Getting There

[Juan J. Sánchez]

12:50 pm: Ate a gyro. Half a gyro. Now I'm tired. Might take a small nap. Bought The Beatles coasters. Met a cute girl at the shop.

 

[Juan J. Sánchez]

10:40 pm: Horrible day. After lunch I had a nap. Overslept. There seems to be some legal issues going on with med students in my country. That took a couple of hours away. I also spent some time figuring if I could trade in my iPad for the new one, since I bought it 5 weeks ago. So far, it doesn't seem like I can, but I will go tomorrow to an Apple store to see if they are lenient on their return policies. Tried studying. Couldn't. When it gets too late, your mind just wanders off. Will admit defeat. Will resume studying tomorrow at 7:00 am. Got to catch up.

 

[Juan J. Sánchez]

Peptide hormone with protein carrier: ILGF
Steroid hormone that's water soluble: DHEA-S
Peptide hormone with constant release: TH
Permissive action: cortisol on cathecolamines, cortisol on glucagon, TH on GH

Gosereline, leuprolide: GnRH agonists
Flutamide: testosterone blocker
Finasteride: aromatase inhibitor

 

[Juan J. Sánchez]

7:30am. Woke up about 40 minutes ago. The house maid is on medical leave so I had to spend some time taking out the birds, taking the dogs out to pee, taking out the trash, and whatnot. Construction workers will arrive in 30 minutes. I need to let them in. If you know me, you know I didn't sleep at all last night. However, I must have woken up after Stage 4 sleep, cause I feel fully awake. The red bull and coffee are just so that I don't eventually crash. If I do crash, that's okay. I always welcome one or two hour naps.

So I've noticed the past 15 days I've done 0 flash cards. That's changing today. I'll spend 1 hour on Pathology audio lectures, 1 hour on Microbiology / Immunology notes and flash cards, 1 hour on Pharmacology notes and flash cards, and 1 hour on Biochemistry / Genetics notes and flash cards. That's a total of 4 hours in the morning. Then I'll proceed to noon break. Then I'll do 3 hours of testing, followed by my afternoon break. After that, I need to review tests as fast as freaking possible (this usually means about 1 test per hour), and if I'm lucky, I should have enough time for a final break and 2 or 3 hours for Physiology video lectures.

I know this seems crazy and yes, I am dedicating an awful lot of time to flash cards, but honestly, my Microbiology and Biochemistry scores have improved dramatically since I started doing flash cards, and kind of came to a halt these last two weeks. I'll take a shower now. Wish me luck.

 

[Toams]

Luck

 

[Juan J. Sánchez]

8:10am. The sun glare makes it impossible to study in my desk. I'll go study somewhere else. While we still are on the subject of dreams, why not take a look at the sleep / wake cycle?

In summary, REM sleep and non REM sleep. NREM has 4 stages. NREM is slow EEG, movable body. REM is aroused EEG, sexual arousal, rapid eye movements (obviously), and dreaming. An idling brain is a movable body. An awake brain is a paralyzed body.

Waves (super important): 1, 2, 3, 4, 3, 2, REM (down the hill and back again)
Awake: low voltage, random, fast beta waves.
Drowsy: 8 to 12 cps, alpha waves (you start feeling drowsy from 8pm to 12pm).
Stage 1: 3 to 7 cps theta waves.
Stage 2: 12 to 14 cps, sleep spindles, K complexes.
Delta sleep: 0.5 to 2 cps, delta waves.
REM sleep: low voltage, random, fast, sawtooth waves.

ATKD (attacked): alpha, theta (1), k complexes (2), delta.
Sawtooth cutting a piece of lumber: dreaming (REM sleep).

Sleep deprivation: low lymphos, high cortisol, high BP, low glucose tolerance, bad mood, high delta, low REM.
Narcolepsy: sleep attacks, cataplexy, hypnagogic hallucinations, sleep paralysis, low REM, modafinil.
Sleep anea: obese and snoring, elderly and Cheyne Stokes, high risk of sudden death, CPAP.
SIDS: no toys, sleep on back.
Insomnia: behavior therapy, GABA drugs, ramelteon.
Night terrors: delta sleep, temporal lobe epilepsy.
Nightmares: REM sleep (dreams).
Sleep walking: delta sleep.
Enuresis: delta sleep, desmopressin, imipramine (TCA).
Teeth grinding: anxiety.

SAND man: 5HT starts sleep, ACh rises, NE decreases, DA stops sleep. I remember this by Dopa do, Sero stops. Drinking lowers REM sleep. Depression increases REM sleep and lowers REM latency (faster and longer).

 

[Juan J. Sánchez]

9:15am. There's no coffee as good as Costa Rican coffee. I made breakfast for my dad. Workers didn't show up. Apparently, one of them is sick. So I guess it's just me in the house today. It's a good study environment. Found my missing Biochem flash cards.

 

[Juan J. Sánchez]

9:45 am. Sphyngolipidosis and mucolipidosis: weird shit you'll never see in real life. They're all autosomal recessive and they all present with failure to thrive (unless it's an even rarer variant with late onset).

 

[Juan J. Sánchez]

Leukodystrophies: genetic, white matter degeneration, demyelinating disorders. Metachromatic: deficiency of arylsulfatase A. Krabbe: deficiency of galactosylceramidase. Adrenoleukodystrophy: leukodystrophy + Addison disease, XR, defective breakdown of fatty acids.

 

[Juan J. Sánchez]

10:00 am. Enough Biochemistry. Time for Microbiology.

 

[Juan J. Sánchez]

11:10 am. Done with Micro. I actually only saw like 6 different bacteria (Gram positive), but I also reviewed how to differentiate them on cultures.

NO STRESS, OVRPS (overpass), B-BRAS

NOvobiocin: SaprophyTicus Resistant, Epidermidis, SenSitive
Optochin: Viridans Resistant, Pneumoniae Sensitive
Bacitracin: B-hemolytic (S. pyogenes and S. agalactiae) Resistant, A-hemolytic (others) Sensitive

In case you're wondering, novobiocin, optochin, and bacitracin are antibiotics that are put on cultures to see whether a bacteria grows or doesn't grow. This, along with catalase test, coagulase test, and mannitol fermentation help differentiate bacteria. It's really more of a microbiologist's job to know this, but, eh.

 

[Juan J. Sánchez]

12:30 am. Lunch break. It's hard to get things done with my dad home. Still, it's been a fairly productive day so far.

 

[Juan J. Sánchez]

1:20 pm. Watched news and had lunch with my dad. I cooked. I figure I should go back to work in about 10 minutes.

 

[Juan J. Sánchez]

10:10 pm. Lost some time do to my best friend having a breakdown. I'll catch up later this week. I at least did three tests: 63%, 50%, 63%. The 63s are decent scores. The 50 is a really shitty score. I was falling asleep during that test block.

 

[Juan J. Sánchez]

Will the review hasn't gone well at all. My schedule has been a disaster. I'm still hoping to finish the review book. I'm taking my first serious self-assessment tomorrow so wish me well.

 

[Juan J. Sánchez]

I've got an exam real soon... I took some BDZs to keep me on edge. Also some redbull to compensate. As far as I can say, I'm feeling calm and confident. Not queasy at all. I'm in my apartment. It's a beautiful day today.

 

[Juan J. Sánchez]

Ugh. My practice exam was horrible. Diarrhea. Lots of phone calls. Lost internet connection for about an hour. And there was a parade nearby. It might have reflected on my score. I got a 207, which puts me on the 34th percentile. I've gotten good word from my sister in law and other medical students that you can up 10 to 20 points from the practice exam on the real thing.

As you most certainly remember, I got a 219 on my previous practice exam. This one was harder. So my score is probably going to be somewhere between those two. It seems as though my score will probably be a 214, give or take 10 points, which is on the 44th percentile and isn't that bad for an Int'l Medical Graduate (IMG).

Still, my exam is two weeks away and there's definitely lots of time to do practice Qs, go over my book, and improve that score 10 points.

 

[Juan J. Sánchez]

Ugh. My practice exam was horrible. Diarrhea. Lots of phone calls. Lost internet connection for about an hour. And there was a parade nearby. It might have reflected on my score. I got a 207, which puts me on the 34th percentile. I've gotten good word from my sister in law and other medical students that you can up 10 to 20 points from the practice exam on the real thing.

As you most certainly remember, I got a 219 on my previous practice exam. This one was harder. So my score is probably going to be somewhere between those two. It seems as though my score will probably be a 214, give or take 10 points, which is on the 44th percentile and isn't that bad for an Int'l Medical Graduate (IMG).

Still, my exam is two weeks away and there's definitely lots of time to do practice Qs, go over my book, and improve that score 10 points.

 

[adelec07]

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 Assurance dépendance, 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?

You were lucky it seems. I have never received so much distinction in my life.