USMLE Step 1

With my new 'lifestyle changes', I think my mind has become a bit more clear this week.

I've been studying for step 1 of the national medical boards exam, which I'll be taking in June, and I've been starting to panic a bit about the avalanche of material that I need to learn and memorize by then. Yesterday I decided to scrap my original plan (shoving my head full of facts and hoping it all sticks) and try something new. I've always been more interested in how things work than in the overall function of the machine. Like let's take a toaster; it burns bread... big deal. But if we start talking about the heating elements and the timer and the gears and belts and hamsters and elves that make the toaster work, then I'm intrigued. So my new plan is to view the human body as an appliance, and me as the repairman.

For instance, instead of just memorizing that exophthalmos (bulging eyes) is one of the symptoms of Graves' diseases, I try to think through the causes of bulging eyes. I'm a repairman that walks into a room in the emergency department and there's a person with bilateral exophthalmos staring back at me. Now I work backwards. What causes eyes to bulge out? Well, something must be back there pushing them forward, right? Right, so what could it be? Let's run down the short list of categories of disease; mnemonic "I VINDICATE Me":

Iatrogenic (caused by a healthcare worker)
Vascular
Infectious
Neoplastic (cancer)
Degenerative/Drugs (drugs can cause all kinds of adverse reactions)
Inflammatory/Idiopathic (idiopathic means 'of unknown origin')
Congenital
Allergic/Autoimmune
Trauma/Toxins
Endocrinal
Metabolic

When I get to inflammation and autoimmune, I'll think of the causes for inflammation of the orbital fat, muscles, or connective tissue... basically the only things behind the eye that could swell up and push the eyes out. So is there a disease where these things become inflamed? Yes! There's this crazy thing where the immune system accidentally attacks a hormone receptor (TSHr) that exists in the thyroid gland and in the muscles that control the eye. In the thyroid gland it causes wild over-production of the thyroid hormones (T3 & T4), which in turn causes enlargement of the gland itself (a goiter). The extraocular muscles don't produce any hormones, but they do become irritated and enlarged (i.e. inflammation) which is what causes the eyeballs to bulge out so creepily. What's that disease called again? Oh yeah, Graves' disease!

What makes this method better than the other? It relieves me from having to memorize a trillion little facts. Of course I still need to know about the diseases and their pathophysiology, but instead of trying to remember 2 seemingly unrelated things (bug eyes = Graves's ophthalmopathy), I can rely on logic (bug eyes = something pushing the eye out = a tumor, or inflammation).

Another advantage is that I can use the related symptoms to check my diagnosis. So for example if a patient only has one bulging eye, no elevated thyroid hormones, no goiter, and no serum antibodies, I'm going to start thinking of other causes for the exophthalmos. Maybe there's a tumor growing behind the eye etc...

So I'll try out this new method of studying and report back here on how it's working for me.

~Myles