Connecting with kids

I raced back and forth, darting from exam room to exam room, following the brisk strides of my two peds attendings for the day. It was only a brief moment in time... a single afternoon for only three hours... and I had to meet with my study group right afterward, so I couldn't stay longer. If I could've, I would've.


I love pediatrics.

The first child came from the outer islands. She was a 1 weeker, 40 weeks gestation who got RSV bronchiolitis and she was here for a followup. My attending tried to elicite a few of the primitive reflexes for me, but she was a little fussy. She was a total cutie though!


The second kid I saw came in because the school "nurse" pulled her out of school because of a suspected case of pink eye. I learned that the public school nurses aren't nurses at all, actually.... they just have a bachelor's degree in something or other and then they get recruited to sit in the office and put ice bags and bandaids on kids without any real training! Here in my state, at least. The really interesting thing was that out of this false case of conjunctivitis came a true history of asthma! She was sent off to get a chest x-ray and was prescribed some albuterol and corticosteroids. She had a hard time listening to the directions for the correct way to take her medications... which got me thinking about some of the things I would have liked to do if I were in charge of the patient encounter. First, I'd put her in charge of her care. Give her all of the pieces, the two inhalers, the spacer and have her put it together. I'd have her recite the instructions out loud, practice once without actually using any medication and then again with the inhaler. Instead, it turned into a chaotic shouting match with the pediatrician and the mom telling her to listen. Yikes.

The third kid I saw was a teenager who sprained his wrist while skateboarding. The doctor took an x-ray and found a hairline fracture in the adjacent finger to the one he was complaining about! Turned out that it was dislocated and he reduced it on his own afterward which added to the swelling. The pediatrician buddy taped the two fingers together, his right pinky and ring finger together and splinted it. He didn't like the pink tape, so she went off to find an ace bandage. While she did that, he turned to me and said "good, at least I can still play the PS-II," wiggling his index and middle fingers. When she came back with the PURPLE ace wrap and covered up his entire hand, it didn't go over so well with him. She revised the wrapping to just the two fingers and all the nurses complimented his splint, saying that it looked really cute. The pediatrician recommended taking some NSAIDs for pain relief and he went "what? no, i don't take meds for pain." I chimed in "well, they also help reduce the swelling so your fingers won't be so uncomfortable." "Oh.... in that case, ok." The mom gave me a thumbs up and a knowing nod.

That really made my day.

SAFE Moms Take Really Good Care, others go "AAAAA!"

Antibiotics to avoid in pregnancy:
SAFE Moms Take Really Good Care
Sulfonamides
Aminoglycosides
Fluoroquinolones
Erythromycin
Metronidazole
Tetracyclines
Ribavirin
Griseofulvin
Chloramphenicol


Other serious teratogens that make moms go "AAAAA!"
Alcohol
Anticonvulsants (Valproic acid, Phenytoin, Carbamazepine)
Accutane (aka Isoretinoin, Vitamin A)
Aminopterin
Androgens


References
First Aid for USMLE Step 1
Wikipedia

Life updates.

I've been pretty busy, so I thought I'd take some time to compose my thoughts and share them before they all drain away.

I took my midunit exam today on OB/GYN and pediatrics. It was a good exam, but there were a few multiple choice questions that bothered me. The prompt went something like this:*

So you decided to skip pharm lecture and sleep in, but your conscientious friend pimps you on relevant facts for the USMLE.
1) Which of the following is NOT used for lymphoma?
2) Which of the following is the primary indication for esophageal
cancer?

Here's my beef.... what the heck does this have to do with OB/GYN/peds? What does it have to do with Step 1 for that matter?!? the drugs listed were very specific. We didn't even learn about them during our Heme/Onc cases. I thought it was patently unfair to quiz us on useless information and on top of that, insult us in a passive-aggressive way.

*actual questions modified to avoid Honor code violations, but the essence remains.

------------------------------------

In other news, prepping for Step 1 has begun. I bought Kaplan Qbank and I immediately decided that I didn't like it. The format is slightly different than USMLEworld and the highlight/cross out function doesn't really work. There's no easy way to rapidly review just the wrong answers for an exam you took previously. Still, it's more questions and I'm going to use it (since I bought it) to supplement my learning from First Aid and World.

My approach for studying is slightly different than most of my classmates... everytime we hit something in PBL, I hunt down every possible board-relevant fact about it and try to commit it to memory. Some study groups are hitting up subjects like biochemistry and microbiology already. IMO, that's too early. It's gonna go in one ear and out the other.

The coolest news by far, was the discovery of a FREE Qbank for Step1. One of my classmates told us about it via the class listserv... here's what she had to say:

Ahoy board studiers! I'd like to pass on a resource - it's a free step 1
test bank written by 3rd & 4th year med students. Some facts:

* Free and always accessible
* Questions reflective of Step 1 because they are written by students who took the test
* Good explanations with right and wrong answers emphasized
* Links to wikipedia for more info (provided in answer) - and everyone loves wikipedia!
* Lots of features like qbank where you can look at your results and how you compare to others, flag questions, create personalized tests, etc
* NMBE practice questions too

I think it's pretty cool that a bunch of med students are working together to provide a completely free test bank, and one of my friends (4th yr @ Mt. Sinai) writes questions for it.

Hopefully you find it useful (more questions = better)

One word to sum it all up.

A lot of learning in medicine teeters upon this point of tragedy and education. After all, it is only through the sick misfortune of others that we learn our craft. It ties me up inside to be excited when I see someone with a rare disease that I learned about only a few days before... or to finally understand the mechanism of a medication that will limit someone's lifestyle for many years to come. The cost of these things is often times too much to bear on the cold side of the stethoscope, yet they can be treated so cavalierly from an objective, learning standpoint.

After playing around with a few words with a friend, contemplating "tragimarkable," "remorsexciting"... I settled on my vocab word to sum it all up.

Terribleriffic:
Terrible and Terrific encompass both ends of the sad/exciting spectrum of medicine into a single word. It has the additional advantage in colloquial use by emphasizing different parts of the word.

I think this word is very versatile and it will serve me well. :) IIRC, graham @ overmymedbody! had a similar idea, but I can't for the life of me remember what his word was.

Don't be MEEC about Aseptic Meningitis

There's no need to be "MEEC" with your differential diagnosis for aseptic meningitis! Here's a mnemonic to help you out.

Mumps virus
Echovirus
Enterovirus (like polio)
Coxsackie virus

If an infant comes in with a stiff neck, altered mental sensorium, irritability and high fever, get some CSF. If it's clear and fluid analysis shows elevated protein, but no decrease in glucose and high lymphs... think aseptic meningitis. Bacteria would make it cloudy and eat up the glucose.

Meningitis is one of those critical ER diagnoses. Don't hesitate or the baby could die! Unless its viral, then there's not much you can do but provide supportive care until it resolves. :-\ Herpesviruses and varicella can be treated with antivirals.

Step 1 Starts Now

Thus begins my journey into the gaping maw of dread and doom.

It is time to begin studying for the Step 1 US Medical Licensing Examination, ironically abbreviated USMLE (which most second year med students DO NOT smile about.)

We selected out dates to take this exam a few weeks back. Everyone traded notes and talked about which subjects they already covered and what they were going to cover. A lot of this happened in secret, since our curriculum directors wouldn't be happy to hear that we're studying something aside from their material. My medical school is very different in its setup from other schools. I hear that other students are groomed to take Step 1 the moment they enter medical school. We are groomed to learn clinical and problem solving skills, do research and present it effectively to small groups. I strongly believe in the PBL curriculum but even I'll admit that it doesn't leave much time for the board exams.

One of the things that caused me great anguish was that my brother was graduating from college in the middle of board studying time. Right after he graduates, my parents, his girlfriend and her family are all planning on going on a nice family vacation.

What about me?!?!
I've got this HUGE exam that I'm recommended to take on the week of the 27th of May, the day after my parents return from this awesome family vacation. The score from this exam plays a role in determining where I go for residency as it sums up pretty much my knowledge base for the first two years of medical school.

I reluctantly declined the invitation, choosing school over family. One night, when I was cleaning out my car, I glimpsed at the itinerary that my brother's girlfriend, J, has "forgotten" there. They were going to the Grand Canyon, Las Vegas and Bryce National Park... WHAAAT?!?! I've always wanted to go to the Grand Canyon!!!!! DANG IT

I thought about it and I realized that it would be the LAST family vacation I'd be able to take with all of them.Very painfully, I reluctantly withdrew my resignation and decided to accept instead. J squealed with happiness and they both agreed to do whatever it took to support me (and help me pass my Boards.) Don't know how they'd do that from California, but whatever.

I do have one thing in my favor for taking this exam two weeks earlier though. We took a practice exam in October and I somehow managed to pass that one with a 66/190. I was one of three people (that I know of) in the entire class who pulled that off without even formally studying for the exam! I figure that I must have retained some of that brilliance.

Hopefully.