Friday, 12 April 2013

Ooooh, I'm half way there

But I am still, living on a prayer!

Sorry for the cheesy start... I am half way through my final examinations and the 'revision madness', combined with the relatively small revision play list has got to my head. I though I would 'give it a shot' at putting song lyrics as an introduction. Don't worry; it won't happen again ;)

Anyway, trying to work hard at the moment to finish off the final exams, but I am finding it tough to keep focussed (but not as tough as 'working the diner all day'...) It seems as though I have been working hard for far too long, and the poor brain is getting fatigued! Just need to keep focussed, will all be over by next Wednesday... 'one way or another'...

Exams so far have gone OK. There have been some hard questions and some difficult moments in clinical examinations, but there have also been stations/questions which I have done really well in. I just hope that the goods outweigh the bads! I have one more knowledge (written) test and one more clinical examination (where you are assessed on taking histories/performing examinations) left, so I am actually over half way there, but then that isn't nearly as catchy as a song...

Most of this month has involved me holing myself up in my room (or my ivory tower if you prefer), avoiding having any fun with my flat mates and working at cramming as many facts into my brain as possible, so I can regurgitate them on demand. Not living with other medical students this year is both a blessing and a curse. It makes it a lot harder to practice clinical examinations and histories, as they don't really want to/know how to pretend to have certain conditions for me to practice on. On the positive side, it leads to a much more relaxed atmosphere as around exam time, if the whole house is medical students worrying about the same exams, it feels much more stressful, and people mentioning some condition you cannot remember off the cuff while cooking dinner (those delta waves in Wolff–Parkinson–White syndrome) leads to more stress when you feel as though you don't know as much as your compatriots. This year I have been pretty removed from all that stress, but conversely I don't know if I am learning enough/too much! My thought process has always been that you don't (usually) regret working too much for an exam, but you are far more likely to wish you had worked harder, so I may as well work hard and hope for the best!

As for exams, things are going OK. I have had a few mistakes, most embarrassingly being very sure about a diagnosis of squamous cell carcinoma (SCC) in one of my clinical exams, after taking a history from, and examining, a patient with a prosthetic lesion. It had been created by some kind of skin putty moulage technique, and looked (very similar to) the picture below, but with a darker centre. I described it as below, with the central ulceration, and assured the examiner the most likely diagnosis was SCC

A 'classic' SCC lesion - and I swear the moulage looked just like this!

At the end I formulated my management plan, referral to dermatologist, etc and then for the further questions I was told that the dermatologist thought it was a melanoma, and I had to talk about the management of that condition instead. Below is a picture of a melanoma:

Melanoma from good ol' Wikipedia 

They don't really look very similar at all. I am not too sure what they were hoping for with the moulage, but I hope I wasn't penalised. I think that the paint that I identified as the 'central ulcer' was in fact the melanoma, and the raised edge around it must have been some kind of irregular border. Other people seemed to get it right, though, so perhaps it is just me! Perhaps the lesson here is not to be too certain about anything :P

Hopefully small mistakes like this will not lead to me failing the station, as you can only fail a few stations before failing the exam! I did pretty well across the rest of the examination, so hopefully  I will still pass. I finish my exams next Wednesday, AND find out my job allocation for next year on the same day. Hopefully it is going to be a really good day!

Just need to focus on doing well in the next two exams, so I can pass my exams, and be a (hopefully) brilliant doctor next year!