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DR. GENTRY KINGS ADVICE FOR THE BOARDS First of all, maraming salamat sa inyo at sa inyong mga panalangin.

As i've told you earlier, this is God's work. We are luckier than we know. Thanks be to God! :) I've been getting a lot of requests for tips about the boards and although I am not the best person to give you this advice kasi bulok talaga ako mag-cram, here's my two cents worth and as thanksgiving to my clerks who have supported me all through out. Salamat mga pre! I will begin with an introduction and later discuss specific topics in relation to what you should do in the ideal setting, and what I did...the non-ideal setting. :) Introduction: First of all, the Philippine Medical Boards in my opinion, is not a test of your proficiency, skill or gauge of being a good or competent doctor. I believe that it is more of an obstacle to claiming what is rightfully yours after 5 years of hard work. How difficult was it you might ask? Very very difficult. There are some questions that are well made, and make you think: mahirap talaga. There are some questions that are just blatant memory murder: tangapin mo na lang. There are some questions that aren't even in the mama books: ibigay mo na sa kanila. There are some questions that are supposedly easy, but because of wrong spelling and wrong grammar, become very painful choices: splitting headache. And they will repeat the same question, with the same wrong grammar about 3 times for some tests. And then there are some questions that are answerable. If someone tells you that the boards were easy...well, ang masasabi ko lang: henyong henyo na ang taong iyon, dahil para sa akin, hindi talaga. Hindi lang mahirap, malabo at sobrang nakakapagod. The boards are composed of 12 subjects, and I have to say that the most difficult for me was...everything. But this is how I would rank them from most difficult to least (sa akin lang ito): Surgery, Anatomy, Biochemistry, Pharmacology, Physiology, Pediatrics, Prev Med...and the rest...pantay pantay ang kahirapan. But the difficulty will vary from year to year. This year, surgery took the Gold Medal. Wala akong masabi. Parang Usain Bolt o Michael Phelps...it wiped out the competition. Some topics weren't even in Schwartz. Some of the drugs they asked aren't even registered in the MIMS. Ang hirap talaga, it had the most number of out of this world questions. Anatomy was difficult because the questions were not well distributed. There were only two histo questions if I remember. It was a very lopsided test. I do not think that was randomized. Biochem is always difficult: matrautraumatize talaga kayo first day. Pharama and physio for me shared the same level of difficulty: mahirap talaga ang mga tanong. With regards to these two, you would be able to narrow it down to two choices...and you have to guess from then on because ang labo talga ng mga choices. Pediatrics is always difficult, but I think doable because at least...they give you cases that make you think. Prev Med...either alam mo o hindi: delekado. Review Classes or self study? Either. If you think that your stock knowledge database is less than satisfactory and you think that you do not have the discipline for self study, then take a review class. if you think that you will be able to make the most out of it, or if you do not have any friends who will lend you some materials from review classes, then take a review class. The advantage of a review class is that you will get to study everyday for about a month and at least, and you

hear someone talk to you about it: it's different when you hear someone emphasizing a topic or a clinical pearl, rather than just reading it. Moreover, most review classes will have mock exams and in certain schools, some of the questions in the mock exam came out in the boards. They also give you a lot of useful handouts. The problem with review classes is that not all of it is high yield. Some review classes will talk about depolarization for a whole day and will just really give you a big headache at the end of the day. The other disadvantage is that it is expensive. I didn't sign up for a review class because I thought that I would be just wasting my time and money because I always sleep in lectures. I was always one of the top sleepers in my class during lectures and I thought that I'd be wasting my money if I go to lectures just to sleep. I also wanted more freedom with regards to what I wanted to study. The problem with me is that I read mama books and I made it a point during internship and clerkship to read my mama books so that i would just be reviewing my highlights during review for the boards. So I decided not to take a review class because it would take off 1 month of mama book bedtime stories. By the time internship was done, I had read about 80% of Snell, 80% of Harrisons, 70% of Schwartz, and 60% of Nelsons. I planned to finish the whole of Snell and just browse through my highlights in the other books so i thought of doing self study, kasi sayang naman yung mga binasa ko noong medschool and internship. I was thinking: at least i've read it before, which means that I'm somewhat familiar with it already. I just need to read it again to solidify it in my head. Easier said than done. Looking back the 3 months of review, I think that taking a review class is worth it: the benefits outweigh the disadvantages. I had so many distractions in the 3 months that it took off at least half of my studying time. If you think you need a rigid discipline for the boards, take a review class. Which Review class? The only ones I've heard about are UST, UP and UE. I actually took the UP review class, but it wasn't really a review: it was a week of mock tests and discussion afterwards, so you really didn't review with any structure. It was helpful to an extent because you get to be exposed to answering 100 item tests one after the other. I could not remember any of the questions in the mock tests that came out in the boards. However, most of the lecturers were really good: especially anatomy, medicine, biochemistry, Parasitology. In essence, I took that review class as a security blanket: just to say that I went to a 'review class.' Moreover, you get to pace yourself and learn that it will take you this certain amount of time to answer 100 items. If you want structured review classes with lectures and tests, UST and UE offer such. The UST review class was expensive, but comprehensive. The problem was it was held at the CME auditorium: I had never gone through a lecture there without sleeping. My friends say that some of the lectures were good, some were dragging. The highlight of this review I think is Preventive Medicine and Legal Med. Because Dr. Pineda and Dr. Rebosa gave the lectures and are the authorities when it comes to these topics. I had some notes from my friends and they were very useful during the test. However, some people say that the UE review for legal med was even better because Dr. Rebosa made questions for the mock exam that were very similar to those in the boards. Anyway, I really don't know much about these review classes because I did not take them, but that's what I know. Once again, I think taking a review class is worth it....as long as you have coffee. How to self study for the boards:

Ideally, you should do what the No.1 top-notcher did did: isolate yourself and concentrate. Set aside all hobbies and distractions for three months. Make a schedule and stick to it. In the words of Dr. Sjoberg Kho "kelangan mo talaga mag-aral hangang sumakit ang puwet mo sa kakaupo." And yes, that did happen. Before you begin, you have to ask yourself some questions: What is my objective: to pass or to top the boards? My goal was to pass it, and I never dreamed or imagined that I could get to the top 10, since I had never achieved anything of that magnitude before. My specific objective was to know a little about everything, and not to know everything about something. Remember that you need an average of 75% and that you cannot get a score lower than 50% in 1 subject. Even if your Pharma grade is 98%, but your legal med is 49%, you will fail the exams. My biggest fear was to go through that all over again: what a nightmare. So the thing going in my mind was: the dream of topping it, or the nightmare of repeating it? I don't want the nightmare. Moreover, knowing that some of these subjects (Biochem, Legal Med, Prev Med) had almost no clinical correlation in my 2 years of clerkship and internship, the possibility of failing one of them is very real. Now, if you think that you have learned enough over 5 years to pass even without studying, then perhaps your objective is to top it and for those who think they have the resources and will power to do so, go for it. Note, that it does not always follow, that the statement: "if you aim for the roof, you fall on the ground. Aim for the sky and you fall on the roof." If you focus too much on one aspect, it may escape your cognizance that you are actually digging yourself a deeper ditch. Be balanced, don't be cocky: Be confident, not over confident. What kind of a student was I during medschool: learner? crammer? cheater? liar? This question will still likely reflect the kind of person you will be in the 3 months before the boards. If you are a learner, then it will seem that the 3 months will not be enough. But not to worry, because if you are, then all that you've learned in the last 5 years is still in there and your stock knowledge will be invaluable. However, stock knowledge may become 'stuck' knowledge and you must treat the 3 months as a review and a time to master those areas where you are weak. In a sense, you will need to make a paradigm shift in your studying. You should study the "forest" first, rather than the "trees," (quote from Dr. Baroque) and when you do decide to go into details and full effort: I suggest that you reserve your strength for topics you do not know at all, or know very little of. If you are a crammer, then the 3 months may be very fruitful if your objective is to pass. I, am not a good crammer: I read slow, and I usually want to read everything, even the parts that are not important, which usually takes up a lot of time. If you are a crammer, then you have to be strict with your schedule and stick to it no matter what. Crammers usually do not have as vast a stock knowledge as learners and they will have to cover more ground in 3 months, but their capabilities allow them to do so. Crammers learn a lot at the end of 3 months, and I believe, can match up to the stores of a learner if they really put their effort into it. The disadvantage is that, you will most likely depend more on the reviewers and not the mama books. It will be a disadvantage for some subjects because majority of the questions are straight out of mama books. If you are a cheater, or were a prolific cheater in medschool: you do not deserve to pass, you will fail and if

you pass, the Lord will surely give you an ass-whopping one of these days. When you cheat, you always cheat on someone...it is never harmless. Often times, cheaters are also liars, and if you were a liar or are a liar: then you are just fooling yourself. If you cheated on your friends in clerkship and internship, or became an unreasonable liar/bitch/bastard, you do not deserve to pass...Umuwi ka nalang at ngumatngat ng kahoy para umebak ka ng mga 2x4. And even if you pass, as I said, God will deal with you later. A cheater's/liar's life is a sad and empty life and they usually only notice it when they're dying...wala silang kasama. Sorry for the hard words, but I am fortunate to know that an overwhelming majority of you are not like this. Anyway, it would seem that a combination of a learner and a crammer would be the best for the boards, and I would agree with this. The next question is: how hard am I going to study? I have heard people say that they studied 15 hours a day for 2 months for the boards. If you're the kind of person who can stay up that long and absorb all the things you read, then go ahead, do it. However, you must also know your limits, and keep yourself healthy. It really doesn't help to be sick while studying for the boards, and believe me, you are more prone to sickness when all you do is sit down, eat and read. Get some exercise once in a while and eat right. Ok, now that you've answered those questions, you can plan your study. Schedule: This should consider the type of student you are. I started studying little by little a few days after internship because I knew that I was a slow reader, a bad crammer, reads a lot of useless information, and the type that needs at least 6 hours of straight sleep a day. So I didn't take a vacation, because i knew that distractions and 'mini' vacations would pop up along the way. If you think you study best, taking things slow, by all means, start early. If not, take a vacation first. Your studying period should have at least 2 readings. You will not be able to get the most out of your review with one reading. So you have to decide again, whether to master the core principles or read as much as you can to broaden your knowledge base. I suggest a combination of both. Anyway, the ideal setting would be first reading for the first 2 months, and then 1 month for second reading. Although, I believe 2 weeks of second reading would do. That didn't happen with me, dahil kalat ako magaral. I only started my second reading 2 weeks before the boards and I haven't even started on my first reading for Medicine and Pathology by then. Do not do what I did. Make a schedule, leave some allowance, and stick to it. You really never know what might come up. What should you study first? Clinicals or basics? Some say study clinicals first because basics are harder to retain and it would be more helpful if you study these near the days of the exam so as to retain more of it. I agree with that, but if you think you are really weak with the basics, then i suggest you start with the basics you are weak with, then clinicals, then the rest of the basics. When should you study? late into the night or early morning? I suggest that you start fixing your biologic clocks as soon as a month before the exams. Study in a time where you do not get many distractions. 2 weeks prior to the boards i learned how to wake up at 4 or 5am and sleep at 10 to 11 pm....Ok pala. You have to try and get your body used to the day time if you are a night person. What to study:

In general, I say that you first study the topics you don't know. Study first those topics you have no idea about, so that come 2nd reading, it will really be a review. If you start with those things you already know, you might end up panicking later on about the stuff you don't know. This is what I keep telling people about what to study: unahin mo ang mga hindi mo alam na importante. I guarantee you, it will be very effective because the boards will even ask questions about things that are not important, drugs that aren't even in the MIMS, diseases that are not even in the Philippines, and even captions to some of the pictures in the mama books. For me, the things that were difficult to master and that I didn't know much about: Biochem, Head and Neck Anatomy, Ophthalmology, Anti-virals, Psychopharma, Onco Drugs, Hema-Onco, Pedia Endo, Pedia Uro, Gynecology. Once you've gone through the first reading of the difficult topics, then start on the review proper. Get good reviewers that will help you understand the topics in a simpler way. I always say: quality, more than quantity. You can buy a lot of reviewers but you wont be able to finish them. Stick to one reviewer and master it, and have the mama books as reference. That's what you should do, but it wasn't what I did throughout most of the 3 months. Note that in the following, what may be true of my time may not be true in your time. In general, the boards did not repeat questions in our test. In the following, when I say "high yield" these are the things that I believe you should study because if I were studying for the boards again, i would not miss out on these. I also base the "yield" on the frequency of appearance of some of these topics in the boards over the past 5 years. Anatomy and Histology: Danger Level: 5/5 Level of Difficulty: 9/10 Memory: 70% Analysis: 30% Cheap Shots: Many Main Reviewer: Mama Snell Total days for first reading: 2 weeks at least High Yield Topics: All Difficult topics: Perineum, Head and Neck Potentially Dangerous topics: Basic Anatomy, Joints and Musculoskeletal, Genitourinary histology. Do not underestimate this subject, or it will kill you. Most of my friends, except some PT/OTs, found this very difficult. I found it very difficult. Looking back at it, starting with "Snellito" or "Baby" snell will do for the basic part, and reading the clinical parts of mama Snell should do the job. However, once you think of it, that's like reading the whole Snell na rin. Probably, but it is still shorter. The other reviewer I read was High Yield Gross Anatomy, which was really nice for the clinical parts and I suggest you read this too at least once. It was also easy to read and it will only take you 1 day or less. What did I do? I read the whole mama Snell. Why? Because I had started on it already during clerkship and internship and it was just a matter of finishing the job.

Besides, I had always been reading it in surgery clerkship and internship and was more or less familiar with it. I was about 50% through with Snell at the beginning of Internship and about 80% done at the end of it. I thought that I should just re-read the important parts since I've become "attached" to the book. It's a really good book, and I regret not being able to use it as much in 1st year med because they told us to use Cunningham, which was a nightmare. The great thing about Snell is the Clinical Part and I advise strongly, that you read all of the clinical sections at the end of the chapters. I repeat: read the clinical parts! I also advise you read the first chapter on basic anatomy, joints etc. I advise that because people tend to skip it: don't. Remember, know a little about everything. Now, the bad thing with doing what I did is that, I didn't get to do a second reading. It took me about 1 1/2 weeks to finish the remainder of snell and at the end of it...parang wala ako maalala. hehe. You really need to read what you've reviewed twice. It really hit me hard come board exams because in between tests, they give you a 1 hr break to eat or study. E ako, ang dala ko yung mama Snell. I wasted about 20 minutes, flipping through all that trying to find what I could study. That's the bad thing about reading mama Snell...you don't have a reviewer. The good thing though, is that some questions that came out, were the little details in mama Snell. These were details I remember reading, not in the prior 3 months, but mostly in medschool and in internship. This just goes to show that you need a second reading if you plan to retain what you've studied in 3 months. With regards to histology, you should just make do with a reviewer and concentrate on the parts that you don't know. Biochemistry Danger level: 5/5 Level of Difficulty: 9/10 Memory: 70% Analysis: 30% Cheap Shots: Many Main Reviewer: Kaplan Biochemistry, UST handouts, 1st aid step 1 Total days for 1st reading: 5 days to a week High Yield Topics: DNA/RNA, Carbohydrate Metabolism, Lipid Metabolism, Metabolic Integration, Urea Cycle. Difficult topics: Purine and Pyrimidine Synthesis and Metabolism, Protein Metabolism, Hormones, Syndromes Potentially Dangerous topics: DNA/RNA, Purine and Pyrimidine Synthesis and Metabolism, Basic Chemistry of CHO, CHON and Lipids,Syndromes Biochemistry is difficult, and you just have to accept it. The difficulty lies in its being abstract: pathways, IUPAC names, chemical principles and the memorization. You will die if you read the whole of Harper. This is where a mama book is not recommended. I never read Lippinocot, not even in medschool, so I can't give you a good feedback on it. What I did do, is this: I read majority of the handouts we were given in UST and i must say, they are very complete but it takes a lot of time and memory betrays you. I decided to read those because of familiarity. I then proceeded to read Kaplan's biochemistry reviewer

for USMLE biochemistry. It was so good: It discussed the principles of biochemistry in a very concise and clear manner. The strength of this book is in the RNA/DNA topics and Metabolic integration. However, do not think that reading Kaplan will do! Kulang na Kulang. What I propose you do is this: Read Kaplan first, then read UST handouts or any other reference book for details and stuff you do not understand. Then do a second reading close to the test date. Understand what you are reading so that memorizing. Know the principle of the pathway before paying attention to the details. This is where reading Kaplan first will really help. Then, after reading it all, read First Aid Step 1 2008 edition. The 2008 edition has a lot more useful lists and diagrams than previous editions. For instance, it has a list of all the rate limiting steps of major pathways: very useful. Buy it. But since you guys will take the 2009 boards, buy the 2009. Now, if you don't have UST handouts, or you lost it or you burned it after 1st year...you'll have to do with Harper for reference. It's not a death sentence...you just have to pick out the stuff that is important. With regards to when to study Biochemistry, i suggest that you start your first reading of the basics with either this or anatomy, because it can really eat up a lot of time and energy. And then, do a 2nd or 3rd reading a week before the boards. Let's face it, you really have to have memory on your side. The one topic i suggest that you study right before taking the test, like the day before is Nucleic Acid synthesis. It is very difficult, confusing, blatant memory work and so far, has come out in every samplex I've seen. Another one worth memorizing right before is the Krebs cycle and where which intermediate enters. Lastly, fatty acid metabolism: can be confusing if it is remote in your memory. With regards to Digging up the bones, it will do you good if you read it last, because its packed with a lot of information, but doesn't make sense as first reading. The nice thing about Digging up are the summaries at the back. Physiology Danger level: 3/5 Level of Difficulty: 8/10 Memory: 30% Analysis: 70% Cheap Shots: few to moderate Main Reviewer: BRS, Ganong Total days for first reading: 4 to 5 days High Yield Topics: Respiratory, Gastrointestinal, Renal, Musculoskeletal, ANS Difficult topics: Special Senses, ANS Potentially Dangerous topics: Special Senses, ANS, Deep Sea, High Altitude, Space BRS is great in helping you understand the principles and is a must read. It is concise, straight to the point and orderly. This is the only reviewer I read for Physiology and when you think of it, it would do: because physiology is more of analysis. And so, the point of reviewing physiology is to master the principles. During the test, you will often be able to narrow down the choice to two, and it is your understanding of the principle that will give you the right

answer. Reveiwers are the way to go for this subject. However, you can never count out details and cheap shots. What I have observed in the samplexes was that there were a lot of cheap shot detail questions and you know where they get it from? Ganong...verbatim. In fact, if you needed a reference book, Ganong is the book. My copy is the 17th edition which I bought for only P150 from Goodwill, and it is the most sulit book i've ever bought. It is concise, clear and has a lot of details and data. Why not Guyton or Berne and Levy? Berne, although I am a fan of this book, will kill you if you use it for boards. Guyton is usefull for the deep sea, space and high altitude parts but when you read through it....the authors like to beat around the bush and it takes up a lot of time. Besides, when you take a look at each of these three books....which one is the most convenient for you if you are assigned to make an exam? Siyempre Ganong: you can even do the good old 'flip the pages and point at a random sentence for a question' technique. Masmahirap magcheap shot sa ibang books because you need to read it through and through. So that's what I did: read BRS, answered samplex using Ganong as reference. The thing is, I kind of let Physiology out of my schedule and started on my first and only reading 2 weeks before the exams, and used up 2 days for it. I thought, "wala namang mga bad reviews akong naririnig about physio a, baka kaya nang icommonsense." How did I find this subject in the boards? Difficult. One of the most difficult. The questions were difficult and the grammar of the choices made things even more painful. Do not do what I did. Give Physiology a good 4 days, and a second reading. Pathology Danger level: 5/5 Level of Difficulty: 7/10 Memory: 70% Analysis: 30% Cheap Shots: Moderate to Many Main Reviewer: BRS, 1st aid step 1, Kaplan Total days for first reading: 4 to 5 days High Yield Topics: Cardiovascular, Respiratory, Renal, Infectious, Neoplasia Difficult topics: Renal, Hematology, Immunology Potentially Dangerous topics: Immunology! Renal, Hematology, Inflammation, Neoplasia, Environmental. I personally think that BRS patho is the best of the BRS. When I read through the samplexes of the past years, you could answer 70-80% of the questions just by reading BRS. Some people disagree, because they had a very hard time in pathology, but I think that BRS stresses the important concepts and has great tables. Another reviewer that you must not miss reading is the pathology part of 1st aid step 1: this is probably one of the best, if not the best thing about 1st aid. Moreover, do not forget to read the 'wordassociation' parts at the back. They say that the technique was to read BRS and then the green boxes in Robbins. I wouldn't know because pathology was at the bottom of my priorities and I only used 3 days total reviewing for pathology. I felt that my stock knowledge with this subject was sufficient and that I had to spend my energy on other

subjects. In 2nd year med school, I was always the one who discussed the group discussion: almost everyday, actually. In other words, dinibdib ko talaga yung Robbins nung 2nd year (I flunked my first long test i think, and told myself na babawi ako) and I know the book particularly well. Actually, majority of pathology is recall: its either you know the answer or you don't: that's why i gave it a danger level of 5/5, despite difficulty of 7/10. So, if you think your stock knowledge with this subject is really lacking. I suggest you start studying now. How to study for pathology? In your readings, be weary of the following phrases:1.) "The most Common..." 2.) "The pathognomonic...or the characteristic lesion..." 3.) "The earliest change...." 4.) "The prototype disease..." 5.) "The fundamental defect..." 6.) "A deficiency in this will cause this...." 7.) "The most consistent sign...." Study tables of comparison. Study prototype diseases: eg. SLE for autoimmune. And do not forget to leave out things that are not in the typical "systems" : Inflammation, Neoplasia, Environmental, wound healing. The questions were evenly distributed. A lot of people have difficulty with Renal Pathology and I suggest you study this because it is very histo-pathological and you need to know what the slides look like. Please do not leave out immunology....very very dangerous topics. I think BRS discusses it very well and so does 1st aid. People have recommended Kaplan patho also since they say it is Robbins based, and I would not disagree. Microbiology: Danger level: 3/5 Level of Difficulty: 7/10 Memory: 60% Analysis: 40% Cheap Shots: Moderate Main Reviewer: MRS, Kaplan, 1st aid Total days for first reading: 1 week High Yield Topics: , STDs, TB, Dengue, Typhoid, Rabies, Schistosomiasis Difficult topics: Viruses, anti-virals Potentially Dangerous topics: Viruses, anti-virals, fungi and anti-fungals, Ricketssiae and other microbes or diseases that don't exist in the Philippines This was the first thing I studied because this was the most interesting for me. It took me a total of 3-4 weeks total, but it really should not. It took me so long, because at this stage, kalat pa ako magaral. Moreover, mahaba talaga ang micro and it is a lot of memory work. After you study bacteria, you have to study viruses, then you have to study fungi, then antimicrobials, then protozoans, then anti-protozoans... matagal talaga. It also took me a very long time because during this stage, eager beaver pa ako. I read the whole of MRS, the whole of Kaplan and then...I read the Infectious parts of Nelson and Harrison and Schwartz (not in its entirety of course). Alam ko, sira ulo ako....and it was tiring. So don't do what I did. The "crosssystems" study doesn't work very well with Micro because it's just too much. So here's what you should do: Read MRS first. It is very very very good for review. It has

the basics covered, and then some great tidbits. I love this book. In medschool I read the Syphilis chapter of Harrison thrice and I still couldn't grasp it. Read MRS and you won't have to go through that anxiety. If you want to go further, at least browse through the Kaplan Microbiology reviewer once: it has a lot of very very helpful tables and diagrams. Then after that, read first aid step 1. Along the way....you should make mnemonics: especially for the viruses. Do not forget to study about extinct microbes or viruses...yes you heard me right. Don't forget to study about the Poxvirus.

There are 4 high yield diseases that are not discussed as thoroughly as it should in the reviewers: TB, Dengue, Typhoid and Rabies. These are diseases of our country, and I suggest you go a bit more in depth, especially the clinical aspects of these diseases. For Dengue, the Compendium of Philippine Medicine (CPM) of 2006 has a Dengue Guideline by PSMID. For TB, CPM 2007 has a PSMID guideline. For Rabies, read the guidelines from San Lazaro (highly recommended). For Typhoid, your clinical experience in clerkship and internship will do, if you paid attention. Schistosomiasis is also a local health problem, but it is discussed sufficiently in the reviewers. Don't forget about SIRS and Sepsis. The chapter in Harrisons is the gold standard, but do not forget that the criteria are different in children, so read Nelsons too on that.

Some points on studying microbiology: remember that it is a basic science and that they will ask predominantly, things about the biology of the microbes. Of course, there will always be the clinical aspect, but that is the easy part. The difficult part is trying to remember which has this and that component, which grows in salt and this and that agar etc. Which means that you should also study the different kinds of agars and culture characteristics. Wikipedia is a great resource for the agars and culture characteristics.

Legal Medicine and Medical Jurisprudence: Danger level: 5/5 Level of Difficulty: 7/10 Memory: 60% Analysis: 40% Cheap Shots: Moderate Main Reviewer: Summaries of both books, UST/UE reviewers, UPEC Total days for first reading: 4 to 5 days High Yield Topics: All of Jurisprudence, Sex Crimes, Virginity, Child Abuse, Medico-legal aspects of identification, Medico-legalaspects of death, Causes of death, Special Deaths, Disposal of the dead body, Physical Injuries, Gunshot wounds, Drowning, IQ. Potentially Dangerous topics: Gunshot wounds, Poisoning, Jurisprudence Cases As Atty./Dr. Rebosa has been telling us since 2nd year medical school, do not take this subject for granted. According to him, the top 3 subjects that people usually fail in the boards are: Biochemistry, Surgery and Legal

Medicine. Recently, Pediatrics has been in this clique, but I think that Dr. Rebosa was quite accurate. As you may have noticed, difficulty is 7/10 but the danger level is 5/5. Some of my friends came out of the testing room in tears. Be careful, and study this subject early and well. In studying for this test, reviewers are a must. Read them first to save time and then turn to the books for reference. The reviewers we got actually don't have specific titles so I don't know what to advise for purchase, however, there are some reviewers that have a barrage of questions and I didn't find these very pleasing in particular. I suggest that you look for a reviewer that is a summary of both books that uses the same words as in the book.

morals, but there are also questions that are recall.

The other thing that I must advise you on is attending the lectures of Dr. Rebosa in either UST or UE, or at least get some notes: high yield. Not all the questions will come from Solis. Solis is a very outdated book and you need the current Lawyer/Physicians to teach you about the revisions, current laws and overview of the laws. And yes, you need them.

Pharmacology: Danger level: 3.5/5 Level of Difficulty: 8/10 Memory: 60% Analysis: 40% Cheap Shots: Moderate Main Reviewer: Katzung and Trevor's, UST handouts, 1st aid Step 1 Total days for first reading: 4 to 5 days High Yield Topics: ANS drugs, Anesthetics, Diuretics, Antimicrobials, Anti-Seizure drugs, GI drugs Difficult and Potentially Dangerous Topics: Anti-Virals, Anti-neoplastics, ANS drugs, Anesthetics, Drugs of Abuse, Anti-Arrythimics, Psychopharmacology, Gonadal Hormones and Inhibitors. I usually associate this exam with that of Physiology: you'd often get to narrow down the choices easily to 2, and then you'd have a very difficult time trying to decide which is which, notwithstanding the grammatical errors that make the choices really confusing. I found it as difficult as Physiology. However, studying for this subject is pretty straight forward, Katzung and Trevor's is a great reviewer and I think that this alone will do if you master it. It is also helpful to have the mama Katzung beside you for further reference. Reading the whole of mama Katzung is not worth it in any way.

This is also the subject where samplexes are the most helpful. When you think of it, all or almost all the questions are going to come from the Solis books since they have been the official books for the boards since they were created. So, the ideal way to study for this is, after reading a topic or two, hit the UPEC or the samplexes right away to reinforce what you have learned. Both these subjects are hardly touched on during your clinical training and it is difficult or perilous to rely on gestalt psychology to form the answer for you while reading the question with this subject because of that lack of that "phenomenological experience." In other words, you have to learn this subject and not just review it.

Which to concentrate on? The proportion of each of these subjects in the actual exam will differ from year to year. It will depend on the "chismis" you hear during your review period. I must advise you, however, not to take legal medicine for granted. It is very difficult to retain the amount of information that the book throws at you. Jurisprudence on the other hand is easier and more pleasant to read. In particular, I must advise you to read the examples of each cases because the samplexes use the actual cases as an illustrative question, which might also be the case in some of the questions in the boards. And besides, they really help you understand the concepts well.

I was particularly quite weary of this subject and thus took it seriously. I spent about 8 days for my first reading of these subjects. Why did i take so long? Because I read the whole Legal Med book, all 700 pages. I was particularly frustrated at the questions that the UPEC and samplexes were throwing at me and decided to read the whole thing to at least have some vague idea of every corner of cheapshotable page. The problem is recall power. Come test time, I could only recall the topics that I had read for a second time. However, I still would not advise not reading the whole book. It took me 4 1/2 days to finish the thing and I'm a slow reader. So if you could spare the time and the sanity to read it, go ahead. I regret not reading the whole of Jurisprudence though. It was 300 pages shorter, easier and more fun to read, filled with useful and highyield topics and easier to master.

The thing is, if you decide to try your luck in reading a whole book, I cannot advise you not to read both. Legal Medicine is dangerous because the questions can be taken from anywhere in that thick 700 page abyss, and what's worse is they're "know or don't know," type questions. With Jurisprudence, you can analyze and rely on your

I suggest that you browse through the table of contents in Katzung and Trevor's and then list down the topics that you know or knew had difficulty with during medical school, or those topics that you had very little exposure with in the clinics. Once you have the list, unahin mo yun. You will need all your strength in trying to learn these topics, and not just memorize. I know it's not very pleasing to the learning palate but you have to learn those topics because if you just keep on memorizing, it is very hard for you to recall the drugs come exam time: even after 2 or 3 readings. You have to make many associations and complicate the text in order to retain. Some of that I found difficult to retain and thus put more energy and effort into were: Anti-Virals, Anti-neoplastics, ANS drugs, Anesthetics, Drugs of Abuse, Anti-Arrythimics, Psychopharmacology, Gonadal Hormones and Inhibitors. After you've done your first intensive reading/learning of the difficult subjects, then you can review the other subjects. Anti-microbials take a long time to study and I suggest that you study this with microbiology, or at least do your first reading while

studying microbiology and then the second during pharmacology. For those who still have their handouts from second year, I have always these handouts very very useful and high yield: Basic Principles, Anti-microbials, Psychopharmacology, Opiods

CLINICALS: In general, this is part of the boards that you will have difficulty with because you can't study for this as well as you can the basics. I was able to survive this part because of the experiences I had gained in clerkship and internship. If you took your clerkship and internship seriously, you should have no problem with this part. So my advice is? Take the former two seriously.

didn't highlight everything as such would lead to utter futility. When I was in 3rd year, I had a lot of highlights but they were color coded (into 8 different colors actually, i even made my own color by mixing inks hehe), so I knew what I had to pick out. 3rd is that you have ample time. It does take time, and you should be ready to give a good part of your time for it. If you plan to use Harrisons, I suggest that you read the following systems: Cardio, Pulmo, GI. A lot of stuff on those sections are high yield in comparison to the others. You also don't have to read infectious medicine (the thickest section) because you've already studied Microbiology and Pharmacology. So you are left with with Rheuma, Nephro, Neuro and Hema Onco. If you plan to browse through these....just pick out the important diseases and the highlights. The keywords I mentioned for Pathology goes the same for harrisons. And the good thing with Harrisons is that the tables are great.

Medicine: Danger level: 3/5 Level of Difficulty: 6/10 Memory: 50% Analysis: 50% Cheap Shots: Few to Moderate Main Reviewer: No high yield reviewer available, otherwise: Harrisons, Medicine Blue Book, 1st aid step 2 Total days for first reading: 4 to 5 days High Yield Topics: Infectious, Pulmo Difficult and Potentially Dangerous Topics: Rheuma, Renal, OB and Pedia (yes, you read that right) This was actually my highest grade in the boards along with microbiology, since they were the two easiest subjects according to the majority of the population who took the test. While i studied about 3 weeks or a month for Micro, I really didn't study for medicine. I spent only about 1 or 2 days total for medicine during the 3 months. Why? Now, if you detest Harrisons and can't stand the thought of reading it, people have suggested High-Yield Internal Medicine. I've seen it and it is actually loaded with info. Good book din. I have also seen first aid step 2 a couple of times from my friends, and it has good coverage and key points.

So, was I confident with barely studying for medicine? No. Because when I saw the samplex of 3 years back....ang hirap. I couldn't answer more than half of it and it was really frightening. Fortunately, our test was not as difficult, or it might have seemed that way because it was preceded by the Surgery test from Planet X.

Surgery/ENT/Ophtha: Danger level: 5/5 Level of Difficulty: 10/10 Memory: 65% Analysis: 35% Cheap Shots: Many Main Reviewer: No high yield reviewer available, otherwise: Surgery Oc-Oc notes, Schwartz, Surgical Recall, Surgery Clerkship, 1st aid stetp 2, Sabiston. Total days for first reading: 7 days Sort of, High Yield Topics: Topics of the first 9 chapters of Schwartz, Skin and Melanoma, Plastic Surgery, Breast, Thyroid, Colon, Pediatric surgery, Glasgow Coma Scale, Stomach, Pancreas, Head and Neck, Anatomy of the Eye. Difficult and Potentially Dangerous Topics: All The test from Planet X in the constellation of Deneb in the fifth dimension in the alternate universe of the microcosmos of the subatomic particles of Zeth. It was so difficult, that you'd ask yourself "Ano to? The Hammurabi Code?" Grabe. During every test, I would mark the questions that I was not sure of and would go back to after my first reading of the test. I would usually mark

First of all, medicine is my favorite subject and medyo dinibdib ko to when I was in medical school. My grades were good throughout and I was therefore, quite confident that I had sufficient stock knowledge for this subject. Second, looking back at the different samplexes of previous years, the medicine test was multi-disciplinary. So much so, that almost half of the questions weren't about medicine. Pediatrics, OB-Gyne, Microbiology, Pharmacology questions were being asked: questions that needn't necessarily be related to Medicine per se. The third reason was that I didn't have enough time to study some more. I was so scarred of Preventive Medicine and Pediatrics that I totally left out medicine. This was due mostly to poor time management because i had used up majority of my time with Legal Med and Preventive Medicine. The only thing that I was able to read were the Pulmo and GI chapters of Harrisons. Is it possible to use Harrison's as a reviewer? I think so, with the following conditions: First is that you should have had read Harrison's before and the technique is to just reread the things you have....highlighted. Yes, read the highlights and you will find that it isn't that difficult or tedious. Second is that when you highlighted before, you

approximately 30 questions per test leaving me with 70 or so items that, at least in my mind, I was quite sure of (which isn't really very good because 70 is still failing and you need an average of 75). With surgery, I marked approximately 50-60 questions. Some of my friends couldn't even answer the answer sheet because their hands were trembling. After the test the corridors were just silent with disbelief and gloom, our fate uncertain. It is because of this test, that you will realize the power of prayer.

Danger level: 4/5 Level of Difficulty: 9/10 Memory: 50% Analysis: 50% Cheap Shots: Moderate Main Reviewer: Nelson, Pocket Pedia, Immunization chapters of Del Mundo Total days for first reading: 5-7 days High Yield Topics: Pulmo, Infectious, Breast Milk/Feeding, Vaccination, TB. Otherwise, very equally distributed test. Difficult and Potentially Dangerous Topics: Endo, Rheuma, Neuro, Psychologic Disorders, Growth and Development, Social Issues. People have always been telling us that this is the subject to fear since it was the most difficult. To an extent, it is true. It is very difficult, but not impossible. Pediatrics itself is difficult and the fact that there is no decent reviewer for this subject makes studying for it all the more difficult. Last year, the top-notcher said she got a line of 7 for this subject and it was her first in her life daw, which means that it was really difficult and that she must have done extraordinarily well in the other subjects. Moreover, the general sentiment for the boards over the last 5 years or so was that pediatrics was the most difficult in that it would be practically useless to study since you had no idea where they were getting the questions from. In our time, it was still true to an extent, but surgery fit that description better. How will you study? I suggest that you start now and study with Internship or Clerkship. It is a clinical subject and there is no better way to study for the Pediatrics board exam, than to LEARN it in clerkship and internship. While you are in the wards, study the cases well, and then read Nelsons. Now that you have a more benign schedule than we did and that masmadami kayo...there is no excuse not to be able to read. If I could do it, you can too. There were very difficult cases that were exactly like the difficult cases I encountered in the ward. The cases of the patients will just pop out of the exam and if you really cared for your patients, you will remember them.

How to study for Surgery? They say Surgical Recall, but nothing came out of that book during that test. But for all it's worth, I still suggest you read it because it really is a good book, and that you also start with it early because it's 700 pages long. The surgery oc-oc notes are also helpful and I highly recommend that you read this because I wasn't able to read it substantially before the test and a couple of questions could be answered if you read it. My reviewer? Schwartz. Like I said, i had read practically all the important parts during clerkship and internship and it was just a matter of refreshing my memory. Some questions were answerable if you read schwartz. If you plan to read, or re-read your highlights, i suggest the first 9 chapters and the other topics I mentioned were "sort-of high yield" Majority of the questions were not in any of the books I read. I haven't read Sabiston yet, so they may have used that as a reference during the test.

Is there hope? I suggest that the best way to prepare for this is to take your surgery clerkship or internship seriously. Surgery is not all about hand work and skill. The thing I like about surgery is the decision making and to those in UST, although you may not be able to get many hands on procedures.....thinking and decision making is a skill. And I firmly believe that the phrase "you barely get any skills training in UST" is not true. Learn from your cases and participate in the mental process of finding the best diagnostic pathway or treatment option for your patient. When I was an intern, surgery was one of my favorite rotations because even though kahit sobrang wasak ka, I really got to learn a lot. Before every OR that I would scrub in, I would read the chapter in Schwartz and Snell, so that while the surgeon was cutting etc, I was already imagining the things I would see next or what he would do next. It also helps to prevent boljack. I remembered once where Dr. Olalia was doing an MRM, and he asked me to identify all the structures he was cutting, the borders of the breast etc. what genetic markers could be requested in this patient and their significance. And come boards, I was able to survive, because I used boljack time during surgery as my testing ground and free time as my study period. As I've told some of you before, "learn by trauma." Make learning, a learning experience and it will surely stick. For the clerks, start now. Kaya ninyo yan.

When I was a clerk, i noticed some of my friends had "First Aid, Surgery Clerkship" I noticed that it was a good book since it was comprehensive, concise, up to date and had great little tidbits of knowledge. So I bought it during internship and was only able to read half of it, but it was really good. So I also suggest this book.

Pediatrics:

What to read? Nelson. Nelson talaga. It is a very very very thick book, but you don't have to read everything. Just like with Harrisons and Schwartz, read your highlights of the assigned readings you had in 3rd year. Here are my suggested High Yield topics, topics you should read on, stated as chapters and tables in Nelson's 16th edition: Pulmo: 361-368, table 370-1, 371-378, 383, 389-392, 400406, Cardio: 415, table 417-1, 418-420.1, 420.5-420.6, 422-423.1, 423.4, 424.7, 424.10, 426-428.3, 429-430, table 431-2, 431.4-.5, 434, Hema Onco: 439, 440, 442, 445, 447, table 447-1, 448, 449, 454.1-.2, 454.9, table 467-1, 468, 470-1, 476.1-.6, 483, 485, 487-8, 490-1, table 493-1, Nephro: 501-10, 515-519, 521.1-.2, 529-531, table 532-2, Endo: p.1851, 552, 556 (just now the differentials), 557, 559, 560-2, p.1954, p.1974-75, 586-87, 591.1, p.2113-14, 630, fig.673-1 and 2, GI: p.1200 table 287-2, 296, fig 300-1, p.1230, fig 311-1, 313.3, 314.3, 337 (very important), Allergo: 137, Rheuma: p.799-803, 156-157.3, Neonatology: 82-82.3, 85-85.6, table 85.3, 86.2, 88, 90-91 (very important), 92.2, 97-98, table 70-1, 70-2, 70-3, Psyche: 27, Misc: (just the important parts of the ff): 61,

41, 29.2, and our favorite: 7-15. When reading these chapters, take notes. Note down things you will surely forget and review them prior to the exam. Very high yield.

Special advice: For Pulmo, know the different causes of upper airway obstruction and how to differentiate. Also, the pulmo chapters are loaded with the phrase "the most common..." For cardio, the important thing is to know how to differentiate which CHD is which, which means knowing the "forest before the trees" separate them according to how Nelson separates it: increase, decreased blood flow, obstructive etc. If you studied this, you may not need to review for Surgery CHD. For GI, please read on how to differentiate the causes of pathologic jaundice: what tests to order and what they would look like histopathologicaly. Hema Onco: master Iron deficiency anemia and how to differentiate it from other anemias. Nasama ko pla dyan ang neuro, I forget which chapters. Anyway, please read Seizures and Tet spells. For endo, don't leave out short stature. Neonatology is also high-yield, especially neonat pulmo.

browsed through it and it is also very good and complete. I was just more familiar with BRS. The other good thing with BRS is that it was in outline form. Otherwise, being the sadist I am, I still took to mama Williams and mama Novaks for some of the other topics. The tables are great and sayang naman ang technicolor highlights ko nung 3rd year and clerkship Preventive Medicine: Danger level: 5/5 Level of Difficulty: 8/10 Memory: 80% Analysis: 20% Cheap Shots: Many Main Reviewer: Current UE notes, UST notes, Wikipedia, Philhealth, First Aid step 1, Dra. Maglonzo's book, UPEC. Total days for first reading: 4-5 days High Yield Topics: Statistics, Environmental and Occupational Medicine, Study Design, Family Dynamics, Current Health Statistics, Health Laws, Community Medicine. Difficult and Potentially Dangerous Topics: Environmental and Occupational Medicine, Rats, Water, Shit and eggs...yes, eggs. This is one of the most dangerous subjects. This is primarily so, because you don't know what to study and you don't know how or what they are going to ask. This can be another potential test from planet X if you do not take it seriously. Some found this easy, but I definitely did not. I was the last one out of the room (in part because I fell asleep) while people who took public health were leaving very early. This is where all of you should help each other.

Remember: don't read everything, just the important parts, which you have already high-lighted. Remember also, not to leave out reading the whole of pocket pedia: very very very very helpful. How did I do with pediatrics with the way I studied? It was my third highest grade.

OB-Gyne Danger level: 3.5/5 Level of Difficulty: 7/10 Memory: 50% Analysis: 50% Cheap Shots: Few Main Reviewer: Oc-Oc notes, BRS, Blueprints Total days for first reading: 4-5 days High Yield Topics: Bleeding in Pregnancy, Abdominal Pain in Pregnancy, PCOS, Amenorrhea Difficult and Potentially Dangerous Topics: Gynecology, Puerperium, Gyne Onco People have always told me that mastering the oc-oc notes would do. To an extent, it is true. The good thing with OB is that a substantial part is analysis and you will be able to answer majority of the questions. However, I still had a difficult time. Moreover, if you took internship at UST and attended and listened to all the rounds with the faculty, you should have no major problems trying to review. That's the great thing about the UST rounds: bugbog sarado na ang utak mo sa kakaturo sa iyo. This is what I mean by "learn by trauma." Hehe

For review, I used BRS since I had begun with it during internship and it was pretty good and concise. What i found especially good was the Gynecology part, especially the tables. I definitely recommend it. The other reviewer you could use is Blueprints. I never used it but I've

For this subject, the UST or the UE reviewer is a must. Without them, you will surely be lost. The UST reviewer was very good and complete. I also suggest that you attend the UST review lectures. On the other hand, I was not able to get a copy of the UE reviewer that was up to date....because I got one dating back to the early 90s...na rip off ako. Anyway, I have been hearing a lot of positive feedback from that reviewer so get it if you can. It even has a section on eggs....yes, eggs. In any case, even if you have gone through the reviewers...you will still feel extremely inadequate when you start trying to answer the samplexes and you realize you don't know which species of rat travels the fastest, and which rat poison doesn't kill which species. And so, you look for other stuff to help you and realize, that you've been studying about rats, sewers and shit all day long....and at the end of the day you just feel sorry for yourself. Hehe. I used up a lot of time with this subject, approximately a week and a half total, and I still felt inadequate before the exam because a lot of your time and effort is wasted looking for what to study. So I suggest, you try to look at the topics in the UPEC and make a checklist if you have an article or reading on each of them. Don't take this for granted because it is a "know or don't know" type of subject.

For statistics, I suggest reading first aid first: so good. After that, read our old UST handouts on statistics and study design: that should do the job perfectly. For environmental and occupational, the UE and UST notes will really help. For other environmental and occupational medicine stuff, wikipedia is very helpful: especially with water treatment, hard and soft water, pesticides and rats. Don't forget to study about the different kinds of poisons like arsenic, lead, mercury etc. The scope is so broad...nakakasira talaga ng bait.

headache: I'd be ineffective for 2-3 days. I never drank more than 2 cups of coffee in a day and usually only drink one cup only, in fear of this withdrawal. What kind of coffee? I really love brewed coffee that isn't too strong. It kicks in mildly and keeps you awake for a long time; withdrawal is also milder. If you've ever had the 'smooth' brewed coffee in Krispy Cream, that's pretty much how you want to brew your coffee. When I went to Singapore, I developed the liking for condensed milk in my coffee...panalo mga pre. Winner talaga. Espresso based drinks are kind blatant and hard, withdrawal is also more severe. Im just not the espresso type. Here's a combination that might help you. I found that the combination of a small cup of coffee in the morning followed by green tea at later in the day will keep you awake and functioning longer than either alone. Ideally of course, green tea is the best because it is healthier and keeps you from getting fat, since all you do is just sit down and study. According to Goodman and Gillman, Tea is even more potent than coffee ounce for ounce; it's just that coffee is more concentrated. If you ever decide to buy green tea: I definitely recommend the brand "Ito En." This is the biggest green tea manufacturer in Japan and the quality is exceptional; the tea is really green. Moreover, I have also discovered that if you drink green tea with only one serving of hot water per bag, it is less effective. Get a medium sized cup and refill with hot water for a total of 2 servings to get the most out of it. Green tea also helps because it supposedly keeps you thin and you don't want to be fat come boards because you have to wear either your clerk or intern uniform. Music: Try not to study with music, it really divides your concentration. I used to study with music every time in med school but realized recently that it really doesn't help with concentration and retaining what you've read. Ang problema pa sa akin is that I love music and when I listen to music, I listen to every bit of it, so nadidivide talaga ang attention ko. An indication for music though is for waking up and for inspiration. When I get sleepy, I usually put on my rock and heavy metal stuff (Megadeth, Metallica, Racer X were the things that get me pumped). For inspiration, I listen to Basil Valdez (buy the 'Sundin mo ang Loob Mo' CD and listen to Kaibigan and Tanging Yaman). For relaxation or good mood time, I listened to Mika Nakashima and a bit of classical music with Maurice Ravel, Debussy and Chopin. Otherwise, when you can, do not study with music. You will need undivided attention to retain the things you read. THE MOST IMPORTANT: God The most important aspect of review for the boards: Never forget the One who has brought you this far so far. He is always there to support you and you owe it to Him and yourself to give the Lord time that is due to Him. Go to mass, pray everyday, study with a mission. Study in the name of the Father, the Son and the Holy Spirit. Surely, you will only give your best when you do things for God as He deserves nothing less and I am sure, that your best will get you through. Make me proud and make UST proud. :) Despite all the problems our school or hospital may be facing, I love it and appreciate it very much (and I'm an Atenean). It's Golden Age will be back one day. Let's keep that hope alive. Do your best when the time comes mga kaibigan.

OTHER IMPORTANT STUFF Environment: This matters a lot, although baka medyo matawa kayo sa mga isusulat ko rito. In this area, the main consideration is how to concentrate and fight sleepiness at the same time. Ideally, you should study in a quiet place with a high oxygen tension. I know it sounds funny, but I find that I study best outdoors in the lanai of my house where I have a small waterfall in the garden, the sound of which keeps me awake. I don't know if you've experienced it but if the air is still, humid and hot....tulog ka in a matter of minutes. Outdoors, the wind was usually cool during July and I found it most conducive. I stayed awake longer, retained more of what I read, and had great lighting to combat eye strain. I had only a handful of ideal study days and it would go like this: wake up at 4 am, take a shower, drink a small cup of coffee, go outside in the lanai and study with the cold morning and high oxygen tension. Minsan lang nga, magsusunog ng basura yung kapitbahay namin. Leche. A very cold environment also keeps me awake.

Coffee shops: Not ideal. The problem with coffee shops is that you have to listen to the chatter of so many people around you as the day goes by. We (Me and Sobs) used to study in Starbucks at Corinthian Hills last June and there were some days where you couldn't study because of the yaking of people around you. Plus, starbucks music is such crap talaga. I know that they want to simulate the 'rustic' feel or american ambiance or what not, but most of the music they play will make you dumber as the day goes by. Plus, I personally do not like starbucks coffee: worst brewed coffee in my book. Sometimes I think I'm drinking brewed soil. The food however, is good. I usually order the Bagel, because it's the cheapest and healthiest. Figaro has good coffee, but you stink at the end of the day because they don't use their exhaust fans when cooking. Coffee bean also has good coffee and tea. I soon realized that you can't keep on going to coffee shops everyday because you'll end up spending as much as a review class. If I do go to a coffee shop, it's because I have lost the battle against sleep and distraction at home. That would be an indication for a Coffee shop. Coffee and Tea: I really needed this and it helps. Earlier in July, I had a problem with trying to stay awake in the early morning and I found that drinking coffee first thing in the morning was the key. Drink your coffee before eating your breakfast to get the full effect: it doesn't work as well the other way around. Only drink a small cup of coffee and not a whole glass, palpitations and hypersympathetic activity will work against you. The problem with coffee everyday is that I usually had a withdrawal every 1-2 weeks or so where I'd be hyper-somnolent and with a throbbing

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