Abnormal Facies

The sympathetic nervous system mediates the classic “fight or flight” response – pupils dilate, the heart races, sphincters contract, and hair stands on end.  “If you have a cat at home, put his favorite food in a dish. Then just before he starts to eat, snatch the dish away. Before he scratches you, look at his pupils – that’s a [sympathetic nervous system] response,” a mentor once told me.  Fortunately, if you’re not a cat person, you can also elicit this response by mentioning the USMLE Step 1 to any second year medical student in America.

Having just experienced this exam myself, I can attest to its grueling nature – a 7+ hour exam on all one has learned in the first two years of medical school (with some topics reaching back to undergraduate education).  However, the test is also a rite of passage, and I can’t say I disagree…

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