Awkward Examination - Orthopaedics Chapter

So I'm currently back in London, on a pretty good Orthopaedics and Rheumatology firm - there's a lot of variety to the clinics available, and the teaching has been pretty good (probably the best i've had on firms)!

In fact each week we get rheumatology teaching, and on Thursdays we get an orthopaedics OSCE themed tutorial, and on Friday we come back to practice on each other.

Our consultant splits the group into boys and girls, and we go off to our side rooms/examination rooms to  practice, and the consultant whizzes in and out between the two groups to watch/teach....

...and as it happens, the consultant comes back into the girl's room as i was examining the spine.

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Tofu: "ah, okay i think i've finished my exam now"

Consultant: "So tofu, let's say your patient has sciatica, how would you test for it?"

Tofu: "ah! yes i forgot to test for it! well i will get the patient to lay flat, and i will elevate her leg, and i suppose i could press on her perineal region and see if that elicits pain"

Consultant: "her perineal region?"

Tofu: "yes, her perineal region"

Friend playing the patient: *laughs* "umm.. i don't really want you pressing my perineal region"

Consultant: "Tofu, where is the perineal region?"

Tofu: "it's the area behind the knee"

Consultant: "are you sure?"

Tofu: "yes..." 

*AND then it hit me.. nooooooooooooooooooo!*

Tofu: "NOOooooooooooooooooooooooooooooooooooooooo! i mean her popliteal region! the Popliteal region!"

For reference the top image demonstrates the popliteal region, and bottom image shows the perineal region - definitely not part of the spine exam!

Falls Clinic - Why do old people fall?

So the Falls Clinic is meant to be the bread and butter of the module, and as it was put to us by the man in charge, on the very first day.. 

"you can't possibly do a care of the elderly firm without going to a falls clinic!" 

... and so i went

.. as did two other medical students, a physiotherapist, a nurse, the registrar, the consultant, a patient and their relative... 

that's 9 of us all cramped into a tiny clinic room - Cosy! 

I didn't really know what to expect in the clinic, but luckily I did some ECG interpretation revision the night before, and that came in handy! I'm not sure why i didn't really expect it earlier, but every patient that came through the door had their ECGs taken, and the consultant would shove the ECG to us, and ask us what was wrong with it. (i remember dreading ECGs in year 3, but i've noticed that they're not so frightening anymore.. or perhaps i'm not so afraid to be told im wrong)

I soon gathered that there are too many reasons as to why the elderly are likely to fall, and it's a matter of really going through all the possibilities like a detective -- from visual impairment, to parkinsons, arrythmias, or even just their mix of medications. In most cases, it was the latter...

..and this proved another opportunity for the consultant to quiz us. As he took the patient next door to be examined, he would divide the boxes of medication between us and get us each to talk about each medication and their side effects when he got back. Finally he'd ask us what we thought the cause of the fall was for each patient.

These are the sort of clinics i enjoy! Where the consultant get's the students involved and constantly has something for us to work on... and before i knew it, it was over. 

I'm pretty sure i only enjoyed the clinic so much because the consultant was so engaging, but either way, the man was right, experiencing a Falls clinic on a care of the elderly firm is a must! 

Care of the elderly

On the ward round this morning...

Reg: Tofu, what do you notice about his mouth?

Me: Well, i'm pretty sure that's just a blob of dried toothpaste on the corner

Reg: No not that..... *turns to look at the nurse* So how long has he had the facial droop for?

Okay, so turns out, the Reg didn't really care about the blob of white toothpaste, and luckily it wasn't actually a droop, it had always been there. 

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Ah, it's been a while since i've last blogged! 

Since my last post, I've had 5 weeks of Psychiatry and an ICA in between, and now i'm out in the countryside in the North  ( thanks for pointing that out to me Grumpy) South East of England, with the care of the elderly team. 

In summary, this is pretty much ALL OF YEAR 3 squished into one module, or indeed into a single individual. It's definitely general medicine at its finest.  

Being the "specialities" year, every module this year has been pretty much a different speciality with the same thing week in week out; but COTE makes a really nice change. It's chucking me back into general medicine, and making me realise how much of it I've forgotten. 

I wish i posted a bit more now, i've had a few encounters with really nice patient's and it would have been a nice memory to have kept, and to read back on in the future. I will try! However, until then, there's 9 mini cases I need to get through.... work times!