Well, it’s over. The hardest test of my life.

What’s there to say? I think it went well. I hope it went well. I got pretty lucky - lots of molecular biology†, not much anatomy or pharmacology. This was a good thing for me. I don’t find out how I did for 6 weeks… at which point, hopefully, I too shall be writing a “how to ace the boards” column.

What’s more interesting is that I really don’t know what to do with myself at this point. That was the most consistently amped up - for the longest - that I have ever been in my life, and it’s not easy to go from 120% to 0% instantly. What do you do with 18 hours out of a 24-hour day when you’ve got nothing to do††? Sleep in, for one, but you can only sleep in for so long.

I’m go on vacation tomorrow, to camp on the shores of Lake Tahoe for a week. I’d say I’ll miss you all, but I’d be lying. I’m bringing 6 books, and I plan on reading for the first time in 2 years. I do miss literature.

And now the spectre of the wards is looming. In about a week and a half I’ll be giving my first presentation to a team of REAL doctors. The scary kind that laugh and taunt.

Butler, bring me my brown pants.

†Thanks, undergrad!
††Retiring is going to suck.

askfe.c

fsc

I was walking home, composing this post in my mind. It was going to be deep, eloquent, and more than a little emo. In fact, I was going to talk about peaches. I bought peaches at the grocery store a week ago, but they were rock hard. Over the past couple days they’ve ripened, and now they’re perfect.

It’s a metaphor, you see. I take the boards tomorrow.

Anyhow, here I was thinking about peaches and how very Zen with the world I was. This is the kind of peace the Dalai Lama feels on a daily basis. I got in, shucked my shoes, threw down my wallet, keys, phone, and backpack, and walked out to go get my mail.

The lock clicked behind me.

How exactly do you lock yourself out of your house - for the first time in your life - the night before the boards?

The enormity of the problem soon hit me. You have to prove your identity to take the USMLE - I had no wallet. You also have to get to the testing center. Walking shoe-less through the barren desert is not exactly conducive to test-taking.

What would you do? The night before the hardest test of your life (literally, ever, in your whole life, ever). Remember, you’ve studied 12 hours a day, 6 days a week, for 6 weeks. Would you cry? Run around the street naked like a madman? Would you quietly go insane, babbling to yourself “so close, so close…” while rocking back and forth in a corner?

I’m proud to report that I kept my cool. In fact, all I did was chuckle and say “typical”.

I should mention at this point that my house has steel bars on all of the windows to deter theft (of what, my debt?). TJ and I also lost the extra set of keys we hid outside last year.

And then the most wonderful of things happened. As I walked around to the back of the house, I saw that the latch on my window’s security bars had rusted off. My window, the kind that swings outwards, was slightly ajar, as the handle had fallen off a few weeks ago. The screen’s been busted ever since I moved in.

I swung the security bars open, pulled the window out, tipped the screen onto my desk, and broke into my own house.

Fuck peaches. A peach ripening isn’t a sign. Locking yourself out of your house, and then having all the stars align in glorious union so you can get back in… that’s a sign.

I am going to kick ASS tomorrow.

I’m not a statistician by any means, but I will say an example from High Yield Biostatistics by Dr. Glaser really caught my attention. This stuff is pretty confusing, so I’m going to simplify his numbers a bit further.

There was a study called WOSCOPS that treated obese men with statins. WOSCOPS was a huge study, involving 6,000 men for 5 years. 3,000 of them were given the statin, and 3,000 were given placebo.

Over the course of the study, about 75 men in the placebo group died from heart attacks, while only 50 died in the statin group. We calculate the mortality rates for each group as 50/3000 = 1.6%, and 75/3000 = 2.5%.

Calculating the relative risk reduction is easy:
1 - (risk in the population of interest / risk in the population as a whole)
1 - (1.6%/2.5%) = 33%
Therefore, the WOSCOPS study reported an incredible 33% reduction in cardiovascular mortality from statins. Amazing! Cardiologists everywhere rushed to put their patients on statins, right?

Not so fast.

The absolute risk reduction is calculated by subtracting the 2 percentages. 2.5% - 1.6% = 0.6%. We then calculate the number needed to treat as 1/ARR. This comes out to 166… which means we would have to give 166 men statins for 5 years to prevent one of them dying from a heart attack. This reflects the fact that the heart attacks happened at a relatively low frequency in the study.

Multiply 166 people x $100 a month (the cost of the statin) x 60 months in the study… and you get roughly $1,000,000.

It costs $1,000,000 to buy enough statins to save one life over a five year period. This is why healthcare costs so damn much.

Sorry for the absence†, I’ve been a bit more stressed out than usual. A few quick things:

General Antibiotics for the USMLE Step I

Bacteria
(Almost) Any Gram +: Penicillin
Respiratory Problems: Erythromycin
Big 3 Meningitis(es): 3G Ceph
Diarrhea: Fluoroquinolones
Zoonoses: Tet/Doxycycline
G.E.T. & anaerobes: Metronidazole
Random stuff: TMP/SMX

Parasites
___Worms: Mebendazole / Pyrantel Pamoate (round, hook, whip, pin)
Tapeworm: Albendazole (for cyst form only)
Flukes: Praziquantel
Filiariae: Diethylcarbamazine

A few notes:
Penicillin for community acquired pneumococcus (gram+), 3G Ceph if nosocomial.
TMP/SMX is a random catch-all, including Nocardia (Gram+ but acts like a fungus).
Doxycycline can be used in renal patients, unlike Tetracycline.
1G Cephalosporins are often used pre-op in a surgery suite.
Ampicillin is most often used as prophylaxis before dental work in RHD.
Diethylcarbamazine works for Onchocerca too, but it itches like the dickens. Preferred Tx is ivermectin.

HLA Subtype mnemonics††

Goodpas2ures (DR2)
H3mochromatosis (A3)
Di4b3tes (DR3, DR4)
Ha5himoto’s (DR5)
Steroid Responsive Nephrotic S7ndrome (DR7)
Gr8ves (B8)

Random side note: Type I diabetes is twice as likely to develop in infants who were not breastfed.

† treat with ethosuximide.
†† by the way, I apologize profusely to those of you readers who AREN’T taking the boards in a week. I’m sure this stuff is pretty obnoxious. It’ll get more fun REAL soon, I promise. I start wards in June.