Logic Games

I love logic games as much as the next person.  You know the kinds I'm talking about:  "You're planning a dinner party, and Bob wants to sit next to Mary and Mary can't sit next to anyone over 6 feet tall, and Joe is a gorilla.  So what color shirt is Cassandra wearing?"

That is what it felt like to memorize the catch-up immunization schedule (aka, a 15-month old comes into your office and mom says he hasn't been to a doctor since he was 6 months old - what immunizations are you going to give him today, and when should his next appointment be?).


Well if you are over 6 months old, then you can't get the rotavirus vaccine at all (you snooze, you lose).  But you have to be at least 6 weeks old to start getting any doses of Rota, DTaP, Hib, PCV, IPV, or MCV.  And you have to be at least 1 whole year before getting MMR, varicella, and hep A.  But that's just the first dose!

Let's take Hib (Haemophilus influenza type B) as an example [the vaccine which has, by the way, drastically reduced the number of cases of meningitis, life-threatening epiglottitis (seriously, you don't even see that anymore), septic arthritis, osteomyelitis, and occult bacteremia in kids].  Ok, put your logic cap on, because this is where it gets tricky:

this is my logic cap. find your own.

If Billy received his first dose of Hib at younger than 12 months, then you have to wait at least 4 weeks before giving him the second dose.  If the first dose was received between 12 and 14 months, then you have to wait at least 8 weeks to give the second dose!  But if the first dose was given at older than 15 months, then he doesn't even need a second dose.

But don't worry, you're not even done with Hib yet.  For the third dose, it's similar.  A 4 week waiting period if current age (NOT previous dose) is less than 12 months, an 8 week waiting period if current age is greater than 12 months AND first dose was administered before 12 month and second dose before 15 months.  And again, no third dose needed if second dose was given at older than 15 months.

And lastly, a fourth dose is only needed if all three previous doses were given before the age of 12 months.



That's just one of the vaccines (ok fine you got me, it's definitely one of the more complicated ones - some of them are only two doses with no caveats).  And since we didn't know what aged child we would encounter on the exam, you had to* memorize the catch-up schedule for all possible ages.


I was half-expecting to see the question on the exam to say "So how many kids did Billy ride the school bus with on Wednesday?"


*were supposed to

The Two Kinds of Indecision

As you may or may not have noticed, I have not updated in over a month.  We are right in the middle of picking our fourth year schedule, deciding on fourth year electives and away rotations, and registering for Step 2 of the board exams - aka figuring out the rest of our lives.  NBD.

So obviously having so many things to do and keep track of as well as studying for the pediatrics shelf and OSCE this past Friday have turned me into a mess of indecisiveness with the inability to do anything at all.  Which is exactly the opposite of the reaction one should have with such a full to-do list.


...And I'm one of the lucky ones!  I've decided on what I want to do with my life (for now, anyway).  The people who still don't know what specialty they want to go into have it much harder around this time because they have to figure out all this stuff and also decide what they're going to be when they grow up.  We've now rotated through four out of the six main specialties, and I like to group the people who are still undecided into two groups:

Positive Polly (or Positive Pablo, let's not be sexist) and Negative Nancy (...or Negative Norbert).  Positive Polly looooooves every specialty so freaking much and can't posssssibly be expected to make a decision between them.  On the other side, Negative Nancy has not found anything yet that she could actually imagine doing for her whoooole entire life.


So those of you who are undecided, where do you fit in?  Or is there a middle ground somewhere? (Just kidding, there's no gray area - you HAVE TO CHOOSE ONE.)

Memory Problems

I'm a big fan of the educated guess.  In lots of practice questions, I often have no choice but to try and make one.  But sometimes having just enough information to reason through an answer (but not enough information to actually know the answer), can hurt you more than help you in trying to answer a question.


For example, I had a question about a kid who is brought to the ER because he fainted for no reason; he also had a history of hearing problems, and had a family history of sudden cardiac death.  "Ok, brain," I thought to myself.  "This sounds vaguely familiar as that prolonged QT syndrome, right?"  "Right," my brain answered genially because we often agree on things like that. 

But the question was actually asking what to treat him with - propranolol (a beta blocker), verapamil (a calcium-channel blocker), quinidine (errrr, ummm...), ethosuximide (anti-seizure maybe?), or phenobarbital (definitely anti-seizure).

So I immediately crossed off the alleged anti-seizure meds, and then I was left with the cardiac ones.  I knew propranolol (and verapamil?) lower blood pressure, and the only thing I could remember about quinidine is that it had sooomething somewhere to do with the QT interval.  Since the prolonged QT syndrome has nothing to do with your blood pressure, I went with my gut and picked quinidine.


. . . . Nope.


Turns out quinidine proloooooongs the QT interval, so it is most certainly contraindicated in a patient with an already-prolonged QT interval.  I was right that it had something to do with the QT interval!  Huzzah!  I do know something!  Happy face!  But that led me to the very wrong answer (quite possibly the wrongiest answer of all of them - but at least I didn't think he was having a seizure, right?)  Sad face?  Happy and sad face? 





(For the record, the answer was propranolol, and the syndrome is called Jervell-Lange-Nielson syndrome, duh.  I'll definitely remember that for next time...)

The Most Useful Things I Learned in the Peds ER

1. How to (usually) successfully look in a child's ears

2. What a wheeze sounds like

3. Where the apple juice and graham crackers are kept

Pediatrics - Nursery Week

HOW ARE BABIES SO LITTLE?!??!

Science!

I was in the medical ICU for my elective, and I really learned a lot there.  One neat fact I learned was a scientifically-sound, sure-fire way to tell someone's prognosis...

cartoon bronch

We had a patient who was showing symptoms of a very, very rare lung disease.  The prognosis for this disease is actually much better than any of the other diseases in the differential, meaning we were all hoping this rare disease was what the patient had not only so we could say we've seen it, but because the alternatives if it's NOT what he had were really not so great for the patient.

While the pulmonary fellow was convinced this rare disease was what the patient had, the attending did not really agree.  He gave two reasons for his reservations: one, what we saw in the bronchoscope was not actually suggestive of this rare disease, and two, the patient was a nice guy.


....What?

nice guys finish last

The attending called this "the nice guy prognosis," meaning that the nicer you are, the worse your prognosis is.  He said this with complete seriousness and confidence, as if he had just told us that beta-blockers lowered blood pressure or smoking can make asthma worse.

Sooo, lesson learned.  I'm going to start being meaner.  For my health.

Just Skim It

When I studied for a semester in Spain during undergrad, I took a class on Don Quixote.  The professor "understood" how hard it was for us non-native speakers to read it, so she tried to "make it easier" by telling us which were the important chapters and which chapters we could just skim.

Now, I don't know how many of you have attempted to read any book in a foreign language, much less Don Quixote in it's original Spanish.  It's pretty much exactly like reading Shakespeare... but not in English.  Now, I can't skim Shakespeare and still have a clue what's going on, and I also can't skim even young adult books in Spanish and have a clue what's going on.  I pretty much have to pore over every word to have even a faint idea about what's happening.  So I certainly couldn't just skim 50-100 pages of olde Spanish a night and be able to talk about it intelligently in class the next day. 



This relates to med school, I promise.  Stick with me...

me, reading

I'm working on a research paper that involves reading a billion other papers (more or less) on a rare disease and pulling out specific quotes from those papers.  My boss told me to just skim the papers for the quotes we need.  But since I don't know much about this disease, I feel like I need to read the papers in their entirety so I can actually understand what's going on.  Which is making it go much slower than it probably should. 

In the Don Quixote class, I survived by (DON'T TELL ANYONE EVER) occasionally reading the non-important chapters in English (or much much worse, I even read the spark notes for some chapters --- don't look at me, I'm so ashamed).  I'm still working on a solution for making the research paper go faster, but for now all I'm doing is hoping that the more papers I read, the more I'll understand about the disease, and the faster it will go.