Anatomy and More

It's That Time of the Year Again

2008-05-23T07:35:00.002+02:00

Found this while trawling through the internet. You might find it useful especially points 12, 13, 17, 18 and 19. Be sure to read the very last paragraph. Best of luck to all of you:

Purdy's Test Taking Tips
Naval Nuclear Power Training Command, Florida, 1996

Assumptions: The exam will be a time-pressured knowledge evaluation. The exam will cover a large amount of material and there isn’t much time to study for it. Such a situation will require the level of intensity outlined in this handout.
Strategy: Maximize your performance by taking command of all the factors under YOUR control and using them to your advantage.

1. Get a good night’s sleep (at least 6 hours) the evening before the test, even if it means studying a little less material. Pulling an “all-nighter” may sound enthralling and romantic, but that technique is an act of desperation and rarely works the way you want it to. Remember the mantra: “Well rested, well tested.”

2. On the day of the test, if there is time, go over the material you didn’t get to the night before, if any. If you covered everything, go over it once more to load it into your “high memory.” This will reduce your recall time and thereby free up more time to work on the questions/problems for which you aren’t as well-prepared.

3. Leave so that you will get to the testing center early. If you leave so that you’ll get there merely on time, if there is any unforeseen problem (heavy traffic, etc.), you will increase your anxiety and stress level immeasurably and unnecessarily. Incidentally, if you DO find yourself stuck in traffic somewhere, try to sit back and relax--realize that there is absolutely nothing you can do about it and you’ll get there when you get there.

4. Be physically prepared for the exam--food and drink. Don’t starve yourself and don’t overeat--have a light snack before the test. Have a caffeinated beverage--start drinking it 5-10 minutes before the test and if you can, bring it in and finish it while taking the test. It’ll increase your brain synapse firing rate, thus “keeping you sharp” throughout the exam. Don’t get a super-jumbo size, however, or you’ll be getting up to pee every 15 minutes.

5. Be physically prepared for the exam--sickness. If you are sick, use Nyquil or something similar to facilitate getting that good night’s sleep the evening before. Alka-Seltzer Plus Night Time Cold Medicine works wonders, too. Your goal is to make it so your sickness is not a distraction during the test. So figure out what your symptoms are and use chemicals to combat and neutralize them. This may mean throwing money at the problem by buying over-the-counter drugs. (Obviously, if you’ve gone to a doctor and (s)he has prescribed you medication, use that.) Some good chemicals to combat specific symptoms follow. Headache: conventional Bayer aspirin--it isn’t glamorous, but it does the job; never take on an empty stomach. Stuffed-up nose/sinuses: Sudafed. Runny Nose: bring tissues to the exam. Upset stomach: Pepto-Bismol (affectionately known as “pink cement.”) General feel-like-crap: Alka Seltzer Plus Cold Medicine. Cold Sores: Carmex applied with Q-Tips; never double-dip. Understand some basic principles: you have to balance absorption rate into the body with the chemical’s half-life. In other words, if you take 325mg of aspirin in the form of one giant horse-pill, it’ll last for quite a while as that big tablet slowly dissolves in your stomach; however, you’ll also not feel the effects of the aspirin as quickly. If you take that same 325mg of aspirin in the form of a powder dissolved into warm water, it’ll be absorbed rather quickly and you’ll feel it right away, but the effect won’t last as long. Be cautious about dosage levels and drug interaction precautions. You can do more harm than good if you overdo things.

6. Be physically prepared for the exam--other. Wear comfortable clothing to the test. Bring a light jacket in case the room is cold. Your goal is to be versatile enough such that you have no issues with temperature or physical discomfort. Make sure you’ve gone to the bathroom 5-10 minutes before the test. Evacuate thyself in all ways--this serves to make it so that either you won’t have to go during the test or at least you’ll minimize the number of times you’ll have to go. The idea is to conserve as much testing time as possible.

7. Minimize your distractions by turning off your cell-phone/beeper/watch alarm BEFORE the exam starts. Your fellow examinees will also silently thank you for this courtesy. If you think ambient noise might be an issue during the test, bring earplugs with you. Remember: YOU are in charge of YOUR OWN examination environment. If it isn’t ideal, take command of the factors you can control and make it as good as it can be.

8. Be well-supplied--writing materials. For most humanities-type exams, ballpoint pen is the appropriate medium in which to write. So, bring several of them in case one runs dry. Use black or blue ink--other colors smack of a lack of professionalism. For science-type exams, pencil is the appropriate medium. Use 0.5mm mechanical pencil and make damn sure you have enough lead. In fact, bring TWO such pencils so that in case one jams, you don’t spend a bunch of time screwing with it when you could just drop it and pick up the other. 0.5mm HB lead makes a nice, sharp, easy-to-read line--instructors like that, considering the alternative is something that’s more difficult to read. Most instructors will give zero credit to something they can’t read--remember: the goal is point-loss minimization; you need all the credit you can get. For pencil-based exams, also bring one of those big ARTGUM erasers; they do a very good job of erasing pencil. Also, you don’t want to burn up the teensy little eraser in the end of your mechanical pencil, pull the end cap off to adjust the eraser outward, promptly drop the cap on the floor where it rolls away, pull the eraser holder out and dump all the lead on the desk and floor, etc.

9. Be well-supplied--other materials. For science-type exams, if you can, bring in some plain white scratch paper in case you need it. Bring a ruler so you can make nice straight lines and good, accurate graphs if they’re called for. Bring a watch and put it on the desk in front of you. Note the start and end times on a piece of the scratch paper so you know exactly how much time you have left. Bring a good calculator whose batteries are nowhere near dead and be familiar with the operation of said calculator--don’t borrow one the night before the test. Some instructors will allow you to have a note card to bring in to the test; never pass up that opportunity. Simply making up the note card will help you to study. Certain classes may have additional other supplies that may be of relevance--for example, a compass, graph paper, Moliere diagram, or template. Don’t be without these things. Don’t forget your glasses if you wear glasses. Understand that some instructors will not allow you to have all sorts of extra stuff at the exam--bring it in a backpack anyway in case they do. Better to have it on-hand and not use it than to be able to use it and not have it. Other people taking the test will have proper supplies--don’t be at a tactical disadvantage to them. You may even consider creating an “exam kit”--a designated backpack or carry bag containing all of your exam supplies. Be sure to check it before you leave to make sure it has everything needed for the particular test you’re about to take.

10. Page-check your exam when you get it. Don’t be the first one done and out the door only to find out later that you were missing page four. The page-check is also a good time to get a feel for the exam itself--note how many problems there are, what their relative point values are, which ones you know you can do easily, which ones you know you will need a lot of time to work on, etc. Beware of double-sided pages. The infamous last question on the back page has lost many people many points.

11. It’s not a bad idea to write your name on at least one side of every page. Some instructors will separate exam pages when they grade--if they are clumsy, they may scatter them and subsequently mate up your exam page one with the idiot-sitting-next-to-you’s page two. Protect yourself from being the victim. If the instructor didn’t number the exam pages, number them yourself. You can use them to keep track (on a piece of scrap paper) which problems you skipped and need to come back to.

12. Answer every question. For Pete’s sake, write down SOMETHING. You cannot get any credit for a blank space; however, if you wrote down a key word or tricky phrase and a partial-credit point value was associated with that word/phrase in the answer key, guess what? You may just get some points for it, even if you didn’t know what the hell you were talking about. On True/False questions, unless it’s absolutely 100% True, it’s False. On multiple-choice questions, if you can eliminate even one wrong answer selection, you’ve increased your probability of guessing the right answer. Remember to look for the answer selection that BEST answers the question. More than one may be true, but only one is the right answer. Note that you may even be able to use other questions in the exam against answer selections in a particular question to rule them out, if the exam was poorly written. It’s not your fault that question three’s phrasing essentially gave you the answer to question eight--that’s someone else’s problem. Take full advantage of the opportunity; others will.

13. Make sure you answer all parts of the question. If a question asks you “In how many ways can you make change for a dollar if the bill is 99 cents? List them.” Then your answer is “One way: a single penny.” The answer is NOT “One penny.” Point values may be associated with both parts of that simple question--don’t lose them by not answering what the question asked. That brings up another good point: answer what the question asks, not what you want to talk about. If you have time at the end, go back through the exam and make certain that you not only answered every question and all parts of every question, but that you did, in fact, answer what the question asked and not your particular bent on an issue. This has particular relevance on humanities-type exams. Nuclear Power School Instructors used to write ATFQ for “Answer The Full Question” in red ink on questions not properly answered. (You can imagine what they were actually thinking ATFQ meant.)

14. For science-type exams, don’t forget about UNITS. The area of a triangle is not measured in nothings, it’s measured in square somethings--sq ft, sq in, sq cm, etc. This provides a good check, too, as to whether you answered the question appropriately. If the question asked you for a volume and at the end of your calculations, you have something whose units are in liters, that’s good. If you wound up with something whose units are in inches, or even square inches, that’s bad--you need cubic inches. Units also help in the calculations themselves--by writing everything in a formula with the associated units, you can see whether you’ll have appropriate cancellations and whether you’ll need a conversion factor thrown in somewhere.

15. Also for science-type exams, write down the applicable formula first, then write it with the appropriate numbers substituted in, then solve it. You may get partial credit just for copying down the right formula, even if you make a subsequent math error down the line.

16. Label things (like graph axes), show your work, and write large and neatly. This is especially important in multiple-step problems with many intermediate results. It’ll help you keep track of where you are and will help the grader follow your work if you label the figure you just crunched out as the volume of the spherical portion of the tank and circle it. Once you’ve found the volume of the cylindrical portion of the tank, do the same thing. Now you can easily look back in your work and find the two numbers you need to find the total volume. (Label and circle this final result, too.) If you’ve continued your work on the back, write “(over, please).” If you’ve continued it on scratch paper, label the scratch paper with the problem number and number the scratch paper pages. Make it easy to follow what you’re doing.

17. Use all of the available time. If you finish early, go back through the test and make sure you’ve answered everything. Check your work for stupid math errors. If there’s enough time, rework the problem in its entirety on scrap paper. For humanities-type questions, READ WHAT YOU HAVE WRITTEN BEFORE TURNING IT IN. Does it make sense? Does it flow? Are there grammatical/spelling errors? Catching these things ahead of time is a lot better than turning in good work that has many foolish errors--it brings the outstanding essay down a notch or two and loses you points.

18. Manage your time. It makes no sense to spend 20 minutes on a 5 point question during an hour-long, 100 point exam. You can do the division and budgeting up front and write out your plan on a piece of your scratch paper. 100 points and 60 minutes... so that’s an average of 0.6 minutes per point--hence, a 5 point question should take me about 3 minutes, give-or-take. If it’s been 5 minutes and you still are nowhere with the question, drop it for later. Get to work on the 25 point question on the next page. As a matter of fact, there’s no law that says you have to work the problems in the order they appear--do the 25 point questions FIRST. Then work on the piddly-little 5 and 7 pointers. Better to run out of time and tank one of them than to tank a high-value question.

19. If you find yourself freezing up or panicking because you’ve flipped through the exam and think you don’t know any of it, make yourself knock that unproductive crap off. Take some deep breaths and try to relax. Clear your mind, then locate a question you think you have a chance at--read it carefully and start working on it. Focus. Don’t worry about what you don’t know; work on what you do know. Once you’ve regained control of yourself and have calmed down, become mindful once again of the relative point values and the time available--then act accordingly.

All-in-all, remember that your goal is to minimize your point loss or, in other words, maximize your points awarded. You have a certain level of knowledge. The exam requires a certain level of knowledge. Many times, the exam’s level will be higher. What you need to do is make sure that what you appear to know is reflective of 100% of what you do know (or maybe a little more, if you can manage it!) You do this by making your work easy to read and follow and by answering every question to the best of your ability. After all, your apparent knowledge is the product of your actual knowledge and your test-taking skill. Your average idiot’s test taking skill is a number less than 1.0. Make sure that your test taking skill is a number greater than or at least equal to 1.0.

Last Neuroanatomy

2008-05-11T19:29:00.001+02:00

lecture is found here.

Neuroanatomy

2008-05-04T06:41:00.001+02:00

Lecture 9 can be found here.

Neuroanatomy

2008-04-21T07:56:00.002+02:00

7 Lecture can be found here. Lecture 8 for next week is found here. Please come prepared to discuss the questions next week.

Neuroanatomy 6

2008-04-13T08:18:00.001+02:00

can be found here. Please note that during this session, we will be covering the brain stem in the first hour. Then you will be divided into small groups to discuss the second case presented last week. Please come to class having done some reading about this case and prepared to answer the questions provided.

Neuroanatomy Lecture 5

2008-03-24T07:50:00.002+01:00

can be found here. Please note that during this session, we will be covering cranial nerves in the first hour. Then you will be divided into small groups to discuss the two cases presented at the end. Please come to class having done some reading about these cases and prepared to answer the questions provided.

Cinemeducation

2008-03-07T16:23:00.003+01:00

The film Patch Adams will be shown in ALR at 10 am on Tuesday March 11 and repeated on Thursday March 13 at the same time. The movie will be followed by a brief discussion. I think we will all need a laugh by then....

Neuroanatomy 4

2008-03-07T16:21:00.001+01:00

lecture notes can be found here. Unless there is a national emergency, lecture WILL be held on Monday at 1pm.

Neuroanatomy 3

2008-02-18T07:48:00.002+01:00

lecture notes can be found here. Please note that the next class will be held Monday March 3 at 1 pm.

Neuroanatomy 2

2008-02-11T16:02:00.000+01:00

slide show is found here. Link will be deleted on Friday Feb 15.

Cinemeducation

2008-02-08T07:32:00.000+01:00

Another screening will take place in the KSU Common Room Wed Feb 13 at 2pm. Be there or be square....

Last Abdo/Pelvis Lectures

2008-02-06T07:41:00.001+01:00

Year 1 students please download pelvic walls, rectum & anal canal, and male genital organs lectures. Links will be deleted Friday Feb 15.

Thanks to Anne Marie Bonnici Mallia for two great videos that beautifully depict the rotation of the fetal head through the pelvis during parturition.

All Upper Limb lectures

2008-02-04T15:34:00.000+01:00

Powerpoint shows for muscles, axilla, breast, arm, elbow, forearm, wrist, and hand are found at these links. All links will be deleted Feb 8.

Neuro lectures

2008-02-04T07:48:00.001+01:00

IHC students please click here to download the first neuroanatomy lecture. The link will be deleted on Friday Feb 8.

Upper Limb lecture

2008-02-02T18:45:00.000+01:00

First upper limb lecture will be held on Monday feb 4 at 12 noon at Mater Dei Lecture room 4. Here is the presentation. File will be deleted on friday feb 8.

Brain MRIs

2008-02-02T18:23:00.000+01:00

Some of you are having difficulty with interpretation of brain MRI sections. Take a look at this link for a quick tutorial.

Lectures

2008-01-16T21:00:00.000+01:00

As promised, here are the links for the lectures on Arteries and Veins, Kidneys and Ureters, Lymphatics and Nerves and Bladder and Urethra. Please download these asap as the links will be deleted at 12 noon on Sunday Jan 20.

Punctuation is Powerful

2008-01-11T11:45:00.000+01:00

A professor wrote the following on the blackboard: "A woman without her man is nothing." The students were asked to punctuate the phrase.
Some students wrote: "A woman, without her man, is nothing."
Others wrote: "A woman: without her, man is nothing."
How would you punctuate it?

Cinemeducation

2008-01-09T19:33:00.000+01:00

For those of you who missed it the first time around, we are screening the movie called Wit on Wednesday Jan 16 at the KSU Common Room at 2 pm followed by a discussion at 4pm. It's a great movie. Read this review. If you have already seen the film and just wish to join the discussion contact Daniel Azzopardi or Christine Cannataci at MMSA. Also read the full transcript. Don't fret over the progress tests. Broaden your mind.....

Laughter is the Best Medicine: Teacher

2008-01-08T17:14:00.000+01:00

"If there are any idiots in the room, will they please
stand up?" said the sarcastic teacher.

After a long silence, one freshman rose to his
feet."Now then mister, why do you consider yourself an
idiot?" enquired the teacher with a sneer.

"Well, actually I don't," said the student, "but I
hate
to see you standing up there all by yourself."

Online Hearing Test

2008-01-08T17:08:00.000+01:00

Thanks to Daniel Micallef (Year 2 MD) for this free online hearing test. The site also provides some information on hearing, speech and musical instrument acoustics.

Another interesting site regarding hearing: http://www.hear-it.org/

Heart Sounds Tutorial

2007-12-16T16:05:00.000+01:00

Another free site with wonderful examples of various normal and abnormal heart sounds with matching physiological explanations. The animations are basic but clear. There is also a testing mode to make sure that you got it. Good revision for Year 3 to 5 students.

Testing, Testing, One, Two, Three...

2007-12-16T15:53:00.000+01:00

You should by now be testing yourselves regularly to make sure that the material you are covering is moving from short-term to long-term memory. This website will help you do that by asking you to match structures to their name, and then label them yourself. Fifteen minutes each day should do the trick. Try it!

Aphorism

2007-12-13T19:22:00.001+01:00

"Only two things are infinite, the universe and human stupidity, and I'm not sure about the former.": - Albert Einstein (1879-1955)

A Court Case

2007-12-13T18:42:00.000+01:00

No, don't worry, I have not been taken to jail. Take a look here though and you will find a tongue in cheek argument between the sympathetic and parasympathetic systems. Rather fun way to learn. Enjoy!

Learn the Blood Supply of the Brain

2007-12-13T15:42:00.000+01:00

This website looks primitive but it's a great way to revise the blood supply of the brain and spinal cord. I particularly liked the quiz mode. Try it out and let me know what you think.

Eye Simulator

2007-12-13T15:32:00.000+01:00

This website is a great way to revise the movements of the eyes and test yourself on cranial nerve lesions. Rather clunky, but it works, provided you have Shockwave installed.

Medical Mnemonics

2007-12-13T15:03:00.000+01:00

Generally speaking, I'm not very keen on mnemonics, as I find them rather difficult to remember (unless I think them up myself). This is very much the case with most of the ones on this website kindly pointed out to me by Stefan (Year 2 Medicine). There are a few good ones though and here are my favourites for Neuro and Head and Neck:

ObliqLiques cause lateral rotation of eyeball.

Action of the obliques is opposite to their names. Action of the rectii is rightly fitting to their names.
Both superiors cause intorsion and both inferiors cause extorsion.

Geniculate bodies: paired to respective colliculi SLIM:
Superior colliculi: Lateral geniculate body.
Inferior colliculi: Medial geniculate body.

Geniculate bodies: medial vs. lateral system MALE:
Medial=Auditory. Lateral=Eye.
Medial geniculate body is for auditory system, lateral geniculate body is for visual system.

Spinal tracts: Gracilus vs. Cuneatus: origin from upper vs. lower limbs Gracilus is the name of a muscle in the legs, so Fasciculus Gracilus is for the lower limbs.

Precentral vs. postcentral gyrus: motor vs. sensory Just an extension of the rule that anterior = ventral = efferent = motor.
The precentral gyrus is on the anterior side of the brain, so is therefore motor.

Olivary nuclei: ear vs. eye roles Superior Olivary nucleus: SOund localization.
· Inferior olivary nucleus is therefore the one for sight [tactile, proprioception also].

Pterygoid muscles: function of lateral vs. medial "Look at how your jaw ends up when saying first syllable of 'Lateral' or 'Medial' ":
"La": your jaw is now open, so Lateral opens mouth.
"Me": your jaw is still closed, so medial closes the mandible.

Bifurcation vertebral landmarks · A bifurcation occurs on 4th level of each vertebral column:
C4: bifurcation of common carotid artery
T4: bifurcation of trachea
L4: bifurcation of aorta

Deep tendon reflexes: root supply "1,2,3,4,5,6,7,8":
S1-2: ankle
L3-4: knee
C5-6: biceps, supinator
C7-8: triceps

Interesting Article

2007-12-12T07:40:00.001+01:00

Daniel McKean (Year 2 medicine) has forwarded to me this interesting link from the New Yorker. We have much to learn....

Whole Brain Atlas

2007-12-10T12:21:00.000+01:00

Those of you struggling to conceptualise the brain in three dimensions and to distinguish between T1, T2 and CT scan images, would do well to peruse this web site. Great images and a good place to test your knowledge of normal brain structures as well as abnormal situations. Well worth a visit.

Great Student Blog

2007-11-28T19:42:00.000+01:00

I came across this blog while looking for evidence that getting students to do dissections themselves improves exam performance. Suggest you scroll through some of the past entries: they are well worth the read.

Missing for a While...

2007-11-28T19:35:00.000+01:00

Yes I know I have been too busy to keep this up, but here it goes again. For those of you who need a good revision of the cranial nerves, take a look here.

Interesting Medical Blogs

2007-11-17T17:32:00.000+01:00

Once you start blogging, you begin to realise how much good stuff there is out there. Take a look at the BMJ blog. There is something for everyone.

Cinemeducation: Wit

2007-11-12T07:37:00.000+01:00

The next movie to be screened is called Wit. It will be shown on Wednesday Nov 21 at the KSU Common Room at 2.30 followed by a discussion at 4pm. Times will be confirmed later. If you can't make it for the screening but wish to join the discussion, contact Daniel Azzopardi at MMSA. I will post some links to the movie later. It's a great movie. Don't miss it.

Biochemistry That Matters

2007-11-12T07:23:00.000+01:00

but that apparently you have not covered yet....

A patient with familial hypercholesterolaemia undergoes a detailed serum lipid and lipoprotein analysis. Studies demonstrate elevated cholesterol in the form of increased LDL without elevation of other lipids. This patient's hyperlipidemia is best classified as which of the following types?

A. Type 1
B. Type 2a
C. Type 2b
D. Type 3
E. Type 5

The correct answer is B.

Hyperlipidemia has been subclassified based on the lipid and lipoprotein profiles. Type 2a, which this patient has, can be seen in a hereditary form, known as familial hypercholesterolemia, and
also in secondary, acquired forms related to nephritic syndrome and hyperthyroidism. The root problem appears to be a deficiency of LDL receptors, which leads to a specific elevation of cholesterol in the form of increased LDL. Heterozygotes for the hereditary form generally
develop cardiovascular disease from 30 to 50 years of age. Homozygotes may have cardiovascular disease in childhood.

Type 1 (choice A) is characterized by isolated elevation of chylomicrons.

Type 2b (choice C) is characterized by elevations of both cholesterol and triglycerides in the form of LDL and VLDL.

Type 3 (choice D) is characterized by elevations of triglycerides and cholesterol in the form of chylomicron remnants and IDL.

Type 5 (choice E) is characterized by elevations of triglycerides and cholesterol in the form of VLDL and chylomicrons.

Physiology Question Explanation

2007-11-12T07:18:00.000+01:00

Only one of you attempted this question, which actually is extremely important. Hence it's worth re-stating together with the explanation for all you clinical students out there.

A 26-year-old man is admitted through the emergency department to the hospital for a heroin overdose. His heart rate is 45 beats/min, and his blood pressure is 75/40 mm Hg. Which of the following best depicts the results from an arterial blood sample ?

pH PaCO2 (mm Hg) HCO3- (mEq/L)
A. 7.22 66 26
B. 7.34 29 15
C. 7.40 40 24
D. 7.47 20 14
E. 7.49 48 35

The correct answer is A.

This man has a respiratory acidosis. Overdose with drugs that suppress ventilation (e.g., heroin, morphine, barbiturates, methaqualone, and "sleeping pills") often causes hypercapnia. In patients with an intact renal response, the respiratory acidosis causes a compensatory rise in plasma HCO3-, which lessens the fall in pH. However, the renal response requires several days to develop fully. The plasma HCO3- of 26 mEq/L (normal: 22-28 mEq/L) for this man is typical of acute respiratory acidosis with little or no renal compensation.

Choice B reflects metabolic acidosis.

Choice C is normal.

Choice D reflects respiratory alkalosis.

Choice E reflects metabolic alkalosis.

Mastication Question

2007-11-09T17:39:00.000+01:00

Question: Contraction of which muscles contributes most to the backward movement of the lower jaw during the process of mastication?

Answer: Mastication is a complex process involving alternating elevation, depression, forward movement, and backward movement of the lower jaw. The backward movement step is accomplished by the posterior fibers of the temporalis muscle.

The digastric helps to depress the lower jaw during chewing.

The lateral pterygoid helps to move the lower jaw forward during chewing.

The medial pterygoid helps to elevate the lower jaw during chewing.

The mylohyoid helps to depress the lower jaw during chewing.

Letter to God

2007-11-09T16:12:00.000+01:00

Dear God,

As You undoubtedly know, there is a little argument down hereabout intelligent design and evolution. If You really did createus in a day, and if You ever find humans worth another try,there are a few anatomical modifications that we hope You mightconsider the next time around.

As it happens, Lord, some of the organs You included in themix have not turned out so well. Tonsils and appendixes don'tseem to be especially useful apart from keeping surgeons occupied,or as clues to infection with "mad cow disease." And sinuses.Even if they do lighten the head, all they ever do is get infected.Couldn't we just have stronger neck muscles?

Our perversity in wanting to walk upright, when it is clearthat this was not Your intention, has led to some real problemswith our spines and leg joints. Would it be possible for Youeither to fix the pelvis at a right angle to prevent us fromthis error, or strengthen our weight bearing joints? We alsohope You will anticipate our penchant for portable email devicesby designing tiny little fingertips to operate the keys.

And the aesthetically splendid symmetry—could You extendit even further? It would certainly cut down our problem withtrauma and strokes to have each side of our brain perform exactlythe same functions. The rest of the head is outstanding, asare the limbs, but when we get into the thorax and abdomen,we have a few requests. You probably did not intend us to discardour diet of berries and nuts for fatty meats and pastries, butthat's what happened, with disastrous consequences to our cardiovascularsystems. Two hearts and a lipid-resistant lining to blood vesselswould be just the thing (or give us an enzyme that transformsour preferred cuisine to harmless molecules).

We found out about alcohol, Lord, so it would be nice to havea liver (and maybe a pancreas) in reserve. Or You might removethe enzymatic chain that metabolises alcohol and make us too sick to consume it. Ditto for all the other drugs we seem soprone to abuse.

Thanks to Your gracious allotment of intelligence, we are onthe verge of creating plenipotentiary cell banks, but thereis a serious unresolved problem of individual compatibility.Somewhere—perhaps in redesigned sinuses, if for some reasonYou prefer that we keep them—there might be a little storehouseof such cells that could be tapped into when the need arises.

Despite the beautiful symmetry and economy of design with whichwe are blessed, it has occurred to us that the placement ofour genital and excretory organs in such close proximity waseither done to remind us of Original Sin, or because there didnot seem to be a satisfactory anatomical alternative. CouldYou think about this? No obvious repositioning arrangement comes to mind, but some kind of retractable underarm mechanism mightbe practical.

In fact, this whole survival of the species thing deserves somerethinking. The delicate balance between the pleasures of sexand the pain of reproduction has been an issue for our womenfolk,who have borne the brunt of the pain. Maybe if they were givenonly two or three eggs together with a comfortable course ofpregnancy and childbirth, the need for an endless successionof menstrual periods and the hot flushes of menopause couldbe eliminated without endangering our continued existence hereon earth.

We hope, Lord, that You do not take offence at these suggestions,which are offered in all humility from creatures who surelydo not fully understand the reasons that went into Your marvelof design, from its coating of skin to its molecular engineering,and we are truly grateful for Your efforts on our behalf.

PS: We know You have a sense of humour, Lord, but could youplease do something about adolescence?

Paul Brown, BMJ, June 2006

Medical Maltese

2007-11-05T07:33:00.000+01:00

Attention ALL international students. Today is your last chance to register for the crash course in Medical Maltese starting Wednesday. Classes will be held at the Medical School (SLH for 2 weeks, then transferring to MDH) from 2 to 3.30pm.

Be there or be square....

Muscles of Mastication

2007-11-04T19:29:00.000+01:00

Some of you appeared confused by the muscles of mastication last week. Try this one:

Contraction of which of the following muscles contributes most to the backward movement of the lower jaw during the process of mastication?

A. Digastric
B. Lateral pterygoid
C. Medial pterygoid
D. Mylohyoid
E. Temporalis

Correct answer and explanation next week.

Achieving Your Childhood Dreams

2007-11-04T19:23:00.000+01:00

"Achieving Your Childhood Dreams", the inspirational and moving "Last Lecture" given by Professor Randy Pausch (www.randypausch.com) at Carnegie Mellon University (Sept 2007).

Have patience with the intro….it’s worth it.

Surgery Question

2007-11-04T18:55:00.000+01:00

Must not forget our third year students struggling with surgery. Here is one for you:

Crohn's disease:

A. Is caused by Mycobacterium paratuberculosis.
B. Is more common in Asians than in Jews.
C. Tends to occur in families.
D. Is less frequent in temperate climates than in tropical ones.
E. Is improved by smoking.

Physiology That Matters (Almost Medicine)

2007-11-04T18:47:00.000+01:00

pH PaCO2 (mm Hg) HCO3- (mEq/L)
A. 7.22 66 26
B. 7.34 29 15
C. 7.40 40 24
D. 7.47 20 14
E. 7.49 48 35

Correct answer and explanation will be posted next week.

Biochemistry That Matters

2007-11-04T18:44:00.001+01:00

And for those of you more interested in biochemistry, here is another:

Neurophysiology

2007-11-04T18:39:00.000+01:00

Just to prove that this site is about more than anatomy, here is a neurophysiology question for Year 2 students:

Administration of an experimental drug that acts on PNS myelin is shown to increase the space constant of an axon in a peripheral nerve. Action potentials traveling down the axon would be predicted to be

A. faster
B. larger
C. slower
D. smaller
E. unchanged

Correct answer and explanation will be posted next week.

Coming Clean on Hand Hygiene

2007-11-01T16:17:00.000+01:00

An interesting study conducted in part by your fellow students. Would be good to repeat this at MDH in a few months.

Introduction: Hand hygiene is universally recognized as one of the most effective ways to reduce the cross-transmission of hospital acquired infections. Successful strategies to improve hand hygiene compliance require a baseline knowledge of hand hygiene practices.

Methodology: A direct observational method was used to collect data about hand hygiene practices amongst medical doctors by a group of trained medical students during their clinical assignments. To prevent any bias during the observation, the purpose of the study was not disclosed to the doctors; they only knew that they were being observed for infection control practices. A structured data collection sheet was used to direct the observations. Data on hand hygiene practices was collected during routine clinical work over a number of weeks. Observers recorded the professional grade of physician observed, speciality, location, activity performed, method used, and facilities available.

Results: A total of 898 observations were recorded. Overall compliance before and after doctor-patient contact was 22.7% and 33.5% respectively. Within specialties, hand hygiene practices were lowest in obstetrics and gynaecology and highest in specialized surgical units. Poorest compliance was evident in house officers before patient contact, while the most compliant was the registrar group, following examination. Alcohol hand rub was the preferred method in the wards whilst hand washing was mainly utilised in the outpatient setting.

Conclusion: Hand hygiene amongst doctors in St Luke’s Hospital is low and could be a factor in the high MRSA endemicity.

S Chetcuti, M Montefort, E Scicluna, M Borg, Malta Medical Journal, Sept 2007

Cranial Nerve Quiz

2007-11-01T16:12:00.001+01:00

Which cranial nerve exits the skull base at the pars nervosa of the jugular foramen?

Quiz Response

2007-11-01T16:09:00.000+01:00

Closure of the neural tube occurs around day 26 of embryonic life.

As the neural tube forms, the closing process is critical, occurring from the cranial to the caudal end as the anterior neuropore closes around day 24, the posterior around day 26. This is a critical event, as defects in closure may result in spina bifida or other neural tube defects. The risk of a neural tube defect can be decreased by folic acid supplements.

Lubricating Plastic Specula Does Not Affect Microbiology

2007-11-01T16:03:00.000+01:00

The widespread practice of not lubricating plastic vaginal speculabecause of fears of interfering with bacteriological sampleprocessing has been shown to be invalid. A water based lubricant,Aquagel, had no effect on colony counts when different dilutionsof Neisseria gonorrhoeae were cultured, nor did the gel alterthe results of standard assays for Chlamydia spp. Without lubrication,plastic specula are more difficult to insert and cause morediscomfort, so they should no longer be used in this way.

L Kozakis, J Vuddamalay and P Munday Sex Transm Infect 2006;82: 263-4

Duties of a Doctor

2007-10-30T15:42:00.000+01:00

Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future. You should be willing to contribute to these activities.

If you are involved in teaching you must develop the skills, attitudes and practices of a competent teacher.

You must make sure that all staff for whom you are responsible, including locums and students, are properly supervised.

You must be honest and objective when appraising or assessing the performance of colleagues, including locums and students. Patients will be put at risk if you describe as competent someone who has not reached or maintained a satisfactory standard of practice.

You must provide only honest, justifiable and accurate comments when giving references for, or writing reports about, colleagues. When providing references you must do so promptly and include all information that is relevant to your colleague’s competence, performance or conduct.
Good Medical Practice, GMC, 2006

HPV vaccination campaign to go ahead

2007-10-30T15:37:00.000+01:00

The UK Department of Health has confirmed that girls aged between 12 and 13 will be routinely vaccinated in an annual human papillomavirus (HPV) immunisation programme from next September. There will also be a two-year catch-up campaign, starting in autumn 2009, for girls up to 18 years.

The decision is directly in line with the advice of the Joint Committee on Vaccination and Immunisation (JCVI), which reviewed the issue in June.

This vaccination is available in Malta at a cost of approximately LM180 for the whole course.

Embryology Resources

2007-10-30T15:33:00.000+01:00

A day by day and week by week review of embryological terms with graphical representations from the University of Pennsylvania.

Another one from the University of Cincinnati College of Medicine. In order to play the animations, you need to save them to your computer.

Surgery Quiz Questions for the USMLE

2007-10-29T19:31:00.000+01:00

Preparing for the United States Medical Licensing Exam Step 1, 2 or 3 is difficult, time-consuming, and anxiety-provoking. Knowing the information cold is the best way to ace the test. Although the test is multiple-choice, studies have shown that being able to answer unkeyed questions shows a higher level of mastery of the material. Try these to see how you are doing...

High Power Microscopy is Low Power Histology

2007-10-29T19:20:00.000+01:00

In the histology lab, a common mistake is to "zoom" right into every tissue. Make sure you spend time with your low-power objectives ... this strategy will really pay off during the exams. Check out the histoweb site for a good overview of why histology matters.

Skeleton and Skull Self-Test

2007-10-29T16:06:00.001+01:00

For those of you still unsure of the names of all those cracks and holes, here is a self-test.

Doctors' Gadgets

2007-10-29T07:19:00.002+01:00

Doctors' Gadgets covers the latest advances in personal technology for doctors. You will find complete reviews on the latest handheld computers and medical software. Enjoy!

The Duties of a Doctor Registered with the General Medical Council (UK)

2007-10-29T07:04:00.000+01:00

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must:

Make the care of your patient your first concern
Protect and promote the health of patients and the public
Provide a good standard of practice and care

Keep your professional knowledge and skills up to date
Recognise and work within the limits of your competence
Work with colleagues in the ways that best serve patients' interests

Treat patients as individuals and respect their dignity

Treat patients politely and considerately
Respect patients' right to confidentiality

Work in partnership with patients

Listen to patients and respond to their concerns and preferences
Give patients the information they want or need in a way they can understand
Respect patients' right to reach decisions with you about their treatment and care
Support patients in caring for themselves to improve and maintain their health

Be honest and open and act with integrity

Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
Never discriminate unfairly against patients or colleagues
Never abuse your patients' trust in you or the public's trust in the profession.

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

I have been registered with the GMC since 1981. More aspects of good practice will follow......

Renal Physiology

2007-10-26T16:44:00.001+02:00

Another FREE site developed by medical students which summarizes the important aspects of renal physiology. Covers:

· Renal Handling of Sodium and Potassium

· Urinary Concentration & Dilution

· Diuresis & Diuretics

· Acid-Base Balance

· Divalent Cations

Take the quiz at the end.

Attention Year 2 Students

2007-10-26T16:43:00.001+02:00

Closure of the neural tube occurs on around which day of embryonic life?

a) 26
b) 38
c) 56
d) 74
e) 90

Answers here please. Correct answer will be posted next week.

Attention Year 1 Students

2007-10-26T16:41:00.000+02:00

Most fascia of the body that attach to bones attach by which of the following mechanisms?

A. Blending with the covering periosteum
B. Inserting deeply into the cancellous bone
C. Inserting deeply into the cartilage
D. Inserting deeply into the diaphysis
E. Inserting deeply into the marrow

Answers Here please. Correct answer and explanation will be posted next week.

Attention Year 1 and 2 Students

2007-10-23T20:56:00.000+02:00

A 25-year-old female presents to her obstetrician after taking a home pregnancy test with a positive result. She states that twins run in her family and would like an ultrasound to determine if she has a twin pregnancy. Splitting of the embryo at the blastocyst stage results in which of the following?

A. Conjoined twins
B. Dizygotic twins
C. Fraternal twins
D. Monozygotic twins
E. Single gestation

Post your answers here. I will post correct answer on Friday.

Lumbar Puncture

2007-10-23T20:29:00.000+02:00

Another FREE site regarding the Lumbar Puncture. Covers

INDICATIONS

CONTRAINDICATIONS

ANATOMY

SURGICAL PLANES

EQUIPMENT

PROCEDURE

SPECIMENS

COMPLICATIONS

TREATMENT

QUIZ

Eczema Link to Asthma is Weak

2007-10-23T07:43:00.000+02:00

Only a minority of children with atopic eczema go on to develop asthma in later childhood, Dutch researchers have found.

Looking at 13 prospective cohort studies, they reported the pooled odds ratio for the risk of asthma after eczema was 2.14.

van der Hulst and colleagues reported that: 'Although there is an increased risk of developing asthma after eczema in early childhood, only one in every three children with eczema develops asthma during later childhood. This is lower than previously assumed.'

J Allergy Clin Immunol 2007; 120: 565-9

Attention Years 1 & 2 Students: Embryology Question

2007-10-21T22:01:00.000+02:00

The heart of an embryo first begins beating at which of the following ages?

A. 2 weeks

B. 3 weeks

C. 4 weeks

D. 6 weeks

E. 8 weeks

NB: Your final exam questions will be True/False and NOT MCQs as above.

Your Answers please.

Attention Year 2 Students: Neuroanatomy Question

2007-10-21T21:57:00.000+02:00

A neuroscientist is investigating the development of the nervous system. In his experiments, he microinjects a dye into the embryo of an animal subject in vivo. After birth, he performs histological studies to determine the destination of the dye. In one animal subject, he locates the dye in the dorsal horn of the spinal cord. Which of the following locations in the embryo was the most likely site of the injection?

A. Alar plate

B. Basal plate

C. Neural crest

D. Rostral end of neural tube

E. Sulcus limitans

NB: Your final exam questions will be True/False and NOT MCQs as above.

Your Answers please. I will post correct answers on Friday.

Quote of the Day

2007-10-21T21:20:00.000+02:00

Great minds discuss ideas.
Average minds discuss events.
Small minds discuss people.

Anonymous

Quiz Results

2007-10-21T20:58:00.001+02:00

1. The neurovascular bundle passes deep to the internal intercostal muscles. True

2. The foramen spinosum transmits the middle meningeal artery. True

3. The dura is neuroectodermal in origin. True

Most of you got this last one wrong. Google the words neuroectoderm and dura and you will find information about a rare tumour called Ewing's Sarcoma.

4. The spinous processes of the thoracic vertebrae allow easy introduction of needles between the vertebrae.

False. This is why a lumbar puncture in the thoracic spine would be difficult. In any case, the spinal cord would be at risk.

Blood Pressure Predicts Type 2 Diabetes in Women

2007-10-21T18:53:00.000+02:00

Baseline BP and BP progression independently predict incident type 2 diabetes in women. Researchers followed up 38,172 women over 10.2 years, over which time 1,672 developed type 2 diabetes. Classifying women into four BP categories (<120/75mmhg;>

Eur Heart J 2007

Look here if you want to know more about diabetes in Malta.

Themis

Medical Interventions That Failed the Test of Time: Advice to Lay Sleeping Babies on their Fronts

2007-10-21T18:45:00.000+02:00

Dr Benjamin Spock first published "The Common Sense Book of Baby and Child Care" in 1946. Dr. Spock's reputation was damaged by one profoundly incorrect and ultimately tragic piece of advice. Believing that the risk of aspiration would be reduced if babies slept face down, Spock initially equivocated on the advice of sleeping position for babies. The 1955 edition of his book recommended that a baby sleep on its back, but the 1956 edition and subsequent editions until 1978 recommended that parents place their sleeping babies face-down. This advice is believed to have contributed to the deaths of many thousands of children from sudden infant death syndrome (SIDS). Widespread programmes to reverse the advice in the 1990s saw a dramatic fall in the numbers of cases of SIDS.

Yet, at a time of rigid expectation of infant and child behaviour, Spock spoke of flexibility and individuality. He reassured parents of the value of their own parenting skills and that cuddling their crying babies would not damage them for life.

Fifty million books, 39 countries, millions of babies comforted when they might have been left to cry - and one piece of incorrect advice.

Dr Jon Fogarty

For the record, I followed Dr. Spock's advice for my first child (born 1990), but put the next two to sleep on their backs. Themis

Skull Osteology Quiz

2007-10-21T18:40:00.000+02:00

Attention Year 2 students!

You should be able to answer all these questions by now.

Medical Interventions That Failed the Test of Time: Deep Sleep Therapy and Psychosurgery

2007-10-20T19:25:00.000+02:00

From insulin-induced comas for the treatment of depression to deep sleep therapy for anxiety and obsessive-compulsive disorder, patients suffering from psychiatric disease have intermittently faced a minefield of iatrogenic disasters.

Between 1962 and 1979, at Chelmsford Hospital in Sydney, Australia, 26 patients died as a direct result of deep sleep therapy and 22 committed suicide after treatment. The Medical Journal of Australia in 1973 published a review by Dr Bailey of 150 cases of 'cingulotractotomy', his preferred version of psychosurgery.

Dr Jon Fogarty

Whatever next......
Themis

Spine Trauma

2007-10-20T19:16:00.000+02:00

Another FREE site. Learn how to:

- Determine whether there is spinal cord involvement in a trauma patient;
- Recognize the different injury patterns on imaging studies.

The site contains interactive material including:
· ANATOMY
· EPIDEMIOLOGY
· SPINE RADIOGRAPH INTERPRETATION QUIZ
· CASE SCENARIOS
· SPINE RADIOGRAPH INTERPRETATION
· PRACTICE GUIDELINES
· DETERMINING SPINE STABILITY
· IMMOBILIZATION & TRACTION DEVICES

Take the Test

2007-10-19T17:11:00.000+02:00

Year 1 students check out directional terms and bone.

Year 2 students: You should be able to answer most questions on the axial skeleton and skull by now.

If not, time to study....

Evidence Based Medicine Modules from BMJ Learning

2007-10-19T16:55:00.000+02:00

If you want to improve your understanding of statistics or diagnostics tests BMJ Learning provides helpful modules:
Understanding statistics
Understanding statistics 2: is there a significant difference?
Understanding statistics: tips for hospital doctors (Interactive case history)
What's a good diagnostic test?
How to organise a research project from scratch? (Read, reflect, respond)
These modules are free but you have to register. BMJ Learning also provides a range of other up to date, high quality, clinical and non-clinical learning modules.

Is Dirt Good for the Immune System?

2007-10-19T07:32:00.000+02:00

We all know that our immune antibody responses are specific to the particular antigen invading our body. However, our immune response is also geared for non-specific protection. For example, activated macrophages induced by salmonella can also attack other intracellular pathogens such as listeria.

A recent study in mice showed that even latent infection by herpes induces a prolonged stage of macrophage activation that gives protection from other infections. Keeping the immune system alert like this may therefore confer benefits.

Does a higher antigenic load lead to a better and more mature immune system?

Emil R. Unanue. NEJM 2007; 357: 1345

Medical Interventions that Failed the Test of Time: Colectomy to Treat Epilepsy

2007-10-19T07:24:00.000+02:00

Throughout much of history, epilepsy has been attributed to divine or satanic forces. The rush to science in the early years of the 20th century led to the 'discovery' of so-called Bacillus epilepticus , an organism said to reside exclusively in the colons and blood of epilepsy sufferers.

Variously referred to as epilepticoccus, streptobaccillus and neurococcus, the organism was described as 'actively mobile' and present in the blood of a patient immediately following a convulsion, but absent in non-ictal periods.

In a determined effort to rid patients of the offending and apparently guilty organism, they were submitted to vaccines, enemas and ultimately colectomy for resistant cases.

Dr Jon Fogarty

Do you have any idea of the prevalence of epilepsy in Malta?

Themis

Medical Inventions that Failed the Test of Time: Prolonged Bedrest after MI

2007-10-17T18:40:00.000+02:00

Just as there have been many history-changing medical discoveries and inventions, there have also been ideas that shone brightly for a time and then, thankfully wilted in the glaring light of the retrospectoscope.

There is an inherent logic to the tradition of advising bedrest, even prolonged bedrest, after myocardial infarction (MI). After all, if a broken leg were to rest in a cast for six weeks, and tuberculous lungs were treated with convalescence in remote sanitoria, did it not follow that the damaged heart should also be rested? By lying still and avoiding physical stress, the ischaemic and tremulous myocardium might recover to beat again.

In this model, popular until the 1960s, the post-infarct patient would lie prone for as long as six weeks, forbidden ('doctor's orders') from attending to their own bathing or even brushing their hair. If urinary retention, DVT or pulmonary embolus should spoil the party, this was the price to be paid. Moves to allow post-MI patients to be nursed sitting out of bed, promoted first in the American Journal of Nursing by Drs Mitchell, Lown and Levine in the 1950s, were seen as radical.

Today, patients who have had a coronary artery bypass graft or new aortic valve are not only out of bed within a few days, but back at home and stumbling to the local gym for rehabilitation.

What a change a few decades makes.

Dr Jon Fogarty

Thought For the Day

2007-10-17T18:31:00.000+02:00

Great thinkers have always encountered opposition from mediocre minds.

Albert Einstein

Would a Blog Create a Breach of Trust?

2007-10-16T20:38:00.000+02:00

Question: I am thinking of starting a blog to record my experiences as an FY1 doctor, as I think it would be interesting for medical students to know what to expect when they qualify. I wanted to include anonymised descriptions of some of my more interesting patients, but one of my colleagues told me I could get into trouble if I don't get their consent. Should I go ahead?

Answer: Confidentiality is central to trust between doctors and patients, and respecting patients' right to confidentiality is one of your core duties as a doctor. Without proper assurances about confidentiality, patients may be reluctant to give doctors the information needed to provide good patient care. The fact that you are planning to write up the more interesting cases increases the likelihood that the details will be identifiable in some way, even if you attempt to anonymise them.

In its Frequently Asked Questions publication that accompanies its core 2004 guidance on confidentiality, the General Medical Council (GMC) says: "It is very difficult to anonymise case studies fully, especially if they are of interest because they deal with a rare condition, or the detailed history of a patient with mental illness. For this reason, you must obtain express consent from patients before publishing personal information about them as individuals in media to which the public has access ... whether or not you believe the patient can be identified. Express consent must therefore be sought to the publication of, for example, case-histories about, or photographs of, patients."

When obtaining consent, you must make sure that patients are given enough information on which to base their decision, including how much information will be disclosed and to whom, the reason for the disclosure, and any likely consequences. It may be safest to let patients see, and expressly agree (subject to necessary amendments), the exact text that is intended to be used.
If you include details that could identify a patient to a third party without first obtaining consent from the patient, then you will have breached your duty of confidentiality, even if this was not your intention. If a patient finds out and makes a complaint about a breach of confidentiality on your blog, you risk disciplinary action by your trust or the GMC, and it may be difficult to justify your actions in accordance with the GMC's confidentiality guidance.

Dr Norwell, Medico-legal adviser at the Medical Defence Union.

I will take this advise and so should you....

He Who Can, Does. He Who Can't, Teaches

2007-10-16T20:18:00.000+02:00

This oft quoted phrase harks back to George Bernard Shaw (1903). However, Shaw was referring to revolutionaries, not teachers, so perhaps the phrase is used out of context. Charles H. Mayo, one of the founders of the Mayo Clinic once said: "The safest thing for a patient is to be in the hand of a (wo)man involved in teaching medicine. In order to be a teacher of medicine, the doctor must always be a student."

E-Anatomy

2007-10-15T11:55:00.000+02:00

This is a FREE anatomy e-learning web site. More than 1500 slices from normal CT and MR exams were selected in order to cover the entire sectional anatomy of the human body. A user-friendly interface allows you to glide through multi-slice image series combined with interactive textual information, 3D models and anatomy drawings. Year 2 students look at Face CT and Brain MR. Year 1 students look at Lung and Mediastinum. It's worth registering to get full screen access. Remember: this is the anatomy you will be "seeing" in your clinical years, so get used to it!

Anatomy from Berkeley

2007-10-15T11:16:00.000+02:00

I have come across an excellent series of FREE lectures from the University of Berkeley by Prof. Diamond on the functional anatomy of the human body as revealed by gross and microscopic examinations. These are available for download as videos or podcasts.

Spinal Nerves

2007-10-15T11:14:00.000+02:00

Some of you have been struggling with the concepts of spinal nerves, roots and rami. Click here to download a short slide show that I prepared for another class. Let me know through comments if this is helpful. This show will be deleted on October 19.

Anniversary

2007-10-14T20:41:00.000+02:00

It’s my first anniversary: one month since I started blogging. I had heard of blogs before, but I had never read one. Having looked around Blogger, I can see that most are written by young people (well, I’m young at heart!), and most seem to be a sort of modern-day diary: You write about what you have been doing and the random thoughts crossing your mind. I need to try this out.

Perhaps the best way would be to give you an idea of my (almost typical) weekend. Went to Birgu on Friday night with a few friends. Good thing we took a taxi because there was absolutely nowhere to park. The streets were all beautifully candle-lit. The WW II atmosphere evoked by the architecture and lighting clashed with the loud pop and rock music emanating from the piazza below. Dean Martin would have been so much better. So off we went to the Marina to pick up a water taxi to the waterfront (LM 4 for a 5 minute trip one way!), where we had a lovely meal and excellent wine (LM 14 pp including tip). Taxi home (LM 15 for 3 people both ways). Saturday I woke early, as usual, and stepped off for a brisk walk before waking up P to take him down to B’bugia where his father is escaping reality (he calls it writing a book). P is taking the PSAT on Wed and needs all the practice he can get. His dad is much better with him than I am, so there he goes. Back to Sliema for usual Saturday morning clinic, and then off to buy some vegetables and pick up J from his sleep-over. Must have been quite a night, because it was midday and he was still asleep. Anyhow, managed to drag him home to eat something before setting off for basketball practice.

A hour to kill: get the grocery shopping done. Home to deposit the shopping, then off to Mosta for another party and sleep-over (the social life of an 11 year old is mind boggling). Off to Bugibba to give a short talk on Cinemeducation and Community Service at TRD. Short chat to MMSA reps all looking a little worse for wear: it’s not clear to me whether the point of TRD is to listen and learn or to party. In any case, had a little chat about RCSI: It’s amazing how much effort they have put into this already. Then back to B’bugia to pick up P, who has had a full day of “work” and wants to be taken back to Sliema for a sleep-over.

Finally home at 8pm. Just my mother and I for dinner. Settled down in front of the computer to watch a wonderful film called “Wit” starring Emma Thompson. I think I shall recommend this movie for the next Cinemeducation. It’s a real tear jerker. Sunday morning: another brisk walk, then off to pick up J from sleepover. One hour later, take P to his guitar lesson (who gives lessons on Sundays??). Then cook lunch and off to B’bugia again, so that P can do some more work with his dad while I potter around the house sorting out all the bits and pieces that happen when men are left alone in a kitchen. It’s OK we have been married for 20 years: he’s a great cook, but the cleaning-up leaves a little to be desired. Back home to sort out dinner and get ready for weekly call to child no 1 who is studying in the US.

Skype is wonderful: she plugs in her webcam so I can see how bad the acne is this week (pretty good, actually) and observe first-hand the terrible disaster that has befallen her phone (face plate is cracked). Can I buy a new phone, she asks. You can imagine the rest of the conversation. We sorted out one of her college applications and went over her grades online. Imagine this: I can log onto her (state, not private) school’s website and check exactly how she did in all the homeworks, quizzes and tests she has had since school started in August. Not bad: mostly A’s and B’s. Reminded her to make an appointment for an eye exam and to eat well. Love you!

Well, I enjoyed that little piece of writing. Almost feels cathartic. Perhaps that’s why people blog. I think I will do this again. I’m thinking of a Clinic of the Week…..

For Those of You Who are Unsure About What You are Doing Here

2007-10-14T20:28:00.000+02:00

If it were not for the great variability among individuals, medicine might as well be a science and not an art. William Osler, 1892

Is There a Need for a Chest Pain Observation Unit and Will it be Cost Effective?

2007-10-14T12:28:00.000+02:00

Studies from the USA suggest that using an A&E department based chest pain observation unit (CPOU) saves from $567 to $2030 per patient compared with hospital admission. In the UK cost effectiveness figures are lower at around 78 per patient. This study aims to review current practice for patients presenting with chest pain in St.Lukes Hospital (SLH), to determine the proportion of patients suitable for CPOU evaluation and consequently calculate any related cost effectiveness. Methods: 236 patients presenting with a primary complaint of chest pain to the A&E department at SLH between 1st June and 12th July 2003 were selected. The case histories of these patients were reviewed to ascertain how many of them would qualify for a CPOU management and specific data was collected. Results: Notes were retrieved for 217 patients. A total of 103 (47.5%) patients were suitable for a CPOU management. Mean length of in-hospital stay of these patients was 67.5 hours. Estimated mean cost saving per patient was LM220 and overall LM 19,800 per month. Conclusion: Potential exists for the setting up of CPOU care to reduce health service costs and improve health utility at St.Lukes Hospital. Cassar et al, 2004 Malta Medical Journal 17 (04): 26 - 29.

Poll Results and EBM

2007-10-14T12:26:00.000+02:00

Judging from the albeit small number of votes on this week’s poll, it seems that the least useful aspect of what you find here are journal articles. This is not surprising: you are still learning the basics, so why should you bother with journals? Those of you who came to the Fresher’s week introductions might recall my statement: “Welcome to the first day of the rest of your life”. It has taken most of you 2-6 years to get here, doing A levels and in some cases a first degree.

William Osler said “To cover the vast field of medicine in 4 years is an impossible task”. Think about the size of medical knowledge: There are 11,000 diseases and 3,200 drugs listed in Diagnostic Pro. If I wanted to brush up my knowledge it would take me 30 years, if I learned about one disease each day. Over 500,000 new articles enter Medline each year (1,500 per day), and 30,000 randomised controlled trials are published each year (95 per day). So how do we cope with this information overlaod? The answer was given clearly by Prof Cacciattolo at this year’s TRD: learn to read the literature, learn to sift the wheat from the chaff. But, I hear you ask, how should we learn this? Will this be taught in our medical course? Is there a course we can take, maybe something online? I have no idea (but you could start looking). I helped to run a course on Evidence Based Medicine together with a couple of family doctors a couple of months ago. If you are interested, post a comment here and we will see what can be done. In the meantime, keep a log book of answerable questions and read an evidence based journal.

Purple Urine

2007-10-12T17:28:00.000+02:00

A 76-year-old male nursing home resident with dementia and end-stage renal disease who was undergoing hemodialysis was admitted to the hospital after a syncopal episode that occurred during dialysis. When a urinary catheter was placed, purple urine was drained. Read the full story.

Effectiveness of Chest Pain Units

2007-10-12T17:20:00.000+02:00

Acute chest pain is responsible for one in four emergency medical admissions in the UK. Identifying which patients at low risk of acute coronary syndrome can be safely sent home and which patients need further observation and investigation is not easy, especially when the consequences of misdiagnosis include infarction, arrhythmia, and death. The strategy of evaluating such patients in a chest pain unit based within or near the emergency department is used in 30% of emergency departments in the United States. In theory, a chest pain unit should improve outcomes—but does it? The ESCAPE (effectiveness and safety of chest pain assessment to prevent emergency admissions) cluster randomised controlled trial (Goodacre et al, 2007) enrolled 14 hospitals, seven of which had a chest pain unit. In people admitted to hospitals with a chest pain unit, serial electrocardiography was performed over two to six hours, biochemical markers were measured, and an exercise treadmill test was performed. People admitted to hospitals without a chest pain unit received the usual service typically consisting of admission for troponin measurements over 12 hours, with no early exercise testing. The outcomes were measured the year before and the year after either the introduction of the chest pain unit or continuance of the same service. The introduction of a chest pain unit had no significant effect on the proportion of people attending the emergency department with chest pain, the proportion of people with chest pain who were admitted, or the number of people admitted over the next 30 days. Mike Clancy, BMJ 2007;335:623-624 (29 September)

Enough Said

2007-10-12T09:11:00.000+02:00

After all is said and done, more is said than done.

Radiology Resources

2007-10-12T09:09:00.000+02:00

Radiology is an essential part of today's practice of medicine. The skill of studying and deciphering radiological images can be greatly enhanced by visiting these websites.

Bones and Joints Lecture

2007-10-11T21:51:00.000+02:00

Click here to download today's lecture on Bones and Joints. The audio starts automatically on the third slide. Please let me know through comments how this worked. As most of you will be at the MMSA TRD this weekend, this link will be deleted on October 16.

Risk of Cancer and the Oral Contraceptive Pill

2007-10-11T20:57:00.000+02:00

Full assessment of the risk of cancer needs a long follow-up as effects of the pill may persist many years after its use has been stopped. Between 1968 and 1969, 45 950 women in the United Kingdom were enrolled in the study, and they were followed for a mean of 24 years. Incidence rates of cancer in women who ever used the pill were compared with rates in women who never used the pill. On balance, no higher risk of cancer was found in pill users. Risks were significantly lower for cancer of the colon or rectum, uterine body, or ovaries; the main gynaecological cancers combined (uterine body, ovaries, cervix); and for any diagnosis of cancer. The incidence of breast cancer was similar in pill users and never users. The results show that—in a developed country with an effective cervical cancer screening programme such as the UK—the pill is a safe contraceptive method with respect to cancer. In some developing countries—with inadequate cervical cancer screening and healthcare services, and high cervical cancer rates—the balance of cancer risk is probably less favourable.However, in such settings, contraceptive benefits must be weighed against the risk of cervical cancer, and the balance would tilt in favour of the pill because of the high morbidity and mortality associated with unplanned pregnancies.
Hannaford et. al., BMJ 2007 335: 651.

Sex Education Programmes 'not working': Rate of Casual Sex High but Condom Use is Low

2007-10-11T20:47:00.000+02:00

Malta needed an "urgent re-appraisal" of its sex education and health promotion programmes, because year after year no improvement was being registered, warned Dr. Carabot, who runs the Genitourinary Clinic. Sexually transmitted diseases are steadily on the rise. In 2006, there were 10 cases of HIV (up from two cases in 2000), and gonorrhoea shot up to 32 cases (from 23 in 2005). The vast majority (on average 70 per cent) of GU clinic users never used contraception. Last year, 1,946 people attended the clinic, with 70 per cent of these being new patients. The report shows that 46 per cent described their partner as casual, while 67 per cent never used a condom. "This pattern of high casual sex with very poor condom use is persistent through the years. We must eventually recognise that our sex education and sexual health promotion efforts are simply not adequate and are not giving any positive results," the report said.

The Patient's Perspective

2007-10-10T19:16:00.000+02:00

This site shows you a wide variety of personal experiences of health and illness. You can watch, listen to or read their interviews, find reliable information on treatment choices and where to find support. The site covers cancers, heart disease, mental health, neurological conditions, screening programmes, pregnancy, teenage health, chronic illnesses and many others.

DIPEx was voted by the Times as one of the top 3 patient health sites (2006), was in the Guardian's top 10 health websites (2004) and was singled out in a recent study (Times article March 2007) as a favourite, trusted site for patients.

An Audit of Natural Family Planning and Usage

2007-10-10T19:04:00.000+02:00

The Cana Movement has been training couples in Natural Family Planning (NFP) methods for a number of years, in its efforts to support and to strengthen the Maltese family. J. Mizzi and colleagues conducted an audit to evaluate this education programme, including current use and perception of NFP methods. An anonymous postal survey was carried out among all those who took part in NFP courses between 1995 and 2004. Results are compared to data drawn from the Health Interview Survey (HIS) carried out by the Department of Health Information in 2002 on a representative sample of the Maltese population. The great majority of the NFP respondent population (62%) had been married for 5 to 10 years, and were mostly between 30 and 35 years. A large group of female respondents described themselves as housewives (49%). All women had achieved at least secondary education. The top two occupational groups among male respondents were professionals (20%) and skilled labourers (19%). 57% found NFP methods to be very reliable. This proportion peaks to 75% among 40-45 year old women. HIS figures show the three most popular family planning methods among 16 to 25 year olds and 26 to 35 year olds are NFP, condoms and withdrawal, with the latter method being the most popular in the older age group and condoms being preferred by the younger group. J. Mizzi et al Malta Medical Journal 15 Issue 1-2/suppl. (2003)

Reflections after Today's Faculty Board Meeting

2007-10-09T19:36:00.000+02:00

Following the path of least resistance is what makes rivers and men crooked.

Six Second ECG Simulator

2007-10-09T19:28:00.000+02:00

With all this talk of a new medical school that uses the latest in e Learning resources, it's nice to know that some of the best resources are free!

The Six Second ECG Simulator generates 22 of the more common cardiac rhythms for you to explore and learn. Think you got it? Then test yourself by playing the ECG Challenge. Learning can be fun (and in this case, it won't cost you $30,000 per year).

Secret Worlds: The Universe Within

2007-10-08T20:35:00.000+02:00

View the Milky Way at 10 million light years from the Earth. Then move through space towards the Earth in successive orders of magnitude until you reach a tall oak tree just outside the buildings of the National High Magnetic Field Laboratory in Tallahassee, Florida. I lived right here for almost 12 years.

After that, begin to move from the actual size of a leaf into a microscopic world that reveals leaf cell walls, the cell nucleus, chromatin, DNA and finally, into the subatomic universe of electrons and protons. Amazing...

Tuskegee Study of Untreated Syphilis in the Negro Male

2007-10-08T10:36:00.000+02:00

In 1932, the US Public Health Service began a study to record the natural history of syphilis in hopes of justifying treatment programs for blacks. The study involved 600 black men – 399 with syphilis, 201 who did not have the disease. The study was conducted without the benefit of patients' informed consent. Researchers told the men they were being treated for "bad blood," a local term used to describe several ailments, including syphilis, anaemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last 6 months, the study actually went on for 40 years.

The American people are sorry -- for the loss, for the years of hurt. You did nothing wrong, but you were grievously wronged. I apologize and I am sorry that this apology has been so long in coming.-- President William J. Clinton, May 16, 1997

Remnants of the Tuskegee Syphilis Study Effects on University Freshmen: Yet a Possible Barrier to Research Participation?