Wednesday, 1 September 2010



Time for a quick update as to how things are going. I worked hard for my exams, and let me tell you, revising is nowhere near as fun as bouncing around the hospital. More tiring though. The problem with revision is that during those weeks when you are preparing for your exam, you have no time for yourself. Whenever you do anything fun, it feels as though you should be working, and you are procrastinating. You end up feeling guilty for enjoying yourself. Anyway, enough of that - exams seemed to go well, though I was least sure about the OSCE, which was the last exam, and least prepared for. Let me tell you about two of the stations, for lack of anything else to write about. Who wants to hear about written exams!

The OSCE station I had most problems with was that of a woman who had started bleeding vaginally early during her pregnancy. After asking about dates, pain and amount of blood I wasn't really sure where to go. I cannot really reassure her, as it sounded like an ectopic pregnancy, which would mean it wouldn't be viable. Not point telling someone "it's all going to be fine, don't worry' when its likely the baby cannot survive. I couldn't really tell her that either, as it would have to be diagnosed by blood tests and ultrasound scans. I told her about these, but I really don't think I covered enough in that OSCE to cover the 15-20 marking points. The other OSCE stations (20-30 of them) went with varying degrees of success, but there is one I was very pleased about.

The station I was most proud of came close to the end. This exam lasts for hours, and by the end you are starting to get pretty tired. This was a station where you needed to do a cardiac examination, which involves feeling pulses, looking for signs of cardiac disease in areas from the nails to the eyes, and the obvious listening to the heart. In a 3rd year OSCE there are a few likely problems, such as heart failure or valvular disease, which is probably going to be either aortic stenosis or mitral regurgitation. These are the two easiest-to-hear murmurs, created by problems with the valves in the heart, and among the most common, meaning it is easy to get patients for us to examine. The trick is distinguishing between the two, as they both cause a murmur in the same space of the "lub-dub" of the heart beat, as the heart contracts and with the pulse, they just sound a little different.

[If you are interested Here is Aortic Stenosis and Here is Mitral Regurgitation]

As well as the slight difference in the sound, there are a few other methods of distinguishing between the two. Aortic stenosis partially blocks the flow of blood from the right side of the heart, to the body. Mitral regurgitation causes back flow, so the right heart doesn't just pump blood forward, out of the aorta, but also backwards into the atrium, making it less efficient. Talking to friends in the days before the exam (a good way to revise) we talked about the difference that can be felt at the radial pulse. In particular that aortic stenosis causes a 'slow rising' pulse because of the hindrance the valve causes to the blood leaving the heart. I had never felt one of these before, but in the OSCE, I was sure that there was something odd with the pulse. I went out on a limb and said that the pulse felt like it was slow rising, because it did feel flatter and more delayed, as friends who had felt such a pulse had described it. This was confirmed when I came to listen to the heart with the stethoscope, and heard the ejection systolic murmur, radiating to the carotids. It felt great, having diagnosed someone with my first laying on of hands, and using a sign that I had never even felt before.

Enough self-indulgence. Waiting around and working over summer, exam results came quickly and it turned out I had done more than OK. With grade boundaries up near 90% for an A I had still managed to mission through with some great marks. I won't go into specifics, but I am more than pleased! The OSCE was fine as well, fortunately, though unfortunately we don't get a breakdown of that as it is merely pass/fail. I would like to have known how I did on that ?ectopic question!

The best part about passing all those exams is that I am now off to another university to do research for a year. Something that interests me, and a year where I will have free weekends again! I had to revise a lot of cellular level science for these end of year exams, so hopefully I will know some of it when I get there. I find out about halls on the second week of September, and with term later in September, and no guarantee I will get a halls place this could get quite interesting. I may be sleeping on some friend's sofas for a month or so...

I will keep you posted as to how it goes, but I have a feeling it won't be as exciting to write about as the last clinical year.