USMLE War Journal: 29 Days Until Test Day

So I have been studying for my board exam for just under a week and I have set up Sundays to be kind of a free-for-all day.  I can catch up on stuff if I am behind on my schedule, hit harder on stuff that has been giving me trouble, do chores, etc.  I must confess this was not an original idea of mine but I like building in flexibility when I make schedules. 

I've also scheduled in time for myself at the end of every week day.  I study pretty much from 8 am to 6 pm everyday and then give myself most the rest of the night for dinner, a workout, even reading and tv.  Before bed, I like to go through cases or quiz myself on stuff I need work on.

For my question bank, I use USMLE World, probably the best bank out there.  After two years of medical school, I have (amazingly) a good working knowledge of the medical science out there but what the question bank is good at is helping me hunt down all the little details I may have overlooked and need to pick up on.  First Aid is good but even it does not have all the answers sometimes (although I do have the 2010 edition).  This week alone I already ran into a few USMLE World questions that had no/inadequate information on certain topics like JAK/STAT pathways and direct factor Xa inhibitors (a relatively new class with rivaroxaban as the only FDA approved one currently; older drugs such as fondaparinux have also had Xa inhibitory action).         

In First Aid's defense, there is a ton of information out there and the majority of it has been miraculously summarized into one volume.  Medical information alone is always changing as well.  I cannot even remember all the times I was tested on a current guideline for screening just to hear it get changed next month.  I have begun to wonder how much the USMLE itself has changed since its creation.  Perhaps I will investigate this after I take my own test.

UPDATE: As soon as I finished writing this I got an update on my phone about the US Preventative Services Task Force recommending against using PSA screening for prostate cancer.  They suggest physicians discuss the reliability of PSA with their pateints.  They also admitted we don't have any good tests at the moment for prostate cancer.

The Killer Croc Differential

So today was the first day of dermatology lectures at my school.  I've never been that enthralled with the subject.  So I decided to do a little independent reading on dermatopathology and thought of (as usual) a comic book connection.  Perhaps one of the most famous comic book characters who has a skin condition is Waylon Jones aka Killer Croc. 

Okay, purported to have a skin condition.  But that's what I like about the Killer Croc character, his exact origin is still shrouded and unclear which fits with his status as an urban legend come to life.  Hopefully, it stays this way (I hated when Wolverine's origin was finally established - it was always more interesting when it was left to speculation).  In the couple decades he has been around, there have been numerous depictions of Killer Croc as well as explanations of his condition:

Killer Croc designed by Bruce Timm for Batman: The Animated Series

1. Atavism - a sort of evolutionary reversion.  In real life, this is seen as people with supernumary nipples, large canine teeth, or vestigial tails.  Depending on which depiction you follow, Croc is a mild to very dramatic example of atavism. 

Killer Croc as depicted by Lee Bermejo in Joker

2. Epidermolytic hyperkeratosis - a rare skin condition where the skin blisters and scales.  I am not quite sure where this first showed up in Croc stories but it was definitely featured in Batman: Gotham Knight, the animated tie-in to Christopher Nolan's Batman universe.  Again, Croc would be a pretty dramatic example but I like the possibility that Croc can be medically explained.

Killer Croc in Batman: Arkham Asylum
Designed by the folks at Wildstorm with obvious reference to
Jim Lee's design from Batman: Hush

3. Just a mutation - the comic book fall back explanation for anything real messed up.  Mutants are not featured as much in DC Comics as compared to the Marvel universe (Stan Lee always wanted semi-scientific explanations for his characters and stories) but Croc could just have mutated to be reptilian-like.