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

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