Pathology

Pathology is the most important M2 class. It is your best preparation for Step 1, and will teach you the vocabulary of clinical medicine you will rely on for the rest of your career. You would be wise to make this class a priority.

In the first semester, Dr. Nandkumar will advise students to begin doing a few practice questions every day. The reason for this won't be obvious at first, since the first (general path) exam is very similar to the exams you're already used to. Starting with the next exam, however, you'll be entering the world of board style questions. These are based on clinical vignettes, with two steps of logic. That is, you will read a vignette, then instead of being asked for the diagnosis, you will be asked about some more obscure detail about the diagnosis. The question will force you to integrate information instead of simply recognizing the correct answer from a list. For example:

A 34 year old man comes to the emergency room complaining of a sudden, severe, "10 out of 10" headache. The headache started abruptly 2 hours ago and has been unremitting. Physical exam reveals bilateral papilledema and neck stiffness, but no focal neurological signs. Which of the following is most likely to contribute to this patient's presentation?

A. A DNA virus. B. Charcot-Bouchard aneurysm. C. Adult polycystic kidney disease. D. A budding yeast cells.

In order to answer this question, you must recognize the classic presentation of a subarachnoid hemorrhage, know that SAH can be caused by a ruptured berry aneurysm, and know that adult polycystic kidney disease is associated with berry aneurysms.

This style of question can be considerably more difficult than M1 questions, and is disorienting before you're accustomed to it. The best way to make sure that you don't lose ground to the question style is to take Dr. Nandkumar's advice and begin doing practice questions early and often.

Getting ready for the Subject Exam (the Shelf)
The subject exam is a nationally standardized exam that is cumulative for pathology and worth (at least in 2010-2011) about 25% of your path grade. Oddly enough, though these questions are not as hard (detailed) as Nandkumar's, students generally do worse - because it's comprehensive and/or because they aren't used to the question style. If you've been doing lots of practice questions all year, it will really pay off here.

This should be obvious, but you'll only have a few days (if any) between your last regular path exam and the subject exam. There's no time to re-learn path, so keep up with the class as you go though the year. If you can, the best prep is probably to go through Goljan one more time, or at least re-read your weaker sections. It's also a good time to finish off the Robins Review book practice questions.

This test is probably your first real glimpse of what Step 1 will be like.