After nearly eighteen months of didactic lectures, the basic science component to my medical education is fast approaching. On December 17, the MS2s will be taking our end of basic sciences exam (EBSE) which is essentially a modified version of step 1. Students are required to pass this monstrous exam (200 questions in four hours) to begin clinical rotations in January. 😯
As gunner as it makes me sound, I’m kind of excited about this exam. Besides the fact that it symbolizes the end of one chapter in medical school (basic sciences) and the dawn of another (clinical rotations), it will be the first real standardized test I’ve taken in medical school. It’s a perfect chance to synthesize ALL the information I’ve *supposedly* gathered at this point and apply it to clinical vignettes.
For example, a poorly controlled diabetic patient presents with a myriad of findings.
- Trouble with vision: possibly hard exudate deposits or overall edema of the macula which would subsequently cause a loss of central vision (something we learned in neuro)
- Cannot extend right wrist: a peripheral motor neuropathy associated with damage to the radial nerve due to vascular changes or glycation products (a little neuro, a little anatomy, a little endocrine)
- Blood panel shows a normal LDL count but a modified composition (small and dense LDLs): CETP enzyme is taking triglycerides from VLDLs and throwing them into LDLs while in turn taking cholesterol from LDLs and throwing it into VLDLs (biochemistry)
- Patient’s EKG shows peaked T waves: indicative of hyperkalemia caused by a lack of insulin response since that would normally lower the potassium by bringing it into cells along with glucose (cardiology and electrolyte balance)
Medicine is indeed an all-encompassing art which requires an incredible breadth of knowledge regarding the interplay between organ systems and pathologies. The EBSE will hammer this point home… hopefully in a not-so-brutal manner. 😛