EXAM!

Reiters Syndrome. Felty’s syndrome. Keratojunctivitis sicca. Epidermal necrolysis. Guttate psoriasis. Pulsus parvus et tardus. Pyoderma gangrenosum. Erythema nodosum. Sjogren’s syndrome. Budd Chiari Syndrome. Dressler’s syndrome. Charcot’s Triad. Reynold’s pentad. Troussier’s sign. Grey Turner sign. Cullen sign. Murphy’s sign. Hashimoto’s thyroiditis. Anticardiolipin antibody. Amyloidosis. Pernicious anaemia. Infectious mononucleosis. Vitiligo. Fallot’s tetralogy. Dysdiadochokinesis. Telengectasia. Buboes. Clostridium difficile. Polymyositis. Helicobacter pylory. Systemic lupus erythematosus. Myasthenia gravis. Polycythaemia Rubra Vera. Cor Pulmonale. Torsade de pointes. Citrulinnated C-Peptide. Polymyalgia Rheumatica. Paroxysmal Nocturnal Dyspnoea. Henoch Schonlein Purpura. Non Hodgkin’s Lymphoma. Koilonychia. Onycholysis. Leuconychia. Leukoplakia. Heberden’s Nodes. Bouchard’s Nodes. Boutennier’s Deformity. Dupuytren’s Contracture. Marfan’s Syndrome. Steatorrhea. Malena. Haematochezia. Thyrotoxicosis. Mallory Weiss Tear. Meckel’s diverticulum. Virchow’s node. Oliguria. Erysipelas. Caput medusae. Hydrocoele. Pancreatic pseudocyst. Chvostek’s sign. Pseudomona Aeruginosa. Escharotomy. Cholelithiasis. Sialolithiasis. Cavernous Sinus Thrombosis.Wegener’s Granulomatosis. Ceeruloplasmin. Syringomyelia

I’m not making this up. Show this to your nephews and nieces who want to do medicine.

PS : it took me an hour to type this up

PPS : im proud that i can define at least 90% of the terms above.

Bite me

Tendon reflexes differentiate the men from the boys. It is often the cause of many sleepless nights amongst medical students and even the most senior doctors. The variability that exists among patients’ means that there isn’t really a formula one can stick to when trying to elicit a response.

In order to enhance the reflexes in a tense patient, a distraction test is done so that the muscles relax. The text books reckon that one should ask the patient to clench their teeth just before the tendon hammer hits the desired spot.

“Ms J****, could you clench your teeth on the count of three?” I asked the elderly patient, with the tendon hammer ready to swing at her elbows.

“Oh I’m sorry dear, I don’t have any teeth,” as she smiled a toothless grin.

So much for textbooks...

Stormy days

A hospital can be a very dark depressing place. Within its walls, people often go through horrific experiences that they never ever want to relive.

Today was just one of those days...

I saw a man diagnosed with cholangiocarcinoma (bile duct cancer) break down and cry.

I sat through a family meeting to inform them that their mum was dying

We later visited them in the ‘suite of death’ to make sure that she was comfortable and not in any pain

I heard an old lady crying out in sheer agony and frustration because of unbearable chronic pain;

We had to call security to neutralize our patient who was so desperate to get out that he attacked the nurses with his walking stick

A breast biopsy of our patient who was admitted due to a fall came back positive for metastatic cancer.

A disabled kid in a wheelchair got stuck in the toilet because he wasn’t used to wheeling himself around yet.

A mother not recognizing her own daughter after suffering from an ischemic stroke

And at the end of the ward round, my normally cool registrar asked for a timeout so that he could be alone and just calm himself down after today’s events...

Emergency Room

Back to Vinny's

I was really looking forward to the start of a new three week rotation with the gastroenterolgy team at St Vincent's University Hospital. Being at an elite hospital simply means more patients, ie more action. No disrespect to the peripheral hospitals we're sent to, they have some positives as well.

Danny, our spr aka 'the man who runs the show', is always well dressed and extremely courteous to the patients. Other members of the team include Katie, a gresh ucd graduate doing her internship, and Craig, the senior house officer with his unmistakeable orange(!) stethoscope. They're all generally pleasant people and make it a point to teach us whenever possible. So I am feeling good about the next three weeks.

Adrienne and I met up with our team for the first time in the A&E ward. It’s never as exciting as it seems on shows such as ER or Greys Anatomy. There might be one or two trauma cases, probably due to a bar fight or other alcohol related injuries.

We weren’t expecting any surprises (Obviously there was one)

As Danny was going through the patients charts, there was a loud thump. At first, nobody reacted.

I ran with Danny towards the patient. He had collapsed and was having a seizure.

I looked at Adrienne who was probably as excited as I was.

As the chaos subsided, Danny looked up to us and said, “That’s more action than you’ll ever get to see, unfortunately,”

Better than nothing, I suppose.

And within a minute, Danny was shouting at the top of his lungs,

“Cardiac arrest on bed 12, get me the crash cart NOW!”

Another patient had suddenly KO-ed right in front of us.

The whole ward suddenly burst into life. Everyone seemed to have a part to play in resuscitating the patient whose heart had stopped.

Everyone except us of course; as students, we’re generally told to try and not to get in the way. So yes, it was indeed very exciting.

"What else would you like to look for?" asked Vicky the red headed Scottish registar.

My nerves were having the time of their lives.

"I would like to look at his testicles, please,"

That didnt come out right.

She burst out laughing.

"Geez, would you now!" she said.

I meant to say external genitalia, not bloody freakin testicles.

Worth the pain

“Doc, I couldn’t sleep last night, it was agony. The pain was just...” she broke down.

Mrs AJ was diagnosed with breast cancer a couple of years ago. It had metastasized to her bones...

Pain is something that physicians deal with all the time. A simple analgaesic can sometimes do wonders for any miserable patient in dire pain.

The WHO pain ladder is a step-wise guide designed to aid doctors in describing pain meds.

The higher up one goes, the more side effects there are. Opiods such as oxycodone or oxycontin were very good opioid analgaesics. But their side effects are nausea, addiction and in some cases respiratory depression. Given the choice between the side effect versus pain, which would you choose?

My thoughts wandered...

It was a superb through ball which sent me past the keeper. The last defender was standing between me and the goal...

Judging by the trajectory of the ball, it was 60-40 favouring me to get to it first. I knew I was quicker. I also knew that he'd give it a shot anyway.
We both lunged for the ball.

I toe poked it home.

As the ball bounced into the net his trailing leg was still coming at me in full force.
The referee blew his whistle signalling a goal. As I limped off the field, I sometimes wonder if it's ever worth the pain for a moment's glory.

Rewind to about 9 years ago. I was 14. It was a martial arts sparring competition.

I had injured my right toe in the semifinals. My opponent in the final was a real cocky guy from the east coast. He had earlier whooped my good friend whom now had a crooked nose.

My coach took out a red spray can. He sprayed it all over my toe. I suddenly felt no pain.

A minute passed in the first round. We were evenly matched. Suddenly I felt a sharp pain all over my right foot. I signalled for a timeout.

The coach again sprayed the contents of the red can all over. I felt relieved but still tender.

As far I was concerned, I was destined to lose unless I used my right leg to counter his kicks. It was hard and predictable using just my left.

Round two

He had figured out from my numerous timeouts that my right foot was useless. He had the advantage.

A minute left on the clock...

At that time it felt like I was being heroic. I managed to whack his face twice with a roundhouse kick using my right leg. It probably hurt me more than him. But it was enough.

Two months later...

I stared at the gold medal hanging by my bedside. Then I stared down at my crooked right big toe, which was still tender at times...

Was it worth the pain?