Tag Archives: med school honors

Must Have: Dubin’s Rapid Interpretation of EKG’s

Dubin's Rapid Interpretation of EKGsDubin’s Rapid Interpretation of EKG’s is a one-of-a-kind book that is often referenced in medical schools due to its fun and simple methods of teaching the evaluation of electrocardiograms. More importantly, it provides a high-yield, low-stress method of conveying these otherwise difficult concepts.

In each chapter, the fundamental concepts of EKG’s are delineated in a crisp and clear format. What makes up the bulk of the book is actually not free-text but illustrations that significantly help correlate concepts and electrocardiogram images. Individual diagnoses or findings on an EKG are accompanied by full explanations, including clearly delineated criteria and just enough information to teach pertinent core cardiology concepts (without overwhelming the reader). In fact, the information in Dubin’s EKGs is known for being dumbed down and presented in a “flashcard” style so that it is easy to understand and absorb on-the-go.  All concepts are reiterated and presented repeatedly to ensure maximum retention and an appropriate pace. Interestingly, despite the repetitiveness of the material and the seemingly “dumbed down façade, the book covers all the necessary information that students needs for medical school, and even quick review during residency.  Specific chapters include: Basic Principles, Recording of the EKG, Autonomic Nervous System, Rate, Rhythm, Axis, Hypertrophy, Infarction, and a catch-all Miscellaneous section.

While this title remains highly endorsed by the editors of this site, it is important to still note the drawbacks, for completeness.  Due to the ease of use, some students find Dubin’s EKG to not be challenging enough. While it remains a strong primer, some students (especially those with prior cardiology experience) believe that several pages of information can be condensed into a page or less.  It is important to realize that the aim of this title is to teach only the fundamentals of EKG knowledge. For depth and advanced nuances not needed for medical students, a larger, more condensed resources is warranted. As such, Dubin’s Rapid Interpretation of EKG’s should be used as a quick and superficial “top of the iceberg” but “solid foundations” reference guide to learning the basics of EKG’s.

ECG Complex - Learning the Basics

For medical school: exceedingly useful.
For residency: potentially helpful.
For cardiology fellowships: trainees ought to be well past the basics presented within this book.

Reading Dubin’s Rapid Interpretation of EKG’s cover to cover takes about 4 or 5 hours total, but it is more highly recommended that students periodically return to the book over time for increased retention of the repetitious material.  Overall, this earns a strong endorsement and is highly recommended for any new second year medical student learning cardiology.

 

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Recommended Preclinical Pulmonology: Respiratory Physiology

West's 9th edition of Respiratory Physiology, great for medical studentsRespiratory Physisology: The Essentials 9th Edition (2011) by John B. West is a beautifully constructed book for understanding the fundamentals of respiratory physiology in about 1 to 2 weeks.  Initially opening the book may bring a bout of anxiety due to the seemingly dense text and black-and-white (or rather red-and-gray) visual aids and illustrations.  However, when you actually begin to read this book, it is quite easy to follow and learn the essentials of respiratory physiology. Only a few sections seem slightly more difficult to understand despite the explanations provided.  In each chapter, the content is provided in a narrative manner, interjected by diagrams, charts, equations, summaries of main points, and finishes up with a summary of important pulmonary concepts and some relevant review questions for the chapter.  Although the presentation is not colorful, the material is presented clearly and concisely.  All the fundamentals medical students need to know are contained within, and there is very little digression or extraneous material.

The table of contents reveals the comprehensive nature of this book:  structure and function, ventilation, diffusion, blood flow and metabolism, ventilation-perfusion relationships, gas transport by the blood, mechanics of breathing, control of ventilation, respiratory system under stress, and tests of pulmonary function. As you can see, Respiratory Physiology talks about everything from structure to function to regulation of respiration, so it does not skip on the important topics.  However, it is important to note that this resource is more focused on physiology than pathophysiology: a needed fundamental for any system. This book can be used either for a comprehensive review of pulmology for pre-clinical medical school exams and for the USMLE boards.  It is 200 pages of good information, but may take several days to read if you are studying pulmonology and other courses at the same time.

when you actually begin to read this book, it is quite easy to follow and learn the essentials of respiratory physiology

This book is recommended to medical students who really want a comprehensive basis in respiratory physiology fundaments, those who want to have a solid foundation for clerkship in pulmonology, and pulmonology residents who may want to brush up on the important basics of respiration.  It However, it is certainly not necessary for students looking only to pass. Although West’s Respiratory Physiology is not wordy beyond necessity, it is still quite a detailed and complete book on the physiology of respiration.

 

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First Aid USMLE Step 1 2012 Errata Posted

First Aid USMLE Step 1 2012 reviewFor those interested in making corrections to information in your copy of First Aid for the USMLE Step 1 2012, the official FA errata is now posted to the FirstAidTeam.com website.  You can check out the webpage to learn more about the process, or RSS subscribe for updates. If you’d like to bypass the site and just go straight to the errata, the document can be found here (pdf).

Contribute to First AidKeep in mind that you can send in a correction for any mistake you find by clicking on the “Contribute” button on the right side of their site or this post (both bring you to the same place on their site). While they promise $20 Amazon gift cards for new information, someone else has probably already beaten you to any given correction. Nonetheless, making any submission will get your name printed in the preceding version of Step 1.

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Sneak Peak at First Aid for the USMLE Step 1 2012

First Aid USMLE Step 1 2012 reviewMedStudentBooks.com got a hold of an early copy of the upcoming First Aid for the USMLE Step 1 2012, and we are proud to offer the first internet review.

The 2011 version of First Aid for the USMLE Step 1 was previously reviewed on this site as the must have gold standard of Step 1 board review, and this only builds on it. Reportedly the “world’s bestselling medical review book,” First Aid 2012 continues its long line of teaching with a noticeable update. As the rainbow bar on the cover suggests, First Aid is now in full color. The company also reports approximately 20% new content across the additional pages.

There are a good number of benefits that come with the color upgrade. Previous versions stored a small section of pages near the back of the book with certain must-see color images. In 2012 however, they are blended seamlessly around the relevant text, allowing users to go directly from text to image without page references. The color also seems to make a number of the images pop a bit more. Drawn diagrams are easier to encode into memory, and line graphs are easier to trace (although this may be difficult to appreciate in the below image).  There also appears to simply be more color pictures in general, complementing the text more completely than previous versions.

First Aid for the USMLE Step 1 2012 sizing

Pages without images still have subdued hues of blue and red around the border. Bolding is now in a dark blue, which seems to conflict with one of the improvements many people liked between the 2010 and 2011 versions: bolder, darker font.  Nevertheless text remains easy to read.

First Aid for the USMLE Step 1 2012 QR CodeThe other noticeable addition to the book is the use of QR codes found at the start and end of every chapter, linking the user to updates, errata, “and more.” They all actually appear to be the same QR code throughout the book, and come with a link to the title’s associated question bank. As an aside, that same link is where students can submit errors or recommendations to improve the subsequent version, and get their name printed in it as well. While it is difficult to see the practical use for this electronic QR connection, board-study-psychosis can produce erratic behavior in medical students, and it certainly isn’t a detracting feature.

In general, First Aid Step 1 2012 also does a better job with spacing and sizing, as seen in the above image, although this comes at the expense of smaller margins. As mentioned in the previous 2011 review, most students annotate the book’s blank space.  Because of this, margins have historically been important, although a good amount of white space still remains.  In regard to the physical size of the book itself, it is surprising to see the dimensions to be about equivalent to the 2010 version, despite an additional 50 pages. The downside to this is that the pages are very thin and don’t hold certain inks or highlighting as well as prior versions.

Compare First Aid for the USMLE Step 1 2012

Overall, it is highly recommended that every second year medical student has access to a personal copy of First Aid for the USMLE Step 1. Unfortunately, it is generally contraindicated to obtain a used copy of this title due to the annotation produced by most users. The color update with a reported 20% increase in content represents an improvement that should not be overlooked for a new copy of a previous version. Therefore, we strongly recommend picking up a new copy of First Aid for the USMLE Step 1 2012. As we get further into Step 1 season, MedStudentBooks.com will post any discounts or deals on purchasing this title online, and possibly give one away for free. For now, shop around the below links to find the best price, and be sure to look for the color version.

 

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Careful Consideration: Pocket Neurology

Pocket Neurology LippincottPocket Neurology (also known as “The Yellow Book”) can be readily found in the white coats of many Neurology residents. Unlike its Medicine counterpart (The Green Book), Pocket Neurology does not seem to hold the same popularity among medical students. There are a few reasons for this. First, it hasn’t been around as long, and thus it hasn’t had time to built up the full extent of its reputation. Few attendings will readily reference it during rounds, and residents simply won’t expect students to own or have access to a copy. Second, Neurology is usually a clerkship of shorter duration compared to Internal Medicine in most medical schools, and therefore comprehensive pocket guides are less bang for the same buck.

What Pocket Neurology covers, it covers very well.  However the target audience for this title is not the same as for Pocket Medicine as a result of the focus in our medical education. We are taught the core principles of Internal Medicine from an early point on entering medical school, including history taking, physical examination, general findings, and many organ system courses focused on Internal Medicine subspecialties. It is because of this focus that new third year medical students can open a copy of Pocket Medicine and understand the more advanced topics without the need for referencing the basics.

This is not the case on a Neurology rotation, where most students are just starting to learn the specialty’s language, techniques, and the significance of common findings. For example, students may be frustrated if trying to use the book to assess the common presentations of migraine prodrome, despite a concise and comprehensive overview of headache differential diagnosis and workup. Getting past the basics quickly to fully utilize this book is highly recommended, as it will certainly be a strong resource to those who can wield it well.

As with all of the titles in the Pocket Notebook series, downsides include lack of space for annotation, and small print font, but these come with the territory of creating pocket reference guides.  Another consideration for this title specifically is an index section that is somewhat lacking.  Topics not contained within tidy concepts involve a good amount of searching in the appropriate chapter.  As a result, many residents will place labeled flags or earmarks on pages to quickly access commonly referenced topics.

Specific sections include neurologic emergencies, lesion localizing in clinical neurology, neuroimaging, vascular neurology, neurocritical care, acute intracranial hypertension, interventional neurology, seizures and other spells, electroencephalography (EEG), delirium, dementia, movement disorders, behavioral neurology, poisons and vitamin deficiencies, meningitis / encephalitis / brain abscesses, infectious diseases, headache, central nervous system vasculitis, pain, dizziness and deafness, demyeliminating diseases of the central nervous system, spine and spinal cord diseases, motor neuron diseases, peripheral neuropathy, radiculopathy and plexopathy, neuromuscular junction disorders, myopathy, electromyography (EMG), neuro-rheumatology, neuro-oncology, sleep medicine, pregnancy neurology, neuro-ophthalmology, consult issues, and selected pediatric disorders.

Overall, this is a title worth purchasing for all Neurology residents and medical students interested in the field. Medical students who wish to excel in their Neurology clerkship or enter a field that uses neurology such as Internal Medicine, Trauma, or Ophthalmology should consider purchasing Pocket Neurology with the above considerations, based on their personal preferences. This is probably not heavily needed for students who have no interest in neurology.

 

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Tips for Surviving your Obstetrics and Gynecology Rotation

To complement the recent release of our book recommendation for Ob/Gyn clerkship and Step 2 review, we offer the below experiences in hopes that rising medical students can learn from past mistakes and successes. Obstetrics and gynecology is usually perceived as one of the more labile rotations you will face in medical school.  While there are clear differences between hospitals across the nation, and even great variability between teams within the same hospital, this tends to generally be the case with respect to other rotations.

In distinction to many other clerkships, most medical schools rotate students through a number of different ob/gyn sites and settings, usually highlighting outpatient gynecologic exams, inpatient or surgical gynecology, outpatient obstetrics, and labor and delivery. This generally prohibits cohesive or longitudinal teamwork, and leaves residents and attendings with very little exposure time from which they must draw their evaluations. As such, the first piece of advice is to pre-read before starting obstetrics and gynecology.  This is in distinction to other stable rotations where reading can be done along the way. You will get pimped on day 1, and have few days past that to redeem yourself. Come in knowing your basic terminology and abbreviations.

Outpatient Clinics

Outpatient ob/gyn clinics are usually mixed.  Some will probably be shadowing, while others are primary care based, where focus should be on prevention and good planning.  For gynecology, you should know your in-office STD and vaginosis screenings, what to look for on microscopy, and how to treat each. Every exam should have a complete history on sexual partners, obstetrics (G’s and P’s), contraception, pap smears, STDs, vaccinations. If you’re uncomfortable talking about these topics, now is the time to get over it. Be sure to bring your stethoscope.

For obstetrical checkups, you should go in knowing your screening tests, timeline, and the most common reason for first and third trimester bleeding.  Presentations should always start with something sounding like “28 year old G3P1011”.  G (gravity) stands for the number of total pregnancies. P (parity) has four numbers which correspond to full term pregnancies, pre-term pregnancies, abortions/miscarriages, and live children, in that order. You will be commonly treating bacterial vaginosis and trichamonas with flagyl (metronidazole). You should remember this medication has a disulfiram effect, so it should not be taken with alcohol.  Some patients will actually forego treatment until the weekend is over because of this unwanted reaction.  Yes, really.

Gynecology Surgery

Experiences are usually divided between benign and gynecology-oncology. You should have a pair of gloves and lube packets in your back pocket at all times. Each surgery will start with a pelvic exam on your unconscious unconsenting patient. When the resident lubes up, extend your pointer and middle fingers towards them like a handshake for a “high two” to share their lube. This is how Ob/Gyns bond in the wild, along with matching surgeon caps, black zip-up tops, and playing their favorite game: “find then avoid the ureter.” The pre-op exam is a great opportunity to get your pelvic exam down, so don’t pass it up.

You will most likely need to be able to gown up yourself. If you haven’t had surgery, ask an intern or fellow med student to teach you on the first day of your rotation, regardless of whether you’re starting on something surgical. You should also come into this rotation knowing basic knot tying techniques, regardless of whether you’re going into anything surgical. It’s just a good basic skill to have throughout medical school.  If you aren’t familiar with knot tying, a quick search on youtube and spare string or sutures will be helpful.  If you have these basic skills down, you will be allowed to do a few things aside from retract. Remember, if you are down below, it is considered “dirty” even though you are in sterile garb. Never move from pelvis to abdomen without changing gloves. Crazy pimp question: most med students are taught in anatomy that nothing runs with the round ligament, so naturally many attendings love asking about it. The correct answer is the Sampson artery.

Labor and Delivery

obgyn clerkship fetal ultrasoundIf you are interested in catching babies, try to take shifts when there are minimal residents, such as nights. If your hospital has private attendings who allow medical students with them, jump at those opportunities. They’re the ones who will let you actually deliver, whereas many of the interns (especially new interns around July) will soak up the opportunities with staff attendings. A lot of labor and delivery is just going into rooms and asking “is there anything I can get you?” and then fetching ginger ale. However you should push into the action when it starts.

The best way to learn how to deliver a baby is to find someone who will let you put your hands on top of theirs for a few deliveries so you get an idea of just how much pressure and movement is needed. Next step up is having your hands under theirs. Once you have a good feel for that, you’re good to deliver with observation. This technique isn’t necessarily offered or known to many residents, so be sure to ask, but it really works well. Be careful when you put on gloves in the room, because it is not uncommon to get surprise-lubed by one of the nurses, whether you wanted it or not (although you almost always want it). If you have the opportunity, try to spend a little time on triage (be sure you know the signs of labor!).

If you have tips or suggestions you would like added to this article, please add them in the comments.

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Best Online Histology Database: Boston University

Boston University Histology Learning SystemHistology has generally fallen out of favor and focus for many medical school curricula these days.  Some med schools still have dedicated histology courses and mandatory histo labs with ridiculously priced slide sets, but most have transitioned to incorporating histology within other broader classes, and offer newer digital versions of labs.  Due to this transition, as well as the driving field of pathology, countless databases and software packages have been developed to allow for histopathological visualization of electronic slides.

Whether your school’s applications allows for “real time” zooming and scrolling, or just splatters the screen with images, most software options are not particularly great at teaching the topic. All too commonly, we as med students have instructions that go along with slides and read something like “as it is clearly seen, the eosinophilic uptake shows…” Most of the time however, we have no idea what we are “clearly” looking at. Short of capturing a live histologist and forcing them to use the neon microscope arrows to directly point out key structures to make sense of it all, the next best thing is using a database that directly points to, circles, colors in, and directly labels what you need to know.

There are few free online databases out there, but the Histology Learning System from Boston University is among the best. Sure the background is a dull gray and the site navigation is a bit static, but the content and (more importantly) label system are a sure fire way to both learn and teach the material. This is especially useful when you find yourself needing to put together that annoying last minute power point presentation for some small group show-and-tell the next day.

The database breaks down all of histology by system, and also has a sitemap with every image listed.  Upon loading an image, users have the option of clicking on the LABEL button to figure out what they’re actually viewing, or click on a black rectangle on the image to increase magnification (enhance!) that structure. Some structures are rather straight forward and have no enhanced images, while others can go several layers deep.  Chances are, the histology professor or local guru at your medical school can recognize the BU histology database images on sight, as they are relatively well known in the community and characteristic.

Whether you need a complementary learning tool to be used with your class syllabus, a stand alone reference as you go through medical school, or a database of “normals” to contrast with pathology studying, the BU Histology website is highly recommended.

To prove your gunnery and attain bonus internet points, name the structures contained within this post by commenting here.

Boston University Histology Learning System

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Epic Anatomy Atlas Battle: Netter vs Rohen! (and others)

Anatomy Atlas Showdown: Netter vs Rohen
The age old debate once again emerges. This post will attempt to sort out the confusion to help you make the best decision on your first year med school anatomy atlas purchase. While the main issue is almost always Netter or Rohen, there are actually a few other contenders that will be briefly discussed as well.

First, it is important to specify that there are both better books, and different books.  What that means is that Netter’s Atlas of Human Anatomy (reviewed in full here) is going to be a better learning tool than most of its low budget imitators. However there are also apples-and-oranges comparisons, which is where Rohen’s Color Atlas of Anatomy (reviewed in full here) comes into play.

So which to choose? Rohen or Netter? The difference lies in how you like to study.  Rohen’s Color Atlas of Anatomy is going to excel at providing actual cadaver pictures, so what you study in the book is exactly what you will be tested on in your anatomy practical exams. Rohens’ also has the benefit of only numbering structures that require a legend, so it is perfect for quizzing – simply cover the answer sheet.  However, anatomy is hard for a number of reasons, one such difficulty being that multiple flesh colored structures easily blend together. As a solution, Frank Netter produced his famous Atlas of Human Anatomy, which covers all the same anatomy as Rohen, but with drawings.  His illustrations have the benefit of being able to clearly show the borders of structures with differences in coloring, making the anatomy easier to understand (whereas Rohen paints a small minority of structures to a less effective degree).  Tiny anatomy like nerves or vasculature pop off the page with contrast from their backgrounds with Netter. The down side is that Netter’s Atlas of Human Anatomy isn’t completely representative of anatomy practicals, as exams are not so conveniently color coded.

Head to head comparison: Rohen vs Netter Anatomy Atlas books

Head to head comparison: Rohen vs Netter Anatomy Atlases

This ultimately comes down to a decision of clarity or authenticity. In the end, the debate will always be split based on this and how each individual person studies.  It is recommended that you use both, depending on the situation, to get the best of both worlds. Specifically, Netter’s is a great first-pass reference book to help identify structures when initially exposed to the material, whereas Rohen’s is going to solidify existing understanding based on the actual visuals. In other words, a good strategy is to use Netter’s first, then go to Rohen’s.  As owning both books can get costly, try to own the one that appeals most to you, and borrow the other from an opposite-minded friend or the library.

Rohen’s and Netter’s Anatomy Atlases are not the only Anatomy books out there, though they are generally better than most.  Some other options deserve honorable mention.

The Sobatta Atlas of Human Anatomy (volume 1 and volume 2) is a hidden gem that breaks up the entire body into tremendous detail across two volumes.  Many believe the quality of the illustrations themselves actually surpass Netter’s.  It is important to note that this book distinguishes itself from the others by identifying all of the anatomical structures by their latin names. For a surprising majority of structures, this naming system is perfectly fine, as a good amount of anatomy is already latin. If you can use this book effectively, you will come out with a deeper understanding of the anatomy, its function, and its naming system.  For example, ab muscles are called Rectus Abdominis because “rectus” comes from the latin for “straight.”  Keep in mind that these will increase understanding, but at the time-cost of mastering part of a different language. Own both volumes if you can afford them, but otherwise it is worth going out of your way to find them in your school’s medical library.

Grant’s Atlas of Anatomy is another illustrated book. Unlike Netter, Rohen, and Sobatta, there’s just nothing really special to speak of. It highlights the anatomy and will help your studies, but generally doesn’t bring anything more to the table compared to the above books. Grant’s Dissector, (not to be confused with the Atlas) works particularly well for anatomy lab, but should not be purchased if your med school requires a different book. If they do require Grant’s Dissector, or you purchase it because they don’t require any book at all, you’re in good hands.

Gray's Anatomy AtlasLastly, honorable mention must be given to the epic original (but currently outdated) Gray’s Anatomy, originally named Gray’s Anatomy Descriptive and Surgical. No, it was not named after the TV show. Since the original, a number of revisions and companion books have been produced by new editors under the same name, including Gray’s Atlas of Anatomy, Gray’s Anatomy Review, Gray’s Anatomy for Students, and Gray’s Anatomy: The Anatomical Basis of Clinical Practice (seen right). See that sticker on the front cover that says “150 years?”  That’s there because the original author, Henry Gray, was born in 1827.  While anatomy hasn’t changed much since then, our understanding and technology has improved slightly past the mostly black-and-white images from the original Gray’s Anatomy, which can be found for free at Bartleby’s Online Gray’s Anatomy of the Human Body.  As you go through med school and use Dr. Wikipedia, you’ll see many of the original images from Gray’s Anatomy used as a reference (example below). The above book and many of its similarly name renditions contain up to date text and illustrations, but they are generally anatomy textbooks and not dedicated atlases like the abovementioned publications, to be reviewed at a later time.  Gray’s Anatomy is mentioned here for historic reference as the influential publication that really pioneered the way of the illustrated Anatomy Atlas.
Gray's Anatomy Atlas Heart

 

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