Inside Med School

Today was my first exam in Gross anatomy, and it went very well. The exam covered the back and upper limb. If you would have asked me 3 weeks ago I would have told you there is no way I’ll be able to cover all the material we covered for this exam. Not to mention that at first glance the structures look totally different in real life than they do in the textbook. Take the brachial plexus (a bundle of nerves extending from the neck to the armpit region) for example. The picture on the top shows you what it should look like, and the picture on the bottom is more like what it actually looks like. At first glance it just looks like one big tangled mess. But now that it’s over, I can’t believe it but somewhere along the way I learned all the anatomical structures of the back and upper limb, and the picture on the right looks totally different to me now. By the time this test came around, I was flying through the questions, which is pretty exciting in its self because I was actually freaking about this test only a few days ago.

So before I continue let me describe the exam. It had two components a written, and a practical component. I started with the practical exam, which I thought was kind of fun. Basically, the professors set up the lab by using every group’s cadaver to identify a structure. The structure would be highlighted either by a string around the structure, or a pin through it, and it was our job to identify it. We were given 1 minute to identify the structure, then a buzzer would sound and we would have to move to the next cadaver. Along with the cadavers, was a table with a bunch of bones on it (Bone row.) For bone row, there were several questions asking to identify the bone, structures on the bone, or muscles and ligaments that attach to specific sites on the bone. There were also a several questions from radiographs (X-rays, CT scans, MRIs) that asked us to identify structures on the image, or locate injuries and what structures would be affected by the injuries from the radiograph.

Over the past couple weeks I spent a lot of time in the lab and became pretty familiar with all the bodies because there is a lot of variation among the different bodies, and a lot of the time the structures look a lot different in real life than they do in the textbooks. Our professor was very fair about using clear examples, examples from cadavers that had a deviation or anomaly. I guess that gets us prepared for real life. I found that with anatomy it helped a lot that I spent so much time in the lab with the actual bodies as opposed to studying from a textbook because there is a pretty significant spatial aspect to anatomy. Textbooks usually present all the muscles and nerves in anatomical position (lying on the back with the palms facing up.) However, a lot of structures look very different from different angles and when the body is in different positions. So it helps to be able to orient structures with respect to other structures. That is very important skill to develop because the structures are presented in different positions and you have to be able to orient yourself pretty quickly to do well.

So after all the studying I did, I found that I was identifying the structures almost instantly. There were a few where I had to stop and spatially orient myself, but nothing I haven’t encountered before. Midway through the exam I was impressed by how easily I was remembering all the structures and was kind of enjoying the test.

After that was over, I took the written portion of the exam. By written I mean multiple-choice questions. The written portion sort of contextualizes everything. While the practical was more about rote memorization and spatial memory, the written tests the important clinical concepts associated with the anatomy. So for example a typical questions would ask something like:

A man comes in with a stab wound to the lateral side of the thorax. As a result, his scapula protrudes posteriorly (winged scapula.) Which nerve did he damage?

So to answer that you would have to know that the long thoracic nerve innervates the serratus anterior muscle, which is attached to your scapula and pulls it close to your body. So if you cut that nerve, it disables that muscle causing the scapula to stick out because that muscle can no longer hold it in place. So for this written exam the bulk of it tested our understanding of nerves and blood vessels and where they go and which muscles they affect. We also had to know where different muscles are attached and what motions they cause.

As I expected, anatomy was the class I was most excited for coming into med-school and it still is. I really like this class. But for the next two weeks were taking a break from anatomy and it’s back to the books. In two weeks we have 3 day test covering biochem, physio, micro-anatomy, behavioral sciences, genetics, and nutrition.