Microbiology. She is a mighty beast. But she needn’t be.

Like any subject on the USMLE exams, we can turn them from enemies to allies simply by advancing our knowledge in the subject, and putting devoted practice into our learning.

We recently went over our preferred method of creating pharmacology flashcards, and in this post, we will devise a plan for systematically synthesizing microbiology flashcards.

Before we break down particular strategies, it is important to re-iterate the commandments of flashcard creation:

1.  Keep them simple and brief.
2.  If you have more information than a single card should contain, break it down into multiple cards.
3.  The knowledge you will build comes from BOTH their creation and their utilization

And, the tenet that we will address here and now:

4.  Include the most important and concise information that the test will expect you to know.

Here are the most salient facts that you should know about microbes:

• staining & morphology  — gram stain (and any special stains) & shape
• diseases caused
• virulence factor(s) — if these are numerous (like for E. Coli), consider a stand-alone card 
• treatment — mainstays of therapy; no need to write every possible effective drug
• factoids/misc. — keep it brief (e.g., most common cause of disease X, difficult to culture, etc.)

Now, a caveat: Unlike pharmacology, where the necessary information about a drug is pretty limited, for many “popular” bugs, a single flashcard can become a bit laden with information. For example, let’s go with our old favorite:

Staphylococcus aureus

stain — gram + cocci in clusters
disease — skin infections (impetigo), acute bacterial endocarditis, osteomyelitis, toxic shock syndrome, septic arthritis
virulence factors — coagulase, hyaluronidase, DNAse, superantigen (in TSS)
treatment — penicillins (ox-, naf-), vancomycin (for MRSA), TMP-SMX, doxycycline
misc. — coagulase positive, can cause aggressive post-viral pneumonia

At first glance, this card appears a bit overloaded. However, because we have employed a framework and know exactly what information we expect on the back of the card (stains, diseases, virulence, treatment, misc.), we won’t be left guessing what the card is asking us. Mind you, S. aureus is a hugely tested microbe, so it makes sense that its card is a little busy. If you are uncomfortable with this amount of information, breaking this into multiple cards (“S. aureus diseases,” “S. aureus virulence factors,” etc.) is another viable option.

Let’s take a look at a less marquee bug:

Bartonella henselae

stain — gram negative rod w/flagellum, can use silver stain
disease — bacillary angiomatosis (BA), cat-scratch disease (lymphadenopathy w/fever)
virulence — N/A
treatment — azithromycin, doxycycline
misc. — BA often in immunocompromised; For cat-scratch, look for contact with cat!

Now, in addition to cards for individual bugs, you should also make flashcards that will help compartmentalize microbes that go together. (The process of putting information into “mental boxes,” compartmentalization, is extremely important for keeping these thousands of facts straight in your head).

These cards would be things like:

Lactose fermenters
Klebsiella
E Coli
Enterobacter
Serratia
Citrobacer

Causes of UTI
Staph saprophyticus
Proteus
E. Coli
Klebsiella
Pseudomonas (hospital-acquired)

As for algorithms, like the gram negative identification algorithm, there really is no substitute for drawing and redrawing them. Sorry, everyone.

Like most aspects of USMLE prep that we cover, there are few one-size-fits-all approaches. These creations are organic processes, and you can mold the process into something that works best for you. We can provide the framework and direction, but the more heart and soul you pour into your cards, the more valuable they will be. Don’t be afraid to have fun with the process!

Create idiotic/brilliant mnemonics, draw pretty pictures, keep them close to your heart. Run through them when time permits, and if time doesn’t permit, then make more time! Even 10 minutes before bed will have you internalizing some facts that you otherwise didn’t know. Like we mentioned in the pharmacology flashcard post, there is no easy way out. The best thing you can do for yourself is to make sure that the efforts you contribute are focused and devoted.

Hopefully this provides you with the direction you are looking for. Together, we can save the USMLE world! #We’reSoPunny

Keep the questions coming!