How I revise for exams
Dear Friend,
Hope you have had a nice week. The past week has been a long week for me, as I was working 4 on-call shifts (12 hours) in a row on the medical take. For those of you who aren’t familiar with this, the medical take is seeing patients in A&E who have been referred by the medical team.
Whilst the A&E does any initial investigations and management, my job is to formally clerk the patient taking a full history, doing investigations, prescribing medications, forming a management plan. It involved having ceiling of care discussion (e.g. DNA CPR) if appropriate and then reviewing the patient with the consultant.
As several students have asked me, this week I wanted to share with you how I revise for exams. I am not saying this is the best strategy but it is the one that works for me.
- Make notes
As you have probably figured out by now, I like writing notes. I am not one of those people who can learn directly from a textbook – I find it is not in an easy to remember format. In addition, I don’t like the idea of just doing question and question. I feel this does not give you a proper understanding of the problem and it is only memorising questions.
By making your notes, I do not mean just repeating information in the lecture notes or online. If you rewrite and most importantly reformat the information, your brain is forced to process the information and think about it on a deeper level. And by doing this, it is much easier to remember.
The note taking process is by far the longest part of the process and it may take 75% my whole revision period. But it does prove valuable later.
2. Learn the notes
Once I have written the notes, the next phase is learning them. You will naturally retain some parts easier than others. Unfortunately this is the most boring part of revision, as it involves memory repetition. Working in different environments like libraries and coffee shops can make this less arduous, but it has got to be done.
3. MCQs and past papers
The next phase is the MCQs and past papers. Many people think this is the point where you are testing yourself – however I consider this part of the revision process. The main point of doing this is to find out bits of knowledge that you still do not know. I do not care too much how well I score, and I am just interested in the questions I get wrong.
Once I have done the questions, I make a note of all the ones I got wrong and the extra knowledge I need to learn.
4. Learning from mistakes
I think this is the differentiator step. In this part of the revision process, I make notes on the questions/topics I got wrong and learn those. This helps to iron out any weaknesses in my knowledge.
5. Final mock tests
Once I have done all the previous steps, it is then when I do the final few mock tests under timed conditions. Rather than trying to learn new knowledge, the purpose of this step is to perfect the exam techniques, such as timings etc. If you perform well in this step, you can then go into your exam feeling very confident.
Performing well at exams is as much about strategy as it is intelligence. Alongside this, make sure you are sleeping and eating well as well as taking time out to do fun things. Personally, I can’t revise more than 4 hours a day, and the most I have ever done is 6. I’d rather start earlier in the year, and by now I have enough faith in my formula to stick it out and not panic.
I hope you found that useful and you may wish to consider trying it out.
I know some people prefer using Anki notes – if you are interested, check out this blog on In2Med which explains how my friend uses Anki notes to revise.
Drug of the week
Ranolazine
This is a drug which is used to treat angina and improve blood flow in ischaemia.
In the heart, a late inward Na+ current causes increased [Na+] i
This reduces the driving force for the NCX, which leads to increased Ca(2+) impairing relaxation.
This increases ventricular wall stiffness compressing coronary arteries.
The drug therefore blocks late inward Na+ allowing the cell to get rid of more Ca(2+)
This reduces Ca(2+) overload and reduces compression on coronary arteries to increase blood flow.
For more pharmacology notes, check out the updated pharmacology section on In2Med.
A Brain Teaser
A 72 female patient comes to see you complaining of generalised weakness, which has got progressively worse for the past month. They feel quite stiff and generally sore, without any focal areas of pain. Over the past week she has also noticed a worsening rash on parts of chest and back and particularly her face (affecting the upper eyelids) and her knuckles. She reports that she has had IBS for many years, and regularly gets constipated – she has tried taking laxatives for this which work sporadically. She had her menopause 20 years ago, is an ex-smoker and BMI 28. Takes some blood pressure and cholesterol tablets.
She is sent by her GP for a set of blood tests including FBC, LFT, U&Es, CRP, Vitamin D, Thyroid profile, HbA1c.
- What additional blood test should be ordered?
- What imaging would you consider for this patient?
- Given the underlying diagnosis, what is it also important to screen for?
Answers
What additional blood test should be ordered?
Creatinine kinase. This is an enzyme that mainly exists in your heart and skeletal muscle, with small amounts in your brain. If it is raised, it suggests a diagnosis of a myositis (inflammation of the muscle). This is consistent with the history of muscle weakness and fatigue.
What subsequent investigations would you consider for this patient?
To diagnose dermatomyositis, the following imaging can be helpful:
- Antibodies – there are several antibodies associated with dermatomyositis, including anti-Jo-1 and anti-Mi-2
- EMG
- Muscle biopsy – this is the definitive diagnostic test which should be performed in all cases of suspected DM.
- Muscle MRI – this gives information about whether the muscle is inflamed
- Echocardiogram – dermatomyositis also affects other organs like the heart, so it is important to check this.
Given the underlying diagnosis, what is it also important to screen for?
Remember, dermatomyositis can be a paraneoplastic syndrome secondary to an underlying cancer. In this patient she should be screened for cancer. With her history of vague symptoms and IBS, a particular cancer that raises suspicion is ovarian cancer. Take a full family history and consider sending a CA-125.
