Archive for the 'Medical finals' Category
July 13th, 2011
And here is is…. the answer to our suspected DVT question:
d. It can be used to discharge patients based on their underlying estimated clinical risk score
D-dimer test can be used to exclude DVT in patients who are assessed to be in the category of “low clinical risk” of DVT.
An individuals pre-test risk can be estimated using a “Wells score”. A patient who is clinically “low risk” with a negative D dimmer can be reassured.
The Wells score is shown below.
| Active Cancer |
+1 |
| Paralysis Paresis or plaster to extremity |
+1 |
| Bedridden for 3 days/ surgery within last 12 weeks |
+1 |
| Localised tenderness along distribution of deep venous system |
+1 |
| Entire leg swollen |
+1 |
| Calf swelling >3cm compared to the other leg |
+1 |
| Pitting oedema confined to the symptomatic leg |
+1 |
| Previous DVT |
+1 |
| Collateral superficial veins (non-varicose) |
+1 |
| Alternative diagnosis at least as likely as DVT |
-2 |
| <0=Low Pre-test Probability
1-2=Moderate Pre-test Probability
>3=High pre-test probability |
Check D-dimer
Check D-dimer
DO ULTRASOUND |
The Wells score and an example of its clinical application in terms of planning investigations into a DVT
Although you clearly can’t memorise a wells score its clear from the score itself that patients with numerous risk factors (e.g a man with lung cancer with a swollen right leg with pitting oedema) that a negative D-dimer is not sensitive enough to rule the diagnosis out.
D-dimer is still of some use in patients with a low pre-test probability score.
Did you get it right? Try some more questions like this with our free trial.
September 25th, 2010
Take our quiz below to check if you are experiencing features of burnout. Tick the number of questions you answer yes to, then see what your score means.
You must have Flash to view this file.
What does your score mean on our burnout self assessment?
- 0-4 Minimal signs of burnout as a student.
- 5-8 There are some factors here supporting a level of burnout.
- 9-12 You are exhibiting several features of burnout, and this could become a serious problem.
- 13+ You are exhibiting multiple signs of burnout. Talk to someone, soon
Now, see how you score against other medical students by entering your score below and clicking submit:
What can you do about burnout?
Nina Feghali, A General Practitioner and Contributor to Medical Educator gives her opinion. Nina was not involved in the construction of the burnout survey.
“If you are concerned you have burnout, the first thing is to talk to someone: be it a friend, colleague, fellow student, member of family, personal tutor, head of year.
It’s generally going to be up to you to make that judgement, as to who is going to be the most appropriate person. Don’t shy away from this and if you do recognise signs of unprofessional behaviour, this is even more important. Acknowledging there is a problem is often the first step to solving it. Whilst I am always sceptical of self-assessments like this, they can provide important pointers. The example presented here simply tests a number of constructs associated with burnout. Remember burnout is common (over half the students studied in the JAMA paper), but it has also been linked with suicidal ideation, and a lack of empathy, and here, poor professionalism. Think carefully about this, and seek help if you are concerned.”
Disclaimer: This is an informal score, intended for medical students, and does not represent medical advice. This score has not been validated, but it is free to use, and modify. This means you can use it yourself under a Creative Commons Licence (Attribution-Non-Commercial-Share-Alike). This means you can use it, edit it and share it, as long as you acknowledge the original source.
June 21st, 2010
Thought APACHE II was the latest and greatest game for the Xbox? Not in our book it isn’t. Check out some of our useful free resources that we know and love and think you will find helpful. And best of all, they are all free – not a penny to take out of your loan/grant!
The MPS has a range of online resources and clinical information to help guide medical students and healthcare professionals through their medical training. One thing we like is their magazine for newly qualified junior doctors which are handy for a quick read through relevant junior doctor experiences of life at work. New Doctor magazine can be found here, and Medical Student pages (UK) here.
We love Mnemonics. Take this one for joint pain.
SOFTER TISSUE:
Sepsis
Osteoarthritis
Fractures
Tendon/muscle
Epiphyseal
Referred
Tumor
Ischaemia
Seropositive arthritides
Seronegative arthritides
Urate
Extra-articular rheumatism (such as polymylagia)
They missed trauma out but hey, nobody’s perfect.
We think this picture is of a brain. It’s definitely not the glenohumeral joint.
4. Radiology Help: IMIAIOS
We like this sitter from IMAIOS, who provide detailed pictures like the one you can see here of the famous Scottie dog. We thought it looked like a lumbar spine. How wrong we were.
By the way, you won’t see many more lumbar spine radiographs because your local radiologist will probably have a heart attack if you try to request one! This is because they are notoriously useless at picking anything important up, other than fractures.
The BMJ weigh in with a great free resource which requires no subscription. The BMJ really are helping doctors make better decisions (we’re aiming to help you as a medical student make the best decision).
6. iPhone App: IResus
We love this app from the developers at Imobilemedic.com. You might get a few funny looks from doctors over45 at the next cardiac arrest if you whip this out, and remember not to spill your coffee on your iPhone.
7. Apps for all Smartphones: Med Calc
Thought the Anion Gap was a tourist attraction north of Watford? We’ve got new for you….
If you need to work out a BMI, GCS or Disease Activity score quick? Check out Med Calc… It works on most smart phones. As one contributor said: “I use this most days at work”*
We are fairly certain this is just to show off, but we love this app.
8. General Information: GP Notebook
Most of the GPs that we deal with from medical educator would be doing well to be dealing with most of the complex stuff listed on here. Need to know the classification system for bone tumours? Look no further.
9. Quick information: Wikipedia
Wikipedia is still top of our list for those obscure things you need to know about. As students you always need to be sure to check your sources, however there comes a time when you need fast reliable information, or when you need to read round a topic. The Journal Nature found that Wikipedia was as good as the Encyclopaedia Britannica across a range of scientific areas. That’s good enough for us, this represents web2.0 in action!
You didnt think we would leave ourselves out did you? If you don’t know already, signing up is completely free and gives you access to loads of our sample multi-questions, videos and podcasts.
Got any other top free resources that you know, use and love? Leave a comment and share the joy!
May 24th, 2010
So you have finished uni, you’re fully qualified as a Junior Doctor and you’ve managed to land a job after an intensive application process. What next? Do you sit back on your laurels and enjoy that salary? Or do you take the plunge and jump onto the first rung of the property ladder?
Life is hard for a first-time buyer, now more than ever. There are fewer high loan-to-value mortgages than back in the glory days pre-2007 and after prompting from the Financial Services Agency, banks are reeling in on interest-only mortgages, which were a lifeline to first-time buyers.
It is going to be a while before you save for a deposit, what with paying back your student loan and saying goodbye to student discounts and benefits. However, once you have a few thousand in the bank you then need to find a mortgage you can actually afford.
Many potential borrowers get excited when they calculate how much they could actually borrow. The rate is usually four times your salary, so with an average doctor’s starting salary being around £33,000 or so, you could borrow £132,000. But, and there are some buts, what you can actually afford to pay back and what you can borrow quite often differ.
Say you want to borrow £120,000, if you can muster up a 10% deposit and opt for a three-year fixed rate deal over a 25-year term, you are looking at paying back £772.43 per month. And, seeing as the average UK house price is £205,598, this £120,000 figure is miles below this price.
Getting an affordable mortgage is therefore rather tricky. So what do you do? Well the best advice is to save as big a deposit as possible. Bigger deposits mean less risk for the bank and this results in a better rate for you, and opens you up to better mortgage deals.
You can also look at paying over a longer term as this will work to reduce your rate. But some banks are rather restrictive over this, so you need to fully investigate what each mortgage offers and thoroughly read the small print.
Before going to your bank, make use of online calculators such as the mortgage calculator from Santander. There are also repayments calculators so you can see how much you can borrow and how much you will have to pay back each month. Once you have found the right balance, only then can you approach your bank.
And if you do decide to get a mortgage, right now could be time to lock in a fixed-rate deal. OK – so for the past few months and for probably the next couple of months a tracker mortgage will come out as more cost effective, but the interest rate isn’t likely to get any lower, and with fixed-rate deals at their lowest levels right now, it makes sense to secure these rates for the next two to five years.
January 11th, 2010
One topic that continually crops up in medical student questions is clinical cases exam technique, and issues that can revolve around it. For this reason we have produced a list of the most important things you need to know.
This is based on common errors in exam/ OSCE techniques that crop up in medical examinations from our experience.
Here are the first 5 tips for preparing for your verbal examinations, the next follow soon.
Let’s consider the following features and clinical examination…
A 36 year old male gives the following history:
“I’ve been getting hot for the last 6 weeks, on and off and have been off my dinner, pretty much all the time. I’ve been generally not right, tired and that. I’ve started to get a bit breathless too, not coughing and the like, but still having problems when I’m out. Bad like. Gets worse when I have a fever. Like I’ve had a friend who had the same thing about 3 years ago and he had really bad lung fibrosis, because of infections during his childhood. Not like me and that I’ve always been well. I have still got problems injecting the drugs and that, but like my key worker, she says that me methodone will help me deal with that kind of problem, so form that side I’m pretty happy.
Your Examination Findings are:
- Hands Normal.
- Pulse 80.
- No Signs in the face.
- BP 182/92 Pan systolic murmur left sternal edge.
- Otherwise NAD.
Tip 1. Look professional
Dress smartly and conservatively, in accordance with the accepted policy for dress and infection control. We think this means, white shirts (ironed!), smart black shoes, trousers or dress.
Tip 2. Organise your presenting posture to minimise nerves
This is it. Hands behind your back. Head up. Speak clearly and decisively. By organising your posture fidgeting with your hands (common in stressful situations) will not be possible. Standing with an open posture (feet apart, slightly out turned) is a common technique used in business, and will help you present in an organised fashion.
Tip 3. Structure your presentation of medical terminology
This needs to be structured in the same was that you elicited the clinical case history. PC, HPC PMHx, for example:
Mr X is a 36 year old male with a background of intravenous substance use, who presents with a 6 week history of malaise, retired office worker presents with a three week history malaise, night sweats, dyspnoea and anorexia…
Note the use of medical terminology to describe symptoms. This is not the same as describing clinical signs in the history, which you should not do!
Tip 4. Interpret as you go
Don’t be afraid to explain your interpretations of the clinical cases as you assess the situation. For example with history: “The history importantly raises concerns: substance misuse (introducing a blood borne infection, other viral infections and T cell Disorders transmitted by IV drug use), symptoms that suggest a systemic illness/ infection (fevers, malaise, anorexia) that would have a wide differential based on this information that would include….”
Tip 5. Learn to summarise in one sentence
Floundering, being vague, or summarising in a small essay just won’t do. Be clear and to the point – for example “36 year old male, current problem of intravenous substance misuse with 6 weeks of symptoms that include anorexia night sweats and general malaise.”
We hope this helps some of you student doctors in preparing for your OSCEs…. view the final 5 tips here!