Sarath RS lifting a heavy ball

First of all, let me thank those who read my article ‘My First Year MBBS Experience’ and gave valuable feedback in comments and emails. Their feedback and constructive criticism make me feel more responsible and have been the stimuli to write this article about my second year MBBS experience.

Our final exams ended on the 20th of December 2015. I went to attend a 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 mbbs, or rather 2nd professionals actually last for 18 months, even though the name says something else. The third, fourth, and fifth semesters are devoted to 4 nonclinical subjects: pathology, microbiology, forensic medicine, and pharmacology. The hangover of first year exams may predominate over the thirst to learn this year which happened to me, of course. Since I had enough time, I started watching English movies, and it improved my vocabulary. As we all know, the third semester is the honeymoon period because no one will open the book. Unlike the first year, since the questions are much more predictable this year, we used to skip the least important portions as far as exams are concerned. As usual, the initial exams were tragedies like ‘Othello’ by 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 must 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 reading relevant physiology.

Pharmacology: Why it is easy in second year MBBS

Pharmacology is easy in the sense it is very closely related to physiology. But at the same time, it is difficult because the names of drugs are not very easy to remember. It is important to have an idea because your relatives who think you have become a great doctor will definitely ask you about some drugs, which will be embarrassing if you can’t say about that. General pharmacology is easy to understand because it consists of some basic concepts and some calculations. I am sure that all medical students in India have solved very difficult numericals 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 for understanding the concepts of pharmacology.

All the approved regimens and guidelines are very important. For example, a 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, which will be the 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 foreign authors have not given enough importance to these diseases because they 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 hypertension’. 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 : Why I loved it

Pathology is a special subject for me because I passed all exams of pathology, like biochemistry, in the first year. This statement doesn’t mean pathology was a cakewalk 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 longer, 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.

The heart, liver, GI tract, lungs, and blood are the most important from systemic pathology. 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, are a must to write in the answer sheet. So give yourself enough time for that. The best way to remember microscopic morphology is to correlate it 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 questions like markers of myocardial injury. Differentiating 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 is 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; 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: How tiny organisms can make your second year MBBS hell

Microbiology is the study of microorganisms. But don’t think that it is very small. In fact, this subject is a stand-out example of how small organisms can increase the mental stress of a medical student. It is one of the most memory-consuming subjects. General bacteriology is easy. This portion usually asks for bacterial growth curves, bacterial genetics, and drug resistance. 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 questions 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 Anantha Narayan. 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, pinworm, seat worm, etc., can be asked in the viva in parasitology. I used Baveja for parasitology. K D Chatterjee is another option. Opportunistic infection is the most important topic in mycology.

Forensic Medicine and Toxicology: Please do not ignore!

Forensic medicine was the subject towards which I was slightly ignorant, and the reward was poor scores. You 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 face legal troubles. Age and sex determination using bones is an important topic. The exciting part of this subject is the postmortem examination. It is interesting to see hanging and accident cases and do an autopsy. My teacher once told me that if you don’t know the definition of rape, you will fail. That much is the importance of sexual offenses. Toxicology is another part of this subject that 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 a 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 as I did.

This is a wonderful year because you have ample time to enjoy and relax. Since the 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 nonclinical subjects. Please 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 them.

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  1. Thanks for the guidance. I
    Thanks for the guidance. I wish I could express more gratitude than this. My 2nd professional exams begin this fall and your post has been a source of immense help. Also I appreciate your efforts for posting the important topics in pathology.

  2. A nice read.Which books do
    A nice read.Which books do you recommend for Medicine and Surgery? We have their clinical postings in second year. I am confused between Hutchinson’s and McLeod especially.Thanks.

    1. Hi Mona,

      Hi Mona,
      For Medicine – Harrison
      For Surgery – Bailey & Love and SRB(for exams)
      Both Hutchinson and McLeod are good books. Choose any one of those two.

  3. I have been reading your
    I have been reading your posts from 1st year. …It has been really useful n worthwhile. …Thank you. …so much. ..especially for imp topics in patho. ..

  4. I have reading your posts
    I have reading your posts since last year ( 1st mbbs experience ) n right now I am in my 2nd mbbs. ..All this while the posts have been informative n wonderful. ..Thank you for your guidance. ….

  5. A lot of thanks to you , dear
    A lot of thanks to you , dear brother for sharing your experiences… Strictly matching with mine .A great help for a fresher like me

  6. Hey , I have one month left
    Hey , I have one month left before my prelims , do you have any tips on how I should study for this one month and finish all the subjects and score well. I have a lot of trouble with pharmac and couldn’t pass in my previous exams.

  7. first of all thank u for your
    first of all thank u for your guidance
    now i’m waiting for my first year result
    with your guidance (god willingly)ican do my best in second year

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