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Advice for studying 'smart'? (3rd year med)

I've always struggled with studying smart in medicine and despite working hard I don't seem to revise as efficiently as I could because I seemingly end up trying to cover absolutely everything and dont focus on actual examinable content enough.

Anybody have any ideas on what it means to study smart, and how to do it?
Hi,

My (self-taught) technique was to always ask why and how to any fact - if you have a way of working out facts (and a lot of medicine is deducible from first principles), then it becomes very easy, you don't feel iike you have to memorize 10 heavy volumes each year, AND if you come across Qs that you have not covered you can "calculate" the answer to it.

e.g. in cardiology (I won the prize as a med student), instead of trying to memorize the different heart sounds and murmurs, do it as below:

i.e. work out clinical features from the altered anatomy and physiology:
a) a systolic murmur is one which occurs during systole i.e. between the 1st and 2nd heart sounds [the first heart sound is due to closure of the mitral and tricuspid valves, between the atria and ventricles][the 2nd heart sound is due to closure of the aortic and pulmonary valves between the ventricles and the respective great arteries].

b) a systolic murmur can be produced by aortic or pulmonary stenosis or by mitral or tricuspid regurgitation, since these actions in the valves must occur during systole; the two types are different in quality, pitch and timing as described by Joel. An ejection systolic murmur is usually of a crescendo-decrescendo type [because blood is forced through a narrowed opening], while murmurs due to regurgitation are pansystolic (of steady amplitude and lasting the whole of systole)[since they are produced by lesser backward pressure than ejection ones].

c) a diastolic murmur occurs during diastole i.e. between the 2nd sound and the next 1st heart sound. It can be produced, predictably from a knowledge of the anatomy and physiology of the heart, by aortic or pulmonary regurgitation [leakage] OR by mitral or tricuspid stenosis [narrowing].d) “P2” is the pulmonary component of the 2nd heart sound, the other being the aortic component (A2). In normality, the 2nd heart sound is split into A2 and P2 during inspiration because of the increased venous return in the azygos vein brought about by the negative pressure created in the thorax, which results in a relative delay of contraction of the right ventricle compared to the left so that the P2 (pulmonary artery originates from the right ventricle) is delayed compared to the A2 (aorta is the outflow tract of the left ventricle), resulting in a split 2nd sound. Similarly, the 2nd sound can display reversed splitting in LBBB (left bundle branch block) where the A2 is delayed past the P2 due to delayed left ventricular contraction OR it can be split during expiration, too with a wider split during inspiration in RBBB, in which the delay on the right side of the heart means there is delay of P2 in both expiration and inspiration. Also, there can be a fixed, widely split 2nd sound in atrial septal defect (ASD) where the connection between the left and right atria means that the two chambers act as if they were one, so the gap between A2 and P2 remains constant with breathing [the increase in venous return to the right atrium during inspiration is now effectively an increase in BOTH atria.

2nd example: ANAEMIA: Can result in ONLY THREE basic ways:

1) Reduced input (production) of Hb

a) (aplastic anaemia e.g. rare side effect of some drugs e.g. chloramphenicol [used to treat Haemophilus influenzae meningitis) -

b) deficiency of iron, folate, B12 or copper [all required for synthesis of Hb or of DNA)

2) Increased loss (bleeding [e.g. INTERNAL - perforated gastric ulcer impinging on gastroduodenal artery or left gastric artery) or EXTERNAL - penetrating injury OR multiple fractures.

3) Breakdown of Hb - haemolytic anaemia e.g. malaria in which the plasmodium (malaria parasite) causes rupture of erythrocytes, sickle cell anaemia, or due to toxic substances.

You can use this principle of input, output, destruction, genesis to explain/remember several concepts in medicine

e.g. effects of hyperkalaemia or hypokalaemia on the ECG.Use association/cross-linking to aid memory e.g. above example hypokalaemia can produce U waves on ECG ---> reminds you that digoxin can worsen toxicity of this condition ---> digoxin can cause arhyhthmias -----> digoxin can be used to treat AF ---> AF caused by mitral stenosis + hyperthyroidism + ASD ---> back to fixed wide split of 2nd sound in ASD ---> reminds you of other types of splitting of 2nd sound ---> reminds you of physiology of splitting ---> LBBB and RBBB ---> other types of heart block ---> Wenckebach phenomenon = 2nd degree heart block ----> complete [3rd degree] heart block ---> Stokes-Adams attacks --- other causes of syncope ---> aortic stenosis ---> back to ejection systolic murmur ------------------------------------- > etc ------------------------------------> etc ------------------------------------> etc.

I hope this helps although I appreciate everyone's mind works differently

ANYWAY BEST OF LUCK!.

M (former medical student)
(edited 6 years ago)

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