Archive for the ‘Step 2 USMLE’ Category

2011 Match: The Game has Changed, but the Players didn’t notice

November 20, 2010

There are three more medical schools graduating their first class this year in the United States. The existing schools expanded their classes four years ago and some are coming out now. But this little fact has escaped most of the applicants. People who go unmatched are often like those who die of cancer. You figure it is really sad, but it won’t happen to you and in any event, at least not today.

Yet, yesterday, I had to pare down those we were inviting for interview because we have already seen a LOT of people and the program director is getting fatigued. We chopped off all IMG with scored below 90 and chopped off all US grads who ever failed or had scores below 80.

What does this mean? It is getting harder and people don’t know.


Ooo!!!! New Video! New Step 2 course

March 21, 2010

ooo!!! My new video!
Next year there will be 19,900 FIRST year US med students.

This is after a 30 year FLAT enrollment. The number of First year RESIDENCY positions is FIXED at 23,000 WHO will you choose for the 4,000 spots for IMGs? Take a look at comprehensive cases. It is designed to get the higher score that will be Mandatory in order to get into those spots.

Don’t get shut out! The test is not graded on a a curve.

Forgive my absence, Finishing new Step 2 USMLE book

March 21, 2010

Hello Everyone,
I apologize to the many people have been writing and commenting without my response. I have gone straight from my ‘Routine Miracles’ tour (sept to Nov) I have spent the last five months day and night writing “Master the Boards:Step TWO” which will be out at the end of July. This endeavor takes all my effort, because as you may or may not know, I continue to work as a functional clinical doctor and teacher during the day.

My writing would, I believe, have MUCH less value if I were just some guy who wrote books in a vacuum. Every day I go into New York City and see patients, write prescriptions and deal with the ill, the surviving and the dying.

When a book comes to an end like this, I take time or I am almost forced to contemplate the highest good. Another book? or to contemplate ‘Eschatology’ LOOK IT UP.
What are the ultimate thing? Perhaps this is to be the last one?

In 2009 I produced
Feb 2009: Master the Boards: Step THREE
May 2009: iPhone App ‘USMLE Disease Deck”
Sept 2009: Routine Miracles
Oct 2009: ‘Comprehensive Cases’ an on-line step 2 course.

is my soul larger because of it?
Maybe time to stop. Yet, watching the selfish, hatred and mean spiritedness that I see in the OPPOSITION to healthcare reform, we see…. nothing stays neutral… removal from the fight means it goes backwards…. Never once in all the nastiness that I in those OPPOSING reform do I hear anyone say “Am I my brother’s keeper?” what of those who are sick and injured and need us?

The NEWEST fresh Fisch meal

October 5, 2009

For those of you who are educational afficionados, here is the latest ‘Daily Special”

It’s a Freebie educational case.. Go to the middle where it says “TRy FREE….

THe Fisch Presents at 530 today, October 3 at AMSA convention in Philadelphia

October 3, 2009

Greetings and Felicitations!

Today I will be presenting on Test taking and “Routine Miracles’ at the AMSA convention in Philadelphia. We will be giving away copies of “Routine Miracles” to the first 25 students.

Here is the new link for the Recent TV interview which is a very important statement on the nature of a Heroic Society.

it takes the coagulation cascade 3-6 hours to breakdown a clot then why would it be ok to give TPA in an MI patient up to 12 hours? Just a thought; thanks! Sharron

September 30, 2009


You can give thrombolytics up to 12 hours after a Myocardial Infarction for the bottom line reason is that there is still a measurable Mortality Benefit.

Also, Factor XIII or clot stabilizing factor takes longer than 12 hours to ‘stabilize’ the clot a render it invulnerable to lysis by plasmin.  So, the first part of your question about taking 3-6 hours for the coagulation system to break down a clot is not accurate.

The brain has no GLycogen stores, hence,irreversible damage occurs after only 3-6 hours. There is no point in re-perfusing dead tissue. Like sending flowers to ex-husband five years after divorce.

Live Event at the Pasadena Kaplan Center, 6pm Thurday

September 24, 2009

Come on by!!!

Answering any Step 1,2,3  question. Showing ‘Comprehensive Cases” and…. ‘Routine Miracles”

HIV and pregnancy Question

September 24, 2009

The criteria for starting anti-retrovirals in pregnancy are

1. If the CD4 is LOW (<350) or the Viral load is elevated, then start THREE drugs IMMEDIATELY

2. If the CD4 is HIGH (>350) and the viral load is LOW, then start medications in the 2nd and 3rd trimester and stop after delivery

3. C-Section is ONLY used if the viral load is above ONE THOUSAND. this is a special cut off just for preventing perinatal transmission of HIV.

Presentiations in San Diego and Los Angeles: Test Taking and Routine Miracles

September 20, 2009

San Diego: September 20, 3-5pm

UCSD in the Liebow Auditorium

9500 Gilman Drive

La Jolla, CA 92093


Los Angeles: September 21, 6pm

Westwood Kaplan Test Prep & Admissions Center

1133 Westwood Blvd, #101

Los Angeles, CA 90024


Washington DC Tonight at 5pm

September 18, 2009

I will be at the Washington DC Kaplan Center presenting on test taking and Routine Miracles afterwards. Come by and say hello!