Medical students - get help passing and revise for your medical student exams with our multi choice questions (MCQs/EMQs), videos, podcasts and downloads. Free resources give it a trial!
A 76 year old man presents with atrial fibrillation which is permanent. He is lucid and has specifically made an appointment with you to discuss the best way of stopping him “dying ” as a result of the AF.
PMHx: Hypertension (treated), Mild COPD. Nil else of note.
DHx Verapamil (as treatment for AF)
Amlodipine
Simvastatin
PRN inhalers
SHx Lives alone. Independent. Can carry out all ADL’s (activities of daily living)
What is the anticoagulation schedule you would recommend to prevent stroke?
a. Clopidrogel
b. Warfarin
c. Aspirin
d. No anticoagulation
e. Warfarin and Aspirin
At Medical Educator we are always looking to push the boundaries of what we can do on the web to further medical student e-learning in preparation for medical student finals.
We’re pretty excited about the potential our new technology (in collaboration with the kind folks at iSpring) has to offer medical students an even richer learning experience.
Have a go at our free interactive MCQ picture quiz above to get a feel of the kind of things we will be producing in future - that’s ontop of our established base of over 1000 MCQs for medical students, practical video guides for medical finals, podcasts, and one-minute revision downloads!
Five students are planning a 4 day marathon bike ride, for cancer research in Wales. What a great commitment - all friends, all doing something fun and challenging, for the benefit of charity. They are hoping to raise £1500 for the cause - Medcical Educator salutes them.
Wales Online reports that Huw Morgan, a fourth year medical student, said: “We know cancer is one of the leading causes of death in Wales, and affects so many people. We believe Cancer Research Wales is a great cause and can make a real difference for people suffering with the illness.”
Have any of you med students out there done anything similar or are planning anything similar? We would love to get involved.
So from the initial history of disease [small joints, both hands], the likely diagnoses would be
RA
PsA
(less likely) gout.
Erosive changes are not specific to RA however but the findings were symmetrical
both gout and PsA tend to be asymmetrical
Don’t be put off by the fact he’s male, although RA is roughly 3x commoner in women. You dont get a mention of which joints are affected here: RA has a penchant for the wrists and MCP joints. Erosions of the ulnar styloid are very common.
Common x-ray changes of the different arthritides are shown below:
Non Inflammatory
Primary OA: Asymmetrical
There are classically 4 signs of OA on an X-ray: Occurs in classic joints eight bearing e.g. Hips& Knees. May not be symmetrical.
1. Subchondral bone sclerosis
2. Cystic Change
3. Osteophytes
4. Reduced Joint Space
Charcot Joints:
1. Destruction of the joint
2. Disorganisation (bones not arranged in the correct /usual arrangement through gross destruction e.g. cuniforms of the foot.
3. Increased density (sclerosis)
4. Debris (boney debris from a destroyed joint: often with well defined margins
5. Dislocation
Secondary OA
As per primary OA but occurring in a joint that has been previously damaged from any other disease process (inflammatory disease etc)
Inflammatory
Gout: Asymmetrical
The classical signs of gout on an Xray are: Erosions with sclerotic margins. Asymmetrical.
1. A relatively preserved joint space
2. Minimal periarticular osteoporosis
3. Nodules (these are in fact tophi)
Psoriatic Arthritis: Asymmetrical
The X-ray Changes are similar to rheumatoid but they differ in their distribution, and the formation of pencil in cup deformities along with osteolysis.
1. Asymmetrical distribution of disease
2. Often affects PIP and DIP joints
3. relative absence of peri-articular osteoporosis
4. Erosions seen at the distal interphalangeal joints joints
5. Reduced joint space
6. Pencil in cup deformity (arthritis mutilans with telescoping of the fingers)- this is a result of osteolysis
7. Loss of the terminal tufts of the phalanges (acro-osteolysis)
8. Sacroiliac and spondylitic changes (similar to those of Ank. Spond.)
A 64 year old male presents with a symmetrical arthritis of both hands (history from the GP letter) with early morning stiffness. His X-rays of his hands done before clinic show the following:
Periarticular osteoporosis of the MCP joints
Erosion on the ulnar styloid
Symmetrical distribution of disease
Reduced joint space at the carpal bones What is the most likely diagnosis?
a. Ankylosing Spondylitis
b. Rheumatoid arthritis
c. Gout
d. Secondary Osteoarthritis
e. Psoriatic Arthritis
Medical Educator is now accredited by the leading surveyor of web based health information, namely the Health on the Net (HON) foundation.
An example of the HON Code logo, soon to be displayed on our homepage. The HON Code allows users to check a sites authenticity through the HON website.
The HON foundation have reviewed the site and found it to be compliant with their 12 ethical principles which they have been applying over the past 12 years, leading them to them being the most recognised and one of the most respected sites to search for web authenticity. We hope to continue to abide by their 8 key principles (amongst others) namely:
Authority
Complementarity
Confidentiality
Attribution
Justification
Professionalism
Transparency of Financing
Advertising
We have made some minor alterations to the site at the request of the HON, we continue to respect their authority, and the status of our membership will soon be available via our homepage.
In your medical finals, as with any examination in a clinical setting, you will be asked by the examiners “how would you complete the medical examination?”.
You need a simple, precise way of explaining this to your medical finals examiner. We will talk you through a simple approach for all of the abdominal organ systems in this podcast.
“To complete my medical finals examination, I would like to examine the…
Hernial orifices
External genitalia
Digital rectal examination
Inspect observation charts
Relevant organ systems, for example peripheral vascular examination”
Notice we have not abbreviated terms, and given the medical finals examiner closure, putting the ball back in his court to ask more questions.
Remember you can listen to more podcasts, get MCQs and EMQs, watch clinical skills videos, and download ‘one minute’ revision guides in the medical finals login area of the site.
The overall average score of medical students on MedicalEducator.
The following weeks will represent the culmination of years of hard work by medical students over the past 1-5 years. Revision patterns have been changing and increasingly medical students are approaching final examinations preparing for them using web based MCQ, OSCE and video guides. For the first time, resources like podcasts and the like have taken a firm footing in the medical students preparation for final examinations.
One technique of sitting mock written papers has long been popular. Short answer questions, EMQ and MCQ format questions help people to prepare.
To quote one of our contributors:
I always felt more comfortable preparing for any exam, and I mean any, by running through exactly what I should know, first from a theoretical perspective, then from a practical perspective. If that meant filling in multiple choice questions, I got a book on multiple choice questions. It was what it was.
Maybe you’d like the opportunity to measure yourself against other medical students across the UK or
The average mark in one of our mock final examinations, which was added to the site in April 09.
across the world. A good example of this is our *(tough) mock medical finals paper. This is designed for students sitting year 1, year 2, year 3 year 4 or final examinations, which have a clinical component.
The average for this exam is 49.6%. Tough. But will it help you learn? A comment from a subscriber:
You keep doing questions where a principle that you didn’t understand is explained in the answer. Thats the value of them.
Overall this is a stressful time for medical students, on behalf of the Medical Educator team, good luck in those examinations.
We’re really excited about our new slide technology and the potential it has for creating dynamic, interactive slides with audio and video.
The technology is from the kind folks at iSpring who have collaborated with us to enable us to start producing some great interactive slides for student medical education.
Take a look at our first foray below - it’s a guide to assessing and evaluating back pain.
We have big plans for the future for this - OSCE stations anyone? We feel its an excellent string to our already strong bow of MCQs, video, podcasts and guides. And of course all new content we produce will be available, at no extra cost, to our members.
We would love to hear what you think of it and are open to all of your ideas for developing educational content for medical students. Let us know what you want to see!
Thanks for talking to us Joel. We came across you via the social networking site Twitter. As a UK based doctor, its always nice to chat to students from across the pond. Tell us a bit about yourself and your medical training.
Joel Adler, Studying at the University of Wisconsin School of Medicine, USA, Founded in 1848 (which is significantly before www.medicaleducator.co.uk!
First of all, thanks for asking me to do this. Born and raised in Wisconsin, I earned my undergraduate degree in Spanish from the University of Wisconsin-Madison. I’m presently a third-year medical student at the University of Wisconsin School of Medicine and Public Health. I spent a year between second and third year on a research fellowship from the Howard Hughes Medical Institute. I studied novel therapeutics for neuroendocrine tumors and clinical outcomes of surgical management of endocrine disease. After I graduate next May, I plan to pursue residency training in general surgery with fellowship training in either surgical oncology or transplant surgery.
As you know we’re a British website, run by British doctors but we feel our information is relevant to medical students from across the world. Do you know of any specific differences between medical training in the US and the UK?
As I understand it, the main difference is in the way we split our training. In the US, we do a separate degree (often at a different institution) before enrolling in medical school. The undergraduate degree can be of any course of study, as long as specific pre-medical requirements (biology, chemistry, physics, etc.) are fulfilled. As I mentioned earlier, mine was Spanish. Medical school is four years in length, with optional extensions for other degrees (MPH, PhD) or experiences. But as far as the overall training of medical school, I’m not aware of any large differences.
Medical students in England have very limited professional responsibility and remain heavily supervised at all times (for example, they do not see patients unless they have been first reviewed by an attending doctor. Is this the same in the US?
We’re supervised all the way through. Most medical schools follow a traditional format: the first two years are classroom instruction with sporadic clinical experience, and the final two years are clinically based with less formal classroom instruction. In the final two years, most supervision is performed by resident physicians. Responsibility increases with time, but we are certainly supervised at all times. There’s usually no requirement for signoff before seeing patients, but we are typically observed in our interactions and signed off at that time.
Do you get many opportunities to do practical procedures? If so, what sort of things do medical students in general have the opportunity to do?
Procedures are certainly possible, and are dependent upon the clinical clerkship. Most students have a fair deal of experience in delivering babies, suturing, starting IVs, intubating, and drawing blood. Other more advanced procedures typically come in the fourth year once we have chosen our specialties and spend time working in those specific areas.
In the UK we focus heavily on observed clinical history taking and examination for many of the assessments. Is that something you identify with? And are you familiar with the term OSCE?
Absolutely. The emphasis on this varies between schools, but the majority of school will do some OSCE testing in the first two years in order to prepare for the third year. During the third year, grading is a mix of clinical performance, a written exam, and OSCE-style testing. The emphasis is typically much more heavy on observed clinical day-to-day work, and the OSCE serves as a final exam to ensure that you are competent in areas that weren’t observed. For example, I’m currently rotating on an inpatient medicine service that is very heavy on GI and hepatic disease. During the OSCE, I suspect I’ll have some stations involving either pulmonary or cardiac disease. They seem to be good ways to assess skills, but they tend to be rather artificial situations.
Many UK based medical students wont have heard of the USMLE. What are your views on it as a standard across the US? (in the UK each medical school sets its own exam standards).
As far as a standardized exam, I feel it’s fine. Nobody looks forward to taking them, but many schools provide adequate support and guidance to prepare for the test. The scores are typically used by residency programs when considering applicants, and all parts of the USMLE must be passed before a full medical license is granted. It’s nice to have standard exams to make sure that we’re all covering similar material.
The USMLE comes in three “steps”. Step 1 focuses on pre-clinical knowledge (basic science, pathophysiology, basic treatment and diagnosis) and is usually taken between the second and third years of school. Step 2 is actually two parts: clinical skills (a day-long OSCE-style examination) and clinical knowledge (a day-long written examination on clinical decision making). That is usually taken during the fourth year. And finally, before a medical license is granted, Step 3 is taken during early residency. It focuses on advanced clinical skills and decision-making.
Joel, we’d like to say a big thanks for taking part in our interview. Its great to hear things first hand from an American student. Finally is there anything that you like to use as a US student that we might not be so familiar with over here in the UK?
I’ll share some of the things I use often for studying and caring for patients. I use my iPhone constantly, usually for Epocrates and the Johns Hopkins Antibiotic Guide. I also like MedCalc. On the computer, I love using Evernote to keep track of things to study - I can just open up the program on my phone and studying during downtime. I use Papers (Mac only) to keep my PDFs of articles organized.
Thanks again for your time Joel, and good luck in the forthcoming OSCEs, exams and that USMLE!
How to complete your abdominal examination: 
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