learning medicine

this is a big week for you

it marks the first time you are part of a clinical team (however loosely)

you are also let loose on the general public whilst wearing stethoscopes round your necks

so make the most of it!
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more than anything else SEE PATIENTS!!!

nothing teaches you medicine like your patients, no amount of wonderful professors or brilliant lectures can substitute for getting to know the stories of real people (and having responsibility for making them better)

i strongly recommend you make a spreadsheet/notebook/database in which you record every patient you see

list: initials, hosp number, age, gender, PC, diagnosis & outcome

if you are disciplined you will have an unparalleled learning resource by the time you hit finals

how many patients do you think you will see?

go on, have a guess
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whilst patients are by far the most important thing, they are not sufficient

you will also have to read

i have already offered suggestions for neurology texts

i like davidsons (more chatty & coherent than kumar & clark, but less detail)

harrisons is excellent - don't let its size put you off - the first 50-odd chapters on presenting complaints are really useful & often the first thing i look at



Salaam


sabih

a 64 year old man with incoordination

sheena briefly presented the case of a man who fell over at the bus stop

we focused on examining his cerebellar system

we could only examine his left arm

he had:
- no rebound of the outstretched arm
- no dysmetria
- mild dysdiadochokinesis at the forearm
- moderate dysdiadochokinesis at the fingers
- unconvincing horizontal nystagmus in the direction of gaze
- a reasonable gait
- normal heel-toe walking

we did not test his speech
we did test his power (why would we want to do this?)
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unfortunately we had to rush his story & did not look at his scans

sheena: could you update us (anonymously) please?
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we talked about learning resources

i mentioned the book by geraint fuller which i think is excellent

this site from the university of utah is also excellent & demonstrates many of the signs we were discussing
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Salaam


sabih

new year

welcome to this site: a space to record & review shared experiences


do leave comments / questions
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half of you have heard me rant on SNP-ignorance


i would point you to the first post in this blog for more on the issue
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yesterday 3 out of 5 of you clerked patients with some form of 'collapse'


sheena then went on to present the case of a 64 year old man who 'collapsed' at the bus stop


the first important point was: the terminology is confused & task 1 is to work out which type of collapse the patient is talking about


namely:


- loss of consciousness
- limb weakness
- loss of balance
- vertigo
- light-headedness on standing


see below for half an algorithm from Davidsons

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we mostly talked about loss of consciousness & were tentatively dividing causes into cardiovascular, neurological & other

we did not get round to organising our diagnostic lists properly

we moved on to examining the cerebellar system (see next post)

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