A 72 year old male nursing home resident comes to the emergency department complaining of abdominal pain, nausea, bloating, and flatulence. His medical history includes diabetes mellitus, hyperchloresteremia, hypertension, hypertriglycedemia, headaches, lower extremity cellulitis, obesity, insomnia, obstructive sleep apnea, schizophrenia, and prostate cancer. His surgical history is significant for an appendectomy, cholocystectomy, partial colectomy, and hang-nailectomy. The patient is taking metformin, amiloride, atorvastatin, zolpidem, sertraline, and acetaminophen. The patient has a 78 pack year history of smoking and drinks about twelve beers a night. He is retired and lives alone and is fond of eating Twinkies, watching reruns of Happy Days, wearing mismatched socks and taking long walks on the beach. Physical exam is significant for generalized lower abdominal tenderness without rebound pain or guarding. Vital signs are: BP 210/130, heart rate 43, respirations 25, and oxygen saturation at 91% on room air. What is the most likely color of the sky outside of the hospital?
A. Blue
B. Cyan
C. Azul
D. Turquoise
E. Green with a skiff of high stratosphere cirrus clouds
From this made-up example you can see the real danger in Level 2 questions: many of them are obnoxiously long and the answer choices, though not difficult, are very, very, very similar to each other. It is our job as senior level medical students to be able to pick the best answer from obscure hints in the question stem (The answer to the above question is “D” because it just is.....)
After the test everyone asks, “How do you feel about it?” How can I answer this question? I would love to be able to walk out of the testing center, dancing with various spring-time birds alighting on my shoulders whilst whistling in the sunlight. The reality is that sitting for eight hours and clicking on hundreds of purposely complicated questions is the very definition of tedium. How do I feel? Exhausted.
Meanwhile, results will be available in a month. Do I feel I passed? I will be honest: I was pretty discouraged yesterday. This morning, in the light of a new day, I am feeling cautiously optimistic. Beyond my feelings, though, there remains one thing about which I am certain: God Himself placed my family and I on this road. It is God, not I, Who is making me a physician. In order for this plan of His to come to completion I must pass yesterday’s exam. This being the case, faith and logic tell me yes, of course I passed.
Dear Reader, thank you for your time today. I will keep you posted.
