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M2 SURVIVAL GUIDE
3rd EDITION, 2013
Created by
Class of 2015: Darren Chua, Kamalesh Anbalakan, Tan Jun Hao, Jonathan G. Seow
Class of 2014: Liu Xuandao
Edited by
Class of 2016: Tryphena, Zhang Wei

Introduction to the M2 climate


As you move from the study of normal form and function to the abnormal counterpart, it would be easy to think M2 will be similar to M1. But there is drastic shift from a more conceptual content to a more detail orientated content. Subjects that will be covered will include Genetics, Immunology, Microbiology, Epidemiology, Pathology, Pharmacology, Aging, Neuroscience and relevant PBP.

Topics like Genetics, Immunology, Microbiology and Pharmacology are very content dense and will be taught over a very short period of time. As such, it cannot be impressed upon you enough, the importance being consistent.

Many areas of their study can be broken down and grouped to help us organize and easily recall the pathologic steps. For example, gene products, chromosome location, and toxin names should be memorized after you are familiar with the terminology and pathologic processes. More than likely, the mundane facts will only reside in your short-term memory and will only frustrate you if you first attempt to memorize words and diseases you don’t understand.

Another frustrating thing is the lack of tutorial or lecture objectives. Unlike M1, where the profs tend to keep you focused on the objectives, M2 profs do not. They spend the same amount of time on important and unimportant stuff. This is best evidenced in Microbiology where the time spent on the most important bug will be the same meager one hour as the rarest bug. This M2 Survival Guide hopes to be that tutorial objective that would help you remain focused and most importantly sane.

Assessment outline

The exam format for M2 is pretty daunting, but fear not, the key is in keeping your focus right and being consistent:

CA1:


  • Paper 2: MEQ paper consist of 8 MEQs to be answered in 2hr 40mins and that roughly comes to 20 minutes per question. So unlike M1 where you only have 2 MEQs with a luxurious 30min+ to write one essay, M2 paper is a lot about planning your time and writing a focused essay. It might be wise to go toilet before start of paper......
    • What is the breakdown for MEQs? This is the likely breakdown, but do note that variations are possible!
      • Note that questions will be integrated, as usual. Eg. A microbiology question can be combined with its corresponding antibiotic, or pathology of disease.
      • 1 Microbiology
      • 1 Immunology
      • 1 Ethics
      • 1 Epidemiology
      • 1 Medsoc
      • 2Patho
      • 1 Pharm
  • Paper 1: MCQ paper consists of 120 questions. 3 hours =1.5mins per question. However, time should be more than sufficient. Nevertheless, just keep track of time (e.g. make sure finish at least 60 questions at the 1.5hrs time mark)!
    • Based on my personal estimate, the breakdown is somewhat like this [Disclaimer: this is based solely on my own experience. The DO does not reveal the breakdown of the MCQs and the weightage of each topic may vary from year to year.]
      • 30% patho
      • 20% microB
      • 15% immuno
      • 15% pharma
      • 15%: genetics+ cancer bio



Tips on surviving CA1:
  • Broad principles:
  1. Ensure you are very well prepared in the high yield topics (see below)
  2. Consistent studying. There is definitely a lot more to study in M2 than M1. Although with good exam-preparation techniques (like making sure high-yields are adequately studied) it is still possible to pass CA1 through last minute cramming, we must remember that we are studying for our future patients and not just to pass exams! Remember, late is better than never: it is never too late to become a conscientious medical student!
  • High yield and how to study them
  1. Patho.
    • Why high yield? (a) very high weightage: 1/4 or MEQ and ~30% of MCQ, making up ~27.5% of CA1 (b) requires much less time to study well than microB
    • How to study for it?
      • Read Robbins. Doesn't matter if its Mama or Papa Robbins, just finish those 4-5 chapters and make sure you know everything in them. Read through the lecture notes. On hindsight, It will be helpful to make your own notes instead of relying on Hwee's general patho chapters if you have the time (because you probably wont be able to understand all of hwee's general patho [which is very sketchy] unless you've read the chapters in the books. There is no point memorising something you dont understand. )
      • I personally dont like Hwee's general patho chapters. read the books
  2. Epi/ Med soc/ ethics
    • Why high yield? (a) 3/8 of your MEQ paper! (or ~18.8% of whole CA1) (b) it takes so little time to get them done (as compared to microB)
    • how to study for them?
      • Ethics: I highly recommend reading articles+ attending (or webcasting) lectures and tutorials. Make your own notes by noting down salient ethical arguments (not some random collection of information they give in the article). Here is an example of what i did for cancer ethics. The full set can be found in M2 Dropbox

        Cancer and ethics


        Can strike at prime of life
        Arguments for continuation of chemotherapy

        - Beneficence: try utmost to benefit patient
        i. (palliative chemotherapy) by prolonging survival, reduce symptoms incl pain, improve quality of life [curative chemo only small percentage of chemotherapy treatment, unlikely].
        ii. Chemotherapy drugs are increasingly available and better tolerated: even third line drugs may improve survival or symptoms: e.g. erlotinib, a novel drug that are relatively non toxic shown to improve survival compared to best supportive care by 2 months and improve symptoms such as pain, dyspnea and physical functioning

        - Autonomy: If patient so desires

        - Duty: doctor has a duty to ensure all has been done

        Arguments against continuation of chemotherapy
        - Autonomy:
        i. Whether there is informed consent is doubtful because
        1) Patients are not told of prognosis or are not told well wrt late-stage chemotherapy
        a) One study found out that oncologists consistently overestimate prognosis by at least 30%. Another study concludes that physician’s estimate of survival could be divided by 3.5 for actual survival
        b) In the largest study of 95 patients receiving palliative chemotherapy, prognosis was discussed with them by only 39% of medical oncologists
        2) Patients dont believe/comprehend significance of information about benefits and risks of late stage chemotherapy
        a) Studies show that at least 1/3 of patients and families reported they did not believe the info given them that the treatment was not curative
        b) one study showed that if told that a treatment helps 20% of people like them, patients reported a 44% chance of it helping them personally
        ii. Patient may not play an active role in decision making
        1) In one study of women with metastatic breast cancer, only 43% of women took an active role in decision making for second line chemotherapy
        - Non-maleficence:
        i. Studies have suggested chemotherapy may harm patients because they may not prolong and possibly shorten life for those eligible for hospice (i.e. when they have ald failed standard regiments, have poor performance status and otherwise have a poor prognosis)
        1) e.g. the largest study of matched patients who received hospice care and no chemotherapy v those who did not receive hospice care but had chemotherapy showed that survival was significantly longer for hospice patients with lung cancer and pancreatic cancer, marginally longer for colon cancer, but no different with breast or prostate cancer.
        ii. Harm patients by:
        1) adverse side effects
        2) precipitates hospitalisations and emergency department visits
        3) precludes entry into most hospice
        4) expensive and contribute little to patient’s overall quality of life
        - Beneficence:
        i. higher quality of life by avoiding adverse side effects, allow patient time to engage in meaningful life review and prepare for death
        - Utilitarianian perspective
        i. High cost (harm), little real benefit
        - Ethics of care/narrative ethics?
        i. Loss of opportunities to do other important things with his remaining time while pursuing further chemotherapies and clinical trials
        ii. Focus on patient’s goal of care

        Other ethical considerations

        - (beneficence and non-maleficence) Oncology and palliative care clinicians work together more effectively, w improved communications and earlier involvement of palliative specialist to transition patient to palliative care as soon as necessary to avoid harm.
        - (autonomy& informed consent): as patients are vulnerable to fastening on slim hopes, physicians should aim to improve their communications skills so as to help patients to evaluate their condition and choices more realistically and critically.
        i. Straightforward discussion of quality and quantity of life with or without chemotherapy, and only recommend chemotherapy when there is definite benefit
        ii. Avoid overestimating prognosis (98% of terminally ill patients surveyed wanted their oncologists to be realisitic
        iii. Other specific strategy for clearer communications include:
        1) with the aid of prompt list of questions given to patients in the waiting room
        2) holding family conferences to identify decision makers and getting same information across to all
        3) informing people of and granting them access t the actual medical studies and results
        4) write options down in concrete terms
        5) give patient and family time to come to terms with difficult situation
        - (autonomy) Use of decision aides to help patients make informed decisions: comprehensive review revealed that use of decision aid in oncology yielded increased patient knowledge and more involvement in decision making, which may go into reducing unnecessary chemotherapy.
        i. E.g. FAQ sheets that address prognosis with or without chemotherapy in a Q-n_A format using simple terms (1 in 10 rather than 10%)
        - (beneficence& autonomy) Talk to patient to know what she wants to achieve (e.g. presence of family, stay around longer for family esp children, live longer, reduce pain, not being a burden etc) and avoid through treatment. A study by Duke university shows that patient’s end of life goals are significantly different from what physicians believe their goals are. Hence importance of communication skills to benefit patients& maximize autonomy most by matching treatment to goals. Goals can & often do change. Treatment ends when it can no longer meet patient’s goals
        èCommunications very important


        Miscellaneous
        - Possibility for abuse?: various studies consistently show that patients with cancer generally were willing to undergo aggressive treatment with major adverse effects for very small survival benefit, which a healthy individual like their physician would not have found acceptable
        - Palliative chemotherapy is increasingly given near death with more than 20% of patients receiving Medicare in the US who had metastatic cancer starting a new chemotherapy treatment regime within 2 week of death

      • Med soc& info lit: webcast all lectures and attend all tutorials. This is important because they will NOT test what they did not teach in tutorials and lectures. However, how much information you pick up depends entirely on you. If you treat tutorials like "fluff" and do not take notes/ listen to discussion etc, you might miss out on quite a big portion of the content. because there is so little content, make sure you know it well. I highly suggest making notes of the salient points

CA2:

  • Paper 1: MCQ paper consists of 100 questions
  • Paper 2: MEQ paper with 9 questions
    • Breakdown?
      • 2 Pharm
      • 5-6 Patho (can be fused with PBP)
      • 1-2 Medsoc

Pros:


  • Paper 1: MCQ consist of 120 questions
  • Paper 3: OSPE paper:
    • 10 pictures will be given to you to identify and this can include microbiology and immunology not just the patho pots.
      • Many people freak out when they see CA1 microb and immune tested but it will be
  • Paper 2: MEQ paper with 9 questions
    • 2013's paper was very integrated, with the same question covering 2 or 3 topics. General break down was about:
      • 3 questions on Patho+ related pharmaco and epidemiology
      • 3 questions on MicroB+ related pharmaco and patho
      • 1 Neuroscience
      • 1 Aging
      • 1 Ethics

How you should study


There is definitely A LOT to study in M2. You will invariably, at some point, get lost. You may break down and cry, go crazy and do funny things in the library. But fortunately, with proper direction, you can avoid the need of SSRIs to keep yourself in balance.
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The important thing to realize is that in medicine, about half the diseases you study accounts for 90% of the things you’ll see in practice. M2 is a year of abnormal structure and function, aka disease. Therefore, the way things are set up is that you can naturally spot exam topics. If you were the examiner, would you test a student on HIV or mad cow disease?
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When you actually get down to studying, it doesn’t matter if you’re aiming to just pass, pass comfortably, or outgun the smartest of the class. The basic principle always applies: do the basic stuff really well, then move on to the less important stuff. The top scorers of your class are often not just people who know the esoteric conditions in depth. They are people who have very solid understanding of the basic principles and conditions, and are able to go into the details of these common things. Of course, they often are also broad-based, and scare you with their knowledge of bacteriology trivia.
Disclaimer: it is not our intention to encourage you become a poor doctor with a poor knowledge base. Rather, we’re providing a means for you to refine your focus in learning, making you a more efficient and well-prioritized doctor. Ultimately, it is your decision to selectively pay less attention to some topics.

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Start with this table we’ve created!

how to study table.png

Table: Approach to studying for M2



Important stuff for MEQ


Lecture Topic
Must know
Good to know
Advice for MCQs
Immunology
Soluble factors
Complements, their pathways and effectors
Acute phase reaction
Type I IFN
Know generally what the common cytokines do
Cellular factors
All Immune cells and their functions (Not strictly MEQ testable, but knowledge here forms much of the grounding for essays in pathology, microbiology and immunology)
Basophils are good to know, all others MUST KNOW
Principle function plus important cytokines released by the cells.
IL-1, IL-6, TNF alpha important, all others not so important
Ag processing and presentation
MHC I & II pathways

Signals I,II,III for naïve T cell activation, including the cell-contact and cytokine signals involved

Types of APCs and their main functions

Organ transplantation
Positive and negative selection of naïve cells

B, T cell receptor rearrangement

MHC molecule structure and principles behind it’s polymorphic structure
Must know and good to know will cover MCQs well
T cell function
Cytotoxic function
Helper function (TH1, TH2)
Helper function (TH17, Treg)
Usually will not test in MCQ.
Humoral immune responses
Antibody isotypes and their functions

Process of class-switching and the molecules and cytokines involved

Principle of humoral immunity and vaccination (Especially use of conjugate vaccines)

Principles of T dependent and independent responses
Somatic hypermutation & affinity maturation

Molecular process of class-switching and the genes involved

Clinical applications: Antibody titres
Must know and good to know will cover MCQs well
Immune response genes


TCR & BCR genes
MHC genes
Vaccines
MAIN Vaccine types
Vaccine schedules
Eg. New vaccine technologies
Immune tolerance
Mechanism of central & peripheral tolerance

Consequence of failure to deliver signals 1 & 2

Principles of autoimmune disease (See below)
NIL (ALL under “MUST KNOW”)
Questions will be based on “must know” facts.
Autoimmunity
Proposed theory of autoimmune disease

Bystander effect & molecular mimicry

Immunopathology of AI disease (SLE MOST IMPORTANT!)
Rheumatoid Arthritis
(Will cover in bone path)

Cancer and autoimmunity
Need to know examples of molecular mimicry, tested before.
HSC transplantation
Sources of HSC

Pathophysiology of GvHD

Graft Vs Leukemia effect

Knowing when to increase alloreactive T cells

MOA of immunosuppressive therapy
Time course of bone marrow repopulation

Type of immunosuppression to use
Questions on pharmacology of immunosuppression.

Scenario based questions on HSC transplantation will be tested.
Transplant
Allogenic recognition and consequence of mismatch

Immune mechanisms of organ rejection

Hyperacute, Acute, Chronic rejection

MOA of immunosuppressive therapy
Type of immunosuppression to use
MCQs on principles of MHC allocompatibility will be tested.
Immunodeficiencies
HIV & AIDS

Mainly MCQ->
Autoimmune polyendocrine
SCID
X-linked aggammaglobulinemia etc (Not that I have seen them test so far, but do prepare just in case)
Corticosteroids
Mechanism of action
Adverse effects
Drug interactions
Contraindications
Nil (Must know this well)
Know how intermediate molecules involved in corticosteroid mediated immune suppression.
Immunosuppression
Corticosteroids
Cyclosporin
Tacrolimus
Sirolimus
AZT
Mycophenolate motefil
Polyclonal Ab
Monoclonal Ab
Fusion proteins

Must know and good to know drugs likely to be tested in MCQ, the above drugs are unlikely but do prepare for them. Need to know adverse effects, contraindications and indications of each medication.
Pathology
General pathology
Inflammation, Haemodynamic disorders
Infection, cancer, cellular response.
Eg. focus on the steps of inflammation, no need to memorise the trivial factors such as MMP, etc.
Cardiovascular
Hypertension,
Atherosclerosis,
Ischemic heart disease,
Acute myocardial infarct,
Heart failure,
Infective endocarditis
Valvular pathology,
Aneurysms
Pericarditis,
Myocarditis,
Cardiomyopathy,
Vasculitis,
Congenital heart disease
Respiratory
Infections: Pneumonias,
TB pathology,
Asthma & COPD (Must know VERY WELL) ,
Lung CA (SCLC + NSCLC) and their PARANEOPLASTIC SYNDROMES
Nasopharyngeal CA (NPC), Pulmonary HTN & Cor Pulmonale, Pulmonary edema, Pulmonary embolism,
Bronchiectasis,
Pleural effusions,
Pneumothorax
Nasopharyngeal pathology (Very unlikely to be tested in MEQ, EXCEPT NPC), Respiratory distress of newborn,
ARDS,
Restrictive lung disease,
Pneumoconiosis,
Mesothelioma,
Mediastinal pathology
GIT
Gastritis (Acute + Chronic)
Peptic ulcer disease,
Causes of upper and lower GI bleed, Acute appendicitis, Diverticulosis (OSPE),
Gastric & Colorect CA
Oral cavity CA,
Esophageal CA,
Barrett esophagus (know the metaplasia),
Intestinal obstruction,
Bowel ischemia,
Inflammatory bowel disease (UC, crohns)
Leukoplakia
Salivary gland pathology (IMPT in MCQs!),
Inflammatory bowel disease, Miscellaneous CA (GIST, Carcinoid)
Hepatobiliary, pancreas
Jaundice (ESPECIALLY OBSTRUCTIVE), Cirrhosis, Viral hepatitis (HBV), Portal hypertension, Cholelithiasis, cholecystitis,
HCC
Viral hepatitis (Other than HBV),
All Biliary pathology (other than those stated under must know), Pancreatitis, Pancreatic CA, Diabetes Mellitus
Liver vascular pathology,
Liver neoplasms EXCEPT HCC, Pancreatic endocrine neoplasms
Urogenital + male genital
Acute Renal Failure AND Acute Kidney injury,
Chronic Renal Failure,
End stage kidney,
Urolithiasis,
Urinary tract obstruction,
Nephrotic & Nephritic syndrome,

Renal cell carcinoma,

Male: Prostatic CA, BPH
Acute tubular necrosis,
Acute interstitial nephritis, Pyelonephritis, Glomerulopathies for nephrotic & nephritic,
Urothelial carcinoma
Renal developmental pathology, Polycystic kidney disease, Glomerulopathy for microscopic hematuria, Lupus nephritis, IgA nephropathy,
Renal neoplasms except RCC and urothelial CA, Germ cell tumours
Breast
Diagnostic triad, Breast malignancies (Esp DCIS and invasive lobular CA)
Fibrocystic disease, Fibroadenoma,
Mastitis, Papilloma, Phyllodes tumour,
Endocrine
Multinodular goitre,
Grave’s disease, Follicular & Papillary CA,
Simple goitre,
Hashimoto thyroiditis,
Follicular adenoma, Cushing’s
DeQuervain thyroiditis,
Pituitary pathology, Anaplastic carcinoma, Medullary carcinoma,
Lymphoreticular
Know principles of diagnosing lymphomas (pathologically) ,
Non-hodgkin lymphoma (DLBCL, Follicular lymphoma, MALT lymphoma, Burkitt)
Hodgkin lymphoma
Lymphadenopathy, Leukemias
Bones and joints
Osteoarthritis & Rheumatoid Arthritis,
Osteosarcoma,
Chondrosarcoma
Pseudogout & Gout,
Osteoporosis, Osteomalacia,
Osteomyelitis
All other bone tumours except osteosarcoma & chondrosarcoma
Nervous System
Raised ICP,
Hydrocephalus,
Cerebral herniation,
Cerebrovascular accidents,
Intracranial haemorrhage - 4 types,
Hypertensive encephalopathy,

Infection: Meningitis, TB

Alzheimer disease
Parkinson disease
CNS tumours: Gliomas & Medulloblastoma

Infection: Abscesses, Viral encephalitis
CNS tumours

Infection: Fungal, Syphillis, Parasitic, Prion

Neural tube defects

Forebrain abnormalities

Alcoholic encephalopathy
Microbiology
Introduction to microbes
Nil
Nil
Nil
How microbes cause disease
Comparison between endotoxin and exotoxin
Nil
Nil
How microbes spread
Different types of spread- Direct, indirect, vector, droplet, fecal-oral & airborne
Nil
Nil
Infection control
Nil
Nil
This topic is probably tested as one question in MCQ paper and it is normally straight forward
Antibiotic resistance
Different mechanisms employed by bacteria to bring about resistance

Specific details on Lab methods of accessing resistance
General and diagnostic bacteriology
How to collect CSF, urine and faecal matter
Nil
Nil
Gram positive cocci
S. pneumoniae
S. aureus
S. saprophyticus
S. pyogenes
Coagulase – Staph
S. agalactiae
Group D strep
Viridians strep
Gram negative cocci
N. meningitidis
N. gonorrheae
M. catarrhalis

Gram negative rods (including fastidious)
E. coli
Salmonella
V. cholera
P. aeruginosa
H. influenzae
L. pneumophila
Shigella
V. parahemolyticus
V. vulnificus
B. pseudomallei
H. ducreyi
B. pertussis
A. baumannii
Klebsiella
Proteus
Serratia
Enterobacter
Aeromonas
Pleslomonas
S. maltophilia
B. cepacia
HACEK group
C. granulomatosis
Brucella
Bordetella
Pasteurella
Yersinia
Francisella
Gram positive rods
All Corynebacterium
All Clostridia
L. monocytogenes
B. anthracis
B. cereus
N. asteroides
Lactobacilli
E. rhusopathiae
Anaerobes
All Clostridia
A. israelii
F. necrophorum
F. nucleatum
Anaerobe lecture
Chlamydia, mycoplasma, rickettsia
C. trachomatis
M. pneumoniae
Ch. Psittaci
Ch. Pneumoniae
M. hominis
U. urealyticum
M. genitalium
Ch. Psittaci
Ch. Pneumoniae
M. hominis
U. urealyticum
M. genitalium
Spiral bacteria + “non-true spirals”
T. pallidum
C. jejuni
H. pylori

Bejel, Pinta, Yaws
Borrelia
Leptospirosis
Mycobacteria
M. tuberculosis
M. leprae
Atypical mycobacterium
Fungi
Candida
Aspergillus
Dermatophytes
Cryptococci
All other fungi
Introduction to virology



Respiratory viruses
Influenza A viruses
Influenza B viruses
Parainfluenza
RSV
Rhinovirus
Adenovirus
Coronavirus
Metapneumovirus
Dengue
Know everything about dengue

Hantavirus
Alpha virus
JE virus
Hepatitis
HBV, HCV
HAV
HDV, HEV
Enteroviruses
Poliovirus (Esp immunologic basis of polio vaccines)

Coxsackie A, B
EV 71


Herpes
HHV 1-5
HHV 8 (Pathophy of Kaposi sarcoma in cancer biology)
HHV 6-8
MMR

Measles, Mumps, Rubella (on top of this you need to know about the vaccine)

Prions, rabies, parvovirus, poxvirus

Parvovirus B19
Smallpox
Molluscum contagiosum
Rabies
JC virus
Prion disease
Gastroenteritis virus

Rotavirus
Norwalk virus
Astrovirus
Adenovirus
HIV
Know everything, methods of diagnosis, window period, phases of infection, AIDS defining illnesses, prognostic factors


Protozoa
Plasmodium
Toxoplasma


Helminths


Nematodes
Cestodes
Trematodes
Arthropods

Aedes albopictus
Aedes aegypti
Anopheles gambiae

Laboratory diagnoses
Need to know the various lab tests available and the specific ones used in diagnosis of certain infections! This will be mentioned in greater detail in the notes!
-
May come out for MCQ, of particular importance is Syphillis, Chlamydia, Gonococci and S. pyogenes

Hospital acquired (Nosocomial) infections
Know about MRSA, Vancomycin Resistant Enterobacteria, Pseudomonads and what conditions predispose a patient to HAI.

Phamacology
Need to know everything



Neuroscience
How do we control movement? (motor)
Motor Pathways:
Pyramidal Tracts - Corticospinal & Corticobulbar

Spinal Segments & Nerves

Need to know what constitutes a descending pathway, upper motor neuron & lower motor neuron

Need to know how to distinguish between an UMN & LMN lesion for spinal & cervical nerves (Rule of 4)

Tendon Reflexes
Extrapyramidal Tracts - Rubrospinal, Vestibulospinal, Tectospinal, Reticulospinal

Pathology:
Brown-Séquard Syndrome
Syringomyelia
Muscular Dystrophies
Myasthenia Gravis

Cerebellar & Basal Ganglia Neurophysiology and Pathology: Parkinson's & Huntington's
How do muscles contract

How to appreciate touch?
(sensory)
Sensory Pathways:
Dorsal Column Medial Lemniscus, Spinothalamic & Spinocerebellar

Peripheral Neuropathy
Dermatomes

Upper Limb & Lower Limb Sensory Nerves
Trigeminal Nerve
Nerve Receptors
Transmission of Nervous Signals

Purpose & Classification of Pain
Medication for Pain

Sensory portion of CN VII & IX


How do we hear? (audition)
Structure of ear & steps of auditory transduction
Types and causes of hearing loss



How do we see? (vision)
Anatomy of the eye & retina
Pathology of the eye: Presbyopia, myopia, hyperopia, monovision, cataract
Visual Fields & Optic Tract Lesions
Spatial Resolution
Structure of Rods & Cones

How do we remember? (memory)
Basic Memory Process
Long Term Memory
Aging & Dementia


How do we enjoy food? (olfactory, taste & swallowing)
Olfactory Pathway & Physiology
Gustatory System (Pathway & Physiology)
Process of Swallowing



How do we communicate? (language & speech)
Language Pathway (including Broca's & Wernicke's area)



How do we stay awake & why sleep?
Wakefulness, REM sleep, Non-REM sleep

EEG, EOG & EMG wave patterns for Wakefulness, Stage 1 Sleep (N1), Stage 2 Sleep (N2), Slow-wave Sleep (N3), REM Sleep

Homeostatic Process & Circadian Rhythm
Sleep loss impact on cognition

Common Sleep Disorders:
Insomnia,
Obstructive Sleep Apnoea,
Periodic Limb Movements,
Restless Leg Syndrome,
Narcolepsy, Delayed Sleep Phase Disorders
Neurochemistry of the sleep system
Ageing
Depression, Delirium & Dementia
Know these three very well



Falls in the elderly



Patient Based Programme
Please treat this seriously, many questions may appear in both MEQ and MCQ



HeLP
Just study it (there are only 9 main topics of which the last five can be summarised into 3)




Note:

For the section on pathology and microbiology, any question on any condition/infection may come out as a MCQ. The conditions stated under the MCQ advice column are usually not tested as an MEQ and will thus more likely appear in the MCQs. That does not mean however that one does not prepare for the common conditions as likely questions in an MCQ, YOU MUST KNOW all conditions under the “must know” and “good to know” column as they will VERY LIKELY come out the MCQs too!

The OSCEs

In this section of the examinations, a series of 10 questions are given. You are given 6 minutes per question, and you are to answer a series of short questions, with reference to a picture(s).

Many different types of questions exist, and below are some of the common type of OSCEs
- X-ray
- Photograph of site of lesion
- Photograph of a patient (General appearance)
- Histology slide
- Bacteria culture
- Pathology pots (Gross specimen)
external image M1310181-Specimen_of_stomach_tissue_diseased_with_carcinoma-SPL.jpg
A sample OSCE question
- Describe the gross appearance
- What is the differential diagnosis
- What signs and symptoms can you expect from the patient
- Complications of the disease

To do well in OSCEs, you have to be prepared for anything. By anything, it means even PBP lecture notes. One would also have to be well-versed in not only theory, but how the pathology/ microbiology/ etc slides look like as well. It is definitely one of the more difficult areas of the final exams to prepare for.

Making Notes

With all the truckloads of information they dump on you in M2, there is a more pressing need for notes to retain all that information! Notes-making is an important and helpful asset.

Certain skills are required to make good notes. You have to understand the information thoroughly, pick out the important bits, and synthesize easy-to-recall bullet points. Mnemonics help greatly, especially for microbiology and pharmacology! Here’s a link that demonstrates how to create mnemonics. http://eastasiastudent.net/study/make-mnemonics/

Finally, if you can’t make your own notes for one reason or other, be sure to seek out seniors’ notes. But always use them with caution! Remember, if you can’t understand or easily recall what the guy says, whoever’s notes they are, they are not helpful to your learning.

Check out the Appendix for a sample set of notes contributed by Kamalesh!

CSFC


What is expected of us during csfc

  1. Being able to perform all physical examination with steps as given in the mini-CEX
  2. Being able to take a full history, or parts of the history of the patient
  3. Basic knowledge about the concepts utilized in physical examination and history taking (elaborated below)

How the exams will be carried out

Basically, the CSFC exams have 6 stations.
The breakdown is as follows (for 2011/2012):

a. 2 stations for history taking
b. 3 stations for physical examinations
c. 1 station for clinical skills (Examples includes: BP measurement, AMT, Basic ADL, IADL etc)
How the stations will run
The stations are in a round-robin fashion, each lasting 9 minutes. Meaning, the entire exams will last for exactly 54 minutes and you’re done. The breakdown for 9 minutes is as follows:

|| Time allocated
Task
Remarks
1 minute
Sitting outside the consultation room to read a short description of what you’re about to encounter inside the room
Example: Mr Tan is a 54 year old gentleman complaining of epigastric pain for 4 days. Perform an abdominal examination on him.

Example: Take a social and past medical history from Mr Tan.

*Note that history taking usually only requires certain parts of the history
8 minutes
Entering the room and actually performing the task as explained by the piece of paper outside the room
Many seniors will advise leaving a little time (ideally 2 minutes) to allow for questions by the examiner. Hence, the task should ideally be completed in 6 minutes.


What kind of "outside" questions examiners ask?

As mentioned, if there is spare time, the examiners will try to throw a few theory questions at you.
Below is a list of examples
  1. What are the signs of heart failure?
  2. Explain the grading system when measuring power during a neurological examination? What do you think the power grade of the patient is?

Just a passing comment:
With basic inference skills you will realize that tutorials during CSFC, while still highly important, and not really necessary (when you’re practical about examinations). And also, reading textbooks and memorizing signs and symptoms are not nearly as important as perfecting the steps of all examinations.

Comments and tips

Many will be highly confused and frustrated by CSFC as the aims are not that clearly stated, and you will come to realize that the introduction lecture for CSFC is pretty useless. So here are some tips compiled by various seniors, hopefully it will answer some of the common questions.

  1. Focus on the medical physical examinations first. Every year, invariably there are no surgery physical exams. Things like breast exam, arterial, venous and hernia should be at the bottom of your priority list. However, some basic knowledge of approach to surgical problems is expected in the history taking stations.
  2. During history taking, it is not necessary to ask EVERY SINGLE question in the mini-CEX. If you read carefully, the question paper outside the consultation room (where you are supposed to understand the task in 1 minute) will state that you are supposed to ask questions where relevant. So questions like religion, hobbies, pets, sexual orientation are highly controversial and should only be asked when you have a reason backing it. For instance, pets when the patients have fever, sexual history when patient have UTI, religion I don’t know why maybe when patient is about to die.

  1. Physical examination: Yes you are required to finish the ENTIRE procedure in the 8 minutes in the room. However, often the examiner will ask you to skip some steps. For example, upper limb examination they might ask you to skip fine touch and move on to pain (same actions anyway). But I suggest you should practise with the time limit in mind.

  1. History taking is super difficult to keep within time limit. So practise with time limit in mind! Try not to take half an hour history from patients (which will happen more often than not, trust me)

  1. As some doctors might teach you guys to do running commentary (especially for GS surgeons), it is not necessary unless the examiners ask you to. Usually they will ask you to even before you start, so just look out for it.

  1. REMEMBER TO WASH YOUR HANDS. The handwash green thing will be placed inconveniently (super far away, cannot find, hide behind the examiner etc). But against all odds, find the bottle and squirt many times to wash your hands.

Resources


You will be receiving a folder entitled “M2 Acad Survival Pack of Awesomeness”, either from your seniors directly or from Dropbox shared by your class rep. This is like the Yunnan CD of M2. Inside this folder there is a wealth of information and notes by various seniors. Below is a list of resources that are more popular, but remember 2 golden rules:

  1. You will only be tested stuff that came out (albeit vaguely) in lectures
  2. Notes that don’t help you remember stuff are as good as a pile of words

Pathology
  • Hwee’s Patho, The Catalyst Review (For the main Systemic Pathology)
Microbiology
  • Hwee’s MicroB, Wenchong’s MicroB
Pharmacology
  • Daniel Tay's Pharmacology Notes, Wenchong’s Pharmacology Tables, Tan Seng Kiong’s Tables
OSCEs
  • Ching Hui’s Patho OSCEs
TYS MEQ Answers
  • Liang En’s Answers
Exam Papers Database

As for the rest of the subjects, rarely you will find someone using senior’s notes as lectures notes are sufficient. Hwee’s notes tends to be info bomb, but has everything under the sun.


Appendix: Sample CVS Patho Notes

Download the original file from the top of the page!