I was tasked with writing "board style questions" after giving a series of lectures. A lot of people have asked that I publish these on my blog and give answers and explanations. The questions are written in USMLE/Comlex Step 2 and 3 format, and may also be found on Internal Medicine In-Service exams. Here are the first few questions in a "Board Review Series".

1. A 56 year old male was mowing the lawn and began having chest pain. The pain radiated down his left arm and he became nauseous and lightheaded. He sat down to take a break and then pain slightly improved but was still there. It was a dull achy, squeezing pain that was a 6-8 out of 10. His wife activated EMS and an ambulance brought him to the hospital. Upon arrival his vitals were pulse of 150, respirations of 20, blood pressure of 155/88, and SpO2 of 100% on room air. On exam he was alert and oriented X3, in mild to moderate distress, No JVD, Lungs were clear, Heart was regular, No murmurs, No S3 or S4, Abdomen was soft and obese, extremities were not edematous. An EKG was performed by the ED staff and demonstrated Sinus Tachycardia and ST elevations of 3-4mm in leads V2-V4. The ED staff has placed him on O2, given him 325mg of chewable Asprin, and placed an inch of nitro paste on him. In addition to activating the cardiac catheterization team, what would be the next best step?

A. Start a IIb/IIIa inhibitor
B. Give him clopidigrel
C. Start an ACE Inhibitor
D. Start a Beta Blocker
E. Start Insulin

2. In the cath lab, which vessel was the most likely stenosed vessel in the above patient?
A. Left Circumflex
B. Posterior Descending
C. Right Coronary
D. Left Anterior Descending
E. Right Posterior Lateral

3. Upon discharge, all AMI patients (not just the previous patient) should be on which combination of medications?
A. Statin, Asprin, ACE Inhibitor, Beta Blocker
B. Statin, Asprin, Clopidigrel, Beta Blocker
C. Statin, Asprin, ACE Inhibitor, Calcium Channel Blocker
D. Asprin, Beta Blocker, Spironolactone, ACE Inhibitor
E. Asprin, Nitroglycerin, Beta Blocker, Statin

What's wrong with the Bears?

It's all about teaching and coaching. It's not the talent that is the problem. At the NFL level, you have the world's top 1800 athletes. They are faster, quicker, stronger than any other athletes anywhere. There is no comparison. Not even NBA players can match the vertical jumps that NFL players can jump. NFL players are the most explosive, most powerful, fastest players anywhere.

It's all about coaching. How does a team like Miami and Atlanta go from awful in 2007, to winning their divisions and going to the playoffs in 2008?

The Bears need coaching and teaching in the worst way possible. It's not enough to assemble great athletes. You have to train them, teach them, and put them in position to use their God-given talent. Kyle Orton said in September 2009 that he has learned more in the last 4 months in Denver than he has his last 4 years with the Bears. That is sad. Players need coaching and teachers. Mike Nolan loves teaching and he has turned Denver's defense from worst to first in one year. McDaniels and Nolan stress the ability to teach on their staffs. That's what Chicago needs.

If you watch the offense, the defense, the special teams.... Chicago lacks discipline, loses gap control, is in the wrong gap, the WR, OL, and QB are never on the same page. They aren't taking advantages of defenses weaknesses, they look pedestrian. They need teaching, scheming and coaching!

Urlacher!
Just shut up, Brian! Stop criticizing Jay Cutler. Urlacher should be in the film room teaching the rookie linebackers and defensive players what to look for and how to break down film. Criticizing the QB play at this time serves no purpose. Just shut up!

Broncos
The Broncos are back to playing Bronco football like they were the first few weeks of the season. The Defense is back. This team can't be beat if they play like that. Denver has already beaten nearly all the current division leaders and playoff teams (Cincy, Dallas, New England, San Diego). Orton staying healthy is huge, and they need him in every way. When he came back into the San Diego game, he drove down the field with two pass plays and had us in position to comeback. His two passes to Marshall against Washington were priceless (as were the catches). Denver's remaining schedule includes KC twice, Oak, Indy and Philly. Certainly winnable games. Will we beat Indy in Denver? I think so, it may end up being Indy's only loss. 

Saints
We are watching something magnificent! I mean magical. You only see this type of play once or twice per decade. The San Francisco 49ers did this in the late 80s and once with Steve Young in the 90s, the Ram's Greatest Show on Turf did this in 1999-2000, the 2007 Patriots, and now the 2009 Saints. Extremely impressive offense, with a defense that leads the league in takeaways. And they are doing it with authority! This defense is aggressive and punishing. They punished Wes Welker on those two catches. TWO! He had only two catches!

They lost a lot of starters in the secondary, but still managed to find guys to play and fill in (similar to what we used to pride new england for). Greg Williams on Defense and Sean Payton on offense, with Drew Brees and a bunch of 6th round pick WRs is amazingly electric! We are a witness to history. This is the best team in the NFL and will be in the Super Bowl.

Playoff Picture
In the NFC it looks like the Vikings and Saints will be the top two teams. The rest are pretty bad. There s huge disparity between the halves and havenots. The Saints are very difficult to beat at home and that Superdome is electric, loud, and tough to play in. The rest of the teams in the NFC are second fiddle. Teams with a decent chance are Arizona and Dallas if they can get a home game and things go their way. Philly is really the only other NFC team that looks playoff worthy.

The AFC is more muddy. There isn't such huge separation between the good and the bad. There are a lot of good teams. The AFC championship will likely end up being between Indy and Cincy. Other strong contenders include New England, Denver, and San Diego. (Note: Denver has beaten all of them). Anything can happen with the playoffs. All you need is a chance. Any of these teams can end up being the AFC representative in the Super Bowl, it just depends on what happens with the playoffs. Other teams that can still make it with a strong push include Pitt and Baltimore,. But it's probably unlikely that three teams make it from the AFC North. Go Broncos!

I have recently been fortunate enough to have been appointed as a professor on the teaching faculty of Midwestern University's Chicago College of Osteopathic Medicine. I am currently assigned the following rank and designation:

Clinical Assistant Professor of Internal Medicine
Department of Internal Medicine
Midwestern University
Chicago College of Osteopathic Medicine

I am honored and excited about this designation. Our program director and the chairman of internal medicine, Dr. Matzura and Dr. Reich, have worked very hard to get the university to expidite my application and get some of the fellows and chief residents on the teaching faculty. I am truly honored and will cherish this opportunity. I highly recommend that everyone take advantage of this opportunity if it presents itself.

On a personal level, I have always loved teaching and will continue to teach (and learn!) for as long as can. I don't do it for a pat on the back, I don't do it for titles, I don't do it for monetary gain. You either enjoy teaching, or you don't. I love it and don't care for the accolades or acknowledgement.

I also love learning! I am thankful to be in a field that changes every day. Not a day goes by where new stuff isn't being tried to see if we can get better outcomes and better quality of life. That is exciting!

I plan to learn as much as possible and try and be the best damn physician and cardiologist that ever existed! I am extremely competitive (in a very non-chalant and quiet way) and will do anything and everything possible to be the best there is! I have an internal drive that doesn't like to accept or settle for second best.

I am excited and very honored about this new faculty appointment and will do what I can to teach as much as possible on campus, on the hospital floors, in clinic, in the stress lab, echo lab, on the football field, on the internet..... and any where else where I can be useful!

I love teaching!

A new batch of students, Melissa and Suzanne, are now on EKG week with me and are loving every second of it!

As physicians, we will always be teachers and will always be students! We have to remember this for the rest of our lives. We will never know everything, and we will always know more than someone. We have to teach and learn!

Teaching is a passion and it takes time to hone your teachng skills. I highly recommend teaching. It is extremely satisfying and you feel like you have imparted something important on to someone. It is especially gratifying to know that you are good at explaining complicated concepts in a way that simplifies them and allows them to enjoy being taught.

You should never teach because you feel obligated or because you "have to". You should teach because you love it. It should come from within. You shouldn't teach for a pat on the back or a "thank you" from someone. You should do it because you enjoy it, regardless of reward. Teach for the sake of teaching!

I am especially competitive. My entire life I spent competing with my brothers and friends at everything! Football, basketball, jobs, reporting, business projects, politics, just about anything! We have an inner drive, and we never settle for second. I am the same way about teaching and being the best damn doctor I could possibly be!

One reason I love to teach is because I want to be the absolute best teacher there is. It's a competition for me. When I hear that one physician is a "great teacher", I will attend all their lectures and try to find out what makes them so good, so I can emulate their techniques. If a freind wins a teaching award, I want to win more awards than them. If one person finds a great way to explain something, I will use that same technique to explain other concepts. 

I always love attending Dr. Matthew Kamin's EKG lectures. I know EKGs pretty well, and his lectures are very elementary and usually at the level of a third year medical student. However, I always manage to gleen a nugget or two from his lectures. All those nuggets add up over the course of a year and Dr. Kamin is a great teacher. He has amazing ways of explaining complicated issues. I can never get enough of him!

These are people who we should model ourselves after and emulate! Teach on!

It's especially exciting when your students' eyes light up and they start to "get it". They suddenly are excited about the material and want even more! That is the ultimate satisfaction, the ultimate high! Nothing is more rewarding than when someone says, "Hey, can you teach us again tomorrow?"

One component of life that goes with teaching and being knowledgable is staying humble. It's very easy to mistreat people, be condescending or to think highly of one's self when you think you have achieved something. Humans should never think highly of themselves nor mistreat anyone. We are one and the same.

We should treat everyone exactly as we would treat the person who we have the most respect for. Treat everyone as you would want to be treated! Treat everyone as you would treat your parents, or a famous celebrity, or a role model that you have a ton of respect for. There is no excuse for not respecting people or being kind and generous.

I hope to continue many more years of teaching and learning!