Saturday, December 29, 2012

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...)

Saturday, December 22, 2012

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

Wednesday, December 12, 2012

Monday, December 10, 2012


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.


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.

Monday, December 3, 2012

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.