Getting There

[Juan J. Sánchez]

6:30 am: Got up early today. Didn't sleep much last night. Drank red bull. Off to a good start. Exam is exactly two months from now.

Goals for today: 2 blocks of Qs, 6 biochemistry flash cards, 12 microbiology flash cards, review vascular physiology.

7:15 am: Getting ready to leave.

 

[Juan J. Sánchez]

9:30 am: Had coffee and danish. Dr Conrad Fischer lecture today. Changed goals. Only 1 block of Qs instead of 2. Practice test will take 1 hour. Video lectures will take 4 hours. Test review will also take 4 hours. Lecture estimated to last 2 hours. Flash cards will also take 2 hours. Should be done by 10pm. Starting 2 blocks of Qs per day tomorrow.

 

[Juan J. Sánchez]

10:40 am: Finished practice test. Scored 57%. Not bad, but still 3% below average. Need to sleep more before doing practice tests. Will now proceed to review biochemistry flash cards and cardiac muscle mechanics.

 

[Juan J. Sánchez]

Biochemistry dump:

Citric Acid Cycle: 1 acetyl CoA yields 2 CO2, 3 NADH, 1 FADH2, 1 GTP. Overall ATP yield is 10 ATP, 7.5 from NADH, 1.5 from FADH2, and 1 from GTP. Regulating enzymes are citrate synthase, isocitrate dehydrogenase, and alpha-ketoglutarate dehydrogenase. Inhibited by ATP, NADH and succinyl CoA.

Mnemonic: Citrate Is Kreb's Starting Substrate For Making Oxaloacetate.

Electron Transport Chain: Complex I (NADH dehydrogenase), Complex II (succinate dehydrogenase), CoQ, Complex III (cyt B), cyt C, Complex IV (cyt A), Complex V (ATP synthase). Each NADH yields 2.5 ATP. Each FADH2 yields 1.5 ATP. Inhibited by amobarbital, rotenone, cyanide, CO, and oligomycin.

Alpha-KG and PDH: Both require B1, B2, B3, B5, and lipoic acid.

Glycogenesis: Requires glycogen synthase and transferase enzymes. Stimulated by insulin. Inhibited by glucagon and epinephrine.

Glycogenolysis: Requires glycogen phosphorylase and debranching enzymes. Stimulated by glucagon and epinephrine. Inhibited by insulin.

Glycolysis: Requires 1 glucose and 2 ATP. Yields 2 pyruvate and 4 ATP. Deficiency leads to hemolytic anemia. Regulated by hexokinase (body), glycokinase (liver and pancreas), phosphofructokinase, and pyruvate kinase. Stimulated by insulin and F-2,6-BP. Inhibited by G6P, glucagon, ATP, citrate, and alanine. Rate-limiting enzyme is phosphofructokinase.

Pyruvate metabolism: PDH produces acetyl CoA. Inhibited by acetyl CoA, NADH, and ATP. Pyruvate carboxylase produces oxaloacetate. Stimulated by acetyl CoA. PDC and LDH replenish NAD+ stores. LDH is stimulated by high NADH to NAD+ ratio.

For the record, I very much dislike biochemistry.

 

[Venetia]

Poor Juan

I personally am rather fascinated in biochem, but organic chemistry is an entirely different matter. I can visualize many of the biochem reactions & the "why"s or "how"s. But organic chemistry usually just makes my eyes glaze over in the same way that calculus, physics, etc. does. Letters and shapes with no illustrative reasoning. Bleh.

Though I studied biochem mostly in practice, which likely was the biggest help. Did a shit-ton of experiments. If I were to just read about it on paper and try to memorize it that way, I'd be sunk. I'm too visual. I can't seem to grasp concepts or equations I can't visualize. Probably why I was MUCH better at geometry than any other math.

When I had to take tests on pure memorization things, I'd actually think back to the memory of how the book looked when I read about the thing in question. What the air smelled like. What someone was saying at the time. It's why my notes were mostly random doodles of shapes rather than actual notes. It was easier for me to remember how the shapes looked or when I drew them, when I learned something, than the fact itself. When I was in theatre, I highlighted my lines with different colors, and would remember the color to know what line I had to say. (When I had a lead role, it was VERY hard to find enough colors for it, and to make sure they were sorted by chromatic scale lol)

You may not have the same fucked up semi-synesthesia thing I have going on, but maybe try to add visual cues to your notes somehow to make them more memorable?

 

[Jason]

 

[Juan J. Sánchez]

1:20 pm: Finished reviewing biochemistry flash cards and wrong answers in test. Going out for lunch. Will read some pharmacology notes in the meantime. Should be able to finish most of my videos before my 5:00 pm lecture. After the lecture, I'll finish watching videos, review right answers in test (takes less time), add notes to microbiology flash cards, and perhaps listen to an hour of pathology audio.

@Ven I actually really liked organic chemistry, the class, not the lab. Too bad it's not part of this test. I tried to aid myself with mnemonics, which sometimes work, and sometimes don't. Visual aid is also really important, and the reason why I got myself a really colorful book which I'm filling with my own notes,

@JB My dad doesn't want me to be a doctor. There's already lots of those in the family. He wants me to be specifically an interventionist cardiologist. That'll take a long time... :lol:

 

[Juan J. Sánchez]

2:30 pm: Had shrimp tempura and vegetables gyosas for lunch. Amazing. Drinking red bull to avoid post prandial narcolepsy. Reviewed some pharmacology notes while eating. Time for videos.

 

[Venetia]

He wants me to be specifically an interventionist cardiologist. That'll take a long time... :lol:

is that what -YOU- want????

 

[Juan J. Sánchez]

4:40 pm: Finished my first video. Cardiac muscle mechanics. I still have another 2 hour video. At least the topic is easier. Blood flow and pressure. Lecture soon. Gotta go. I'm excited. Dr Fischer is a teaching legend. Very Dead Poet Society. This day is going well.

@Ven Heck. I don't know what I want. If it were for me, I'd stay home all day, every day, watching Frasier on Netflix and eating Subway. My dad usually has a generally good idea of what I like and don't like. Except for soccer. He still thinks I give a damn about soccer. To be honest, it sounds hard, but also very interesting, and very promising. It's something I'd be able to do anywhere. However, it seems as though the market is very competitive. I'll probably go with the flow on this one. But what's the point of obsessing over something that's years ahead. Right now I just need to focus on passing this test, and the other three Board examinations. Then I'll worry about what I want to do for the rest of my life.

 

[Juan J. Sánchez]

6:40 pm: Amazing lecture. Motivated to study. Still a lot of things to do. Eating leftovers.

 

[Juan J. Sánchez]

10:40 pm: Finished reviewing test and microbiology flash cards. It's too late to study Physiology. I'll leave it for tomorrow. Cardiovascular physiology is a hard subject and should not be taken lightly. I'll add some notes to my flash cards, listen to some Pathology audio and call it a night.

Me and Dr Fischer

 

[Juan J. Sánchez]

7:50 am: Got up early. Didn't sleep much last night. Drinking red bull. New phone arrives today. Have to stay home to receive package.

Goals for today: 2 blocks of Qs, 6 biochemistry flash cards, 12 microbiology flash cards, vascular physiology.

The videos should take about 4 hours. The practice tests take about one and a half hours. Flash cards should take about one and a half hours too. Reviewing the tests should take about seven or eight hours. Should be done before midnight.

 

[Juan J. Sánchez]

8:00 am: Decided to do biochemistry flash cards first, while I wake up. Afterwards, I will do 2 blocks of Qs. Then I'll watch my videos. Finally, I'll spend the rest of my day reviewing my tests.

 

[Juan J. Sánchez]

Biochemistry dump:

Pentose-Phosphate Pathway: Yields 2 NADPH, maintains reduced glutathione inside RBCs, yields IM molecules for nucleotides synthesis and glycolysis (R5P, G6P, F6P). NADPH is used in fatty acid and cholesterol synthesis.

Fructose Metabolism: Requires fructokinase and aldolase. Yields DHAP and glyceraldehyde for glycolysis.

Galactose Metabolism: Requires galactokinase and uridyl transferase. Yields G1P for glycolysis or gluconeogenesis.

Gluconeogenesis: Not in skeletal muscle. Requires 2 pyruvate, 4 ATP, 2 GTP, 2 NADH, and 6 H20. Requires pyruvate carboxylase (biotin), PEP carboxylase, F-1,6-bisphosphatase, and G-6-phosphatase. Pyruvate carboxylase is activated by acetyl CoA. Fructose-1,6-bisphosphatase is activated by glucagon and inhibited by insulin and fructose-2,6-bisphosphate. Deficiency leads to hypoglycemia.

Cori Cycle: Lactate in muscle is taken up by the liver and converted to glucose through gluconeogenesis. Allows muscle to function anaerobically, netting 2 ATP per cycle.

Fatty Acid Synthesis: Requires acetyl CoA carboxylase (biotin) and fatty acid synthase. Requires 8 acetyl CoA, 7 ATP, and 14 NADPH. Yields palmitate and 7 H2O. Activated by insulin. Inhibited by glucagon and epinephrine.

Citrate Shuttle: Transports acetyl CoA from the mitochondria into the cytosol. Requires 2 ATP and 1 NADH. Yields 1 NADPH.

Fatty Acid Oxidation: Requires fatty acids and H2O. Requires hormone-sensitive lipase (HSL) Yields acetyl CoA, NADH, and FADH2. Reduces fatty acids to acetyl CoA or propionyl CoA. The latter can be converted to succinyl CoA (biotin and B12) for entry into the citric acid cycle. Stimulated by epinephrine. Inhibited by insulin.

Carnitine Shuttle: Shuttles long-chain fatty acids into the mitochondria for beta oxidation. Deficiency leads to hypoglycemia, muscle pain, and muscle atrophy. Treatment is medium-chain triacylglycerols (i.e. butter).

Exogenous Lipid Transport: Cholesterol and TGs are absorbed in the intestine and incorporated in QMs in the blood stream. Lipoprotein lipase (LPL) degrades QMs to glycerol and fatty acids. Free fatty acids are stored in adipose cells or used as fuel. QM remnants are taken up by the liver or transported to the liver by HDL.

Endogenous Lipid Transport: VLDL is secreted by the liver and broken down into fatty acids and LDL. LDL is absorbed by the liver and peripheral tissues through a LDL receptor. Peripheral tissues degrade LDL into cholesterol and cholesterol esters. Cholesterol esters are transported to the liver by HDL.

Lipoproteins and Apolipoproteins: QMs are secreted by the intestine and deliver TGs to tissues and cholesterol to liver. Requires Apo As, B-48, C-II, and E. Excess leads to pancreatitis, eruptive xanthomas, and lipemia retinalis. VLDLs are secreted by the liver and deliver TGs to tissues. Requires Apo B-100, C-II, and E. Excess leads to pancreatitis. LDL delivers cholesterol to tissues. Requires B-100. Excess leads to atherosclerosis, arcus corneae, and xanthomas. HDL is secreted by the liver and intestine and mediates cholesterol transport to liver. Requires Apo As and A-I.

Sphingolipid Synthesis: Requires serine and palmitoyl CoA. Produces sphingomyelin (nervous tissue), gangliosides (ganglion cells), sulfatides (nervous tissue), and cerebrosides (CNS myelin).

Cholesterol Synthesis: Requires acetyl CoA and acetoacetyl CoA. Requires by HMG CoA reductase. Yields cholesterol and mevalonic acid. Inhibited by high levels of cholesterol. Lecithin cholesterol acyltransferase (LCAT) traps cholesterol in HDL to prevent membrane uptake.

That was a really long dump. Join us tomorrow for aminoacid and purine metabolism.

 

[Juan J. Sánchez]

10:15 am: Scored 67% on my first practice test. 3% above average. Great job. Might have cheated a bit on the last question. 10 minute break. Then it's time for another test.

 

[Juan J. Sánchez]

11:40 am: Finished my second block of Qs. Scored 59%. Not as high as before but 2% above average. Not a bad day.

 

[Jason]

These average scores seem pretty low... just saying.

 

[Juan J. Sánchez]

I know. That's because they make the practice questions super hard. On the real thing, they do a standard curve, which bumps your final score to like an 80-85%. It's probably the hardest multiple choice test for basic sciences all over the world.
It's a hard test.

 

[Jason]

Ah I see, sort of makes sense I suppose, make the practice questions harder so when the real test comes the questions will seem easier, hence giving you a higher final score... clever. :thumb: