Archive for the 'Medical finals' Category
May 17th, 2012
The pressures of everyday life can leave you feeling like you can’t cope. Revising for your medical exams is a particularly stressful time, says Charlotte Hudson. Here are some tips to manage stress.
Photo by JixarThe symptoms of stress vary, from feelings of anxiousness to outbursts of temper, and during times of increasing pressure or when something is important to you – like passing your exams – you should follow some simple advice to help keep yourself grounded.
Dr Fiona Donnelly is chair of the Doctors’ Support Network (DSN), which is a confidential peer review support forum for doctors with mental health concerns. These concerns include stress, burnout, anxiety, depression, bipolar disorder, psychoses and eating disorders.1
She says: “Unfortunately medical student exams are only the start of your exam career – once qualified there appears to be a never-ending stream of exams, and it is important to learn techniques to deal with the stress involved.”
Looking after yourself and maintaining a good ‘work/life balance’ is very important.
Below, Dr Donnelly has provided some useful advice on how to handle stress:
- Make sure that you eat properly and have a regular sleep pattern.
- Exercise can be a really good way of switching off from the pressures of revising, and if you don’t normally exercise simply going for a walk is enough.
- Timetabling social outings is also important, and although medical friends are good, they can be stressful as they always seem to know more than you. It may help to try and spend time with non-medical friends socially prior to exams.
- On the subject of socialising, while the odd alcoholic beverage may be relaxing, too much leads to a significant lack of revision the following day – so drink in moderation!
- Students prepare for exams in different ways. For those steady revisers make sure you take on board the above advice and timetable in breaks, food and exercise.
Last minute revisers
“In an ideal world we would all prepare well in advance; however, I have to confess that I am a bit lastminute.com,” says Dr Donnelly. “For those in a similar position, ensure that you have left enough time to prepare; the night before is generally too late.”
Did You Know?
Doctors have among the highest rate of mental health problems of any profession, but often feel isolated and unsupported.
Dr Donnelly advises that although caffeine may seem like the answer to all your problems, taken in excess it tends to increase anxiety and reduce productivity, so drink in moderation.
Don’t be late
The day before your exam ensure you know where you are going, how you are going to get there, and when you need to leave the house. Being late is one of the most stressful experiences and is not conducive to a good performance on the day.
If you find that your stress levels are going beyond those of other students, you are using illegal substances or are drinking too much, then contact your local student support service or GP as soon as possible for support.
MPS offers a free confidential counselling service to all members who are suffering from the effects of an adverse outcome or a medicolegal issue, and are experiencing emotional or psychological difficulties as a result. More information can be found on this service here.
1Visit www.dsn.org.uk for more information.
February 13th, 2012
An Incidental blood pressure of 148/94 in a fit and well 50 year old man. What next?
Photo by jasleen_kaurManagement of hypertension is becoming increasingly complex.
Here our contributors summarise the complex use of BP to measure cardiovascular risk.
“Its always a case of measuring multiple things. We know we should be aggressively treating BP with patients with chronic renal disease and diabetes, but what about those without? Follow the NICE guidelines with our quick digest.”
We recommend management in accordance with the recently released NICE 2011 Hypertension guidelines.
Our step-by-step guide is below:
| Action |
Discussion |
Comments |
| Concerned about high blood pressure? |
If your first reading is >140/90, take two further readings, then take the lower reading of the second two to record as ‘clinic blood pressure’. |
If blood pressure is close to 140/90, repeat after an interval e.g. 3-6 months. |
| If the blood pressure is elevated (>140/90) by this method, perform ambulatory blood pressure monitoring |
Ambulatory blood pressure recording is the preferred choice for measuring is someone has hypertension. This averages waking BP measurements, to give a more accurate reflection of cardiovascular risk. |
Regimes for home BP measurement are also available from NICE |
| Classify according to Stage
|
Stage 1 HypertensionAmbulatory BP >135/85 and <150/95
‘Clinic’ >140/90 – <160/100 |
|
|
Stage II HypertensionAmbulatory BP >150/95
Clinic >160/100 |
|
|
Stages III and IV:Clinic BP >180/110 |
|
| Treat everyone with hypertension and ANY of the following. |
- A CVS Risk of >20% over 10 years.
- Target organ damage
- Established cardiovascular disease
- Renal disease
- Diabetes
|
|
| Consider immediate treatment +/- other investigations for stage III /IV hypertension |
BP of >180 /110 should be considered for immediate treatment, +/- specialist advice and referral. |
|
| Treatments:Use the ACD combination |
Step 1 (A or C)Start with either an A or a C. Use an ‘A’ in <55y.o. patient.
Use a C in >55 or all black patients (more likely to have ‘low renin’ hypertension, and are therefore less likely to benefit from an ACE inhibitor).
Step 2 (A&C)
Then add in the other
Step 3 (A&C&D)
Add in a thiazide e.g. bendroflumethiazide
Step 4 Others
Consider spironolactone or beta blocker |
A=Ace inhibitor or ARIIRBC=Calcium channel blocker
D=thiazide like diuretic
|
| Key points |
- Beta-blockers have no role in the first line management of hypertension.
- Cardiovascular risk assessment using the Joint British Societies charts (back of the BNF) requires age, smoking status, blood pressure and lipid profile.
|
|
So the answer is?
In the case above, with a BP of 148/94, we need to do two further blood pressure measurements in the clinic. If the lower of these is >140/90, then offer home ambulatory blood pressure measurement.
You can read a quick reference version of the 2011 NICE guidelines here.
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!
