USMLE War Journal: 15 Days Until Test Day

At this point, my fellow medical students and I have been out of classes for about 19 days (which seems unbelievable).  This week I noticed a lot of my colleagues starting to wear down but many seemed to have anticipated this and cope in their own ways. 

Here are two more sketches from the past couple weeks.

This first one is my version of my school's old logo.  Since my school has changed its name and logo I really do not think (and hope) that there are any problems with me posting this.  At the very least, I have only good things to say.  I was a really big fan of the old logo from a graphic design standpoint.  Symbolically, it told you every thing you needed to know about my school.  Like any good logo it had seen some slight changes throughout its use but it was still recognizeable.  Mine does the same in making some slightly different design choices.

This second one is a sketch of the superhero Dr. Mid-nite after the famous painting The Doctor by Luke Fildes, which I have wrote about before.

Step 1 Art: My Tribute to the Original Orignal Green Lantern and his Children

This is the first of many just-for-fun sketches I've done in my spare time to do something creative during Step 1 studying.  There's quite a bit into why I decided to draw the characters I did.  A couple days ago, DC Comics announced that in his new incarnation, Alan Scott, the original Green Lantern, would be gay.  As a big fan of Alan Scott and the JSA in general, this has been one of the most bothersome of the changes at DC Comics. 

It's not that I have anything against gay people.  In fact, I have many gay friends and I am a fan of many gay fictional characters.  As a matter of fact, Todd Rice aka Obsidian, Alan Scott's son (the blue guy on the left) is an openly gay character from the old DC.   

What bothers me is DC's discarding of Alan Scott's rich, albeit more obscure, 70-year-history as a DC character and the work of the writers and artists that helped make that happen all for what is nothing more than a publicity stunt.  In the preceding weeks before the announcement, DC teased that they were making an "iconic" character gay and there was much speculation on who this might be with names like Tim Drake (one of Batman's Robins) and Wonder Woman thrown around.  But when it was annouced that Alan Scott was the character that was coming out many including myself have felt it is the king of all cop outs.  Sure he is a Green Lantern but he's only really known in comic circles these days so most people are probably just as confused when it was announced that Miles Morales, a Afro-Hispanic-American, would be the new Ultimate Spider-Man. 

While I do appreciate DC trying to be progressive, it feels that the LGBT movement has been undermined to generate more publicity for itself (a common theme lately).  I doubt sales this week will be that much more increased or gay readers will be more drawn to DC titles.  So the victims of this little marketing ploy?  Just the original Alan Scott and, until some comic book universe tweaking occurs, his kids Obsidian and Jade.  If you knew the old Alan Scott, you probably enjoyed that everything about him was old.  I mean, his costume for most of his history has been a red shirt tucked into green pants with a cape!  However, the other DC characters respected him as a veteran.  He represented that Golden Age morality that is impossibly forthright and good and survived for 70 years despite the changing of the times.  And maybe it's appropriate that such a character is retired now but I really would rather he was still around. 

USMLE War Journal: 22 Days Until Test Day

Well this last week started off great and by great I mean I had a low-grade fever for three days.  Next time I am going straight to acetaminophen.  NSAIDs just wouldn't keep the temperature down long enough.  It was not really a preference thing - I was just hoping to treat myself with whatever I had laying around the house.  On day three, I gave in and went to go buy some acetaminophen. 

This is exactly the sort of unexpected thing I anticipated when I built in leeway in my schedule.  There were times where I couldn't power through anymore and had to lay down.  It seemed the more I tried to do board studying, the higher my temperature got.  What made it worse was I had terrible sleep those nights.  I got up every two hours it seemed.  Unable to exercise due to illness, I found myself a little depressed from not having some kind of non-academic outlet.  Watching TV is a little too passive for me and sometimes I am not in the mood to read (although I did read a ton of comics while sick).  The past couple days, I started drawing again, mostly superheroes.  I am not a a particularly amazing artist or anythign like that.  My own honest assessment of my own work is that it is a slightly above average amateurish style.  But it did give me something to do.  When I finish my first one I might upload it.  My second one is my own take of a classic medical painting.         

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.

My Favorite Board Question

I've been studying almost all week during my spring break and it made me think of this question which is pretty well known among medical students.

Why Studying for Boards is Going to be so Much Better Than Studying for Classes

These are the changes I am welcoming in about a month (yikes!)

1.  I can stay home.  My spending on gas is going to be at least half of what it is now. 

2.  I can keep things interesting.  Usually I am mentally checked out after about the second or third hour of lecture unless a really good lecturer is going to talk.  I definitely plan to go through multiple subjects daily so that I don't get tired of the same subject all day.

3. My leather chair at home is a million times more comfortable than anything I ever sit on at school.  'Nuff said.

4. Dr. Edward F. Goljan.  Do I really need to explain this one?

5. My one job everyday is going to be studying for boards.  All other demands on my time are going to be suspended and my purpose is going to be singular... sexy.