End of term, and a surprise result (yay!!)

Yayeeeeee!!! Finally the long awaited 2 week holiday is about to begin!!

I'm looking forward to hibernating under my duvets, eating lots of festive food, seeing some old friends... and generally just having some time off ^^

CSP week 2 was challenging.. not so much because of the content, but more the freezing cold lecture theatre, and the inability to switch the heating on.. or switch the air conditioning off!!!! Everyone is sat here with coats, scarves, and hats still on.. and I've even had to put my gloves on too! It's so cold in here!!!

But yay! That's the 1st term done and almost dusted, ICA results to follow in January, and to end it all on a high note.. I got some fantastic news this week!!

We had an email sent out to us randomly about an exam board meeting with instructions to check blackboard for rankings, deciles and distinctions..... And I checked my results and was lucky to get a distinction for preclinical medicine ^^ - yay!!!!!!!!!!

(One of the best random emails ever!!)

Now ... Xmas and general relaxation till CR in January!!

Zzzzzzzzzzzzzzz

MET3B End of Firm + ICA exams

Last week was incredibly slow at the hospital.

All the other medical students had already moved back to London, and it was just the 4 of us doing Met3b... and to be honest, at this point i was pretty burnt out from all the late night revision for the exam looming around the corner.

I tried to keep myself busy during the day, and made lots of visits to the EAU. I did the usual thing, and introduced myself to the sister, and asked if i could help them take some bloods and put in a few cannulas... the sister was VERY enthusiastic... but her enthusiasm was more towards telling me to sit in the staff room and eat cake (literally - carrot cake).

From experience, bugging the HCAs are the best way forward...they know all these nifty tricks!! I stayed a few hours every day, took bloods, clerked a few patients and managed to bug a respiratory registrar to let me do my first ABG.

Doing my first ABG - i was instructed to find the pulse with the tips of my index and middle finger, to then lift the index finger and insert the needle in its place. It sounds simple..but the tricky bit here.. was not being able to feel or see the vessel (compared to venepuncture). I was pretty lucky and managed to get the needle in on the first attempt, and instantly got the pulsatile flashback (probably the coolest thing i saw that week)!!!!

BUT i did feel incredibly guilty during the procedure, as the patient was moaning quite a bit and telling me how painful it was whilst the blood was being drawn out. However, we took the sample to the blood gas machine.. and whilst i can be honest here and say i had no idea what i was looking for on the print out.. the registrar said the patient was good to go home.. excellent!

Whilst it was fun, I couldn't wait for the end of the week to come, and when it did.. i got my logbook signed off and swiftly moved back to London for the BIG CRAM!!

Met3B ICA EXAM

I was literally freaking out last weekend, trying to cram every bit of information i could get out of each lecture, forgetting it the next morning and trying to learn it again in the evening.... and my room is currently a dump.

In hindsight (having sat the exam this morning)... i could have probably relaxed a bit.... but more importantly i could have revised for it more efficiently!! i didn't quite believe the transition of the ICA papers from pre-clinical to clinical years... it's VERY DIFFERENT!

We won't hear the results till after we come back in the new year... so for now.. it's one more week of CSP lectures... and then freedom!

End of firm OSCE

I LOVE OSCEs!

I panic, worry, and get so nervous just before it, but once the first 2 stations are done, i start enjoying it and just have fun!

Stations:

Cannulation

Radiography interpretation

ECG interpretation

Cardio exam

Respiratory exam

Thyroid exam

PNS exam of upper limbs

First station: Cannulation

- Okay..this was not expected....i just didn't expect there to be a cannulation station! I walked into the room, and was greeted by a nurse stood next to a plastic arm on the bed, and with a tray of random things right next to it (i think some things were there to confuse us.. or er.. i just didn't know what i was meant to do with it!).

I was given the instructions, and off i went to gather my equipment.... and there was a lot to choose from.. i didn't really think much of it at the time, and just picked up what i knew was "the normal stuff".

I was rather lucky with this station, as i've just cannulated 2 patients recently (one patient just the day before!), so i was feeling confident with it. It was a bit of a weird artificial situation, talking to a plastic arm and gaining consent, but i got on with it.. and finished well within the time limit.

Then came a few questions which were quite straightforward.. "what else would you do now?" "how long can the cannula stay in for?", "why did you choose that cannula size", "what is the flow rate?"

Second station: REST station

- This was definitely a lucky draw, i had an easy first station, and my second station just involved me sitting on a chair, reading magazines in the waiting area... !

Third station: Radiography Interpretation

- Again another station i didn't quite expect. I've never had to do this in an OSCE before! I just walked in, and there was a familiar FY1 sat at the desk and a 5th year medic in the corner who was going to record my answers.

I was faced with a computer screen showing a KUB with contrast compared with one without contrast (calculi in the ureter), then one of a pancreas with several calculi within, and lastly a pretty obvious chest radiograph with a huge pneumoperitoneum. I just had to sit there and talk about each radiograph, and i'm sure they've made the exam easier for us, by choosing pretty obvious abnormalities...because i've had to do the same thing on a ward before and never been able to spot anything!

Fourth station: ECG Interpretation

This was a question paper sort of station. I just went in, sat on a desk, and had a list of questions, a pen, and a blank piece of paper to record my answers on.

Thankfully, there were more questions on management of the patient than anything on the ECG in particular, the questions sort of eased me into it, and gave me clues on what to do.. and following from my last post.. the first ECG and set of questions were for a patient with AF! - okay this wasn't so bad, i had a PBL on AF last year, so the management side of things just came from some 2nd year regurgitation...

But with 2 minutes left.. i was stuck with the 2nd set of questions... with an ECG where i couldn't even identify what was wrong >.< .... this went badly. I could only work out the rate and that was about it......... i later found out it was an ECG of a patient showing a complete heart block.. i wasn't going to get that!

Fifth station: Cardio Exam

Everything was going smoothly, until i got to the murmur. I finished off the exam and when presenting my findings to the examiner (one of my favourite FY1s) i just panicked and got so confused. This wasn't helped by the fact that the bell had gone.. and i had to move on to my next station....

examiner: quick quick, tell me your diagnosis

tofu: err errr... er... its an ejection systolic murmur.... er.. er..

examiner: so what is it? quick quick!

tofu: errr ... *first thing that comes into my head..always a bad idea* mitral stenosis?

examiner: are u sure?

tofu: errrrrr errrrrrr errrrrrrrrrr.... no? i dunno!

examiner: so what would you do?

tofu: an echo!

...and then i had to move on!

mitral stenosis is a diastolic murmur, and from what i gather.. it's pretty uncommon >.

eeks! I know this.. but under pressure, it all goes out of my head :(

Sixth station: Respiratory Exam

This was a relatively straightforward station, the patient had a right sided pleural effusion... BUT i found the exam so so so scary, simply because my FY1 was the one marking me! I just got anxious before i started examining the patient!

Seventh station: Thyroid Exam

I walked into the room, and before the examiner explained the station to me, i was pretty confident that it was going to be a thyroid exam. It was probably the first time i've seen exopthalmos in a patient, other than in a textbook.

This was a pretty good station, and i finished well within the limits, and even had time to discuss the findings with the examiner (FY1 from my ward!), investigations and management with time to spare!

Eighth station: PNS exam of upper limbs

This was the first time i've actually done a complete PNS exam on a patient with signs, with slightly reduced tone in all aspects, slightly reduced power, co-ordination was fine, was able to elicit the supinator reflex, but unable to elicit the bicep and triceps even with augmentation. Sensory was fine (tested DCML and spinothalamic tracts).

I gave a list of differential diagnoses.. and the examiner kept asking for more..this was when i mentioned inclusion body myositis.. and then remembered.. i should never mention anything i don't know a lot about!!! Thankfully i was saved by the bell - and didn't have to look stupid again!

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The OSCE was purely for our learning purposes, and after that OSCE i definitely feel a lot more confident now, and know what i need to work on before i hit the real end of year OSCEs next summer!

One more week left!

Irregularly irregular

I was at my last day of my GP placement yesterday, and i took an observed history of a patient with atrial fibrillation.

I asked about his palpitations, he told me how he feels odd irregular beats across his chest, and with all that in mind, i then did a cardiovascular exam, and what seems logical went out of my head..

i just went with my "routine" comment, feeling for the pulse and commenting: "the pulse is of sinus rhythm, regular, HR within normal ranges, symmetrical on both arms, there is no radial-radial delay.." this was when the Dr looked very worried and stopped me...

"Tofu... are u sure?! this man has AF!"

.. this was when i snapped out of my stupid routine and realised how stupid i was! i was almost day dreaming, and just repeating a routine... so so so stupid >.<

AF - is irregularly irregular! i should have known that from the history alone!

This was embarrassingly stupid, but in a way im glad it happened in hindsight. It annoys me how silly it was, but i guess it's a good time for me to realise i need to REALLY pay attention to things... to look, listen and feel for signs.. and not just assume patients are "normal".

I will take it as a learning experience.. going to never do that again!

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Okay.. it's now croissant and coffee time, then off to my ward! (with a more serious approach to clinical examinations, no more relying on my safety routine comments!!)

Random Happenings

Random happenings:

I put in my first ever cannula!

the elderly lady was so lovely, and kept reassuring me the entire time... telling me how she was used to having needles stuck into her arm, and it won't hurt her at all. The fact that she was so nice, really did make a big difference, as i was relaxed and took my time to make sure i had everything where i needed it...and yay it went in first time! As soon as i stuck the cannula in, i got the flashback, and in it went!

I know in a few years time i will probably think "whats the big fuss in putting in a cannula" it might just be second nature in the future.. but for now, it's an entire new learning experience, and i just need to keep practising it.

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Mitral Regurgitation

I heard my first mitral regurgitation with radiation to the axilla last week too, i was pretty excited!!

I've recently been converted to start listening at the mitral valve first, and then move through the different areas...and as soon as i placed the stethoscope onto the mitral valve position i noted the murmur! (this was when i realised i forgot to place my other hand on the carotid pulse to time it!)

I placed my other hand on the carotid pulse and identified a pan-systolic murmur.. i moved my stethoscope more laterally, and there it was! it radiated to the axilla region!!!

- i know it sounds so odd, but i've learnt the cardiovascular exam, more or less as a routine, and ive tried listening to the axilla many many times before, and never heard anything different, and nor did i expect to... but when i heard it there.. i can't explain it.. it was just different.

i told my bf about my experience and how interesting i found it... and he had to kill the moment, and tell me its nothing special and he's heard like 5 on his firm already ¬.¬ !!! ... well it was pretty exciting for me!!

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Met3b OSCE!

My firm is quickly coming to an end, and i'm sadly going to really miss this place!

.... and on that note my firm has organised a mock OSCE for us this Thursday, with real patients from the hospital, with real signs to elicit and present back! This is a big BIG change from my first 2 years of OSCEs, where we've basically been examining healthy individuals.... it's going to be an interesting experience! .. i'm pretty sure i will moan about how difficult it was in my next post!

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Endocrine firm is almost over...

My endocrine firm is almost over.. and in some ways it seems that way already..

My FY1 has nights this week, my reg has nights, the other reg has taken annual leave, and last but not least my consultant is going to a conference abroad on friday too... so it's just going to me and the locum this week.. it's going to be an interesting week..but hopefully.. it means a lot of random jobs for me to do!

the nurses like to joke, and call the medical students "vampires" and i guess they aren't too far off... the other student on the ward and myself always offer to take bloods... and its fun!

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.... ok back to revising for ICAs!

Renal Firm over.. and now Public Health

Just as i've become really settled in on the ward, and struck a nice rapport with the doctors and the nurses, who saved chocolates and lemon sherbets for me.. and promised to find a urinary catheter for me to put in (though this never happened) i'm done with renal and have to move on! :(

.. and what could be worse.. i'm moving back to london for a week of.. PUBLIC HEALTH lectures! (zzZ) BUT i'm glad to be home ^^ - can't beat laying down on my own bed, and drinking tea from my favourite mug at home.... but annoyingly i've left my keys and oyster card in Essex, so i will have to be the annoying bum who needs people to open and lock the front door for me everytime i leave the house >.<

I really REALLY enjoyed renal medicine, and i know i will probably say this for EVERY firm i do... but.. i might even consider nephrology as a future career!! - in fact, i like it so much i arranged an SSC on renal transplant.. i may regret this.. but for now.. i love kidneys!

(i know i should be more open, and i'm sure i only love this so much, because it's my first ever taste of clinical medicine... but meh.. right now.. i'm loving the kidneys!)

Next Week: Public health lectures

Next Firm: Endocrine

Clinical Examination: Feeling & Hearing "abnormal" for the first time

For my year 1 and 2 OSCE exams i more or less learnt a "script" of what needs to be done, without really knowing what i was suppose to be feeling for, hearing out for or eliciting when i do a certain clinical examination.

(Well, i knew the exam, in that i know i can hear murmurs for different valves at certain points, feel an enlarged kidney if i balloted and can percuss the chest to look for areas of dullness etc..But i didn't really "KNOW" the sounds, or the feeling... since we only ever practised on healthy individuals)

BUT, slowly slowly now, i've had the opportunity to feel and listen out for different signs, and have started to collect a small collection of ideas as to what "abnormal" feels or sounds like... and hopefully i will pick up more of these "sounds" and "feelings" throughout the year. It sounds so odd, but i when i do a routine examination as i would in an OSCE exam and feel something for the first time, it really surprises me, and in a way in which i think i will never be able to forget "the first time"

Examples:

"the man in the side room with aortic stenosis"

- i approached the chest with my stethoscope, and first placed it at the 2nd intercostal space on the right of the patient's sternum and listened to the aortic valve (i've been taught to go A-P-T-M) and heard a wooshing sound... i wasn't sure if it was abnormal, and continued to place my stethoscope at the P position and so on, and then all of a sudden i realised.. A was definately abnormal! I timed this with the pulse, and the abnormal sound occured with systole, this was aortic stenosis!

"the lady with malaria, and hepatomegaly"

- i was on a ward round with the team, and when we got to this lady, my FY1 told me they had found something on an abdominal examination, but i had to go find out what it was myself. I started feeling all 9 quadrants, and they all felt pretty much the same to me, soft and non-tender. Then i continued to find the borders of the liver, and this was when i first suspected the liver may have been enlarged, and to confirm i continued to feel for hepatomegaly and there it was, an approximate 3cm enlargement. The first time i've ever come across hepatomegaly.

I've had many of these "firsts" so far, and hope to continue adding more experiences to my collection.