Sunday, November 30, 2008

and it's down to...

99 days left!!!!!

-cue panic attacks-


Thursday, November 27, 2008

clinical confidence

today, a nice intern told us to have a look at a patient, and perform a neuro exam of her lower limbs.

now, neuro, is certainly not one of my best topics in internal medicine (gastro is, by far). in fact, i used to have ZERO confidence in it at all, thankfully, 1 month of subinternship in neuro (and seeing nothing but neuro) did give me a fair bit of confidence.

however, in this dear old lady (who happily chatted with us the whole way through and really made us laugh! :) i hope i'm like that when i'm old too!), her constellation of signs was puzzling.
- slight hypertonia of the Right LL, normal on the Left
- no reflexes at all bilaterally
- upgoing plantar on the Left, equivocal on the Right.
- normal power on the Right, weak on the Left.
- sensory loss in a stocking fashion

so the overall picture is that of a mixed pattern, with peripheral neuropathy thrown into the picture.
she told us that she had an old stroke, which explains the weakness and upgoing plantar on the Left.
the peripheral neuropathy explains the missing ankle jerks bilaterally.
so how does that explain away the Right hypertonia and the missing knee jerks?

her upper limbs were fine, no cerebellar signs or cranial nerve signs. she was admitted for a fall (her Left sided weakness), and there was a bruise over her left knee.

i then started questioning myself- were my signs correct? did i do the right thing? did i examine correctly? am i thinking straight? maybe this is ALS or SACDC instead?

so, unsure, i went off to ask the intern - who happily assured me all my signs were correct and it was due to many pathologies!
(the absent knee jerks were due degenerative disc disease/PID that was large, and the hypertonia was due to a new stroke, albeit a small one).

in short? clinical confidence is very important. you've really got to know what you're doing!

another 2 friends of mine were told by the resident to examine the cardivascular system of a patient - both could not hear heart sounds and were depressed and anxious.
the resident proceeded to tell them," that is exactly what i wanted you to hear!"
it turns out the patient had a pericardial effusion (with bulging neck veins) so therefore the heart sounds were muffled!

Thursday, November 20, 2008

medicine revision, 1

2nd week of medicine revision posting now (out of 6), and the countdown begins in earnest. there's 12.5 weeks of school left, 2 weeks study break, and then the end of the beginning is here. medical school is a long road (compared to other degrees), but we've only just begun!

i can most safely say i will be extremely sad and sorry to see my undergraduate days behind me.

12.5 weeks. and then it's make or break.

i have only 12.5 weeks to brush up on clinical skills, to perfect my examinations and differentials and presentations to a level for passing (hey, i'm not aiming for distinctions here!). i want to be a safe doctor, a good doctor. so i'll work hard. but i think that half the stuff we're tested on is pointless and useless.

i'm still getting scolded left right and centre for my gross lack of knowledge and ineptitude. sigh :(
take today for a case in point - the opening stem was "this man complains of intermittent joint pain. please examine his legs"
i just went ?????!!!!!! in my brain and proceeded to try to wing it with an ortho exam, trying to incorporate what little of rheumato i remembered. and was told by my tutor - " you'll fail if this is MBBS" :(
to think my group mates got easy stuff like hand and neuro exams :( oh well but at least i'll have a better idea of what to do now, i guess.

8 minutes for examining and presenting sounds like a mighty short time, i have no idea how we're going to do it, but like generations before us, we'll survive somehow :\

may more mid-diastolic murmurs come my way! (although i did hear plenty in india, i can't really hear them anyway) and may all the patients for MBBS please be admitted in the remaning 4 weeks so they'll be called back for exams well :P

12.5 weeks!!!!

angry, it's good to hear from you that you're alive! :) hope you're enjoying clinics!

and dearest dragonfly, i hope you're safe in whereever you were going to from rurality :)

Tuesday, November 11, 2008


2 weeks of geriatrics has ended and i must say it's been an eye opener. geriatricians are truly the best clinicians around, they manage patients holistically and genuinely seem to care for them. on top of that, their medicine knowledge by no means pales in comparison with those doing internal medicine!
some of the hardest MBBS examiners around are also geriatricians. hmmm.

i've learnt about polypharmacy (so common!!!!), falls, incontinence, dementia etc. and it's startling to know just how many of these we attribute to "aging" and write off as being normal when they could be treated!

and another scary thing is how fast my parents are heading into the geriatrics age bracket (alright it's a good few years but still), they're no longer as young as i thought they were. and it's never something easy to understand, your parents growing old. somehow i always thought they'd always be there! :\ i can't imagine life without my mum and dad (i mean, even when i was overseas/staying in hostel, they're still there.)
but all things must come to pass. i just hope i don't get there too soon!

seeing all the elderly folk every morning on rounds makes me sad. most of them have social issues and no caregivers, and the wait for nursing home places is miles long. as a result, the doctors are frantically trying to get them out of hospital to make way for more acute patients, and it seems that no one wants them. must feel terrible, to be so old and to have lived so long and done so much (i'm assuming) and to be so unwanted in the end.

geriatrics breaks my heart, and it reminds me too much of my gram. but i do think that it's an incredibly worthwhile specialty to go into if you're looking for all-rounded care of patients.

we were scolded really badly on rounds, for our gross lack of knowledge and finals being only 4 months away. basic interpretation of ECGs, BP taking (i didn't know that you can't take BP from a hemiplegic side!), feeling of cervical lymph nodes, my groupmates and i have failed miserably.
it's a call to wake up and start studying, we obviously didn't know as much as we thought we did. but at least there's 4 months to go which hopefully should be enough time!

now we're into the final stretch, 14 weeks to go to finals. 6 weeks of medicine and 4 weeks of surgery, with 4 other weeks in between on minor postings. it's the home stretch, so wish me luck!