First of all, let me thank all those people who read my article ‘My First Year MBBS Experience’ and gave valuable feedback as comments and mails. Their feedback and constructive criticism make me feel more responsible and have been the stimuli to write this article.
Our finals exams ended on 20th of December 2015. I went to attend cousin's marriage after that. But surprisingly, the result came after three days. That too at 1.30 am. I was waiting for the result from 10.00 pm onwards. My whole family woke up from deep sleep because of my laughter in the sense of victory. This time also I got 70% marks. I couldn't sleep properly that night because I didn't expect that much even though I was forced to go to my bed. So what I want to say is that, second professionals is comparatively easy.
The 2nd year rather 2nd professionals actually last for 18 months even though the name says something else. Third, fourth and fifth semesters are devoted to 4 non clinical subjects which are pathology, microbiology, forensic medicine and pharmacology. The hangover of first year exams may predominate over the thirst to learn in this year which happened with me of course. Since I had enough time, I started watching English movies and it improved my vocabulary. As we all know that third semester is known as the honeymoon period because no one will open the book. Unlike first year since the questions are much more predictable this year we used to skip the portions which were least important as far as exams are concerned. As usual the initial exams were tragedies like ‘Othello’ of Shakespeare. Frankly speaking, I passed only the pre final and final exams of forensic medicine.
Most chapters of pharmacology and pathology start with relevant physiology. So to understand these subjects well, you have to revisit your physiology textbooks. But microbiology and Forensic medicine are totally new subjects. Just like all the first year subjects, these subjects also have some general topics which would be taken in the first month of the course. It would be good to spend time to read relevant physiology.
Pharmacology is easy in the sense it is very closely related to physiology. But at the same time it is difficult because names of drugs are not very easy to remember. It is important to have an idea because your relatives who think that you have become a great doctor will definitely ask you about some drugs and it will be embarrassing if you couldn’t say about that. General pharmacology is easy to understand because it consists of some basic concepts and some calculations and I am sure that all medical students in India have solved very difficult numericals in order to crack the pre medical test. It is very interesting also. But still the examiners are very fond of asking questions from this part especially based on pharmacokinetics. My pre final long question was based on zero order kinetics. The diagrams of all drug receptors are important especially the G-protein coupled receptors. The book Katzung is a good book to undertand the concepts of pharmacology.
All the approved regimens and guidelines are very important. For example, direct question about different regimens of tuberculosis and malaria can come as a long answer question. You have to learn the dose of those drugs which are included in standard regimens. Otherwise except for emergency drugs, you don’t have to learn the dose of each drug by heart. Initially it will be very difficult to remember the names of drugs. I also faced the same issue, and same will be case with 99% of medical students. With practice and time this problem will get solved. Whenever you read a topic, study the prototype drug well because the other drugs will be very similar to the prototype and questions will be mostly based on the prototype drug. Pharmacological treatment of TB, Migraine, Myasthenia Gravis, Gout, Rheumatoid Arthritis, Malaria etc. can appear in the question paper and make you Hemodynamically unstable. Read TB and malaria from an Indian book because most of the foreign authors have not given enough importance to these diseases because these are not endemic in their countries. I used K.D Tripathi for this. Another important question will be about the therapeutic status of a particular drug. We have faced questions like ‘Write a short note on the current therapeutic status of Methotrexate in Rheumatoid arthritis and beta blockers in hyper tension’. For this question, write whether that drug is the first choice drug or not and why. Chemotherapy was difficult for me. The best way to study it is to correlate it with microbiology.
Pathology is a special subject for me because I passed in all exams of pathology like biochemistry in first year. This statement doesn’t mean pathology was a cake walk for me. It is a vast subject. Any disease will come under this. It forms the base of medicine. But questions from pathology usually come from limited portions. So the fact that the questions are highly predictable makes it easy to pass. Robbins is the book for pathology. It is slightly lengthy but the explanations are too good. The pictures make it easy for you to understand. Unlike general anatomy, general physiology etc. general pathology is extremely important. The ten chapters of general pathology are equally important. The first chapter cell injury is such a chapter in which nothing can be left unread. If you study neoplasia well in general pathology, you can use that knowledge whenever you encounter a neoplasm in systemic pathology. Read Robbins regularly because it will take only 12 hours to forget everything that you read yesterday.
From systemic pathology heart, liver, G.I tract, lung and blood are the most important. Anemia, especially iron deficiency anemia is unavoidable especially in a country like India where it is very common. AML, ALL, CML, CLL, Multiple Myeloma, Hodgkin’s Lymphoma and Burkett’s Lymphoma are the important neoplasms to be learned from the blood cells chapter. Peripheral smear findings of these are as important as iron deficiency anemia. Morphological features of the concerned pathology both macroscopic and microscopic, is a must to write in the answer sheet. So give enough time for that. The best way to remember microscopic morphology is to correlate with slides that you see during practical classes. Pathologists like diagrams as much as anatomists do. So for every question, try to draw a diagram. Rarely, they do ask about questions like markers of myocardial injury. Differentiate between two entities will definitely come for exams. We always had four to five such questions for each exam. Apoptosis versus Necrosis, White thrombi versus Red Thrombi are examples. Examination of CSF and urine are asked in practical exams. The appearance of both in different conditions is asked in viva. Instruments used for different procedures will be kept for spotting and you can expect 2 questions based on that for practical. I used Harsh Mohan’s practical manual. It is a book worth spending money on. A detailed description of all important topics in pathology can be found in my article on Must Know Exam Topics in Pathology.
Microbiology means the study of micro organisms. But don’t think that it is very small. In fact this subject ias a stand out example of how small organism can increase the mental stress of a medical student. It is one of the most memory consuming subject. General bacteriology is easy. Bacterial growth curve, bacterial genetics and drug resistance are usually asked from this portion. Immunology was my favorite topic. It is interesting and easy to score also.
Bacteriology is vast and very difficult to remember. For me, it was difficult to remember the virulence factors of each bacteria. Fortunately our long questions were clinically oriented, so we were not asked about virulence factors often. Small chapters can also trouble you. We had question like Hide Potter’s disease in our pre finals. Learn well the approach towards the diagnosis of pathogens in cases of diarrhea, dysentery, abscess, sore throat etc. Remember, lab diagnosis is the most important question in microbiology. Everything is well given in AnanthaNarayan. Virology, mycology and parasitology are comparatively easy. Life cycle and hosts are must know in parasitology. HIV, Hepatitis B, Influenza and TORCH organisms are the possible questions. Genetic shift and drift of influenza is a burning topic because of the pandemic of H1N1 that consumed the lives of many all over the world. Common names like liver fluke, pin worm, seat worm etc. can be asked in the viva in parasitology. I used Baveja for parasitology. K D Chattejee is another option. Opportunistic infection is the most important topic in mycology.
Forensic medicine was the subject towards which I was slightly ignorant and the reward was poor scores. You just need to have some common sense to understand forensic medicine. All I.P.C sections are important. This subject is important to learn because if you don’t know the laws, you may land up in legal troubles. Age and sex determination using bones is an important topic. The exciting part of this subject is postmortem examination. It is interesting to see hanging and accident cases and do an autopsy. My teacher told me once that if you don’t know the definition of rape, then you will fail. That much is the importance of sexual offences. Toxicology is another part of this subject which is amazing. I used the book written by V V Pillay. It contains so many stories related to the subject. My friends used Reddy and Parek.Weapon examination comes in practical exam. Mention the types of injuries possible whenever you get a weapon to examine. Forensic medicine is easy but don’t ignore this subject like I did.
This is a wonderful year because you have ample time to enjoy and relax. Since course is of 18 months, there are enough opportunities to bunk classes. It is the best time to develop co curricular skills. Clinical postings will go simultaneously with the non clinical subjects. It will be great if you correlate the knowledge you gained from these four subjects with the case allotted to you in the hospital. Watch serials like House M.D now because now you can understand the pathologies and drugs stated in that.
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