[update] Women's rotation over. Children's rotation next

My rotation at the Royal Women's Hospital finished yesterday. So far, it has been the rotation I enjoyed most overall this year. Why? In both obstetrics and gynecology, many of the interventions make sense. I like things when they make sense. I also like all the technology they use nowadays. I still prefer cardiology though, and it was a bit sad to see that one of my favorite classes of drugs, the ACE inhibitors, could not be used on pregnant women.

Next week will be intersession, then I will be doing the children's health rotation. I am looking forward to that rotation too. But first there will be three days of "random" lectures.

[update] Birth week completed. Conference essay review correction

I had my birth week last week. Although there was excitement when the baby finally popped out all those times, there was also a lot of waiting. Apparently it was a quiet week. I once had one full morning shift when I did not witness a single birth!

We are expected to get at least seven births signed off, although they can include caesareans. I already had two births signed off from elective caesareans before the birth week and had the rest of the seven signed off during birth week. Since it was quiet, I was just relieved at the end of the week that I had all my required births signed off.


It seems like the faculty realized their error in the 500 word word count for the conference review essay. Now they are accepting 300 to 500 words. I had already written my 500 word version though with many unnecessary words with long-winded sentences, so hopefully two people can have fun reading it.

[update] Student conference essay review time. Birth week next week.

As part of our pass/fail assessment for the student conference, we were required to do two critiques of MD2 essays. This year, for some reason it was decided that we were supposed to do 500 word critiques instead of 300 words like last year! I mean, personally I thought 300 words was sufficient enough, but someone decided that that wasn't enough.

Well, honestly I don't think most of us would be giving that much more information with our 60% longer essays that we had to write for critique this year. Naturally, it goes something like this:

Needless to say, after an initial essay which was around 300 words (last year's word count), I proceeded to add many needless words. Some of the sentence constructs I used must have made me sound like I was a completely different person!


Anyway, regarding my current women's health rotation, my week at the birthing center is next week. Should be something different from what I've been seeing so far.

[update] Halfway through women's rotation

I'm about halfway through women's rotation now. So far, it is probably one of the best I have had this year, if not the best rotation.

This rotation is about obstetrics (birth giving) and gynecology (more about the pathological things to do with the gynecological system). Right now, I enjoy the obstetrics part of it more, although the gynecology part is still OK. It is really amazing when you find the fetus's pulse with the doppler ultrasound probe, or visualize the fetus using the ultrasound imaging!

We also had the opportunity to scrub up into theater at times, for gynecological or caesarean operations. I got to see the surgeon do a hysterectomy and then follow the specimen straight to pathology and watch as it was cut up and analyzed right there. It is a lot more interesting when you can relate the pathological specimen and slides under the microscope to the patient whom it was taken from.

The caesarean sections were also very interesting, with the incisions and closing up, together with the birth of the baby. It is quite an interesting feeling to see the obstetricians make an incision in the uterus and break the membranes, knowing that the fetus is right there inside.

Apart from caesareans though, I haven't had my birth week yet, so I haven't seen the natural births. That should come later.

[update] 2014 MD student conference over. Semester 2 about to begin. SS1 and Women's Health.

This week we had the MD student conference for the University of Melbourne. It was the first time that we had a student conference encompassing all the years of the MD course during the conference.

Overall, I think this conference has been the best one I have been to so far. We were able to listen to the research which had been done by the MD4 students, some of which was very intriguing. We also had more "optional" sessions this year, where in the past conferences there were more sessions which were compulsory for everyone.

I also felt that the food was better than last year, although not as good as at the MCG. However, others disagreed, saying that the muffins were better last year. Perhaps it is because I don't particularly enjoy muffins anyway, or eat the dessert, so I had that off my radar for "evaluating" the food.

Anyway, I somehow managed to finish my 1500 word essay reflection already, so I won't have to worry about the conference again for a while, when I will need to peer-review two MD2 reflections or e-portfolios.


Meanwhile, over the next few weeks, I will be trying to organize in greater detail my research project to get ready for next year, and writing a literature review. This should be interesting, as we don't have time off for this. As I had hoped for though, I did get a project at St Vincent's cardiology, so I am happy about that.

My next rotation will be Women's Health at the Royal Women's Hospital, then my final rotation will be Children's Health. I think this should be a better semester than the last, although we will be required to spend a few nights at the hospital seeing babies being delivered. Let the semester two proper begin!

[update] MD3 semester 1 over!

The GP rotation is over, and semester 1 this year is now over! For reasons inside and outside of medicine, this semester was more dramatic than I hoped it would be. But I have made it through, and it is now done.

The GP rotation was my favorite rotation this year so far. Right now, although GP is not my top preference as a future specialty, I think it is a viable option for me. Apart from the coughs and colds, most of the other things in GP land are varied and interesting. GPs are at the front line of cost-effective preventative medicine in Australia. It is also a better lifestyle choice compared to other specialties.

However, the main thing making GP a less attractive option is that it is not as well supported financially compared to other specialties. Furthermore, even now the federal government is trying to cut money to Medicare and charge the GPs a co-payment for "bulk-billing". Unfortunately, this will serve to make it an even less attractive option!


Meanwhile, I am happy with the results of the MCQ progress testing for this semester so far. I have not done as well as towards the end of last year, but I still have one more semester left. I am more concerned about how my OSCEs will go compared to written exams.

We should be getting our scholarly selective (research) supervisor details on Monday. I am hoping to get a cardiology project. Why? I believe that "if you are not interested in cardiology, you have no heart". Well, not exactly, but I do think that cardiology is interesting.

Well, now I have a week break, and then we will have the MD student conference. I'm looking forward to the food, and to the research presentations that this year's MD4s will be giving about their research.

Petition: Stop the co-pay cuts: GPs make the difference

Australian Doctor has started a campaign to hold a petition to oppose the proposed $7 copayment for bulk billing GP visits. Please sign the petition to support primary healthcare in Australia.

http://gpsmakethedifference.com.au/sign-our-petition/

#StopTheCoP

In the Federal Budget announced just over two weeks ago, the Abbott government has announced cuts in funding to hospitals and GPs, with an inclusion of $7 copayments for GP visits starting from next year.

GPs are the gatekeeper of the medical system in Australia. They are in the front line of preventative healthcare, and the forefront of prevention, intervention and screening. They do pap smear tests, blood pressure checks and screening for diabetes and high cholesterol, smoking, and excessive alcohol use, where cost effective lifestyle and pharmacological interventions are used to prevent morbidity and mortality.

However, it is known that people from a lower socioeconomic status are more likely to have poor health. The effect of this copayment will be fewer visits to the GP from people of lower socioeconomic backgrounds, which are likely to lead in an increase in the overall disease burden. Furthermore, there will be likely an increase in presentations to the emergency department for trivial matters, wasting the resources of the hospital where GPs could have provided appropriate care.

As such, the copayment is opposed by the peak bodies representing doctors in Australia. See what the AMA has to say, or the #StopTheCoP posts on twitter.

GAMSAT 2014 results released!

The GAMSAT results for 2014 have been released today! Congratulations if you have done well, and commiserations if you have not done as well as you would have liked.

If I have tutored you this year, I would like to know how you went. Send me an email if you wish to let me know.

[update] Aged care rotation over. GP rotation starting next week.

Yesterday on Friday was the last day of our aged care rotation. In total, there were three weeks of geriatric medicine, two weeks of palliative care, and one week of psychiatry of old age. I found geriatric medicine reasonably good and palliative care OK. However, as per the adult psychiatry rotation in last rotation, I was not very keen on psychiatry of old age.

The next rotation will be the GP rotation. I am looking forward it.

The ECG song - Song and lyrics

S1 Q3 T3 From: Life in the Fast Lane http://lifeinthefastlane.com/ecg-library/pe/

<<Intro/Chorus

It’s ECGs,

Everybody reads ECGs,

GPs read ECGs,

Physicians read ECGs.

Rate, rhythm, axis,

LV hypertrophy.

First start at P,

Then QRST.

End Intro/Chorus*>>

The rate is easy,

Take 100 times 3,

then divide by large squares,

between two R-Rs you see.

The Rs from the rhythm strip,

Alternatively,

Can be multiplied by 6,

More time but more easy.

The next one is rhythm,

See if there’s a P

Then a QRS,

It’s sinus rhythm you see.

If it isn’t regular,

And there is no P

Then chances are

It’s AF you see.

*Chorus

If there’s a sawtooth,

or a pace of 150,

Then I would suggest

atrial flutter it be,

If the PR lengthens,

before each QRS,

drops one complex before resuming,

Then it’s Wenckebach.

If there’s one QRS,

after every 2 or 3 P,

Then it’s Mobitz II,

Heart block of 2^nd degree.

If PR is more than 200 ms,

heart block first degree,

If P and Q are dissociated,

Then it’s CHB.

*Chorus

Leads I and II usually,

Should both point up you see,

Otherwise see if the pattern is

LAD or RAD.

S in V1 or V2

Plus R in V5 or V6

Greater than 7 large squares,

LV hypertrophy.

Look for Q waves

Quarter of the QRS,

Two in the same territory

Could be an infarction past.

Less than 100 ms

QRS length should be

Otherwise a ventricular rate

or bad ventricular conduction it be.

*Chorus

If the QRS is long,

look for two rhythms you see,

MaRRow for right bundle

WiLLiaM LBBB.

Things are more complex

with a LBBB,

Hard to assess ST

Or LV hypertrophy.

If there is ischemia,

there can be depressed ST.

But if it is elevated,

It may be a STEMI.

Pericarditis has globally

elevated ST;

Ischemia or old infarcts

cause an inverted T

*Chorus

It is a massive pain

To assess prolonged QT

But it is important

To prevent polymorphic VT.

QT on root RR

Will give you QTc

Less than .45 for males

and .46 females see.

*Chorus

It’s S1 Q3 T3

a huge PE

and leads aVF, II and III

an inferior STEMI

If there’s a LBBB

Look at a prior ECG,

If it’s VF or VT,

Get the defib ready.

*Chorus

<END>

nucleophilic addition-elimination, 2014

Disclaimer: No responsibility will be taken for any harm as a result of following this song. This song should not be used for entire preparation of ECG training. Also learn about the different regions of the ECG, spotting SVT, VF, VT, right sided infarcts, and differentiating atrial and ventricular ectopics just to name a few other things. Or other things like ECG signs of hyper/hypokalemia and hypothermia, and the various more common signs of PE on ECG.

Edit to add: Youtube link to ECG song.

[update] Aged care rotation and research project selections

I am now two weeks into the aged care rotation. So far, I am enjoying this rotation a lot more than mental health. I have heard several others say that they enjoyed mental health a lot more than aged care, but I found the opposite.

For me, it was very refreshing to go around in the ward round and see the patients being asked history questions and being examined, with medications being reviewed. Due to the holiday at the end of the year and the mental health rotation, it had been very long since I had seen patients having their chest listened to or their JVP checked. It was as if I had almost forgotten that these things could actually be done!

It was also refreshing that we didn't need to spend too long with each patient. For me, mental health was very draining, spending such a long time with each patient during a ward round.

In this rotation, apart from general medicine, there is more emphasis on learning on things such as falls, incontinence, reduced mobility, delirium and dementia. It was interesting to see some of the more functional tests in action too, such as the functional reach test and three minute walk test, while the standard neurological exams and eye exams were also performed to examine for potential causes of a fall.

I will have one more week in the geriatric medicine ward, then I will have a few weeks of palliative care, before my GP rotation.


There have also been sessions recently at the various hospitals advertising about scholarly selective projects that they want us to do. The scholarly selective is a research project during the first semester of fourth year MD at Melbourne. I am personally trying to look for some cardiology related projects and contacted a few supervisors, looking forward to meeting them. Some of them are in Austin though, which requires traveling by me from St Vincent's, which takes up considerable time. I haven't conducted any research before myself, so I am looking forward to this research semester next year.

GAMSAT 2014 Australia over. No new student intake until after end of year exams.

Today was the date for GAMSAT 2014. If you sat the GAMSAT this year, I hope you have done well. The results will be out in approximately mid-May, in 8 weeks.

I am planning to concentrate more on my studies, so I will not be taking on any new students for the GAMSAT or VCE until after my end of year exams this year. I'll also be required to do a medical student elective during the upcoming summer break, so my availability will be restricted on some days more than usual on holidays. I apologize for any inconvenience caused.

GAMSAT 2014 in two weeks!

The GAMSAT Australia 2014 is in two weeks time! If you were one of my tuition students, I have sent an email on some tips. If I have tutored you and you haven't received this, feel free to send me an email and I will send it to you.

Not too long to go now! Keep up with your studies and good luck for the test!

[update] two more weeks in mental health rotation

I have spent four weeks in the mental health rotation so far, with two more to go. Many of the doctors I have observed in the psychiatry rotation are very nice and seem to do a good job. However, I don't feel like this is the specialty for me.

In this rotation, we need to get a list of tasks signed off. This is proving to be quite annoying indeed. Many of these patient encounters are touch and go. However, I can understand the thinking of those making this list in wanting us to get a minimum amount of exposure to tasks.

Anyway, it seems like I have a mini-CEX next week and one the week after. I hope they go well. I'll probably give another update when this rotation finishes.

[update] MD3 2014: first day back. Mental health rotation.

Today was the first day back in medicine this year for MD3. My first rotation is mental health, and I was at the Austin today. I'm not sure exactly why that was the case, because I don't think I need to go back to Austin for the rest of this mental health rotating term, but I was required to go today.

It was the first time I drove from my home to the Austin Hospital. I was a bit nervous leading up to it because I never drove completely this way before, although a large portion of the trip was familiar from other travels. Nevertheless, I managed to find out where to go without major hassle. So that was good.

Since I was there, there were a few people I met who were not from my home clinical school, so it was a good experience to catch up with them all. I also enjoyed playing table tennis on the Austin clinical school table tennis table. It nice getting back into playing table tennis after this holiday break again, and I didn't feel too out of touch.

Needless to say, being the first day in the mental health (psychiatry) rotation, there were some psychiatry lectures. This is not one of my favorite topics, but I guess I'll just have to get through it. Other rotations this year seem more exciting, so I guess that's something to look forward to.

Back for another year of medicine study!


By the way, all of you who are intending to study for the GAMSAT, there's less than six weeks left until the exam. Go and prepare for it!

The role of common sense

I do some voluntary tutoring almost every weekend during the school term. It has opened up my eyes to how much the national Australian mathematics curriculum lacks rigor in primary school years, but that is not the topic I will be discussing about today. Recently, as the school year has just started in Victoria, there was a training session for voluntary tutors in the tutoring program I am in.

As part of the training session, we were discussing a few cases of imaginary students who had real or potential difficulties in their learning due to their backgrounds. In my case, the "student" I was required to discuss about on our table was in late primary school, and had trouble at school and in tutoring. Even though they willing to learn, they were easily distracted and seemed to lose concentration.

At discussing the case, I first listed the more specific things related to this student's background - namely that there could be deficiencies in their English ability and mathematical ability present, particularly if they did not come from a country using English and if their country did not have strong mathematics standards in their school. To counter this, the steps would be to explain clearly any mathematical terminology they did not understand, starting from the basics if necessary.

After this, I also listed a few other potential causes. I felt that it may have been a possibility that they did not have breakfast in the morning, or they did not have enough sleep during the night. So I suggested that if this was an ongoing issue, I should ask the student whether they had breakfast in the morning and how much sleep they got. I felt that if there was a simple solution to this problem, then it should rightly be solved.

Finally, I raised the unlikely possibility of a medical condition causing the lack of concentration, and said that if all the rest failed, the student may be advised to go to the doctor. This was a bit ill advised on my part. I now recognize that the action I suggested may have been reasonable for talking to an adult, but it is different because the student in question would not have been an adult. One of the other tutors on the table criticized my recommended intervention, and I accepted the criticism - perhaps I should not tell the student directly and it should go through the course coordinator.

However, after this, he also opined it is not the tutor's role to inquire on issues of breakfast and sleeping patterns - that some topics should be off-limits. While I did agree that some topics should be off-limits, particularly if they have nothing to do with learning, I definitely did not agree that issues of breakfast and sleeping patterns should be off-limits.

Yes. We are at the tutoring program primarily to tutor the students in the subject matter. However, the end result of this is for the students to perform well and gain confidence in their studies. Issues of breakfast and sleeping patterns are not what we need to teach, but if a student is lacking breakfast or good sleeping patterns, then addressing these issues has the potential of having a greater benefit than the supplementary teaching of school content done in the tutoring program. That is why I feel that these questions are relevant for students who cannot concentrate very well.

In some way, I could see where he was coming from. It is definitely "safer" to stick with what the tutor is "supposed" to do. Any deviations from the common practice is liable to be controversial. This is particularly the case in the litigious society of today.

On the other hand, I do think that common sense should prevail. Anything that can help with the outcome we want without too many side effects should be considered, whether or not it follows the usual "process". We should not be biased in what strategies to implement. The leader of China during the crucial "opening up and reform" period, Deng Xiaoping, once said: "do not care if the cat is black or white, what matters is it catches mice". This pragmatism is an excellent attitude to have even today.

EDIT to add: it seems like now the policy is to inform the coordinator. Perhaps this is the best approach. That way, the coordinator can advise the parents directly.

[update] 2013 MD2 mark breakdown released

Today the mark breakdowns for us in MD2 for our PCP2 subject (the main one this year) were released. As I had expected, it was the OSCEs which brought my mark down. However, it is good to see the individual breakdown to analyze where I did well and where I did things badly.

For the MCQ, there was not much of an issue. I scored above average; just one point less than in the final progress test actually (both were out of 80).

For the SAQ, my score as a percentage was not as high, but it was still above average and just one point from the "H1" standard.

Now the OSCEs. Overall, I did worse than average, but this was a mixed picture:

There were two stations where I had actually scored above average. Now this is actually the first time I scored any OSCE stations above the average, so I was happy about this fact. These were the respiratory exam (COPD) and iron deficiency anemia (bowel cancer) stations.

There was one station where I had scored within a point of the average. This was the surgical abdominal exam (acute cholecystitis) station. After the exam I realized that I forgot to assess for rebound tenderness. I would have remembered if it was appendicitis signs but forgot for cholecystitis! Ah well.

Then for the other two stations, I scored below the average. Perhaps that is an understatement though - I scored below the "cut scores" (aka pass marks) for both of these. These were the headache history (SAH) and weight loss (T1DM) stations. Actually this is worse than I had expected to score. However, I do think that I have a tendency of narrowing in a diagnosis and not asking enough things to rule out other diagnoses, or in the weight loss station case, not even thinking of T1DM as a possibility in that station! I also don't know if I am particularly good at getting the "rapport" or "global" types of marks in the OSCEs for history taking. It is something that I need to work on for the future.

Overall, it seems like I have improved slightly on the OSCEs this time around compared to last time, although I have not tested to see if it is statistically significant. Last time my exams were worse than my history stations on average, but this year it seems to have reversed into the other direction. It seems like I will need to work on history taking in general for next year.

Anyway, scoring worse overall this year (by about 3-4 points) was mainly because the OSCEs were worth more this year and SAQ/MCQs were worth less overall. Actually scoring some OSCE stations above average for a change this time was a promising trend, but two history stations below the "cut scores" is a bit concerning. I will have to improve this into the future. Hoping for a turn-around like the Australian cricket team this summer. So far they have been quite spectacular!

[update] 2013 MD2 - results release, year in review and looking ahead

Today the final results were released for MD2. I did not do as well as I would have liked to, but I have passed quite comfortably. We have not received our OSCE marks yet, but it is most likely the OSCEs are where I have lost marks again this year. Ah well. At least it seems like I won't have to sit any supplementaries or repeat this year!

I guess maybe a reason why I would have liked a better result was because I did a lot better in the progress test. For the final progress test, I received a score of 70/80, which is a major improvement from the first one I posted at the start of the year! That said, the progress test is only testing on MCQs, and I think it is in the OSCEs where I have not scored that well.

In terms of knowledge and MCQs, I think that practicing BMJ onExamination questions was very useful in gaining knowledge. There is a free subscription through the medical school. Being interactive, it can facilitate learning more than reading over lecture notes or books. The other thing for exams is because the university repeats many questions, well... fill in the rest of the sentence yourself.

Generally speaking, this has been an interesting year, in the clinical environment and learning about things which are directly related to clinical management which build upon our basic sciences in first year.

There were a few highlights for me this year in medicine personally. There was once a patient who we were examining in a bedside tutorial, and everyone in our tutorial group took turns to listen to his heart. When it was my turn, he jokingly asked me: "are you too young to do medicine? How old are you? 12?" I laughed a bit at this, and said to him "Yeah, I'm probably the youngest in the tutorial group. Just switch around the two digits." The ironic thing is that back in the times of undergraduate entry, my age would be average for the first clinical year. It was only "young" because this was a graduate entry course!

There were quite a few times where doctors and other staff at the hospital asked us medical students what courses we did before medicine or what other life experiences we may have had prior to doing this. Although there was the occasional person who did something quite different, usually the answer from most students would be science or biomedicine/biomedical science. This was exemplified once when a dermatologist was taking one of our lectures. He asked everyone to introduce themselves with their names and what they did before medicine. Almost everyone in the lecture theater systematically said their name and indicated that they previously did biomedicine, biomedical science or science! It was quite humorous and ironic indeed!

Another thing which was the highlight in the hospital was when I was following the ward round of the Director of General Medicine. One of the patients did not feel like eating their food that morning, and the professor noticed the full bowl of food on the table. I was very surprised when I saw her spending the time and effort to spoon up the contents of the bowl and help feed the patient herself! Very remarkable!

Another highlight was that I was part of the winning team for the Inter-Clinical School Quizbowl Championship. In fact, this was a total accident! I was planning to attend the final of the competition so that I could eat some free pizza and learn some medicine from the quiz answers. I wasn't part of the team which was supposed to represent St Vincent's, but one of the team members was having a rural GP placement and unable to attend the final. One of the other team members suggested that I take their place. I was quite nervous when we were sitting there waiting during the first round since we played in the second and third rounds that night, and even more so when taking the position ready to answer the questions. But I managed to get the first question of that second round right, and quickly got settled and got a few random questions right in that round, making a contribution to the team. It's funny what happens sometimes when you least expect it!

Looking ahead to next year, I am not that keen on some of those rotations, although some others might be interesting. I start off with the mental health rotation, then aged care, then GP. Semester 2 will consist of women's and children's health. I am not looking forward to the first two so much, but the later few should be better.

It has been just over three years since I first made this blog. I am already halfway through medicine! Time has gone by very quickly!

The blog post graph still has this annoying glitch which displays some years incorrectly, so I have corrected them in the diagram above. Although my blog views are higher than I would have ever imagined when I started the blog, I have lost readers recently. This would have been unexpected for me at the start of this year since I thought that people would be more interested in clinical medicine over preclinical medicine. However, the requirement to protect the confidentiality of patients precludes us from sharing too many of the interesting events which sometimes occur on the wards. I have erred on the safer side in not posting too much where confidentiality can be impaired, and thus I have not made as many posts this year compared to last year.

Perhaps another factor is because I have made some more posts about politics this year due to the election, and the "Scrap the cap" campaign issues. I have a feeling that many of you are not so interested in politics. But politics is quite important and as the scrap the cap campaign has highlighted, policies have quite a significant impact on our future not only in medicine but also in life in general. As such, I will continue posting on these matters whenever I feel it is necessary. However, given the electoral cycle, it is unlikely that I will post as much on these matters next year.

Regardless of all these factors mentioned, I guess I have to lift my game to make my blog more engaging to everyone in the future to get back to where I was before!

Finally, to everyone who enjoys reading my blog and commenting, thank you very much for your continued reading. I hope you continue to enjoy reading my blog into the future!

Free webinars on GAMSAT preparation from PrepGenie: The Eureka Webinars

This is a message from PrepGenie. PrepGenie, a medical test prep company is conducting a series of free online seminars on GAMSAT preparation: The Eureka Webinars.

This series consists of 4 webinars which will be delivered by GAMSAT toppers:

• Sumudu Perera (95 percentiler)
• Michael Marazita (98 percentiler) and 
• Reuben Lim (99 percentiler).   

Click here to enrol

What to expect from the webinar:

• Exam Strategies, smart tips and silver bullets in your pocket from the toppers.
• Live demonstration of solving difficult GAMSAT questions.
• Special Eureka Q&A session to get your queries resolved.

If you are still wondering if this is for you, check out what we will discuss in the four back to back webinars:

• GAMSAT: The New Perspective
• GAMSAT Humanities and Essays
• GAMSAT: Science Demystified
• GAMSAT Strategies Explained

What's the catch? We designed this as an exclusive workshop for only those who are serious about taking action, so we are limiting the seats. Grab yours now!

Simply CLICK HERE and you will be sent to a registration / checkout page and you will be off to the races.

If you have any questions please feel free to contact support@prepgenie.com.

Microbe Invader game

During swotvac, someone from my year in the MD course posted a link to a game called Microbe Invader. This is a highly addictive game which helps people learn microbiology diagnoses and presentations, and the different tests to distinguish microbiological organisms. It is based on the Pokemon console game. After successfully diagnosing the patient, you throw different antibiotics or antivirals or antifungals at patients, or just wait turns if you expect the infection to clear by itself, and heal the patients with normal saline. Unlike some other applications etc featured, I don't personally know the person who made this game.

As above, right now there seems to be a bug which makes interferon treatment count as first line therapy for viruses where supportive care is first line, but this is a minor point. There are a few errors, and a few things where you don't need to do things like you would for real life (ie no need for multiple drug therapy TB or HIV), but overall the game is nicely done and best of all free! The main drawback is that it is based more on an American context, with various organisms which we will not see commonly in Australia. However, it is a very fun game regardless. Maybe good if you want to do the USMLE and want some entertaining preparation!

So for the link again, it is http://www.microbeinvader.com/

[update] 2013 MD2 OSCE done! Available for GAMSAT/VCE tuition.

Today I did my last exam for the year, the OSCE. We had two examination and three history stations.

I now realize a few things which I forgot to do during the stations. Also, there was a weight loss station, where the correct diagnosis was apparently type 1 diabetes. I did not get that diagnosis right, and many people I talked to didn't either. Some people did, but others had answers ranging from hyperthyroidism to cancer.

Ah well. I hope that I did better than in last year's OSCE. For now, all the exams are done. I should be able to tutor people now. Keep in mind that it will be more convenient for me to tutor in Monash on the holidays than Melbourne. For more information, see the GAMSAT Science 100 + VCE tutor page at the top of the blog.

I will do a longer post about this year after the results come out. In the past I made some annual posts on the anniversary of my blog creation, but it is more logical to make them at the end after results come out and not have repetition.

[update] 2013 MD2 MCQ and SAQ exams finished, OSCE on Friday

On Monday and Wednesday, I completed the MD2 MCQ and SAQ exams for this year. In general, I think they were very fair exams. There were a few harder questions which were there to separate out people.

I generally like MCQs better than SAQs, although I find SAQs a lot better than essay questions/extended response. It is hard sometimes to know what the examiners want you to write for extended response. And SAQ is better, but sometimes it is also hard to know exactly what they want. With MCQs, it is a lot less ambiguous, unless the question is worded badly. An example of this would be: what exactly is the "best" approach?

I got a bit put off by today's SAQ paper with the number of lines given for some responses though. In some of them, I feel like I can answer the question fully in three lines if answering exactly what is asked (eg giving a list). But because there was more space, I was wondering if they wanted more of an explanation, so I gave some anyway. At least in this year's SAQ, unlike last year's MD1 SAQ, we were not required to write completely non-stop from start to finish as a test of our writing speed.

There was one question where they asked eight different causes of seizures though. Eight causes! Not precipitants. I was struggling with this, but then realized that hemochromatosis and Wilson's Disease were probably causes (wasn't 100% sure though) so I wrote them down and it seems like they were right. What was frustrating though was that I wrote MEOS instead of MELAS as a cause of seizures! Argh! So close... I had 60% of the letters there!

I also recall giving quite a few pretty "out there but possible" answers after my standard answers when I couldn't think of anything else to write in the space, just to see if I could score a few extra points. One of them was regarding the possibility of the patient having a hemolytic anemia before the first HbA1c reading for their diabetes, explaining why the HbA1c rose this time compared to 6 months ago. I hope the examiners have a laugh at that.

Finally there is something else which I was somewhat amused by, although it may sound strange. Following on from my table tennis "ACE inhibitor" comments from my med jokes, I have been joking that "if a multiple choice option is ACE inhibitor, and you don't know the answer, choose the ACE inhibitor". Actually, ACE inhibitors are first line for hypertension, heart failure with reduced ejection fraction and chronic kidney disease. They are very useful for reducing cardiovascular events.

Although it was a joke which stemmed from table tennis playing, from personal experience of practice tests, the advice is actually mostly true. As an example, the best treatment for reducing progression of diabetic nephropathy is not actually good blood glucose level control. This sounds very counter-intuitive indeed! But the best treatment is actually using an ACE inhibitor. One of the nephrologists told me: "The three most important things for chronic kidney disease are: 1: good blood pressure control. 2: good blood pressure control. 3: good blood pressure control".

However, even though there have been 1-2 questions when using an ACE inhibitor was the correct answer in MCQs in some practice tests I have done, there was not one question with ACE inhibitor as a possible answer in the MCQs this year! Such an oversight of one of the most important drugs in medicine...

Oh and final point on the MCQs and SAQs, unless I missed something completely, there were absolutely no questions at all regarding EP! I am very grateful that the University of Melbourne has not overemphasized this portion of the course (which may be known in other unis as PPD) to the detriment of the more "traditional" aspects such as basic sciences, history taking, clinical examinations and hard knowledge of conditions, aetiology and presentations; which I hear is the case sadly in some other medical schools in this country. At least so far in the Melbourne medical course, we had none of this rubbish of reflective essays with rigid marking criteria. Well, we did have reflective essays, which were a bit annoying, but at least they were pass/fail and we could properly reflect on experiences. At no stage was I required to bend the truth and give a false reflection in order to pass an illogical marking scheme like what some people from unis in NSW were required to do.

Anyway, OSCEs are on Friday. I did not perform as well as I would have liked in the OSCEs last year, although I feel that I have improved my clinical skills this year significantly. I hope it shows up in the results.

PrepGenie GAMSAT Comprehensive Series 20% off

I was involved in reviewing questions for PrepGenie last year and this year. PrepGenie’s GAMSAT Comprehensive Series consists of 10 full length tests and 20 sectional tests on Humanities, Biology, Chemistry and Physics along with 10 sets of free essay evaluation. PrepGenie also wants to give all readers of my blog a 20% off on this course. The price set for the package is 475 AUD but you get it at 380 AUD, unbelievably low.

To take advantage of this offer, use the discount coupon "BOBBYLI". To purchase multiple courses with discounts, please contact support@prepgenie.com.

The GAMSAT Practice Test Papers can be found here: http://prepgenie.com/gamsat/gamsat-test-papers/

$2000 CPD cap scrapped

Today it was announced that the coalition government was not going ahead with the previous Labor government's plans to implement the $2000 CPD cap. You can read more about it here: http://www.medicalobserver.com.au/news/govt-scraps-the-cap-for-good

While there are a number of policies from the current coalition government which I disagree with, this policy is a win for continuing medical education and continuing education of other professions which have high CPD costs.

It is true that doctors and other professionals should not rort the system with benefits such as tax deductions from continuing education related expenses. However, that is also true for politicians. Claiming allowances to go to people's weddings? Seriously?

2014 entry UniMelb and Monash local medical school places released

Today the University of Melbourne and Monash medical school places for local students were released. Congratulations if you have received an offer!

If I have tutored you for the GAMSAT, I would like to know how you went in this cycle of the admission process. You may post a comment, or if not, send me an email to my email address. If you forgot the email address, you may see it when clicking on "comments".

To prospective students, I will likely resume tutoring after my exams finish (after 22 November).

2014 entry: most GEMSAS offers released. Melbourne still to go.

So today, most of the GEMSAS medicine offers had been released, along with the emails of unsuccessful application (for now). Commiserations if you have received an email of unsuccessful application, although there is a chance of being offered a place still as people decline a place for one in USyd or dentistry etc.

Melbourne and Monash still have to release their offers though. Well, the other universities have been remarkably efficient this time! Monash used to be one of the earliest releasers in the past two years, but not this year.

Anyway, good luck if you're still waiting for an offer, particularly from Melbourne!

2014 GEMSAS medicine offer list completed. Offers out next few days.

Today the 2014 GEMSAS medicine offer list was completed. Offers for all the different GEMSAS universities will be out in the next few days. In particular, the University of Melbourne MDHS facebook page indicates a 1 November 2013 release.

Good luck for everyone waiting for an offer!

2013 Unimelb end of undergraduate classes

Yesterday was the last day for undergraduate classes for undergraduate students for the University of Melbourne. Good luck for all your exams if you have them soon! We still have two more weeks left of MD2 to go, due to longer semesters for medicine. Meanwhile, in MD2 our multiple choice exam is only worth 17.5%, compared to 40% of semester 8/9 back in the MBBS course. They have also added in a SAQ component. Boo! What do they expect to do? To see if we have doctor's handwriting yet?

I guess all the first round of GEMSAS med offers should be coming out within the next few weeks then. Ah sorry... I just reminded you again. In any case, good luck for any offers!

NAE's medical jokes

Since Drug Lion has commented that he wants to hear my med jokes, I'll post my original compilation of variable quality here. I assure you that all of these are my own, but there may be a possibility of others having come up with them before.

As with many jokes, if you abhor anything not 100% politically correct or are easily offended, then read no further.



Many of these jokes are puns, so you have to imagine them being read out.

Q: What do you get when you drink too much Milo?

A: Multiple myelo-ma.

Q: How can you win more points off your opponent's serve?

A: Use an ACE inhibitor.

Q: What do you get if you ping a cardiologist?

A: You get an echo.

Q: What happened when the girlfriend teased her boyfriend with type 2 diabetes about his weight on a cruise ship?

A: He took his ex-en-a-tide.

Q: What happened to the patient with type 2 diabetes who forgot to omit one of his medications on the day of surgery?

A: It was a MET-formin'. (MET)

Q: How much is a contaminated bacterial culture worth?

A: A penny-ceilin'.

Q: Which Pokemon treats Non-Hodgkin lymphoma as well as current therapy?

A: Archeops.

Q: Why did the screenwriter rush to the hospital in the ambulance during his stroke?

A: So he could still alte-plase.

Q: Apart from the heart, what is a cardiologist's favourite organ?

A: The TOE.

Q: Why was the soldier bleeding and bruised all over?

A: He was warfarin'.

Q: Why did the patient take too much paracetamol?

A: They had the NAC for it.

On that note, if any of these issues are affecting you or someone else you know, contact Lifeline on 13 11 14. Medical student and doctors' mental health is a very worthwhile discussion to have. But I will save that discussion for another time.

On a more serious note, it was with some sadness that I have learned by checking the medical records that one of the patients I saw in the hospital has died. This a patient that I put a cannula into too. There are other patients which I see who also have terminal diagnoses in oncology with poor prognosis. It is sad, but these are some of the things we need to learn to cope with in medicine.

What do you call the worm that ate Mozart?

original link: https://www.facebook.com/photo.php?fbid=630221933664634

Credit: Beatrice the Biologist on Facebook (photo seen through I fucking love science on Facebook)

This was so gold that I needed to share it with you. It's a lot better than most of my jokes that my fellow med students have to listen to. Although if you want to hear any of them, leave a comment and let me know.

[update] MD2 GP placements

Yesterday, I undertook my first GP day out of four that I have in the GP placement (weekly) this year. It was a refreshing change being assigned to a GP clinic which was a lot closer to my home than the clinical school was, in contrast to the case for many of the other people I have spoken to. They were also kind in letting me share the lunch that was bought for those in the clinic!

The first session was very interesting, and I was encouraged by the GP I was with to participate and attempt to take the history and examinations first for some patients myself. In that way, I consider myself lucky, comparing against some of the other stories I hear around.

In general, it was interesting to note the contrast between "undifferentiated" patients visiting GP and those visiting the ED; those going to ED were sicker. That said, it also hit home that we didn't have much practice interviewing in some of the more common (compared to hospital) GP presentations like URTIs and neuro/muscular type pain, so I was a bit unsure of what to do at times. I also had the practical experience of seeing a final year medical student pick up on systems review something important which was not the presenting complaint of the patient, which I did not ask about myself, reinforcing the usefulness of the systems review as part of the medical interview. So it was all a useful experience. Looking forward to the placement next week!

Unimelb 2014 entry medicine interviews finished

Yesterday was the last day of the interviews for 2014 medicine entry at the University of Melbourne. I have heard that they have had a shake up on the topics being assessed in the interview!

I hope you have all done well in your interviews. Now it is the long wait until offers.

[update] ED shifts!

As you may know from reading my previous posts, right now I am in the ambulatory/ED rotation. I have completed most of my ED shifts now, with one more to go in just under a week.

ED has been an amazing experience! It has been very fast paced at times. However, it is not overwhelming so, at least at the hospital I am in. There are some quiet times in between.

I enjoyed putting in IV cannulas and doing some suturing for closing wounds. I am getting better at both of these as time goes by.

Putting in cannulas successfully in one go is very satisfying. However, there have been a few frustrating instances, even apart from missing the vein completely.

One time, I put in the needle for the cannula and there was flashback initially, but it stopped abruptly - it looks like I went straight through to the other side of the vein.

Even more frustrating, I once put in the cannula and bung covering it successfully. But then when I wanted to take bloods, I accidentally took out the cannula from the vein! Not only did I need to reinsert another cannula, I also had to change the pillowcase of the patient's pillow.

On the bright side however, on the same day, there was a patient who needed a relatively large cannula inserted quickly for blood tests and fluids due to hematemesis, and I did manage to get that one in on the first go without pulling it out. So I feel like I redeemed myself.

The other thing which can be frustrating is when you successfully puncture the vein but the venous flow is bad when using a vacutainer to collect blood. That has happened to me a few times. I feel as if I should try using a syringe to see if it works better like I see some of the doctors and nurses doing.

I would like to thank all the readers of my blog who have allowed students to practice their skills, including taking bloods, putting in cannulas, and suturing. It is greatly appreciated.

All in all though, ED has been quite a refreshing experience. It is now one of the specialties which I am considering for the future. Now for the rest of the ambulatory/ED term which consists of hematology/oncology/dermatology...

Subscription feed link (Atom) fixed

Today I had the late realization that due to the policies of Google changing at the end of last year, my news feed site did not work and update as it should anymore. Now this is very annoying! I should have kept a closer eye on it, and the thought should have crossed my mind when the update occurred.

Anyway, I have updated the link to it now, so using the new link there should be no problem with subscribing to my blog. The new atom link is here: http://additionelimination.blogspot.com/feeds/posts/default

Sorry for any inconvenience!

GAMSAT SIII 100: Win The Day (Team SIII parody)

For some reason, today I've decided to make a subtitled video regarding GAMSAT SIII.

GAMSAT SIII 100: Win The Day (Team SIII parody)

I will most likely resume GAMSAT tutoring after my exams in November. For more info, visit http://additionelimination.blogspot.com.au/p/blog-page_8.html

Ace Physics free iOS app‏

One of my friends in the Melbourne MD program has made a new iOS app called Ace Physics (Android app not yet available). I have tried a few of the questions and had a look at this app myself. This is a question bank app with questions of varying difficulty and random number generation, together with very detailed, comprehensive worked solutions for each question. It is an excellent way to consolidate physics knowledge on the go.

This app has trial questions which are free to try, with extra topics able to be downloaded with additional charge of 0.99 c (notation parody intended) if you are satisfied with the trial questions and solutions.

Download the free trial version at http://www.acephysics.com/ and send any feedback to the form on that site at http://www.acephysics.com/contact.php.

There may be instances when the numbers do not make sense. If this happens, then an app reset or phone/tablet restart is required.

New Prime Minister Tony Abbott. Kevin Rudd resigns as Labor leader.

Today, Tony Abbott was elected as the new Prime Minister of Australia. As a result of this, the former Prime Minister, Kevin Rudd, has resigned as the leader of the federal Labor Party to allow for renewal within the Labor Party.

Whilst I disagree with several of the Liberal Party's key policies, most notably their position of "direct action" being more cost-effective than a price on carbon in reducing emissions (which is at odds with most current economic thinking), I note on the medical front that the Liberal Party have maintained a commitment in funding medical research, particularly for Alzheimer's Disease. Alzheimer's Disease has been quite a "black hole" in terms of finding effective disease modifying treatments of late, although a few agents are currently in the clinical trial stage. Let's hope we can get something better than Souvenaid out of this research, which we were talking about for EBM.

I realize that some or even many of you may not want to say anything at all positive with regard to Prime Minister Abbott. However, while I disagree with several of his main policies, there are a few which are commendable. Furthermore, we will be spending at least three years under his government; which will be a long time; unless of course he miscalculates on a double dissolution election repealing the carbon tax. If you really feel strongly about it, then maybe you could join the ALP. I don't know if there is any waiting period, but given the new rules, you may even get a say in who the new leader is. Otherwise, it may be prudent to wait a while for the dust to settle and see if they have ended their bitter infighting and see what their new team and policies are first.

[update] St Vincent's ED simulation

Yesterday and today, I was in a group doing simulations for various situations in ED, with a mannequin which had a pulse, pupilliary responses and various other responses; with a monitor and facilitator giving speech as a patient. We were asked to pretend we were doctors and initiate the management of the patient in front of us. We were also video recorded and they played back some portions of our performance to show us, although it is not part of our assessment.

It was very fun! Unfortunately, due to confidentiality agreements, I am not able to say what the situations were. This was not a university wide thing for medical school though. It was just at St Vincent's. So the ED simulations are another reason to come to St Vincent's, apart from the rigorous teaching. And of course the table tennis.

[update] end of Surgery block

Last Friday was the end of my Surgery block in the MD degree. In some aspects, surgery is very interesting and technical. I have not ruled it out as a career, but so far I think some other specialties are more likely. I have some interest in anaesthetics, and I was exposed a bit to it during this surgery term.

As per the other terms beforehand, I needed to write another hurdle EP (ethical/empathic practice) reflective piece essay. These essays are widely detested throughout the medical school student cohort. As with the conference essays, I imagine that there would be a lot of superfluous word usage in many essays to make up word counts.

There will also be another formative test next week to see how we are going. It will be interesting to see how I go. This term I have been using the BMJ onExamination app a lot to revise and reading the pathology and clinical examination texts, but I haven't been keeping up with the lecture revision very well.

2014 entry: GEMSAS medicine interview offers and UQ offers released

The GEMSAS medicine interview offers and UQ medicine offers were mostly released yesterday and today, with the GEMSAS unsuccessful application notice also coming out two days ago. To all my students and readers of this blog, congratulations if you have received an interview or offer at UQ. Good luck for your interviews!

Also, commiserations to all of you who may not have received an interview or offer at UQ.

[update] Finished review of MD1 conference reflective pieces

As part of the student conference assessment in the MD course at UniMelb, in second year, apart from writing our own reflective piece, we were required to also review and provide feedback on the reflective pieces of two students from MD1 (pass/fail). I managed to get both of the reviews done this morning, so that is the end of my assessment for the conference for this year.

For next year's student conference there will be four cohorts doing the MD program, so we should be able to see the MD4s present their research results during the conference. That might be interesting to see.

Context is everything - in the economy and in medicine

During the past week, there was the usual bickering of politicians about interest rates policies, with the RBA dropping the overnight cash rate target from 2.75% to 2.5%. As expected, Labor seized the opportunity to announce that the interest rates are lower, which makes it better for working families with home loans; directly contradicting the former coalition government's advertising campaign that interest rates "will always be lower under the coalition". To counter this, the coalition opposition mentions that "context is everything", and the only reason why the interest rates are low is because the "economy is struggling", which is a bad thing.

Now, both these arguments have some element of truth behind them. That said, if the government was to support the economy further, perhaps the only way to do this would be to increase the budget deficit even further, which is not desirable. Now, even for budget debt and deficit is context very important. The coalition talk of debt and deficit as if it is the "be all and end all". However, while it is very true that debt should not be ever increasing, and there should not be continual deficits, it is also true that temporary deficits are justified to support the economy in bad times; to be made up with surpluses when the economy is strong. As such, the government was quite justified in spending in the stimulus package at the peak of the financial crisis in order to support jobs and growth, even though this resulted in a larger deficit for the budget.


One thing I have realized though is that "context is everything" also applies to medicine. I recall an interaction with my CSC (clinical skills coach) tutor, who was quizzing the group about the effects and side effects of certain medications. The interaction was as follows:

CSC: What does aspirin do?

(At this stage, my pharmacology major instincts kicked in)

Me: Aspirin is a non-selective, irreversible cyclooxygenase inhibitor. It inhibits both COX-1 and COX-2, by irreversible acetylation of the active site. This reduces the amount of prostaglandin production. In this case, for this patient, the wanted effect is a decrease in TXA2 to decrease platelet activation, and we want an irreversible inhibitor because platelets don't synthesize new COX and other tissues can...

CSC: What you said was all true, but if you can summarize this in three words, what would you say?

Me: Stops blood clotting?

CSC: Close. "Thins the blood"

Now I was actually quite surprised that we were allowed to use this terminology, because aspirin doesn't actually decrease the viscosity of blood; it just stops the platelets from aggregating. But it seems like it was OK in this circumstance.


Another interaction was with a cardiologist in cardiology outpatients.

Cardiologist: How would you tell the difference between someone with fluid retention due to kidney failure and heart failure?

Me: Heart failure might have displaced apex beat, additional heart sounds, valvular regurgitation, murmur...

(seems like he was after investigations, rather than examination findings)

Me: BNP level...

Cardiologist: The BNP level might give you some idea. But what else?

Me: Echo

Cardiologist: Yes. An echo!


In contrast, there was a question of some similarity but also considerable differences asked in a tutorial I had later in ICU.

Intensivist: How would you assess if his heart and circulation is working well?

(I had the cardiologist experience in my mind)

Me: An echo

Intensivist: Get out. You won't have an echo everywhere you go.


Now it seems like the answer to the same question depends on the context in which it is asked. In pharmacology class, the molecular mechanism is important, but in the clinic, the CSC tutor is after the end broader effect. And in cardiology, the echo is very useful in determining heart failure, but not practical for immediate measurement of cardiac function. So as it is the case in many other things, context is everything in medicine too.

2013 Student Appeal: Students with a cause

In 2011 and 2012, I was part of the University of Melbourne Student Appeal, part of the team raising money for students who were finding it hard to meet with living expenses. This year I will be unable to continue doing so since my clinical school is not right next to the university and we don't have very long breaks usually. However, the Student Appeal is a very good cause, so I recommend supporting it if you have some spare time or money.

If you want to become a volunteer or donate, see the official website or their Facebook page. Donations of $5 or more are matched by the university.

$2000 CPD cap deferred for 12 months

The government has decided to defer the $2000 CPD cap for at least 12 months pending further discussion as to the best way to continue to support education without allowing the perceived abuse of the system from using the money for holidays etc too. This is a good move from the Labor government, which is discussed on the Australian Doctor and Medical Observer sites. Now we should hope for a more common sense approach to this matter. Ideally we should see the new policy before the election because as it stands it is not out of the equation for Labor to return to this $2000 cap. But without too much rushing, so that it can be a good policy.

USyd 2014 entry local applicant interview offers out.

It seems like today the USyd 2014 entry local interview offers are out. It seems like the cutoff was 68 this year. If you have an interview, good luck with it.

Coalition backs "Scrap the Cap"

Today, the coalition opposition indicated support for the "Scrap the cap" campaign. They have yet to announce their full policy decision, but it seems unlikely that they would do nothing in their policies after they have put their words of support for this campaign. Now it would be good if Labor did the same and reversed their policy of the cap.

For more commentary, see the articles from Medical Observer, #Scrapthecap, or Australian Doctor.

[update] Surgery rotation, theater time

As you may know from reading my blog, this term is my surgery rotation. While the basic skills of history taking, examination and investigations have much in common with the medicine term, surgery not surprisingly does have a different flavor to it.

I have recently been in theater to witness some of a surgery. It is quite an interesting experience to go into the operating theater and see the whole team of surgeons, anaesthetists and nurses working together to ensure the successful operation. This was a very long operation - double mastectomy and full reconstruction. This was going to go for 10 hours, and I only saw the first two hours before I had a tutorial to attend.

What is your favorite clinical sign?

What is your favorite clinical sign? I got asked this question by someone last week at my clinical school.

It was something I had not thought about very much in fact. However, the first thing I shall say is that as medical students and doctors, we should be wary of referring to patients as their clinical sign instead of as a person with their clinical sign when there is a possibility of them hearing. It is understandable that doctors and medical students want to take shortcuts with their language amongst themselves to convey information quickly, but some patients take offense to referring to them as "the murmur in 1.1" for instance rather than "the person with a murmur in 1.1" or "Mr A with a murmur in 1.1".

The other thing to take note of is that pathological signs while "cool" to medical students and doctors may not be "cool" to those patients experiencing the pathological processes associated with them.

Now that all that is said, what is my favorite clinical sign? There are quite a few which I have found interesting, and a few others which I have heard of but have not seen myself.

Of those which I have personally seen, the first one is aortic stenosis. I have mentioned this one before in my blog, since this I have examined a few patients with this. The change in the loudness of the murmur with full expiration and sitting upright is quite remarkable!

Another one is the prominent v waves on the JVP of tricuspid regurgitation. It is quite fascinating to see the jugular vein pulsating up and down very prominently on the right side of the neck.

Another one is clubbing. Clubbing has many causes; some respiratory, some cardiovascular and some other causes. Very marked clubbing can be quite a sight to see when compared to normal fingers.

The other one is an upgoing plantar response. Usually the plantar reflex is down in adults, but it goes up in upper motor neuron pathology such as MS or with strokes. It was quite spectacular to see the first time around.

The last one I have personally seen which I will mention (which I find interesting but not as much as the other ones) is the "shifting dullness" of ascites.


Of those which I have not personally seen, Pemberton's sign sounds quite spectacular to see. I have heard that a medical student was particularly amazed when eliciting this for the first time during an exam that they had to be prompted by the assessor to continue the examination.

The last one I will put on my list is the flashlight test for hydrocele.

So that's my take. What's your favorite clinical sign?

[update] 2013 Melbourne MD student conference

The MD student conference finished yesterday. This conference is something which is quite unique to the Melbourne medical school, and contains topics which aren't in the curriculum generally. For instance, it has among other things some social science topic symposiums and other things with some relevance to medicine but not clinical or basic sciences per se.

For the conference we had to also write an assignment of 1500 words and as MD2 people we have to review two MD1 assignments (both pass/fail). I decided to get my assignment over and done with yesterday and today.

Next week we will resume class in the hospital again. My next term is the Surgery term.