Tag Archives: Physiology

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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USMLE Step 1 Series: The 7 Essentials of a Solid Study Strategy

To kick off the USMLE Step 1 advice, we present the big picture overview of studying. Some of the below are well known strategies, but we hope to present some clever caveats that have been compiled by a number of med students along the way. Over the next few weeks, in depth articles will detail more of the little tricks that offer that competitive test taking edge. For now, let’s stick to the basics.

Figure Out Your ACTUAL Strengths and Weaknesses, with Evidence.

Early in the study process, you will be bombarded with different strategies and study practices. The problem will always come back to figuring out what works best for your specific learning style and knowledge base. Before you even decide where to start, you should have a basic idea of big-picture learning goals. After all, it would be silly to dedicate the same amount of time to a topic you despise as one you already know really well. Don’t guess. That’s an easy and common mistake. Get evidence.

The National Board of Medical Examiners (NBME), the same guys who bring you the Step 1 exam, have created a number of helpful exams for this goal called the Comprehensive Basic Science Self-Assessment (CBSSA).  They use Step 1 style questions and provide performance profiles (above) similar to that found on your actual Step 1 assessment. It lays out a visual representation of strengths and weaknesses. Hopefully your med school provides them to you for free (if they don’t, petition for it).

It is recommended that you take an untimed enhanced CBSSA exam early on or even before you start studying. Assessing your Step 1 knowledge before studying, and seeing the score and performance profile early on will definitely sting, but the purpose is to push you in the right direction. It can serve as a strong motivator, and has been shown to increase board scores at certain med schools by 1/4 of a standard deviation.  If desired, take another one about 10 days before the actual exam for comparison and reevaluation of focus. Using a question bank to accomplish this goal is an alternate option, but they are focused on teaching topics, and nothing is as authentic and insightful as an exam coming directly from the NBME.

Get a Plan, and Stick To It.

Once you figure out strengths and weaknesses, creating a study schedule is the next essential step. We’ll cover the various types of plans more extensively in future posts, as there are many out there. The big picture point is that it should keep you focused but remain flexible. This can be a large stress-inducing topic for med students, as gunner plans will require no sleep and IV hydration. Construct something right for you that also maintains sanity.

Get a Copy of First Aid for the USMLE Step 1 2012

First Aid USMLE Step 1 2012 reviewIt has been reviewed and highly recommended on this site, and even given away in a contest. This should be at the core of every med student’s study plan, and can be purchased confidently, regardless of your individual study strengths. However, this absolutely cannot be the sole source of information for Step 1 studies. Every commercial question bank and review course will cite some arbitrary number that suggests First Aid doesn’t hold 100% of the needed knowledge. They’re right.

The proper way to use First Aid for the USMLE Step 1 is as a guide. The sections corresponding to the subject of your focus should be lightly overviewed first. This should then be followed by in-depth learning from a dedicated resource. Some students like returning to review First Aid after that, and/or in the days just before the exam. Either way, it should be used as your starting marker to point you in the right direction, not your end point. Furthermore, it should be annotated thoroughly, which will be discussed with tips in an upcoming post.
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Stock Up on the In-Depth Books NOW

Now that we convinced you that First Aid won’t make you a Step 1 superstar by itself, let’s look at what else to consider. You will find that there are about three million medical books out there. After narrowing down the list to those designed specifically for med students studying for the USMLE Step 1, you will find yourself left with about 43,943 books. Pro-tip: you can’t read them all.

Feuds have started over which books present the highest of yields. You could sink a lot of time into researching every title, and fall prey to the gunners and trolls of the SDN forums, never wanting to hear the term “high yield” ever again. Here at MedStudentBooks, we like to keep things simple. Below is a list of recommended titles to support various Step 1 topics. As always, we highly recommend using the titles you already know and love to jog your memory. But if you don’t have a favorite, the following is a list of highly recommended titles from the MedStudentBooks team, surveyed med students, and med school administrators that you should consider first:

MedStudentBooks Recommended Step 1 Resources
Lippincott’s Biochemistry (full review here)
Q&A Review of Biochemistry
Clinical Microbiology Made Ridiculously Simple (full review here)
Q&A Review of Microbiology and Immunology
Lippincott’s Microcards
BRS Physiology (full review here)
BRS Behavioral Science
BRS Pathology or Goljan’s Rapid Review Pathology (full review here)
Robbins and Cotran Review of Pathology (question book) (full review here)
MedMaps for Pathophysiology for true visual learners
Lilly’s Pathophysiology of Heart Disease (full review here)
High-Yield Gross Anatomy with your favorite atlas for reminders
High-Yield Neuroanatomy with this gem

Clearly you should not seek out every book on this list. In fact, purchasing too many books can stress you out if you have a large pile of materials you feel you must get through, without the time to actually do it. These are just top recommendations for the subjects with which med students tend to need extra help.   The key is to figure out what topics need to be strengthened as mentioned above, and focus on them from the above list appropriately. We’ll go over general question and case books in another post.

Do not be that med student who waits until the day before they are scheduled to start reviewing a topic to buy the associated book. You should not dedicate any brain power on bookstore trips or figuring out why the postal service didn’t deliver your Amazon order in the middle of your studying. Added stress is not welcomed. Figure out what books you need from your self-assessment, and purchase them early.

Use a Question Bank to Complement Your Studies and Track Progress

Your med school may host an obligatory Kaplan lunch talk, or notify you of a USMLERx “scholarship” (?). Maybe you’ve heard some rumors about a new and upcoming question bank weapon for gunners. Like books, there are several options out there, but this choice is even simpler than books: use USMLE World.

USMLE World Step 1 Question Bank

Much like First Aid, this is not a question of learning style. If you’re a visual learner, use UWorld. If you’re an auditory learner, use UWorld. If you work for Kaplan…  use UWorld. We’ve previously mentioned that we’re not a fan of their company policies or prices, but the high quality of their question bank is undeniable, which is why they are the gold standard. Unless your exam is scheduled within the next 8 weeks, get a 3 month subscription. We’ll discuss question bank strategies and alternatives in upcoming posts, but for now rest assured that you don’t need to worry about other companies unless you’ve blown through UWorld and come out hungry for more. Again, the price is unfortunately high, but it is an absolute necessity.
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Learn by Rote Memory Over Time

So far we’ve covered basic science subjects that are largely conceptual. Unfortunately, Step 1 (and the rest of your career) will require straight up no-thinking-through-it memorization. By this point in med school, you’ve probably created lists that you’ve stared at for so long that you not only remember the factoid, but the irregularities of the paper as well. This will most likely come up for Step 1 in pharmacology and microbiology. It is an unfortunate necessity, however it can be improved slightly. Just remember that large amounts of rote memorization are best retained with spaced repetition. In other words, you should identify the long lists somewhat early, and continue to review them in short bursts throughout your study schedule instead of dedicating large chunks of time without returning to the information.

(Try to) Relax

A lot of us really neglect this one, and it can have devastating effects on productivity and exam scores. We’ll be discussing burnout in greater detail soon, but you should start thinking of things that keep you sane now. Step 1 sucks, but you are awesome.
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Lange Case Files Pathology: For Your Review

Lange Case Files: PathologyLange’s Case Files Pathology is a book whose purpose is to integrate our knowledge of pathology for diagnosing realistic scenarios in medicine.  There are 50 clinical cases written in clear USMLE-style format.  For each clinical case, there are four parts: 1) a summary with straightforward answers and clinical correlations, 2) basic science concepts including objectives and definitions followed by a brief discussion of the topic of interest, 3) a few comprehensive questions that reinforce key points, and 4) “pathology pearls”, which are important take-home points.   When going through each case, important information is bolded for emphasis and explanations are concise and precise—eliminating the trivial concepts that should have become second nature by the end of organ systems.  This means that this book is not for learning materials, but rather more effectively used as a tool for review, reinforcement, and integration of learnt information to allow for synthesis.

Although all Case Files books may or may not fit the needs of boards review, Case Files Pathology is a book that can only help.  With key take-home points and short-and-sweet explanations of case material, you should have little problem learning the essentials—the fundamental architecture of clinical pathology.  For example, you may come across a case of ventricular septal defect (VSD), requiring you to utilize your knowledge of epidemiology, embryology, physiology, and the clinical presentations of cardiac defects. Of course, take note that this book is for pathophysiology and not just for lab-based pathology, so a good foundation in second year organ blocks material would make this book much more useful for synthesis of all the loosely connected information.

The downside of Case Files Path includes: 1) lack of pictures and images to allow the medical student to truly appreciate the clinical appearance of certain diseases, 2) lack of explanations for various diagnostic tests that may be useful for understanding the diagnostic and elimination process, and 3) the multiple choice review questions at the end of each case are generally very simple and superficial questions asking more for recall than synthesis, despite the fact that the case itself is pretty good at elucidating the more detailed aspects of disease.

Overall, Case Files Pathology would be great to have for some last minute studying or USMLE Step 1 board review, but definitely not for the initial phase of studying. Get the foundation down solid, and then use this book to cement everything together. As for where to use this book, it is not a useful resource for studying for medical school classes since the cases in the book is written in USMLE format rather than in the format of questions on medical school examinations. However, it is definitely a good book to have at the end of your studies for USMLE Step 1 to get the bigger picture and practice applying medical knowledge to realistic medical cases, uncertainties and all.


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Must Have Cardiology: Lilly Pathophysiology of Heart Disease

Lilly's Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and FacultyDid you ever wish your course materials had less research-driven material that was bogged down in details? Did you ever wish that relevant information wasn’t presented in a complex and sophisticated manner such that you could spend more time learning and not sorting through the hot mess that is a syllabus?

Lilly’s Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty solves both commonly-heard complaints with a well-organized and informative text that will be essential for your Cardiology or Physiology course. The book was written by Dr. Leonard Lilly, a Harvard cardiologist, who understood the pains of the first two years of medical school. He gathered 79 medical students who provided insights on how to present and teach pertinent information to medical students. The book itself has received many accolades from around the world and may already be required at your medical school.

There are quite a few benefits to using this book. The content is set up in a way that allows you to read the book, well… like a book (I know it’s hard to imagine in med school). It starts with pertinent information that med students will need to know in order to understand each subsequent chapter. The material in the Fifth Edition covers: 1. Basic Cardiac Structure and Function, 2. The Cardiac Cycle: Mechanisms of Heart Sounds and Murmurs, 3. Diagnostic Imaging and Cardiac Catheterization, 4. The Electrocardiogram, 5. Atherosclerosis, 6. Ischemic Heart Disease, 7. Acute Coronary Syndromes, 8. Valvular Heart Disease, 9. Heart Failure, 10. The Cardiomyopathies, 11. Mechanisms of Cardiac Arrhythmias, 12. Clinical Aspects of Cardiac Arrhythmias, 13. Hypertension, 14. Diseases of the Pericardium, 15. Diseases of the Peripheral Vasculature, 16. Congenital Heart Disease, 17. Cardiovascular Drugs.

If you choose to use Lilly as a supplemental resource, it is structured in a way that allows you to easily reference sections that integrate disease processes with normal physiologic processes. For example, Chapter 2 has a 6 page excerpt with descripitions of all normal heart sounds, as well as pathological causes and explanations of abnormal heart sounds. If a disease is explained later in the book, Lilly places the appropriate chapter number to point you in the right direction.

Lilly Pathophysiology of Heart Disease Fourth Edition

There are a few disadvantages to this review book. Lilly admits that Pathophysiology of Heart Disease is not meant to be a resource for in-depth questions prompted by the burning minds of future cardiologists. For example, although the book goes to great lengths to describing the mechanics behind an EKG, it falls short of providing the best explanation and a more exhaustive list for pathologies seen in different EKGs. However, to make up for the lack of detail inherent in a review book on cardiology for a med student, Lilly does provide additional readings that he cites at the end of each chapter.

Nevertheless, Lilly is a must-have to help you sort through the massive amounts of information thrown at medical students during Cardiology. It breaks everything down into concise, but understandable text that is rarely found in medical education. The Fifth Edition of Lilly’s Pathophysiology of Heart Disease can be found at the below links. If you want to save some money, the fourth edition (above) covered practically everything needed for my Cardiology course. Regardless of the edition that you choose, Lilly will not disappoint!


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A High Yield Complement: BRS Physiology

Board Review Series (BRS) PhysiologyBoard Review Series (BRS) Physiology, now in its 5th edition, is the leading resource on physiology concepts crucial for the foundation of medicine as well as those highly tested on the United States Medical Licensing Examination (USMLE) Step 1. This book, written by the esteemed Linda S. Costanzo, Ph.D, provides very clear and concise explanations of essential physiological principles of each organ system as well as those of cellular physiology. This text contains many clinical examples and sample problems to help medical students test their understanding of these concepts and their application in clinical scenarios. Each chapter concludes with a review test, accompanied by explanations and references to sections from which the question arose. To further aid appreciation and long-term retention of these key principles, many full-color illustrations, flow diagrams, and tables as well as a summary page of “Key Physiology Equations for USMLE Step 1” are included. Additionally, each book features a scratch off code which provides access to supplementary online resources, such as a question bank and a comprehensive examination with an image bank, on The Point.

This book provides a clear outline with appropriate breadth and depth of high yield material that is most commonly tested on USMLE Step 1. It is recommended that this book be read in conjunction with corresponding physiology courses throughout med school or as part of review for the boards. Because this book presents the material in a very straightforward manner, it helps to simplify difficult concepts to better understand medical physiology.

Despite the many benefits of using this book as part of any study plan for the USMLE, there are a few drawbacks which should be noted. Many of the questions featured in the chapter Review Tests and Comprehensive Examination are not written in the style of the USMLE Step 1. Rather, most are short questions that are aimed to test the knowledge of key concepts and should not be relied upon to gain familiarity with the format of the USMLE Examinations. The review questions are also simpler than most found in question banks and the exam itself. Lastly, this book is designed to be a review book and as such should be used in conjunction with more comprehensive resources such as textbooks, classroom lectures and syllabi.

The material in this book is organized into seven chapters by organ system, each of which ends with a review test and explanations. The first chapter provides a general overview of Cell Physiology followed by chapters on: Neurophysiology, Cardiovascular Physiology, Respiratory Physiology, Renal and Acid-Base Physiology, Gastrointestinal Physiology, and Endocrine Physiology. This Board Review Series book culminates in a 99 question comprehensive examination which is followed by explanations and page references.

Overall, this book is highly recommended to medical students for learning the physiology of the major organ systems, and especially in conjunction with Tao Le’s First Aid for those who are preparing for the USMLE Step 1. This reasonably priced review text will provide any medical student with a clear understanding of the most frequently tested physiology concepts and to provide a solid foundation for a career in medicine.


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