Year 2 Bristol Med School | Summer Exams

It has only been a few days since completing the final summer exams, and you bet your sweet bippy I’m still experiencing severe withdrawal symptoms. These episodes are of an unfortunate recurrence after every exam season, and leave me chaotically conflicted. I’m gonna call it…post-exam subjection trauma (PEST). You know what I mean; how every little ordinary detail in daily life triggers this automatic all-out regurgitation of lecture knowledge where you completely blackout, before snapping back into reality dry-heaving “May 16th please be kind to me”.

*sees a mother breastfeeding her baby in public*

Okay oestrogen = ductal system, progesterone = secretory system? Ooooo but don’t be fooled since progesterone & oestrogen actually inhibit lactation. Nice one. And then, what was it? Oh, dopamine inhibition due to suckling relieves restraint on PRH, prolactin release causes milk production, oxytocin causes that weird “milk ejection reflex”…that reminds me of the “viscous fingering” mechanism in the parietal cells of the stomach, omg that lecture was kinda weird, ha ha ha *still staring at the breastfeeding*

Sigh. This is what PEST does to you – you only see science, not people. 

Anyways, I did a similar review last year of the Year 1 summer exams. Thus, as a sucker for continuity, here’s another.

Systems of the Body 2: Paper 1 (April 23rd)

Structure: 70 best-of-five questions | 1 hour 45 mins

What: Gastrointestinal, respiratory, renal

Remarks: Because we had January mocks on Systems 2, this was just a smidge less terrifying than the others. I have to say, it was much more clinical than I prepared for, but I was definitely expecting it. There was one question where it said a man came in with fever, diarrhoea, etc. and we had to figure out which bacteria he is most likely to be infected with. At this point, it could be any of the options. But then, the vital bit of information is that upon history-taking, it is learned he works in a lab…with lizards.

…so, okay. I get medical school is all about lateral thinking, but the lizard thing was just a little bizarre. Can’t get over it. Lizards.

With drug names, I can safely say this on behalf on all of us: we don’t remember them entirely, and just commit the first syllable to memory. It’s best-of-five, after all. For example, one of the cysteine leukotriene antagonists for asthma is montelukast, but I just think its that Monte Carlo drug, or the synthetic analogue of PGE1 protecting the stomach mucosa for peptic ulcers is misoprostol but I remember miso soup. And then, we all have our idiotic tactics of remembering a list of drugs. Anti-emetics, for example: the 5-HT receptor antagonists. One of them is Nabilone, which sounds like Naboo, that planet in the Star Wars universe, so extraordinarily picturesque it’s almost euphoric (one of the side-effects of the drug). Or furosemide is a loop diuretic; I remember this by the thinking “fur” = dogs, one of my favourite dog breeds are shiba inus, and they have curly tails (“loop” diuretics)…

A lot of the tactics used are incredibly crude, linking up selective information required for exam purposes only in a strange way. And then for others, you go over and over them again, until they just suddenly give way. Like, for me, I didn’t want to just accept the definitions of SaO2, CaO2 & PaO2 – we’re told it’s saturation, content and partial pressure, respectively. I never really properly understood this in relation to the equations given, but one day, it just randomly fell into place for me: SaO2 = the oxygen binding to Hb, PaO2 = the oxygen actually dissolved in plasma, and CaO2 = summation of SaO2 & PaO2. Highly likely I’m just really slow, but I never really got it until I kept staring at it.

Systems of the Body 2 & 3: Anatomy & Histology Spot Test (April 25th)

Structure: 80 MCQ questions | 45 seconds per station (1 hour exam) | Includes topographical anatomy, case scenarios, pathology cases, clinical examinations, radiology, and histology

What: Gastrointestinal, respiratory, renal (Systems 2); nervous system, endocrine & reproduction (Systems 3)

Remarks: Right, so this was the exam I was more disappointed at myself in compared to the others. Anatomy tends to be the slightly (better subject for me than the written papers (keyword: slightly), but I walked out feeling absolute dismay; it didn’t feel like the dozens of hours spent revising, especially on the topics you make an extra effort to understand, paid off. Things that we spent a lot of time in the DR learning (“You need to know this!”), like the various strictures of the oesophagus & its multi blood supply or the lumbosacral plexus roots, didn’t even come up. We had a whole practical dedicated to ears & eyes, and only 2 questions max came up in total for both. My friend said she only knew the answer to another question because she happened to overhear someone directly ask the demos; so unless prompted, there would be no explicit answer that wasn’t even in the booklet (but apparently on the exam).

The questions came at obscure angles, like the innervation of the ureter (only PSNS, only SNS, both PSNS & SNS, etc.) – not even joking when I say it’s this tiny, vague statement at the bottom of the renal booklet “Nerve supply via autonomic plexuses”. There was one station displaying a radiograph of the thorax, and the right lung clearly showed pleural effusion. The question was, “What is the pathology in the left lung?”, in which the correct answer was simply “Normal”, which I didn’t even realise was a trick question until somebody asked me after the exam, “Hey, that trick question though, right?!” I think what irks me is that the formative spot questions in the sessions give the wrong impression of the style of questions that actually came up. But then again, this was just my experience; a lot of people came out feeling pretty good, and that it went better than expected, so I could just be an unpopular opinion (story of my life).

Systems of the Body 3: Paper 2 (April 27th)

Structure: 70 best-of-five questions | 1 hour 45 mins

What: Nervous system, endocrine & reproduction

Remarks: Held in the grandiose Will’s Memorial Great Hall, it was a pretty adorable way to finish the gruelling pre-clinical years. Most of us were tremendously jittery beforehand, because of the fact we have handbooks the length of your average 3.5/5 Goodreads YA novel and tedious 9-5 lectures that happily shoved us off the cliff into anxiety. So, it was a shocker to say the paper went much better than anticipated for the majority of us. Once again, a rather clinical paper – there were quite a few questions on contraception applying theory to legitimate context useful in practice, which I appreciated (though mind-boggling at points). The first question threw everybody off – “How does alcohol cross the blood-brain barrier?” For some reason, I thought drawing the molecule for ethanol would help me decipher the answer (it didn’t). Ask us about the basal ganglia pathways in relation to Parkinson’s disease, and we’ll give you this immaculate answer all backed up with Vancouver referencing. But a stupidly easy question about alcohol’s solubility properties? Well-played, examiners, you’ve caught 228 med students off-guard. My favourite question asked how a patient with mania would present at the GP – one of the options had convoluted SAT words with way too many vowels, but the real star answer was “Staring at the wall and counting”. Not the right answer, but just…right.

There were other little bits I picked up on, like how there were equations the lecturers specifically said to commit to memory, like % ionised, that they just straight up gave in the paper anyway. Then various pathways, including the motor & sensory tracts, auditory & optic pathway, or the spermatogenesis & oogenesis processes, barely made appearances, if not at all. Embryology was absent. It was a little frustrating, because with those topics,  it actually took a substantial amount of time to methodically learn them step-by-step. Then there were those one-off questions, like what the uterus fundal height is by 20 weeks – it’s this tiny sub-bullet point on a slide amongst 37 others, let alone in a booklet of 225 pages. Or which condition can cause increased feet width; intuitively, most would choose acromegaly anyway, but this information was in a video the lecturer showed, not on the actual lecture slides given.

••••••••••

I know a lot of this was nit-picking and complaining about parts of the paper, but overall, I understand exams will always be like this. The really wishy-washy, extremely unpredictable questions that you’ll feel are unfair, but you gotta play the game whether you like it or not. What I’m basically saying is, no matter how much you revise, it’ll never be enough – the learning isn’t necessarily harder than IB or A-levels, but probably down to the sheer quantity and conceptualisation of certain ideas (e.g. the reticular formation or the basal ganglia). It’s learning how to cover everything effectively (but not beating yourself up if you don’t, either), preparing to accept there isn’t always a correct answer, but most importantly, being able to not always want to know why. I say this with a conviction suitable only in this context; this is a mindset that our high school curriculums set us up to think, that there is always some kind of explanation for every question-mark – it’s the whole “big fish small pond” syndrome shaking up the high-achieving kids who tumble down the pyramid. Falling isn’t the issue, but trying to climb to the top again purely out of familiarity, most definitely is. Whether you agree or disagree, hopefully it’s something to think about.

©TMK

5 Songs That Helped Me Survive Exams

       Thank goodness for music. Personally, during exam period, I tend to avoid lyrical music because my mind will latch onto the words and I get a plethora of distracting earworms. The same reason applies as to why I have to revise in silence. So when I am running or on a break, I’ll be listening to the most mellow songs, or if I’m feeling really frisky then I’ll listen to the following soundtracks on extremely low volume when doing work. A little odd, I know, but there you go. Here are a few select songs that ease out the wrinkles on my brain:

  1. “Anna (Piano Version)” composed by Takatsugu Muramatsu from “When Marnie Was There” 
  2. “Katherine” composed by Hans Zimmer, Pharrell Williams & Benjamin Wallfisch from “Hidden Figures”
  3. “Pi’s Lullaby” composed by Mychael Danna & Bombay Jayashree from “Life of Pi”
  4. “Spacewalk” composed by Thomas Newman from “Passengers”
  5. “Go To Her” composed by Mike Higham & Matthew Margeson from “Miss Peregrine’s Home for Peculiar Children”

©TMK

Year 1 Bristol Med School | Summer Exams

Wow, I apologise for the unexplained hiatus I took. 2 months! This post is going to be an unofficial breakdown on the summer exams here in Bristol med school and how I found them (they’re finally over for me, now let’s hope I’ve passed </3).

Systems of the Body #1: Anatomy & Histology Spot Test (May 30th)

Structure: 60 MCQ questions (40 anatomy + 20 histology); 45 seconds per station (hence 45 mins long). The anatomy questions are 50:50 between pathology and identifying structures.

What: In Term 2, we began the Systems unit – for first year, we learn about the cardiovascular system and the musculoskeletal system. Each system integrates both the anatomy DR sessions, histology practicals, and the of course, the abundant lectures. Students tend to prefer Systems over MCBoM, because this is actual information we may need to retain as doctors in the future since it’s much more focused on pathology and we begin distinguishing the normal from abnormal. And for this same reason is why students buckle down and revise that little bit more than the January exams, because it’s the real deal.

Top tips:

  1. DO NOT NEGLECT HISTOLOGY. In Term 1, students saw histology as a bit of a joke, thus neglecting it partially or completely, and got away with relying on knowledge retained from the histology lectures in LT 1.4 those few weeks ago. Sorry, but this ain’t gonna work for Systems! I highly recommend going over the virtual microscope slides (no need to remember the names of each slide – they label it in the exam), identifying what things are and functions of certain cells/structures. All you need to know is in the lecture and the VM, so don’t get all worked up with histology, but do not neglect it. People came out of these exams saying “The frikken histology stuff though, not even funny how much I guessed…”
  2. LOOK THROUGH THE RADIOGRAPHY SLIDES. Again, be efficient with your time and don’t dwell extensively on them, but they definitely come up – it’s the only kind of pathology you’re seeing in first year, so whatever slides they use to teach the clinical stuff, focus on those. They won’t give you a random tiny fracture in the 4th metacarpal bone to identify. Sometimes you’d like to rely on your anatomy knowledge of where things are, but there are just things the radiography slides have that can trip you up if you haven’t seen it before.
  3. KNOW OBVIOUS SIGNS OF CERTAIN PATHOLOGIES. Okay, really obvious. But, if the case scenario starts talking about a 63 year-old man complaining of pain radiating to his back, you can almost guarantee the answer will be coarctation of the aorta without having to read the rest of the scenario. Or if there’s an image of splinter haemorrhages or Osler nodes, it’s bacterial infective endocarditis. If you attempt to remember the hundreds of other causes of back pain or splinter haemorrhages, or research the extensive pathophysiology of pericarditis, it’s a waste of your time at this point – to pass the exam, just key points.
  4. NEVER LOOK BACK. It’s so easy to think back 7 stations to that question on the umbilical cord when you’re looking at the brachial plexus, and be tempted to change your answer. Stop! Don’t do that. I was a victim of that in the January exams. Completely derails your focus on what’s currently in front of you. Trust yourself, because knowledge is lingering in that brain of yours and don’t question your instinctive answers.

Final remarks: Dare I say, the most fun exam, since approximately 60 of us are crammed into the DR, madly stressing under the same sky of glaring white lights that illuminate the bags under our eyes. It’s kind of teamwork in the most independent way. I remember seeing some questions that no way came up in the red booklet, like “What does the umbilical cord contain” and then permutations of 1 artery 2 veins/2 arteries 1 vein etc. – don’t freak out about it. Chances are, if you’ve done your revision and this has not come up in the statements, your course mates will feeling equally baffled. And, there will definitely be specimens you’ve never seen before, like how I saw a hand with Dupuytren’s contracture; not a difficult question, but very interesting to see.

MCBoM Element 5-9: Written Paper (May 31st) 

Structure: 120 best of five questions (mind you, different from MCQs – all could be correct but one answer better than the other); 3 hours.

What: Basically, anything could come up based on all the hundreds of lectures you had since the beginning of Term 2. Also, some random questions pertaining to the various practicals, eBiolabs and STAN sessions could come up.

Top tip:

  1. DO WEIGHTED REVISION. What does this mean? The number of questions per element depends entirely on how much content there was in that unit and how much lecture time was dedicated to it. So, I tended to focus a bit more on Element 8  (clearly not enough, judging by the amount of guesswork done on all the hospital acquired infection stuff…).
  2. START EARLY. Even before all the CVS & MS stuff. Just because the amount of content will make your head implode if you begin two weeks before the exam. Just take it slow and let everything pass your eyes at least once through.

Final remarks: Back in high school I was one of those annoying kids who learned everything on the syllabus and beyond. In med school, that ain’t gonna happen. We’ve all gone from “I’m going to get top in my class!” to “I pray I get 50%”, because if you’re attempting to learn ALL the lectures from Element 5-9, you’re crazy. And no, not crazy in the smart way. Be efficient with your time – 12 hours revision per day will do more harm than good. All I can say for this exam is, just do it + repetition.

Systems of the Body #1: Written Paper (June 1st) 

Structure: 60 best of five questions; 1.5 hours.

What: Basically all the theory you learned in Systems that isn’t anatomy or histology.

Top tips:

  1. CUT THE WAFFLE. You know when you’re listening to Mediasite, and then the lecturer begins droning on about their current research project (ahem stem cells)? Yeah, don’t even bother understanding that stuff – no way they can test us on information they can’t even validate yet. Maybe during summer if you’re really keen on their expertise, but for exam purposes, skip that portion of the lecture.
  2. DRUGS DRUGS DRUGS. There are some lecturers who highlight exactly which ones to remember, and then there are ones who give a list longer than your arm. This is where you really have to listen to the lecturers – which one do they mention a lot? For example, the calcium channel blockers do end in -dipine (well, one subset of them), but the one selective for the heart is verapamil. As for learning side-effects, just know the more outstanding ones – like, one of our questions was “Which of the following drugs has a side-effect of rhabdomyolysis?” and a string of foreign words were listed, but the only drug ever mentioned to have that special adverse effect were the fibrates. Just little things like that.

Final remarks: I did a lot of idiotic things. For example, on the exam, they wrote “osteoprotegerin” and my  mind threw a tantrum because for goodness sake I swear I have never seen that in my life why would the examiners do th- oh. OH. It’s…the same thing…as OPG… Also, there was quite a bit on skin and joint infection stuff which I completely neglected (when in doubt, choose S. aureus). And I spent crazy long revising what cytokines and pro-inflammatory mediators were seen in rheumatoid arthritis and osteoarthritis, but none of that came up. 

••••••••••

Take all of this with a pinch of salt (because we are the last year in the MB16 program of Bristol; starting next year is the fabulous new MB21). Everybody is vastly different in their revision style and approach to learning, so let me just say: I’m not smart. Honestly. I rely a lot on being hardworking. If you’re one of those who naturally assimilate information from just listening to the lecture once through and have the ability to formulate an intellectual question to ask afterwards as well as retain it in a few weeks, amazing! You are awesome. But I’m definitely not one of those people. So, that’s the direction & perspective I took on these exams; it’s just a little something to be aware of.

©TMK