A 29-year-old woman presents to her physician because of decreased libido and amenorrhea. She has tried unsuccessfully for 5 months to achieve pregnancy. CT of the head reveals a tumor. Secretion of a hormone from this tumor most likely directly suppress which of the following hormones?
A. Estrogen
B. Gonadotropin-releasing hormone
C. Growth hormone
D. Somatostatin
E. Thyroid stimulating hormone
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A 1-year-old girl with ambiguous genitalia is discovered to have undetectable levels of serum cortisol and high levels of corticotropin-releasing hormone. What is the most common enzyme deficiency in this patient’s disorder?
A. 17-alpha-Hydroxylase
B. 21-ß-Hydroxylase
C. 11-ß-Hydroxlase
D. 17,20-Lyase
E. Cholesterol desmolase
The First Aid and USMLERx team are please to announce a Free Images Database. This database is filled with numerous images that are useful for the media questions on the USMLE.
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A 50 year old man is intubated in the ER following a trauma. Over the next few days he develops a temperature of 103.3 F, BP of 106/66, Pulse of 112/min and a Respiratory rate of 31/min. The patient is producing purulent, foul-smelling sputum which, on culture, shows many gram-negative rods that are oxidase positive and unable to ferment lactose on culture. There are also ronchi in the lungs. Which of the following agents could be used to treat this patient’s infection?
a) Cefazolin
b) Ceftriaxone
c) Cefepime
d) Penicillin
e) Vancomycin
New feature in the Step 1 Qmax
We have added a predictive score feature. On the Overall Cumulative Analysis Page, the system will calculate the predictive score. The formula uses data from the last 2 weeks of previous tests completed by the subscriber.
The feature is also available for each simulation.
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Finding out you didn’t pass your exam can be traumatic & demoralizing. It can be difficult with all of your friends asking how you did, talking about the exam, and having that weight lifted off their shoulders. You may begin having thoughts about it being a stupid test, blaming your school for not teaching you properly, and thinking you’ll never overcome this hurdle. You may become depressed. Don’t hesitate to get help should you need it.
In the end there is one reality - you have to study again and pass the exam. Analyze how you studied the first time, what was deficient, what was not. Did you do enough practice questions? Were you deficient in a certain subject? Was it just a bad day?
If you took a prep course - contact them and see what services they provide to help you. Contact your school administration to find out their policies regarding students in your situation. Talk to your friends and get advice about what resources will help you best. Consider time off of rotations. Get things in order to go through the study process.
All in all don’t look at this as a horrible predicament. This is a chance to fill the gaps in your knowledge and build upon the foundation that will serve you for the rest of your career!
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There is an interesting study that questions whether or not medical students maintain their empathy towards patients.
Of special note are the following results:
Vicarious empathy significantly decreased during medical education (P < .001), especially after the first and third years. Students choosing core careers had higher empathy than did those choosing noncore careers. Men choosing core careers initially had empathy exceeding population norms, but their empathy fell to be comparable with that of norms by the end of their third year. The empathy of men choosing noncore careers was comparable with that of norms. Women choosing core careers had empathy scores comparable with those of norms, but the scores of women choosing noncore careers fell below those of the norms by their second year.
The study raises interesting points about the difficult road students undertake throughout medical school. Of note is that empathy seems to decline significantly after the 1st and 3rd years.
Certainly this study is not generalizable to the general population, as it only includes students from the University of Arkansas for Medical Sciences for four classes (2001-2004). It does, however, stir an interesting discussion about medical education and its connection with problems in the health-care industry.
Is our medical education system too impersonal? Is it so grueling and competitive that it forces students to “harden up”? Does this problem lead to poor bedside manner in practice? Does our level of empathy predict which specialty we end up choosing?
Hopefully these are problems that are addressed by future interventions in medical education. Until then we must do our part to maintain empathy and do our best to remember why we chose this profession to begin with.
Please feel free to add your opinion about this topic by commenting to this post.
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