How to remember the Helical Viruses :)

Helical Viruses
(All enveloped, all helical, all ssRNA, segmented 2nd floor, all negative, except Corona/Sars)

This story revolves around a frat house…
All frat houses have a sign: This house is the helical house (swirl on the roof)
The Flag for this house has a bottle of CORONA and stars (SARS)
v It’s the only good thing about the house (only +).
When frat boys are outside the house they try to portray a (+) image… but inside the house, there’s a bad reputation (it’s all (-)) and there are lots of secrets (everything’s ENVELOPED).

On the 2nd Floor – segmented into ROOMS.
ROOMS = SEGMENTED
Far Left Room
What do frat boys like to do… Watch football… Thus the ARENA Room today’s game is between LASSA vs LCM in a Machupo (match-up). There are 2 teams in the game (2 segments).

Middle Room
The window was left Open (ORTHOMYXO) and “in flew” (INFLUENZA) 8 birds (8 segments)…

Far Right Room
Here we have a crazy rabbit with three ears (3 segments) named BUNYA, who is bleeding (hemorrhagic fever). He has a bit of a mean streak so he carries a bloody spear to go hunting (HANTA). (Alternatively, he is “Haunted” by the others in the house.) He hates living at the frat house so he decides to run away by jumping on a RAFT and going down the RIFT VALLEY, crossing to LA, California (La Crosse) where he unfortunately gets CALIFORNIA ENCEPHALITIS.

On the 1st Floor
NO ROOMS = NON-SEGMENTED
Far Left
PARAMYXO party (a “pair of mixers”) with MMR – P
MEASLES, MUMPS and RSV – PARAINFLUENZA – all these kids are underage (these hit mostly kids), and one’s in a wheelchair
(don’t confuse this with the MMR vaccine, which is measles mumps and rubella. Para-myxo – Greek = around -mucous)

Far Right
Once during initiation time, one very unfortunate young, MARBURG man came down with EBOLA.
As you can guess this didn’t turn out favorably so the frat FILO (filed) this incident away for no one to hear.

Middle To protect the file cabinet, behind the bullet shaped door the, the boys bought a mad black dog (Nigri bodies) named RHABDO, who had RABIES

Virus Story

The Virus Story - draw it out & make it better! - for you!! - (click on image to enlarge)

Icosahedral Viruses – all RNA viruses, all +
First, draw a hexagon (I know it’s not an Icosahedron, deal). Draw a dotted line down the middle (the “Great Naked Divide”) – now remember Everybody’s naked on the West Coast (tough stretch… I know), but in the East, everyone wears Envelopes.

1) PICO
A very sick boy named PICO POLIO who can’t walk. That’s why he rides a RHINO. He drinks saki (COXSACKIE), but someone has put feces in his saki. Now he has Hep A (fecal-oral transmission). He complains of his aching stomach and yells “Oh…Oh…Oh…” which sounds like an ECHO.
He decided to go to Cali(ci) (i.e. California) for a 2nd opinion.
2) CALICI
He arrives at NORWALK for his 2nd opinion and is told he doesn’t have Hep A, he has Hep E (still fecal-oral)
Bothered by the news he decided to go south.
So he hops on the Reo.
3) REO
Going down the river isn’t quick – it takes 10-12 days (segments). (Rotavirus has exactly 11 segments and is the only human Reovirus of concern).
After arriving down south he meets a foxy NAKED lady named ROTA.
They hook up and have a baby, which happens to suffer from infantile diarrhea…
They decide to leave the south and go to Colorado so they DOUBLE BACK (Reo & Rota = only double stranded RNA viruses) on the Reo to CO where they both get the Colorado Tick Fever.
CO didn’t treat them well so they decide to go back South to New Orleans, LA
4) TOGA
They find a Toga Party and decide they want to put on a toga (they’ve crossed the Naked divide, so everything is no longer naked, they’re ENVELOPED) & party…
A few drinks and a few months later they find themselves with 4 more really sick kids: EEE, VEE, WEE (Eastern, Venezuelan, & Western Equine), and RUBY (who can’t see – cataracts, or hear – deafness, and has a bad heart – PDA). Incidentally, kid with the most Es dies first (EEE more fatal).
Tired of the South, once again, they decide to go to D.C.
5) RETRO
(DC because Retroviruses have Double Copies of RNA strands)
In DC, being the partiers they are, they find a Retro party, drink some more, and have a “swinging” good time… They catch HIV and HTLV…
Finally tired of the party scene they move their sick family to the Midwest where it’s “safe”
6) FLAVI
They go west (West Nile) to St. Louis. When they arrive in St. Louis (St. Louis Encephalitis) they are hungry so they go to a JAPANESE restaurant called FLAVI, which we’ll pretend is along the West Nile (West Nile Virus). The waiter recommends a drink to the couple called YELLOW DENGE. It’s full of C, they say, only it turns out to be Hep C and not Vitamin C. They order it and live SICKLY EVER AFTER…

USMLE Preparation

Check out my posts below and look for me on twitter.

I have also formed a Twibe specifically designed to band together those interested in optimizing their test taking, knowledge base, professional associations and passing on gifts to those who have yet to walk the Steps, made it through medical school or residency and have mentoring to share, stories to tell and pearls to share!

Check it out! http://www.twibes.com/group/USMLE-Prep

d.

Exam skills: The recall muscle will be built over time, effort and energy.

I am of the belief that there are several key skills associated with doing well on the USMLE Step 1 exam. All of which come together to deliver a day in which all we have learned, all the we have strived to become, dovetail together and culminate in a day we will never forget.

Skill One: Determination & perserverence
This skill is developed by doing the absolute best you can do during your 1st two years of medical school. The determination is honed by working daily. Now, there were several in my class who understood this very well. They took every opportunity to study and move information from short-term to long-term memory. Always pre-reading lecture material, always attending class, taking notes, asking questions, involving every sense into the time spent learning material. During breaks b/w class, I would see students huddled in groups discussing the intricacies of the previous lecture materials, going over objectives or planning new strategies. After class, spend time with the material of the day. Go through the objectives and attempt to answer these objectives without your notes (Recall muscle: this will come up again later, so this is important)! Now, break up the material into chunks, working from the area of most familiar to could not recall any part of an objective. Move quickly and effeciently and leave enough time and importantly, energy to cover those items you were not familiar with. How much time is this? Really, it will be up to you, your priorities and obligations.
What did I do, you say? My ave. day was to school by 7am. Whether class was at 8am or 10am, noon or whether we were off that day. I spent at least one hour prior to lecture organizing my day, outlining objectives for my learning that day, making small goals and some pre-reading of lecture material (I also would do some pre-reading after my children had gone to bed). Then, I would attend lecture. I know all you podcasters out there are saying, "ahh, pooey". But, I still attest to the school of thought of involving senses to my learning experience. That involves sight, smell, feeling, writing, & hearing the talk of students all clearly and in the moment. I did use a tablet PC, but the closer I came to exams, the more pencil and paper I used to crunch the info into a study format. After lecture is where the real money is made. If you can get to a point where you can recall information and teach it to someone else, you're golden.

Skill Two: Teach.
Speaking may not come naturally to you, but if you can teach material to someone else, do it. Some people say skill two should be memorize. This is important and they go hand-in-hand, but if you can teach someone material, it will stick @ 5x the speed b/c you have to know it and not look bad doing it and then it will go to long term memory b/c it requires a different set of neurons to store and then retrieve in your own language! You can do this, but you should attempt to not use notes and if you use notes, only crib notes should be allowed. My good friend and I found would do this by learning the material, then coming back with "slick" ways to remember it and teach by going up to a board and writing/drawing/illustrating, etc.

Skill Three: Crunching and Prioritizing.
The exams you will take throughout your med school career all seem to come down to 10 pages of must know material. How you organize this material will be a completely individualized function. I used a lot of keywords, buzz words and major themes that enabled me to conceptualize large amounts of information with as few words as possible. This is the memorization and recall you will put to use.

Skill Four: Practice.
This is a must. Taking the USMLE and for that matter any exam is a matter with being comfortable with the exam questions and how they are asked, what foil answers are there and how to identify key words. Therefore, practice questions and review the answers (even the wrong answers) and why they are the answers or not the answers. I spent a lot of my final days doing question after question. This will deepen your understanding of simple concepts and firm up your understanding of weaker areas. I did this for any test I've taken.

Skill Five: Crunching and Prioritizing.
Once you have crunched once and done some questions, do it again and again until you have the material down to 2-5 pages! This forces you to review, review, review and build your confidence. This will become a cornerstone to your program and will enable you to b/c comfortable answering questions with pressure. It will also put info in that deep, long-term material and build your recall muscle.

Skill Six: Confidence.
You have done the work and then some, you have studied, you have taught, you have crunched and prioritized. This material is there. Speak into your head. Visualize success and the feeling of doing well. Develop an energy of confidence as you enter that room that you are ready to take it on and smoke this thing!

Skill Seven: Calmness.
Once you are psyched and ready to roll, compose your mind, purposely think of focusing your mind on the attack you about to undertake and the single minded alertness to the moment. Let go of distractions of noise and talking around you and focus.

Skill Eight: Taking the Test.
This is important and involves steps (That's an understatement!).

1. Cover the answer choices. Now, I realize this isn't possible with computer exams. However, it is important that you not look at the answers. So, when you are practicing and for a period of time, do this and it will then b/c 2nd nature. We are working on a system here. Stay with me.
2. Read the Stem. What is the question asking you? Many times the vignette will ramble to all ends of the earth and come back to a question that you were not thinking they would ask. Therefore, read the stem of the question 1st.
3. Go back and read the vignette, making note of important keywords, concepts and data a. If you believe you can answer the stem without the vignette, you can attempt it. And, be willing to go back to the vignette if you need to.
4. Recall. Try and answer the stem without seeing the answers. This is where all the recall work & muscle you have built up will come to life and live in the moment. a. If you don't just know it, write out on the side or on a piece of paper what you do know. This will help you build a case and bring in different pathways to answering the question.
   
5. Uncover the 1st 3 answer choices.
6. Eliminate one of those choices.
7. Uncover 1 more and eliminate 1 more.
8. Continue until down to 2 choices.
9. Which of those two choices answers the question best and fits with the information you know about the subject. Or, which of these does not or does not quite fit.
   
10. If you are still unsure, go with the one you have the best gut feeling for.
11. Important step, especially when practicing questions. Rate yourself. Rate yourself on how well you think you did by confidence level. I would put a (+) or a (-). Plus for confident, minus for not confident. Some people used 1 - 3 - 5 (not confident - wavering - confident). By doing this, you can develop some data on yourself, develop confidence in your ability to take exams as you continue to do this. It will give you data on types of questions that make you stumble and those that you rock!

Skill Eight: Is given more in depth to students at the University of Kansas School of Medicine by Student Resources.

Motto of the day: The recall muscle will be built over time, effort and energy.

You can do it!

Trepidation and new beginnings

Starting any new adventure is a time of trepidation. The trepidation is buffered with an excitement and energy that keeps the fears, mostly, at bay.
The previous four years have enabled me to become a physician, yet somehow, I am anxious about the process I will endure in my internship (and the next year in my 1st year of residency as an Anesthesiologist). I think that I am ready, yet I know I am unprepared at the same time. I know there will be many times I feel completely fulfilled and others where I know I have yet to learn what I should already know. I do know I am ready to complete the process and excited to learn.

In the mean time, I will be helping prepare 2nd year medical students for their USMLE Step 1 exam. This is arguably the most important exam of their career and one which causes great 'trepidation' to many a 2nd year medical student. I feel their pain, yet know they will do fine, IF they listen to me (haaaaaaaaaa!). I will be apart of The University of Kansas' Step Prep Program. This program is designed to give 2nd year medical students some basic tools to maximize their potential score on THE exam. I am part of a 3 person team that will facilitate them, coach them, and encourage them in this process. There will be approx. 10 teams with 8-10 students/group.

Over the next month, this blog will, hopefully, pass along some of those pearls and encourage you to reach your best. Check back here soon and I will be posting questions, pearls, mneumonics, links and other such info you might want to know.

Good luck!