Last ICA at Barts

So yesterday i sat my last ICA of medical school! 

I was a little behind the ball, and didn't quite realise it was going to be the last in course assessment (part of Paper A) of my medical school years... until my friend texted me at 1am in the morning to wish me good luck. I couldn't quite believe it.

That's it; no more in course assessments, and what simply stands between me and my medical school final exams, are these 4th year exams in 2 weeks time.

Quite scary, how quickly time has flown by!

On a positive note, the ICA yesterday turned out pretty well (i hope, it still needs to be marked). I normally blog about how i'm revising for it etc, but this time round I simply didn't have the time as I was so busy reading the material again and again, and making sure I did a lot of emq questions.

So... with only 2 weeks to go, the medical school has organised a few optional revision lectures for us (love the medical school), with a few hours dedicated to each module. I'm not sure i'll be attending all of them, but a few i think are pretty much essential (O&G!!).

So here's hows revision looking so far:

Care of the Elderly
CSP
ENT

Dermatology

Neurology 

Neurosurgery

Obstetrics and Gynaecology

Ophthalmology
Orthopaedics 

Paediatrics

Psychiatry
Rheumatology

Sexual Health and HIV
OSCEs

Whilst i've got a chunk of it striked off, there's a problem of actually remembering it all... !!

Here's 2 weeks of a lot of reading, emq questions practising, and general junk food consuming - hello chubby tofu!

Derma-holiday + revision update

"Derma-holiday" - it's in the name!

The dermatology placement so far has been as described, pretty much holiday-esque. There's just 3 clinics to attend in 2 weeks, and the rest of the time.. well that's all private study or teaching sessions.

That said, dermatology is far from simple. In principle (from the books) it seems pretty straight forward, but when it comes to seeing these skin conditions, unless it's screamingly obvious (Psoriasis - silvery plaques on the extensor surfaces).. then sadly for me, everything pretty much looks the same.

Triple diagnosis

So last week, i was paired up with my friend (T) for the dermatology placement, and amidst a slow paediatrics dermatology clinic, i showed T my nails. I've got these weird dark vertical lines running through a few of them. T whips out his hands and goes "oh, me too, they're just normal i think". We sort of just left it at that.

Today in clinic, on a 2 week referral (i.e. something suspected to be pretty sinister), comes a young lady. After sitting herself in the chair opposite the consultant, she puts her hands on her laps, and indicates to these lines in her nails. The consultant asked us to come closer and have a look, and asked us what we thought of them.

It was exactly what T and I both had! - and before I could even process if it would be a good or bad idea, I stuck my hands out, and said: "oh, i have these too, and always wondered if it was a fungal infection or something".

So in clinic, there's the patient, myself and T all examining and comparing our nails with each other, and the consultant googling images to reassure the 3 of us, that it's simply a normal occurrence.

... being the medical student with a bad case of medical student syndrome, this was a pretty good day - getting a clinic done and a diagnosis all in one morning.

Revision left to cram 

So there's now only 34 days till end of year exams, and just 17 till the ICA!
Here's what's left to be done:

Care of the Elderly
ENT

Dermatology

Neurology 

Neurosurgery

Obstetrics and Gynaecology

Ophthalmology
Orthopaedics 

Paediatrics

Psychiatry
Rheumatology

Sexual Health and HIV

... best make full use of my dermaholiday! REVISION TIMES!

Revision - [27 Days + 44 Days] left

That's 27 days to the last ICA of the year (Rheumatology, Orthopaedics, Dermatology and GP), and just 44 extremely scary days left till the first end of year exams!

Monday 15/07 - Section B (EMQ/SBA)
Tuesday 16/07 - Section C (Data Interpretation)
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Monday 22/07 to Friday 26/07 - Section D (OSCEs)

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Thursday 01/08 - Examination Board Meeting
Friday 02/08  - Results Day

Year 4 is meant to be the hardest year, and well, there definitely is a LOT for me to go through before the end of year exams.. here comes the list!

Care of the Elderly
ENT

Dermatology

Neurology 

Neurosurgery

O&G

Ophthalmology
Orthopaedics 

Paediatrics

Psychiatry
Rheumatology

Sexual Health & HIV

................................. and somewhere along the line i swear i had some public health and ethics that i've completely forgotten about...

So yes.. i best get cracking on with my revision! 

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! 

6 Years old

I wasn't actually sure my mental arithmetic was correct, and childishly had to whip out my fingers and count to be 100% certain. This blog is 6 today ^^

Back in 2007 i was scribbling my journey through Biochem. at KCL, and now 6 years on, I'm a 4th year at BL, scribbling my way through medical school.

Hopefully next year i'll be scribbling my way to finals! - but for that to happen...let's get on with some revision!

PS - i don't actually drink as much soya milk as i did 6 years ago.....!