Moldova Clinical Guide

By:
Baher Krayem
Mohammad Asla

Hey all, as a graduates of USMF university, and after we Passed the state exam from first time thanks to
Allah, we saw it is obligatory for us to prepare a guide for all the students in Moldova, regarding our
experience and advices for the clinical years, as these years are important for the state exam and the
professional life, and we remember how confused we were time after time when entering every course
in our clinical experience. We collected these advices from students who finished before in Moldova and
many other places, and we put here what we think is right to do in these years. These advices are not
absolute and it is our own opinion, some of you maybe see things otherwise and in other perspective,
any other help you need you can ask us by mail and we will be more than happy to help
Baher Krayem:
baher33277@gmail.com
FB: Baher A.Krayem
Mohammad Asla:
aslamohammad491@gmail.com



Clinical years:
Many students think that these years are the years to rest especially after 3
rd
year. Yes, you can pass all
the courses in these 3 years with minimal efforts, and get marks like 7 8 9 without studying even, but
what is important, is what will stick in your mind when you will face the state exam, as hard as you work
in these years, as much it will be easier for you to pass the State exam from first time!
How to think?
In the clinical section of you med study, you have to program your mind in this set:
Disease name, definition, etiology, diagnosis, treatment and management! Know everything according
to this template. If you hear Addison disease or Creutzfault Jacobs or Kawasaki, you have to know the
things that we mentioned in order to consider yourself know the disease!


4
th
year courses:
1) Pneumology/allergology:
One of the most important courses at 4
th
year, we recommend to you to study from Harrison
directly, revision of physiology materials from Guyton is also very helpful. Kaplan Internal
medicine lecture notes is also a good option (with the videos), but Harrison is the best option,
you have to study in this course very well, especially pneumonia, asthma and COPD as these are
topics that you will face in the state exam and in your professional career.
Sources: Kaplan IM http://www.4shared.com/office/PfbcLejH/Kaplan_Step_2_CK_2008-
2009_IM.htm
Harrison: Buy it
2) Pneumophthisology:
It is the same as Tuberculosis, this course is very wide in Moldova, we sure studied this course
better than what they teach at Israel. The course slides and material are very good, understood
and cover all the material, you can also study from Harrison, but to be honest we felt that
Harrison in this subject is not sufficient and not enough! In Israel TB is not very common disease.
3) Surgical diseases:
One of the best courses that we studied at moldova, maybe the best at 4
th
year, very strict
faculty, with Teachers with wide knowledge, the catedra book is very good, and they
concentrate on the important materials mainly that you should know for the state exam.
Yet, certain topics are missing in this surgical rotation that you should know for the state exam,
such as hemostatsis, electrolyte balances (Na, K, Ca mainly), try to fill the gap from schwartz or
sabiston.
Schwartz link:
http://www.2shared.com/document/lktp0t98/Schwartzs_Principles_of_Surger.html
4) Urology:
Very bad rotation as we remember, the almost teach nothing, so you have to depend on
yourself (we hope it is not like this now), some topics like pyelonephritis, BPH (benign prostatic
hyperplasia), prostatits, prostatic cancer, cystitis are important to know.
Most of the topics you can find in Harrison and study from there, or Kaplan IM.
5) Ophthalmology:
Not very important course for the students who are not willing to become a specialist in this
field, you should know certain topics in general, like diabetic retinopathy, cataract, glaucoma,
conjunctivitis, and blepheritis. The course in moldova in general is a good course.
Sources: there is a small book from the Catedra, it is enough, this is the link:
http://196.29.172.66:8080/jspui/bitstream/123456789/379/1/E66.pdf
6) Orthopedy/traumatology:
We remember it was one of the worse courses we had at moldova, even though it is very
important for the daily life of a physician, try to concentrate on studying trauma and not
orthopedy, because in the State exam you will face trauma question.
Sources: We dont have a good source here
7) Military Management/Toxicology:
Just dont waste your time on the military part, regarding toxicology, in the state exam there are
some toxicology questions, like organophosphates poisoning, or opoids intoxication, study it
from Kaplan IM.
8) Pediatrics:
One of the most important subjects that you have to know, to be honest, Moldova almost give
you nothing in this course, so you should work alone to acquire the needed info for your
professional life and for the State exam, there are two sources mainly, Nelson (essential the
small one) or Kaplan pediatrics, both are OK, but both are superficial and not deep, we
recommend that you try to mix your study with questions from state exam, so study from
Nelson/Kaplan_peds and Pretest pediatrics (12
th
or 13
th
edition).
Sources:
Kaplan Peds: http://www.4shared.com/office/fcG8yKZp/kaplan_step_2_ck_lecture_notes.html
Nelson essentials:
http://www.4shared.com/office/5BlZDVza/nelson_essentials_of_pediatric.html
Pretest 12
th
: http://file.zums.ac.ir/ebook/139-Pediatrics%20PreTest%20Self-
Assessment%20and%20Review,%20Twelfth%20Edition%20(PreTest%20Clinical%20Medicine)-
Ro.pdf
9) Obstetrics:
Very important course, study very well in this section!
Kaplan OB/GYN is one of the best books from Kaplan, study it with the videos! In the obstetrics
part, this book fills every gap you need to know for the state exam. (BTW obstetrics and
gynecology is the most difficult part in state exam). Another very recommended book is LANGE
obstetrics and GYN, it is also the recommended book for the state exam according to the Health
department (it is not like Williams 3000 pages, it is just 800 pages )
Source:
Kaplan OB/GYN http://www.4shared.com/office/TK1aEpyp/Kaplan_Step_2_CK_2008-
2009_ObG.html
Lange: couldnt find a good online source.
10) Neurology:
The course of neurology is a very good course in Moldova, you have to know topics like CVA,
Epilepsy, Dementia, motor neuron diseases, Demyelinating diseases, Infections (meningitis,
encephalitis), Peripheral neuropathies (like Guillian barrre), Neuromuscular disorders (like
myasthenia gravis). You can study from Harrison or Kaplan IM.
11) Cardiology:
Do NOT study from Harrison, very complicated and not easy to understand, we recommend you
to study from Kaplan WITH the videos, it is very organized, and easy to understand. In cardiology
you have to know everything, and in Moldova they dont teach arrhythmias, study them alone
and try to understand! Also vulvular diseas, and cardiomyopathies, do not underestimate them
and know them! Concentrate on the differences between STEMI/NSTEMI/UA/stable angina and
know the pathophysiology of each one.
12) Hematology:
One of the most annoying Catedras at Moldova, with a very annoying teacher (he will try to
convince you NOT to study from Harrison), you can study from Harrison or Kaplan IM,
Hematology is wide and not easy, so be focused, try to study: Anemias (iron, B12, folate,
hemolytic), myeloproliferative diseases, AML/CML, ALL/CLL, lymphomas,
Thrombocytopenia/thrombocytosis disorders. If you do not remember hemostasis, go back to
Guyton physiology and study it.

5
th
year courses:
1) ORL:
This course is NOT very improtant course for the state exam or for your professional career if
you are not planning to work at the field, we recommend to study the important subjects in the
course mainly, like acute/chronic sinusitis, acute/chronic otitis media, tonisilitis, adenoids,
Material sources:
Catedras book is very sufficient, you can download this book also which appropriate for a 4
th

year student level:
http://www.pmc.ps/pdf/Lecture%20Notes%20on%20Diseases%20of%20the%20Ear,%20Nose,%
20and%20Throat.pdf

2) Pediatric surgery:
Not very important, concentrate more on the pathologic aspects and less on the surgical
aspects, you can study the topics from Kaplan peds or Nelson.
3) Gastrology:
We ought Dr. Angella Peltec and this department a lot, we studied in a very high level, with
great lectures, seminars and practical skills, every catedra and teacher in Moldova should take
them as an example (we hope it is still the same), study from Harrison, as the daily tests you will
have is also from Harrison, try to keep the pace as it is not easy to study 30-40 pages everyday
from Harrison. We assure you that this part we had the least problems in the state exam
because of what we studied during the course in this Catedra.
4) Legal medicine:
Just ignore this course PASS and goodbye.
5) Clinical pharmacology:
Very good course to revise all pharmacology from 3
rd
year, very stressing course because you
have to study all the pharma materials in 10 days and the final written exam is at the end of the
course, you can depend on Lippincots or the pharma material from third year.
6) Oncology:
Even though Oncology today is one of the two leading causes of death worldwide (alongside
cardiovascular diseases), in moldova they still teach from books that were published in 1995 !!!!
Go to Harrison and study the syllabus of the course from there, you need to know the cancer
type, risk factors and etiologies, symptoms, grading and staging (not to memorize), and
treatment options. Again, Harrison is your source.
7) Gynecology:
Just like obstetrics in 4
th
year, gynecology is recommended from Kaplan GYN/OB (download the
source from 4
th
year obstetrics), we recommend to study from LANGE about contraception and
infertility (they ask about these topics the most in state exam). Cancers are very important to
know, breast, endometrial, cervical, ovarian and vulvar, you need to know from A to Z about
them.
8) Family medicine:
Use the time in this course to study other topics, in Moldova what they teach in family medicine
is just a waste of time
9) Endocrinology:
Also one of the catedras that we ought a lot, you study mainly about every system, but
concentrate more on the pituitary, thyroid, parathyroid, adrenal and pancreas.
Harrison is a very good option with a lot of material, Kaplan IM is less beneficial but it is also a
good option.
10) Pediatrics:
See pediatrics 4
th
year.
11) Nephrology:
Very short course (4 days as we remember), we didnt manage to finish nothing in this time,
concentrate on Acute renal failure, chronic renal failure (study them both from Harrison), and
glumerulonephritis (which we recommend to study from Kaplan IM) and pyelonephritis.
Nephrology is very difficult field in medicine, you dont have to know everything in this field,
know the things that we mentioned and you will be OK, try to revise from Guyton physiology if
you feel you have weakness.
12) Rheumatology:
Very easy topic, but you need to know the names of the diseases (which are not easy Sjogren,
behcet, reiter are difficult names to remember), you can study from Harrison or Kaplan IM, pay
attention that in Moldova they dont teach all rheumatology topics, so we recommend, what
they teach you in Moldova study from Harrison, and study the rest from Kaplan IM (to save
time).


6
th
year courses:
Dear 6
th
year students, 6
th
year in Moldova and many other countries in the world is just to fill
time, this is a great opportunity for you to start preparing and studying for the State exam, we
started studying at 1.10.2012 till 6.10.2013, and we can assure you that what we studied at
Moldova helped us a lot, especially the material that we read about the questions.
VIN (very important note): If you want to PASS from first/second time, do not memorize
question like a parrot (there are 15000 Qs at least), because you will not memorize them at the
exam, and if you do, in the exam they repeat 80-120 Qs, and if you will face new questions you
will be helpless, TRY to understand every question that you read, and READ EVERY COMMENT
about ALL the questions. Do not ignore the comments, because comments = material, and if you
dont know the material simply your chances to pass are very low! State exam is not a monster,
it is not very difficult as a level, but what is difficult is to study almost everyday 3-6 hours for the
time you are still in Moldova and 10-14 hour everyday when you go back home at July! It
doesnt matter if you are a great student in Moldova or you are just average, you need to start
to work hard and study daily, at the beginning, it will take a lot of time and you will finish max of
30 Qs daily (with comments), but at some point (after 3-4 months), the books will start to repeat
the material, and you will manage to finish more (one day we finished 1200 Qs in one day ),
try to put as LESS efforts as you can in Moldova courses in this year and keep studying for our
state exam. BTW, if you study to state exam you dont need to study for Moldova state exam
because it is the same material (which is called MEDICINE).

In moldova we recommend you to study this Question books:
Kaplan Psychiatry (with comments)
Harrison (with comments, last two chapters you dont need)
Schwartz surgery (with comments)
Nelson peds (with/out comments)
Brattons family medicine (with comments)
Pretest series (5 books with comments)
It is a totall of 10 books, if you study these books before going back home, you have a very good
chance to pass, but again and again, WITH COMMENTS!

How to study:

Psychiatry:
We recommend to start with psychiatry from the very simple reason that you have psychiatry at
the beginning of the 6
th
year study the Qs with comments you know the material you
will know better the teacher of course
Start with Kaplan psych (no need for the combinations questions, just the American),
concentrate on schizophrenias, anxiety, mood, somatization, dementia,personality, substance
abuse, and psychopharmcotherapy. Rest of the topics are important too, but the topics that we
mentioned before they ask more about.
After Kaplan psych immediately or 3-4 months after study Pretest psych (Great book). Psychiatry
is 35 Qs in state exam, it is the easiest part, and usually they repeat Qs in this part, believe us
that you should get at least 28 out of 35 in this part if you want to pass.

Surgery:
After that you can begin with surgery, here we recommend to start with pretest surgery with
the material and after that Schwartz (because it is not organized)! Surgery is the 2
nd
most
difficult part in state exam, to pass it you have to memorize INDICATIONS, for example: you
have to know if it LCIS breast cancer or DCIS cancer how to treat (one to observe and the other
radical), if you have hepatoblastoma you have to know that if it is bigger than 4 cm you dissect,
lesser you observe, and likewise. Topics like breast, hepatic, thyroid, Colorectal, Anal,
appindiceal cancers are very important, memorize all pathologies affecting these organs with
indications.

Internal medicine:
Harrison is you first book to go here, it is very difficult, but study it with comments, it can take 1
month till 1 month and a half to study it, after that you can do Pretest medicine (5 days max you
will finish it), and also Bratton family medicine (3 or 4 months after that), Bratton is a very
simple book.

Pediatrics:
Start with Pretest pediatrics with the comments and after that go to Nelson. Anyone who
studies Pretest and Nelson very well will face any other question in state exam successfully.
Nelson is a very big book (1700 Qs), so try to revise it a lot.

OB/GYN:
Very problematic part, we do NOT recommend to study Williams as it is 3000 Qs, we personally
recommend to study Pretest in moldova and after you come back home do an evaluation on
how to continue in this section.