya know… that’s cool.

Test 2: Endo

10% of this exam is from our repro section by the way…

  • Pathology: 43%
  • Clinical medicine: 29%
  • Pharm: 19%

Review from last test:

  • Pathology: 2%
  • Clinical medicine: 6%
  • Pharm: 1%

Total: 70 questions.

Overall, it was a very fair test. I just frankly had a really hard time studying as it was the end of the semester and we had a lot of other exams going on. I did less studying for this particular test because of all the end-of-the-semester crap. But since I had a better idea of how the material was presented given the course directors and the previous test, I cut back on what I did to study.

  • The pre-made notes by a former student were not done for the endocrine chapter. I ended up reading and making my own. Somewhat helpful. I made myself more charts/compare contrasted to help learn some things.
  • I utilized the powerpoints heavily as the professor teaching pathology had most of her information in her slides. I did watch her lectures as well for another pass.
  • For pharm, I wrote out/drew some of the physiology pathways and where the drugs blocked this pathway. It helped me learn them tremendously in this section.
  • Clinical medicine I just reviewed our high yield handouts. Most of what was covered in clinical medicine was a review of sorts for pathology. So the main focus was on treatments for these diseases and what lab tests you would need to identify them.
  • I did review more of the CIS questions which helped a lot.
  • I did not do as much pathoma or flash cards for this section

Average: 83%. So much better!

Anywho, I hope this helped in directing some of your studies for endo/repro!

Scribe Series: HPI Practice Case 3

Hey all,

I’m back with some more HPI practice! This will be text practice; I’m not technologically fancy enough to do a voiceover. These cases are long, so I will do 1 per post. Let me know if you find this helpful in the comments below!

Also, here is a drive worksheet you can use. Feel free to make a copy of it or print it out so you can work through this on your own. I will not be giving edit access out simply to allow others to come across a blank worksheet. Worksheet here.

Diarrhea

Here are the list of complaints given to you in no particular order.

  • 27 y/o M
  • Diarrhea, having several episodes a day
  • Watery, not much mucus. No blood.
  • Stomach hurts all over. 
  • Some nausea and vomiting. Vomited 2 times.
  • Symptoms started 3 days ago. 
  • Having abdominal cramps that seem to get better after going to the bathroom. Cramps and pain are a 6/10. 
  • He’s been taking pepto bismol with slight relief of cramps and diarrhea. He hasn’t been eating much as he just gets sick when he does. 
  • He doesn’t have a thermometer at home to take his temperature. 
  • He was travelling recently before he got sick.

Task 1: Can you pick out the elements of this HPI?

Age/Sex
Chief Complaint
Onset
Location
Duration
Characteristic
Alleviating factors
Aggravating factors
Associated Symptoms
Radiation
Timing
Severity
(anything else you can add at the bottom of your paragraph).

Answer:

Age/Sex: 27 y/o M
CC: Diarrhea
Onset: 3 days ago
Location: Abdomen
Duration: episodic. Having several episodes a day.
Characteristic: watery, no mucous or blood.
Alleviating factors: going to the bathroom to relieve himself. pepto bismol. Not eating.
Aggravating factors: eating
Associated symptoms: abdominal pain and cramping. Nausea and vomiting x2.
Radiation: None.
Severity: 6/10
Everything else: He recently travelled prior to symptoms seeming to start.

Task 2: Write an HPI!

Write an HPI so that your order, flow and story makes sense. Use medical terminology as if you were writing this in a chart. The blessing is this is text, and you aren’t converting it from what you are hearing down into text form.

My version of this HPI:

Patient is a 27 y/o M presenting with 3 days of diarrhea. It is watery, but no mucous or blood noted. He is experiencing several episodes a day with associated cramps and generalized abdominal pain rated a 6/10. This improves briefly with bowel movements. Patient is also experiencing nausea and has had vomiting x2 since onset. He has been taking pepto bismol and not eating as much with some improvement in symptoms. Of note, he was recently traveling before symptoms started.

Bonus!

On exam, he appears uncomfortable. HR is 103, RR is 18, Temp is 99.7’F, BP is 115/87. Conjunctiva are pink. Mucous membranes are slightly dry. Heart is slightly tachycardia, but regular rhythm. No murmurs, rubs, or gallops. Pulses equal and bilateral to upper and lower extremities. Abdomen: Generalized tenderness without rebound or guarding. Hyperactive bowel sounds noted. in all four quadrants. Negative Murphy’s and McBurney’s sign. The remainder of exam is non-contributory.

Labs show a slightly elevated white count. But normal hemoglobin. Slightly elevated hematocrit. BMP shows a slightly elevated BUN and creatinine, but still within normal range. Negative liver panel. Stool studies were sent off and are pending.

Task 3: Can you guess what happened?

Now this is just for funsies as I certainly didn’t give you all of the clues or everything that I would order for this patient. You also wouldn’t be asked to do this as a scribe! But just for fun, what do you think this patient has?

Answer:

I was going for a viral gastroenteritis here. There are lots of different presentations for this and it could be viral or bacterial. This is a very common thing to get in the winter (viral) and popular in the summer at cookouts (bacterial). You see this frequently in both outpatient clinics, urgent cares, and ER’s. Since this one is likely viral from his recent travel, he will probably get some fluids and some anti-emetics and left to ride it out. The biggest concern with diarrhea is dehydration. Depending on someones baseline of hydration will depend on how much diarrhea will cause dehydration to that patient.

So our diagnoses (or Assessment!) is as follows:

  1. Diarrhea, likely viral.
  2. Gastroenteritis, likely viral.
  3. Mild dehydration.

Hopefully you enjoyed this practice HPI post! Let me know if this helped in the comments below.

Cheers!