Cambridge

Medical Tripos 1B

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Introduction

1B Medicine has gained a somewhat infamous reputation for being a really tough year, and this may seem daunting at first. However, it can be managed. Remember, you’ve already been through a year of Cambridge, you’re probably more set up to deal with this year than you were to deal with 1A when you first arrived.

However, there is definitely a lot of work to be done this year, just think about the light at the end of the tunnel (part II in third year is supposedly way more chill). Pace yourself, this is a marathon, not a sprint, keep up a reasonable level of work over the holidays and you should be fine!

Score Calculations

1B is out of 460, with 140 from NHB, 100 each from MODA and BOD, 80 from HR, and 40 from HNA. Of each of those subjects, half the marks come from essays.

The weightage of different subjects is kind of interesting, because it does show you that you can’t really neglect HR. However, the low weightage of HNA does make cramming it close to the exam quite a tantalising prospect.

HNA

  • There are 5 major segments to the manual, with 5 corresponding prosection sessions
  • This course only runs in Michaelmas, with an exam in Lent comprising of MCQs and short essays 
  • The MCQs are much more chill than FAB
  • The “essays” are really 3 paragraph long short answer questions, so it’s quite easy to plan most of the past paper questions
  • The embryology ones (there is usually 1) are often neglected, so the mark range is insane (10%-90% for one year)
  • If you can master your embryology, I would recommend going for this essay 
  • What I did for these exams
    • Learnt all of the manual + lecture content in the Christmas holidays and wrote myself mock MCQs (available on the drive)
    • Made a limited number of essay plans
    • Started memorising the manual and lecture content 1 week or so before the exams 
    • In tandem with this, I planned quite a lot of the essay questions, which was very helpful – the embryology ones are all pretty much cut from the same cloth, you can always chuck in CHARGE, DiGeorge and the other neural crest cell disorders
  • Interestingly, you can link this stuff to FAB embryology (for bonus marks I reckon)

NHB

  • Section I -> short answer questions, Section II -> Neuroanatomy and Neurophysiology paper, Section III -> tripos essays
  • I opted to make my own notes using lecture slides + notes, and just made flashcards off those to prepare for section I
  • My approach as a whole was to try to gain marks from the essays, so I made sure I planned at least 5 or 6 essays over Christmas
  • I also learnt all of the content for the prior terms over the succeeding holidays (e.g. Michaelmas content over Christmas, Lent content over Easter Holiday)
  • Biology of Neurons
    • Relatively easy, and always comes up as a essay title
    • I would try learning the experiments and the corresponding diagrams (particularly the LTP experiments), as this works well for essays
  • Senses
    • Generally, there is 1 essay a year asking you to compare and contrast senses, so it’s worth coming up with a broad framework for doing this
    • My framework (which is probably a bit too limited) operated along these lines (TET-C)
      • Transduction
      • Encoding
      • Thalamic Analysis
      • Cortical Analysis
    • From each of these ideas, I’d usually branch off to stuff like the molecular mechanisms of transduction, long v short receptors etc
    • Also I’d consider checking for plasticity under thalamic and cortical analysis, this is not usually covered, but worth talking about
  • Vision
    • Probably the most difficult NHB topic in Michaelmas, I went through this lecture by lecture, and the first time I did struggle to learn it
    • However, revisiting it a second time closer to exams, it felt a lot easier to learn, so I would suggesting learning this as soon as possible in Christmas, then revisiting it in Easter term
    • The diagrams for the last lecture are super confusing, especially those related to threshold, so maybe make a note of those axises and why they are what they are
    • Lots of definitions to cover, make sure you get them all!
  • Chemotransduction
    • Really quick and simple lecture
    • Make a note of TET-C for the senses
  • Hearing
    • Pretty chill set of 3 lectures
    • Make a note of TET-C for the senses
  • Somatosensation and Pain + Pharma of Pain
    • A bit trickier, worth knowing specific laminae levels for different pain/touch pathways
    • Again, experimental evidence introduced in this series is great for essays
    • The pharma of pain lecture is really good, ties in nicely with inflammation MODA lectures that you do at the end of Lent, so you could easily wait for that, and learn them together – I wish I had done this
  • CNS development and regeneration
    • The lecture notes alone probably will work for this, but know the little details, like which chemicals promote growth, what strategies there are for repairing nerve damage etc
  • Motor
    • Probably my favourite of the lot, very detailed but also quite logical
    • The essay questions tend to revolve around feedforward v feedback, so know which systems/reflexes would fall under which!
    • The basal ganglia stuff can almost be entirely learnt in diagram form, so this should speed up revision
  • Arousal, Motivation, Sleep
    • Pretty detailed for 3 sets of lectures, but sometimes you get an essay question on it
    • Know which lesions lead to what and why
    • Learn the sleep mechanisms well
  • There is usually an intro to psych lecture after this, but it’s pretty pointless, I didn’t bother learning it, apart from 1 or 2 experiments they mentioned in it
  • Emotion and Anxiety
    • Pretty chill lecture series, good tie in to the hypothalamus and amygdala stuff discussed in the arousal and motivation lectures, learn the links
    • There’s a good diagram for the roles of the amygdala in fear, it’s pretty complex but well worth learning for essays/section I
  • Attention – short lecture but quite dense
  • Cognitive Memory
    • 2 lectures, really easy stuff
    • Learn the models and know them well, also make sure to learn how to test for implicit vs explicit memory
  • Neurobiology of Memory
    • One of the harder bits of the psych course, there’s a good diagram that summarises information transfer into and out of the hippocampus that simplifies it massively
  • Addiction – 1 lecture, a bit tricky, but supervisions should help clear this up
  • Language – pretty chill I think, you can learn this in terms of the models and how they evolved
  • PFC + Cognitive Development – the former is in lent and the latter is in easter, but worth learning them together
  • Decision making and IQ – v little content, so you can distill this down to the essentials
  • Psychopathology
    • Irritating because there is a fair amount of content, and can come up as essays
    • However, you can add loads of extra stuff in essays for this

BOD

  • 30% MCQs, 20% prac, 50% essays
  • Essentially this is pathology, so you start off with immunology, followed by viruses – this is all of Michaelmas really
  • In Lent, you do bacteria, parasites, vascular and cancer (+ a small summary immunology lecture, which is super helpful for essays!)
  • Among the “big 3” (MODA, BOD, NHB), this is the shortest course, as you do not have any Easter lectures.
  • There is an initial introductory lecture which has some stuff on heat shock and cell injury, but I don’t think it ever got tested
  • Immunology
    • This is the nicest bit of the BOD course, it’s quite logical and easy to follow
    • However, the lectures can be up to 1hr 30 min long, so you could easily skip those, and just use the slides and the notes
    • If you want a jump start/want a clearer explanation of certain concepts, I highly recommend this book, it’s a fast read and isn’t quite as clunky as most other textbooks 
    • I didn’t like the way the concepts were divided up, so I made my own notes along these lines
      • Innate 
      • Complement
      • MHCs
      • Adaptive 
      • Autoimmunity and Hypersensitivity
      • Transplantation
      • Responses to Pathogens (Lent lecture)
  • Viruses
    • 7 lectures, all quite dense, but well taught for sure
    • For the classification system, I recommend drawing everything out and then learning that diagram, rather than testing yourself on individual groups
    • You can tie in loads of immunology to the immune response to viruses/evasion of the immune system by viruses, this is critical for essays, and there is a Lent lecture which deals with this
  • Bacteria
    • Probably the most interesting of the pathogens, but this lecture series is arguably the densest of all the BOD topics
    • You can use diagrams here to streamline your learning and improve your essays
    • The practical stuff is also really important here, you can do a flowchart for all the different bacteria types and how to identify them. Alternatively, a table works pretty well too
    • You can also tie in loads of 1A MIMS to this topic, particularly apoptosis – the intrinsic apoptotic pathway diagram works wonders when you have to discuss H. pylori! 
  • Parasites
    • I found this to be the most boring part of BOD, but you do need to learn this stuff, thankfully it’s only 4 lectures
    • I just compressed all of the slides + notes into 4 pages worth of notes and just memorised those
  • Vascular
    • I thought this whole series was just a test of brute force memorisation, because it just comprises of a series of lists you just have to know
    • However, since you would have done clotting + atherosclerosis in MODA prior to this, there is some familiarity
    • Diagrams here can also help, and would be useful in a vascular essay (usually 1 each year)
  • Cancer
    • The lectures mainly recapitulate loads of MIMS cell cycle and apoptosis signalling, so if you know this, you’re set
    • In addition, if you bring in the cancer stuff from MIMS, it looks like you’re going above the lecture material
    • Examples of MIMS stuff you can use
      • Myc, Ras, and Src
      • P53 pathway
    • Beyond MIMS stuff, there is so much out there you can add onto your cancer essays (usually 1 a year), and this would push you really high up 
    • I did a talk about how to approach cancer essays for the university’s Oncology Society – the slides are shown below.
Ardon’s Oncology Society TalkDownload

MODA

  • Probably the best organised 1B course
  • Same exam layout as BOD basically, but the MODA MCQ is generally much easier
  • What I found helpful was writing all my drug flashcards in term, and learning those in term time, it made revision later much easier, and also made supervisions bearable
  • Over the holidays, I made a bunch of drug tables as a revision exercise, and found this to be quite useful
  • There are also a bunch of drugs that are in the footnotes of the lecture notes which can be tested, so learn these too!
  • Receptors/Pharmacodynamics
    • This covers all the 5 main receptor classes, as well as all the pharmacodynamics stuff you need to know for the practical
    • I recommend making some sort of sheet that summarises all the equations you need
    • The receptor bits themselves are very simple, it’s mainly MIMS rehashed again, so it should be familiar (for the most part, there are some new things)
  • PNS
    • Even though this is only 5 lectures, it’s probably the densest lecture series
    • Thankfully, the lectures are really well structured, and the drugs come after the concepts are presented, so you can understand how they mess with the systems involved
    • Don’t neglect NANC transmission in essays on PNS stuff, usually this is what you would need for a good essay, whether it’s an essay on the sympathetics, parasympathetics, or even generally on uptake or termination
  • Cardiovascular
    • 6 lectures shared with vets, and then 4 medic specific lectures
    • Quite chill, recapitulates a lot of HOM, with the addition of drugs that control certain processes
    • Lots of ion channels in the first 1-2 lectures, detail on these would serve you well in essays, e.g. Nav essays which are common
    • The clotting lecture overlaps massively with BOD vascular lectures, so learning the cascade early in Michaelmas/Christmas break is a big help for Lent
    • Don’t worry if the anti-dysthymic drug lecture (lecture 10) feels confusing, the drugs in question are really tricky
  • Pharmacokinetics
    • Unlike pharmacodynamics, which is concerned with drug-receptor interactions, this is all about how the drug gets to the receptor
    • First 2 lectures are about the principles of administration, distribution, metabolism and excretion
    • Metabolism’s pretty cool, learning the specifics will help massively for the practical paper
    • Just like PD, I suggest creating sheets that summarise the equations you need to know
  • Chemotherapy
    • Likely ties with PNS for densest lecture series, although this is slightly more boring
    • The antibiotic stuff is really heavy, but diagrams help to expedite the learning process
    • Antiprotozoal drugs are really chill, especially since you’ll have done parasites in BOD before this
    • Antivirals are more tricky, and it’s worth splitting these up into the stages of the viral life cycle that the drugs interfere with, makes for a good essay structure as well
    • Anticancer drugs are pretty ok to learn, at time the names of the monoclonal antibodies can get complicated, but once again, diagrams help massively!
    • The last lecture is on resistance, and is probably the most interesting, but is also quite difficult
  • Immunology/Inflammation
    • After BOD immunology, first few lectures should be chill
    • A diagram for all the lipid mediator synthesis pathways is super helpful, especially for leukotrienes (which can get complicated)
    • Links nicely to pharmacology of pain when you get to NSAIDs and COX-2 selective drugs
    • Can combine the paracetamol stuff with the PK stuff in earlier lectures, might make for a good essay link
    • The monoclonal antibodies and DMARDs are horrendously named, so make some time for learning these, it will be difficult
  • Neuropharm (Easter Term)
    • I’m not very qualified to speak on this; crammed this in Easter term, and hoped I wouldn’t have to resort to doing an essay on it

HR

  • This subject only gets introduced at the start of Lent, usually 3 lectures a week
  • Sadly, not all lecturers provide lecture notes so I would recommend making your own for most of this course (I have starred(*) the bits which might require this)
  • Populations etc*
    • 4 or 5 lectures which deal with quite mundane stuff
    • Make sure you know how to calculate life expectancy and things like that
    • The Barker Hypothesis gets more grounding in the Easter lectures, so I wouldn’t worry too much about this till then
  • Gonads*
    • All about male and female gametogenesis + ovarian cycle and puberty
    • Lots of good diagrams to be learnt here, also commonly gets tested as an essay question
  • Fertilisation + Placenta
    • Super long block, with about 10 lectures or more
    • Coition, fertilisation, and implantation are best learnt together
    • Both placenta lectures are easily combined too
    • There’s a lecture on the immunology of pregnancy which gives you loads to use in placenta development essays
    • Then there are 3 lectures* which involve IVF, embryo loss and prenatal testing
  • Preparing for Birth
    • My favourite lecture block, very easily to understand and rooted in basic physiology
    • Maternal adaptations, fetal growth, parturition, fetal physiology, and finally, fetal adaptations
    • Lots of cool diagrams here, and also, you can very easily reuse 1A HOM knowledge to score high, like the resetting of the chemoreflex and baroreflex, how T3/4 and GH work, + 1A FAB (fetal circulation and shunts) + MODA re prostaglandins
  • Epigenetics + Sexual Health (Easter Term)
    • Crammed this in Easter, so not sure I’m qualified to advise on this

All the best with 1B!

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