John Stossel on insurance

I was not surprised but found the lasik argument interesting. The video is worth 6 minutes...

"The Surgical Check List"... Its like a fighter pilots checklist... But not really...

Medicine has been stealing safety ideas from the aviation industry for quite some time.   If you don't believe me, talk to any older anesthesiologist and they'll give you the scoop.  They will tell you all about when they had to actually pass gas by hand (got that image in your mind?...Yes!) and how modern anesthesia consistently sets the bar for safety standards in medical practice.  They always brag about this, usually between their crossword puzzle and post intubation nap(I kidd I kidd!)!

Even though it may have taken surgeons a while to figure out how to improve their outcomes across the board, today surgeons around the world can look at their anesthesiologist with delight and happily start a discussion about that new study from the New England Journal of Medicine...

Pass the Sudoku...

The New England Journal of Medicine NEJM (also known as the "New England Journal of Rejection" if you have ever tried submitting a paper there) just published an article entitled, "A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population." In short, the paper states that, "The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001)."> concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals."

The idea of having a pre operative surgical checklist seems like a pretty simple tool to use to improve the outcomes of any operation.  Its also pretty cheap! More money for the medical malpractice lawyers.. YES! The results of the study in my opinion are remarkable... Now my question is...

If the surgical check list is based on the same format as check lists used by aviators, is it appropriate to drop you voice down real low, give yerself a sweet southern drawl and pretend like your Maverick from Top Gun while reading the surgical check list?  

Lets hope so!

This video is from http://www.scoap.org/checklist/SCOAP stands for Surgical Care and Outcomes Assessment Program, it is based in Washington State

I found this video of Dr. Atwal Gawande author of, "Complications: A Surgeon's Notes on an Imperfect Science an Better" and "A Surgeon's Notes on Performance" and many other books just while I was cruising around YouTube.  Here they are performing a "Surgical Checklist."



Below is what happens when inexperienced co pilots get through the check list but dont have adequite training...The take home lesson for surgeons from the video below is... DONT PASS OUT! But its only because your anesthesiologist is waiting to laugh at you!

Obama chooses CNN’s Gupta for surgeon general

Cnn's Dr Gupta has been approached to be the new Surgeon General.  I have not looked at his positions on healthcare reform but I am curious to read his positions.  We might as well add another voice to the Cluster F@ck we call U.S. healthcare.  Maybe he will bring something interesting to the table.  Maybe not.  Meh...

  

I will say that this news story has made me think about other TV personalities I would like to see working in government.  Now that the Obama Administration is accepting TV personalities applications for positions, I believe I have a few questions for the Obama camp...

Question 1: Will Obama ask Oprah to be his Press Secretary?  If not, why not?  Is it because of her lack of experience?  To quell that argument I refer to her handling of Tom Cruise on her own couch (or is that just a weird modified love seat??). 

Look at that picture.  She ain't scared!  Even in the face of certain death from "Weird Bunny Ninja Style Attack" from Tom, she still has her legs crossed!  Come on!  It Screams QUALIFIED!  I believe this is Proof she could handle anything from Fox news.

Question 2:  Staying with the theme of using TV personalities in the new administration...

I and maybe one other American would like to know if it is at all possible to have either Jake "The Snake" Roberts OR Jessie "The Body" Ventura as the new ambassador to the United Nations?

How many times have you heard the phrase, "pass me the snake!" used at the UN? Never? Well its about time!  

 

Wait....  Scratch that....  Could we send Both Jake, his snake and Jessie Ventura to the UN? It could be be another first for the Obama administration....

The first "UN Ambassadors Tag Team?

I have three questions for you.....

Question 1:  Who would you choose as Obama's Press Secretary? Remember, they have to be able to handle many styles of Kung Foo. 

Question 2: Could your "US Ambassador to the UN" beat up my "UN Tag Team"?

Question 3:  What about Colombo for Attorney General?

I wanna hear from you!

-EN

My Day Off...

Guest writer: GAB 

MSc, MD, Royal College of Surgeons in Ireland

founder of www.MedschoolForums.com

Dear Educated Nobody,

Today was a good day. Not an epic, truly Herculean day, full of achievement nor one filled with Hippocratic ‘doing no harm’, but a good day nonetheless. You see, every doc I know works gruelling hours, toiling for their patients, and we all need some rest – an occasional ‘mental health day’, if you will. For me, today was one of those.

As you know, I am a perpetually-busy, conscientious Type A body and so I was reluctant to spend the day in bed. Equally, I wasn’t fit for any gainful use of my time (the bathroom remains unscrubbed), so I racked my brains over a leisurely breakfast.

What do retired or unemployed individuals do during business hours? I needed something that didn’t involve Post Office queues, pointless wanderings on public transport or plotting a bank heist, so I hit on the ideal past-time – prospecting for bargains at the local Aldi store.

Aldi is an ultra-low-end supermarket frequented by the great unwashed and specialising in the employment of those with an MMSE of <19/30. By only taking cash, and by eschewing aesthetics, mood-lighting and clever packaging in favour of large piles of canned peas, Aldi manages to be extremely inexpensive for basic foodstuffs.

The ‘twist' that attracted me on this soggy December morning, is the stuff of legend – Aldi Thursday Specials. (Thursday, coincidentally is the day that pensioners and the unemployed collect their pensions and social welfare payments and Aldi wants in on the action).

The thing is, Aldi doesn’t do ordinary Thursday Specials… half-price peas…nah!, mark-down dishwasher powder, no chance! 

But Specials they truly are, for nestled in between the ketchup (in tomato-shaped containers) and the gherkins-on-a-string were 1600W electric mitre saws with laser sights (Figure 1; note the fresh vegetables in the background).

Cuddled up next to the ice-cream shelf was a display of inflatable mattresses and next to the pick-and-mix underpants was a battery-powered, life-size singing Santa. 

The weather has turned chilly, but our friends at Aldi are prepared, and tucked up with the 

cheeses is a set of electrically-heated insoles for your shoes – just plug into the cigarette lighter in your car for toasty toes (Figure 2)!

Fun was definitely had by most.

-GAB

Video: The "Key" to Staying Young!

I know there are no double blind studies on the topic but... Fast forward to 1:40ish to hear the secret

behind staying young.  

Hint: It rhymes with "Procrastination"

"Lessons Learned by Random International Surgical Interns" Vol. 1

I just graduated from a very international medical school, The Royal College of Surgeons Ireland (RCSI for short).  

About 80% of my colleagues hailed from around the world (only 20% of my class was Irish).  I have asked my various associates who just started "interning" to send me "lessons" that they have learned since starting their internship just a few months ago.  

So, compiled from all around the world by newly graduated doctors who are now "minty fresh interns......"

Educated Nobody proudly presents...  

"Lessons Learned by Random International  Surgical Interns"

Lesson 1: "Newly instituted Hospital Visitor Infection Control" 

Dear Educated Nobody, 

A completely bald man entered the hospital reception and sterilised his hands with the Spirigel.  The man then proceeded to rub the alcohol gel into his shiny scalp.  6 years of medical school and I am quite unhappy that  this "New" sterilizing technique was never taught to me before I became a Surgical Intern.

p.s.  You know I have great hair.

Lesson 2:  "Tricksyness lives in the Radiology Department"

Dear Educated Nobody, 

The key code to the x-ray department so you can sneak into and schedule a CT that was rejected by the radiologist three times. (the pass code is 4,3,2,1)

Lesson 3: "Why take the Stairs?"

Dear Educated Nobody, 

The key code to the consultants lift (elevator for your Americans) is 1,2,3,4.

Lesson 4: "Monks On Call.  Seriously!"

Dear Educated Nobody, 

Did you know that your hospital may have a monk on call?  I had no idea.  If you bleep the right, or in my case wrong bleep number,  You may find yourself having to answer to a holy man in brown robes and sandals!  I had no idea! He was nice though.

Lesson 5: "I realize I suck at IV cannulation"

Dear Educated Nobody, 

After 6 years of medical school and 4 weeks of being a surgical intern, I am still not as capable as an "IV user" in putting in a venus cannula (He put it in his first try for me.  I had stuck him twice.  Sorry!  Regardless, we were both pleased with his result rather than mine).

More to come later I am sure, 

- E.N.

(image courtesy of http://www.brighamandwomens.org)

Ralph Nader on Texas... (non medical post N.M.P)

"This (Texas) is the worst state in the country in terms of denying voters their own choice of candidates," he said. "What is it about Texans, who consider themselves rebels and tough critters, and they're just patsies when it comes to corporate barons?"

intrigued? 

You can read the entire article here.

Ralph Nader's quote refers to getting a third party on the presidential ballot in Texas.  I don't disagree with his sentiment, even though I probably wont vote for him.

When I read the article the article originally I misread patsy and in my mind substituted patsy with pastie! It goes to show you where my mind is...  Whoops!

Thanks Rochelle for the correction!  Regardless, How can you pass up doing a Google image search on "pasties?" 

read the article here from the Chron.com

(Pastie image courtesy of Google search "pastie" and www.whatkatiedid.com)

-EN

USMLE Step 1 Study Guide (by a hairy Neanderthal)

I have been reluctant to write a post about the USMLE Step 1 because I believe there is a lot of advice out there already. I also believe that when the time comes to take the Step 1, you already will have been in medical school for a while and have a sense for how you study as well as a serious collection of books (most of which you bought and never read). 

At this stage in your higher education, you are probably reluctant to take exam related advice from your colleagues as well.

The reason for this exam related mistrust most likely has its roots in the speculation and scuttlebutt that revolves around your medical school's exams. Really, consider how many times have you heard statements like, "I heard the professor say that (insert random topic) is DEFINITELY going to be on the test," or, my personal favorite, "Oh dude, I barely studied."  All of these "tips" probably ended up as pure unadulterated B.S.  So, you don't trust your medical school pals.  I don't blame you. Liberal Arts students are a lot more fun. Go get some new friends.

Since I went to medical school like you, I don't expect you to trust me either. So, to gain your trust, I will hang my head in shame and admit that I did not get a 99 on my USMLE Step 1 Exam.

Dang! 

Trust me now?

I believe it's a simple fact that by the law of averages, you probably won't get a 99 on Step 1 either. The addendum to the previous statement is that you should still work very hard and do your best (that's what your mom would want and who can disagree with your mom).

When I was looking for advice on message boards online, I found that most of the advice was coming from people who claimed to have done really really REALLY well on the USMLE. Still don't trust me? Check out the student doctor network forums and have a blast. It takes about three minutes to realize that most people are living in a world of rumors where he said she said talk reigns supreme. This is usually coupled with the uncanny knack for bloviation (I spot it very easily since I consider myself the master).

You know who these people are on the message boards. They sit amongst you in class. They are a different breed of person. They like to upload pie charts of their practice tests, study guides, pictures of themselves studying and time tables that include a regimen for a 36-hour workday. They document there preparation with meticulous detail including tips on how to avoid your girlfriend, when the optimal time to go to the bathroom is and diet advice that will make your Gastroenterologist envy your perfect pooh.

After you read the crap that's posted about the USMLE, your brain will probably (if it didn't, I'll spot you this one) jump to the logical conclusion that more people seem to get 99s than actually take the stupid exam.  Or at least it certainly feels that way.   I believe that the majority of people who write about their Step 1 experience do no reflect the silent majority of people who fit into the rest of the bell curve that must exist.  It's simple; not everyone can get a 99, but the people who write about their Step 1 experience sure do! So...

If you are looking for advice from a "man" who has a distended cranium, slumped forward shoulders, ridiculous kyphosis, with hands that hang past his knees, you my friend are in the right place!  If you are the medical student who has no grasp of the wheel and have no clue how to start a fire, you may join the club of intellectual knuckle dragger's like me! Read on my Neanderthal brothers and sisters!

The list below is the materials I used and recommend.

 

THE LIST

(It's Kaplan heavy, so watch out)

 

Study like you are taking the test - The day you take your exam is really long. I quote Wikipedia,

"The exam was an eight-hour single-day computer-based test composed of seven 50-question sets (350 multiple-choice questions in total). However, as of May 9, 2008 the number of questions has been reduced to 48 questions per set with a total of 336 questions for the day. The time provided for each section has not changed. Each section is one hour long, allotting a minute and fifteen seconds for each question. ^[1] The test taker is permitted 45 minutes in total for the whole day for the purpose of breaks that can only be taken between sections. There is a 15 minute tutorial at the beginning of the exam, which the test-taker can choose to skip, and have the time added to the break time. If the taker finishes any section before the allotted 1 hour time limit, the remainder of the time is added to break time. ^[2] The test is administered atPrometric testing sites around the world.

Study the same way. I assume your getting my drift.

Kaplan Videos - These are great when accompanied the Kaplan lecture notes. The videos are lectures of professors teaching with power point. What I like is the fact that word for word is taken from the lectures and put directly into the Kaplan lecture notes. I am not sure if it is illegal to bootleg copies of the books or videos, so I don't sell them. I will just tell you how to get them! There are a lot of videos--about 24 hours of lecture per subject. At six hours per day, you can get through them in about a month or a month and a half. I purchased the videos is from the site UsmleStep.com. There is also a host of other study materials for Step 2, etc. if you are interested. http://www.usmlestep.com/2005-kaplan-step-1-dvds-lectures.htmKaplan 

Kaplan lecture notes (the holy blue books) - The Kaplan lecture notes can be found on ebay and are a stack of blue books. The prices range from 250-350 dollars plus or minus shipping. If you click this link, you should see the search "USMLE Step 1 Kaplan." I like the idea of these books because it's what the fine people at Kaplan recommend. You really don't have to use any other books except maybe First Aid (which is not the only book you need contrary to popular belief).

You really don't need any other books. I am serious about this. Don't bother with your other books except for reference. All the Kaplan people do all day is study what comes up on the USMLE. That's it; KAPLAN people have no lives. Trust them. They are serious. I have never seen anyone from Kaplan Smile. Serious.

First Aid - I am not a huge fan of this book. It's for the memorizers amongst us. If you can read lists with no context and interpret graphs with no explanation this is the book for you (why are you reading my blog if you are?). I heard a lot of talk about First Aid before I took my exam. "It's the bible without Jesus." "It's all you need." "Dude, best book ever! You're reading something else?" Bollox. If someone says any of these statements in your presence please take the following advice:

Walk towards this soothsayer slowly. Make sure your arms are akimbo for effect. Smile, deep down you are a nice person. Now that you are in position take a slow deep breath and proceed to kick this person in the kneecap. You have just met a person who is in medical school who "barely studies!" You're a hero! Now go call the on call Orthopedic Surgeon because you're a nice guy and went to medical school in the first place to help people.  Now help that jackass. 

I do believe you should look at the First Aid book. I do believe it helps for memorization. I do not believe it should be used as your primary text! If you are planning to stare at this book for two months and do well on the exam, think again.

Pass Videos - There are three DVD's that come with this set. The teacher is a very large dude who teaches good USMLE concepts in an entertaining way. Plus he loves a kid in the back who makes connections to other topics. "Jesus (that's the kid's name)! My man! Making connections!" Entertaining, hilarious, slow at times, but well worth watching.

Goljan Pathology Mp3's - You must know who Goljan is already. Goljan's pathology mp3 lecture course with notes can be found online. Since I took my exam, I don't think I could listen to him ever again. He teaches very well, and I think he is very smart but his voice just got grating after a while. Use it until you hate it. By then, I am sure you will know your stuff so well that pathology will be a breeze.

Question Banks - Do as many questions as you can.  Your life's ups and downs should revolve around questions. Girlfriend broke up with you?  Do some questions.  Wondering what you should do right before you are about to get a new haircut to replace your mullet? Do some questions.  You turned 32 and have a quarter million in debt because you went to an out of state medical school?  STFU and do some questions. 

I think question banks are great. It's no secret that the more questions you do, the better off you will be. As for the rumors regarding the Q-banks, word on the street is that Kaplan is the best to use. USMLE World is harder, but still very good as well as being the cheapest.  I liked the fact that USMLE world also uses diagrams to explain some of their answers. I recommend doing all of them (I still did not get a 99, but my mom is proud).

USMLERx - Made by the people that make the first aid book. If I were to choose between the First Aid book and the USMLERx question Bank, I would take the question bank, because you get asked on the whole drop knowledge questions you either know or you don't. It is a question bank of essential, must-know facts. The answers for the questions are actually pages copied directly from First Aid book.  It's like studying from the First Aid book with a clinical vignette that the first aid book left out. 

Step 1 Score Estimator - When your doing q-banks, if you go to medschoolforums.com or click this link,http://www​.medfriend​s.org/step​1_estimato​r/ You can estimate your two and three digit score using Kaplan's Q-bank. It's really helpful and frighteningly accurate.

NBME exam - A lot of people take stock in the NBME practice exams. They can be found at www.usmle.org The advice is take the first exam when you begin to study just to get a feel for your weak areas (don't freak out if your score sucks). The rumor is that NBME exam 2 is the most accurate predictor. I took it a week before I tested, and it was within a few points of my real score. I have heard this same type of talk from a number of students and colleagues.

That's it. I hope it helps. It's only the essentials. If you think there is stuff I should add delete, etc., leave a comment or shoot me an email.

Trust me now?

Medicare Reimbursements Part 2 "Houston Chronicle Style"

I Just read an article in the Houston Chronicle written by Todd Ackerman entitled, "More Texas Doctors opting out of Medicare." The article addresses the same issues that were raised in the New York Times article that I blogged about yesterday (see entry below).

This article takes the national problems of medicare and puts them on a state level which is nice, since I now live in Texas (spits). Two quotes that struck me were:

"Only 58 percent of doctors in the state now accept new Medicare patients, according to a recent survey by the Texas Medical Association, down from an estimated 90 percent before 1990. Among primary-care doctors, the percentage is 38 percent."

AND

"With reimbursements cut 20 percent in inflation-adjusted dollars the last seven years, many such doctors are having a hard time making a go of it. Houston internist Lisa Ehrlich found that the only way she could keep her current patients as they became eligible for Medicare was not to take on new Medicare patients."

I always knew in the back of my mind that primary care doctors were taking hits on this issue. I did not know that they have almost stopped taking new Medicare patients all together. It is unfortunate that patients who have been paying into this system are now getting stonewalled by no fault of their own. It seems that to many hands are in the Medicare cookie jar and its pretty obvious that its not doctors stealing the cookies!

I was not surprised when I heard that a few doctors were not going to take new Medicare patients. When I read the New York Times article yesterday I thought to myself, "Hey you big stud, we are going to see a future mass exodus away from Medicare."

To my chagrin, the numbers of the future seem to be here today!

you can read the article here.

Medicare Reimbursements (Oh crap! Here we go..)

The New York Times writer Robert Pear has written an article entitled, "Doctors press Senate to Undo Medicare Cuts."

It begs the question...

 

Can you really reduce payments to your doctor by 10% and still expect the same quality of care?

I believe you can. 

But no one should be surprised when physicians will stop accepting medicare as a form of payment and ask nicely for cash (it's already happening folks).

Regardless of your thoughts on this particular situation, it makes for a very interesting read. You get a sense of the bedlam occurring in Washington regarding healthcare policy.

Doctors, insurance agents, congressmen (who are always up for reelection) and senators all at each others throats over legislation which decides where YOUR tax dollars should go.

To your doctor or to insurance companies?  That is the question...

   

Horology Kicks

Since medical school graduation I have been looking at some of my favorite pictures taken when I was living in Ireland. 

This picture was taken on the way to Blanchardstown Hospital in Dublin.  Its the hospital where some of the more gifted graduates (EN not included) from RCSI want to spend their intern year.

Although its a good hospital, there is a place that is much more tempting to go to for "educational" purposes in my opinion. If you make the left hand turn before you make a right into the hospital I am of the firm belief fun will be had by most who venture in. 

I never had time to go BUT... Maybe someone will send me an email revealing the inner secrets and debauchery that must be had at the "Irish Swiss institute of Horology."

You can visit the hospitals website here

-EN   

"You may all go to hell, and I will go to Texas"

I have received a few emails regarding my absence from blogging. Ok ok, I received one email from my mom.  Dang!

Well, I graduated med school and have moved across the ocean to Texas.  I am in the process of moving my crap into a new house. At the moment the move is taking up most of my time.  Renovating the garage, buying toilet paper, scaring off stray cats, trying to keep my mom from visiting 12.4 times per day and trying to keep my brothers dog away from said toilet paper sounds like fun but in reality, not having a fork sucks.  

I will begin posting more on the regular in the coming weeks. To my readers who number in the dozens, you are not forgotten!

Yee haa! (spit) (kick dirt) (trip) Repeat.

Dr. EN

We passed.

Most of us passed.
All of us got wasted last night.
This hangover is killer.

That is all

Dr. Educated Nobody

To my people! (or should I say person?)

To my readers who number in the dozens!

My medical school finals are next Monday and Tuesday. One day will consist of a long case and the other will be a series of short cases. As a result of my frantic preparation, I have neglected writing for the moment. Dang!

Rest assured after my finals (that I hope to pass) I will begin writing at more regular intervals.

I'm Out!

BJM

RCSI International Night 2007/2008 (2 RCSI Women 1 Cup)

RCSI's annual International Night this Friday 11th April in the Mansion House on Dawson St.
show starts at 7.30pm

For the last 3 years, I greedily relished the opportunity to host RCSI's "International Night." This is the first time I will not be hosting the event (sniffle, shrug, ahhh F*kc It.) But, for those of you who don't know, "RCSI International Night" is a night where students representing each nation gets its cultural Mojo together and puts on a series of performances (dancing, signing, plays, etc.)

Last year, I made a series of videos to promote the night. It was my first and probably last venture into medical marketing, but by and large, I had a great time making the videos. Needless to say, this year’s video was AWESOME! (Not so much).

I have been asked to post the last video made (Trailer 3) which involves one of my favorite moments from my medical school education. Getting two medical students (females, my friends!) to kiss on camera is not an easy task to accomplish. You should try it sometime, its well worth the effort.

You should go. Fun is usually had by most.

Mostly warm regards,
BJM

Surgical Recall Audio (plus a hot chick)

Anyone in medical school who aspires to be a surgeon knows that Surgical Recall is the book to memorize. If you hate reading or would like to imagine your mom and dad are teaching you about surgery as you are about to fall asleep, I have the perfect remedy for you.

I was cruising around online and found a version of Surgical Recall that is in mp3 audio format. It is literally a woman's voice reading the surgical questions from each chapter. After a brief pause, a very manly man's voice answers the question. There is no additional pause to show the whole class the pictures. You can read along with the book or just listen and try to answer the questions faster than the woman. She sounds pretty hot as well. Sa-Weet!

The audio format is also useful for wasting time when traveling to the hospital via the car, bus, camel, magic carpet, elephant, Viking war ship or knacker pulled wagon. My school is very multicultural, which is represented by the students' various methods of transportation.

You can buy the audio book from Amazon.com (I have put a link on the lower right). The chapter files will download automatically and you only have to open the zip file which should open magically into I-tunes. I assume it works the same way with a PC; I am not sure, because I roll with a Mac.

The cost of Surgical Recall Audio is between 33 and 39 dollars. This sucks if you're buying the product in dollars, but if you are purchasing Surgical Recall via Euro to dollar conversion, then your only spending about 3 Euros or 1.98 million pesos (insert bitter sarcasm here due to the fact that a certain student's loan check is in dollars which is later converted to Euros). Dang!

Regardless, the Surgical Recall Audio is a good purchase. I like it so much I take it to bed every night! "Oh really?" Oh Yes! The same students who listened to Goljan when studying pathology will be interested in this download.

Later

BJM

Final Med Surgery Exam March 14 2008 (fun was had by most)

So for all you keener's who want to know what the final surgery exam was like today, this post is for you.

Let me start off by saying that the multiple choice questions were TOTALLY representative of the course (insert sarcasm and four letter words here). The person writing the exam had a complete fetish for tumors of the parotid gland... it was uncomfortable to say the least. I have since taken a shower and still feel dirty. The questions on the written paper which lasted 2 and a half hours were very specific. There was no room for bloviating so, all you folks who like to couch you answer in 3 tons of horse puckey were shit out of luck.

Also, the exam started a half hour late because there was a "printing problem." Pretty hilarious, 2.5 hours out of an entire year (365 days) and it cant start on time. sooooooo with out further ado (insert 70's skin flick music here)...

The Short Notes
Question 1:
What are the indications for thyroid surgery? what are the complications of a thyroidectomy? what is the management of these complications?

Question 2:
Describe the symptoms, investigations and management of low rectal carcinoma.

Question 3:
Describe the classification of neck of femur fractures. Describe the management of these injuries. Who is at risk of developing these fractures?

Question 4:
Describe the presenting features assessment and initial management of acute lower limb ischaemia.

Question 5:
Describe the epidemiology and aetiology of gastric carcinoma.What does he t stage indicate in gastric carcinoma and how is it defined?

Question 6:
List the complications of enteral and parenteral nutrition. What factors influence your choice of supplemental nutrition.

Question 7:
What is a full or partial thickness burn? Describe the difference between full and partial thickness burns. Classify the causes of burns. List the complications of burns listed under the classification of immediate early and late.

Question 8:
List the indications and complications of ERCP. Itemize the steps you would take to prepare the patient for an ERCP as an intern.

Question 9:
Describe the presentation, diagnosis and treatment options of prostate cancer.

Question 10:
List the indications, methods used and contraindications of sentinel lymph node biopsy.

Long Case:
It was a short history of an epidural haematoma. They wanted to know:
1)assessment management of the case in the A&E.
2)Prognostic indicators of traumatic brain injury.
3)The managent post operation in the ICU.

Thats it. Leave me alone. Boozin.

BJM

Resuscitate me, Carlos! Book review get's published, jealousy ensues!

I am correct when I say that you read it here first.

This is a screen shot of the author's proof that is sent out before publication. The author added my name in red (because he has authorship guilt) because I kept on yelling at him to write something for me so I could selfishly post it here. He wrote a review of the book, "Fluids and Electrolytes in the Surgical Patient."

It annoys me to no end that the first thing he wrote for me got published (what an ass). I did not write a sentence in his work and it's obvious… It's good!

Congrats to the author.

Although, it is within the scope of my personality to write a crappy review of the book review out of pure jealousy!

The original post is here.

If you have not read the book yet, you should, I really like it. Carlos Pestana can rehydrate me anytime.

-BJM

Paediatrics (and a fail list)

The below post on Paediatrics advice for the average student at RCSI was a bit worrying to write because when I wrote it, I did not know if I had passed the Paediatrics examination. As of this evening, I humbly report that I have passed that exam. So, if you would like to have your child examined, please go to a paediatrician.

We received our results today via an email, which contained the numbers of students who did not pass. Although it was nice not being on that list, I cannot imagine what it would be like for those who failed to face the Medicine and Surgery writtens and MCQs only a few days from now (this coming Wednesday and Friday).

I do believe the college could have waited to release these results until the end of this week to keep everyone in the right state of mind for their upcoming exams.

This is just another reason why you should all vote for me when I run for "Supreme Emperor of the Planet Earth…" Wait, never mind (no more elections for me); that revolution will be by force.

It's the small injustices that are the worst.

Keep your heads up.

- BJM

Paediatric study guide for the (average) RCSI medical student

As of today, my medical school class has finished all the pediatric learning that my fine medical institution (RCSI) has to offer.

Now that I have finished paediatrics (pending my results), I am just going to write a few lines about the resources I wish some one would have told me about before I started my rotation.

As a child, my mother told me many times that I was special (in a good way, jackass). As a result of her nurturing policy, I do not use the marks I score on exams as a measure of anything other than my ability to take that exam on that given day (most days, I am in the middle of my class). SO, if you are looking for a list of resources and books compiled by some one in the top of the class that gives advice on how to kill a herd of Zebras, you ain't in the right part of town stripy.

But, I assume by the law of percentages you're somewhere near the middle of your class as well, and that's good -- this is meant for you.

1) The Pediatric book with the sunflower on it is reviled by most medical students, yet somehow it is the standard recommended text. Dutifully I bought it. I opened it. I closed it. It really was terrible. BUT, there is a copy of notes floating around that were disseminated in the back RCSI library corridors, under cover of muffled cell phone conversations and Butlers coffee. They are a distilled version of what's HOT in "The Book That Will Not Be Named." Essentially, a student read the book and took out all "the fluffy bits." The end result is a really well written list of topics with only the essentials. Go ahead. Ask around. These are worth getting a hold of. You can always shoot me an email if you have not been able to tap the "appropriate network."

2) Pediatrics at a Glance is a good book to start with. I always enjoy the pictures from that series. The unforgettable picture at the top of this post is in the book concerning Sudden infant death syndrome; We added the "bollox." As per usual, all books in that series are lacking in written text. So, if you are into visual learning, it is a good resource and a rapid review. Today before my exam, I flipped through the whole book in an hour, just looking at the pictures. I guess it gives you a decent quick revision of topics some medical artist deemed important enough to draw.

3) If you like lectures and Kaplan, I do recommend the Kaplan lecture series and the yellow books for Step 2. They are not tailored for the RCSI course, but it is well worth the 12 hours of video and a glance through their version of what you have to know for on Step 2. Think of it as a two-for-one deal; you're studying for your exam and your Steps (and that sucks!). If you stumbled upon web page, then I assume you know enough about the web that I don't have to tell you how to find them on eBay.

4) Paediatrics and Neonatology in focus by Ros Thomas and Dave Harvey is a small book with a lot of pictures that will take you a day to read cover to cover. Again, it is fast revision of conditions that present visually.

5) Pocket Essentials of Paediatrics by Nandu Thalange et.al. I used this book on the wards. It's not a must have, but I know a lot of people who liked it.

7) For the OSCE, those of us who had an 8 month gap between our paeds rotation and the exam were a little nervous since we had not examined a kid in quite some time. I found the book OSCEs in Paediatrics by M.A Khan and M. Pandya useful, and it really put my nerves at ease.

8) Paediatrician Dr MDK video-blogs is a series of short interviews with a host of his Paeds colleagues on an A-to-Z list of topics in General Paediatrics. I'm not totally sure if these are aimed at parents or medical professionals as the language falls awkwardly between the two. That having been said, it is a fairly comprehensive, succinct review of the frequently asked questions and common presentations in the Paediatrics clinic that is well worth 2-3 hours. If you find New York accents grating, viewer discretion is advised. His videos can be found at www.drmdk.com

So, that's the list. I think it served me well... We shall see.

As always, if you have any additions to this list or want to tell us how you feel about it, feel free to comment below. Feed back is always appreciated.

Also, A very good friend of mine just matched in Paeds in Canada today (Not an easy task. Canada hates it when their students leave and try to come back). Giles, congrats, and remember back up at least 10 feet for all cases of pyloric stenosis

-BJM
-GAB (secret ghost writer)