A 22-year-old woman from the Netherlands suffering from chronic bone disorder had increased thickness of the skull from 1.5cm to 5cm, causing reduced eyesight and severe headaches.
about 7 years ago
A presentation on the visual system, explains the basic concepts of Anatomy, Physiology, Embryology, Pathology and a little information on examination. It's a great presentation for teaching purposes.
almost 9 years ago
An edited version of my Friday Evening Discouse given to the Royal Institution on 11 April 2008. Abstract: The vagus nerves (cranial nerve X) connects our brainstem to the body, facilitating monitoring and control of many automatic functions; the vagus electrically links our gut, lungs and heart to the base of the brain in an evolutionarily-ancient circuit, similar between mammals and also seen in birds, reptiles, and amphibians. The vagus comprises a major part of the parasympathetic autonomic nervous system, contributing to the motor control of important physiological functions such as heart rate and gut motility. The vagus is also sensory, relaying protective visceral information leading to reflexes like cough and indication of lung volume. The vagus has been described as a neural component of the immune reflex. By monitoring changes in the level of control exerted by the vagus, apparent as beat by beat changes of heart rate, it is possible to indirectly view the effect of pharmaceuticals and disease on brainstem function and neural processes underlying consciousness. The paired vagus nerves of humans have different functions, and stimulation of the left vagus has been shown to be a therapeutic treatment for epilepsy, and may modulate the perception of pain.
over 12 years ago
An easy way to draw the basic components of the brachial plexus. On paper, it's pretty easy to draw the brachial plexus using this method in around 10 seconds. I know I fumbled on a few words here and there but that shouldn't distract from how easy it can be to draw the brachial plexus.
about 7 years ago
I started medical school in 2007 wanting to 'making people better'. I stopped medical school in 2010 facing the reality of not being able to get better myself, being ill and later to be diagnosed with several long term health conditions. This post is about my transition from being a medical student, to the other side - being a patient. There are many things I wish I knew about long-term health conditions and patients when I was a medical student. I hope that through this post, current medical students can become aware of some of theses things and put them into practice as doctors themselves. I went to medical school because I wanted to help people and make them better. I admired doctors up on their pedestals for their knowledge and skills and expertise to 'fix things'. The hardest thing for me was accepting that doctors can't always make people better - they couldn't make me better. Holding doctors so highly meant it was very difficult for me to accept their limitations when it came to incurable long-term conditions and then to accept that as a patient I had capacity myself to help my conditions and situation. Having studied medicine at a very academic university, I had a very strict perception of knowledge. Knowledge was hard and fast medical facts that were taught in a formal setting. I worked all day and night learning the anatomical names for all the muscles in the eye, the cranial nerves and citric acid cycle, not to mention the pharmacology in second year. Being immersed in that academic scientific environment, I correlated expertise with PhDs and papers. It was a real challenge to realise that knowledge doesn't always have to be acquired through a formal educational but that it can be acquired through experience. Importantly, knowledge acquired through experience is equally valid! This means the knowledge my clinicians have developed through studying and working is as valid as my knowledge of my conditions, symptoms and triggers, developed through experiencing it day in day out. I used to feel cross about 'expert patients' - I have spent all these hours in a library learning the biochemistry and pharmacology and 'Joe Bloggs' walks in and knows it all! That wasn't the right attitude, and wasn't fair on patients. As an expert patient myself now, I have come to understood that we are experts through different means, and in different fields. My clinicians remain experts in the biological aspects on disease, but that's not the full picture. I am an expert in the psychological and social impact of my conditions. All aspects need to be taken into account if I am going to have holistic integrated care - the biopsychosocial model in practice - and that's where shared-decision making comes in. The other concept which is has been shattered since making the transition from medical student to patient is that of routine. In my first rotation, orthopaedics and rheumatology, I lost track within the first week of how many outpatient appointments I sat in on. I didn't really think anything of them - they are just another 15 minute slot of time filled with learning in a very busy day. As a patient, my perspective couldn't be more different. I have one appointment with my consultant a year, and spend weeks planning and preparing, then a month recovering emotionally. Earlier this year I wrote a whole post just about this - The Anatomy of an Appointment. Appointments are routine for you - they are not for us! The concept of routine applies to symptoms too. After my first relapse, I had an emergency appointment with my consultant, and presented with very blurred vision and almost total loss of movement in my hands. That very fact I had requested an urgent appointment suggest how worried I was. My consultants response in the appointment was "there is nothing alarming about your symptoms". I fully appreciate that my symptoms may not have meant I was going to drop dead there and then, and that in comparison to his patients in ICU, I was not as serious. But loosing vision and all use of ones hands at the age of 23 (or any age for that matter) is alarming in my books! I guess he was trying to reassure me, but it didn't come across like that! I have a Chiari malformation (in addition to Postural Orthostatic Tachycardia Syndrome and Elhers-Danlos Syndrome) and have been referred to a neurosurgeon to discuss the possibility of neurosurgery. It is stating the obvious to say that for a neurosurgeon, brain surgery is routine - it's their job! For me, the prospect of even being referred to a neurosurgeon was terrifying, before I even got to the stage of discussing the operation. It is not a routine experience at all! At the moment, surgery is not needed (phew!) but the initial experience of this contact with neurosurgeons illustrates the concept of routines and how much our perspectives differ. As someone with three quite rare and complex conditions, I am invariable met in A&E with comments like "you are so interesting!". I remember sitting in the hospital cafeteria at lunch as a student and literally feasting on the 'fascinating' cases we had seen on upstairs on the wards that morning. "oh you must go and see that really interesting patient with X, Y and Z!" I am so thankful that you all find medicine so interesting - you need that passion and fascination to help you with the ongoing learning and drive to be a doctor. I found it fascinating too! But I no longer find neurology that interesting - it is too close to home. Nothing is "interesting" if you live with it day in day out. No matter what funky things my autonomic nervous may be doing, there is nothing interesting or fascinating about temporary paralysis, headaches and the day to day grind of my symptoms. This post was inspired by NHS Change Day (13th March 2013) - as a patient, I wanted to share these few things with medical students, what I wish I knew when I was where you are now, to help the next generation of doctors become the very best doctors they can. I wish you all the very best for the rest of your studies, and thank you very much for reading! Anya de Iongh www.thepatientpatient2011.blogspot.co.uk @anyadei
Anya de Iongh
about 8 years ago
Hi guys, my name is Angela! I am currently an F2 doing a year in Australia! My key interest is neurosurgery and as a neurosurgery SHO now in Adelaide, I thought I'd start a blog on a few neurosurgery/neurology issues I encounter regularly on the wards. This is aimed to help all medical students studying neurology/F1/SHO in neurosurgery. Few topics could include: Basic management of neurosurgery/neurology patients - the neurology exam Ophthalmology exam and lesion representation Understanding GCS Raised intracranial pressure Acute head injury Seizure management Cauda equina Headaches Decreased conscious level Cord compression Electrolytes imbalance in the neurosurgical patient Fluid management in the neurosurgical patient Acute meningitis Any thoughts/comments?
Angela Li Ching Ng
over 7 years ago
I recently read a question on meducation posted around a year ago, the jist of which was “as a medical student, is it too early to start developing commitment to a specialty?” I.e. “even though I haven’t graduated yet, should I start building a portfolio of experience and evidence to show that specialty X is what I really want to do?” MMC revolutionised (for better or worse) the medical career structure forcing new graduates to decide on a career path much earlier. Many have appreciated the clear delineation of their career pathway. Others have found the 15 month period between leaving university and applying for specialty training too short to make an informed decision (just ask the 10% of FY2s that took a career break last year (i)). Whether right or wrong, there is now less time to rotate round ‘SHO’ jobs, decide on a career and build a CV capable of winning over an interview panel. You’ll probably find you’re in one of 2 camps at university: Those who are absolutely 110% certain there is nothing they want to do, ever, other than specialty X, or Those who really like specialty X, but also like specialties W, Y and Z and haven't made up their minds (A few people find themselves feeling they don’t want to be part of any medical career, but that’s for another post.) Students identifying with the first statement are usually concerned they will not get enough general experience, or that they will be stuck with their decision if they change their minds later on. Those who are leaning more towards statement 2 may not build as strong a body of evidence for any one specialty; however it’s possible to get involved in activities either relevant to a few career options, or several specialty-specific activities and subsequently edit the CV for a specific interview. The key message is that whether you think you have your career mapped out or not, medical school is the perfect time to start collecting evidence that you’re interested in a career in a particular specialty: time for extra-curricular activities only becomes scarcer when you have a full time job complete with working long days, nights and weekends. Your experiences at medical school can then be supplemented with taster weeks, teaching and judicious use of your study budget for training days and conferences; bear in mind that all specialties allow at least 3 years* following FY2 before starting specialty training which can be used for gaining further experience (but be prepared to justify and defend your actions). It’s also important to consider the manner in which individual specialties require such a commitment to be demonstrated: In general terms, the more niche and/or competitive the specialty, the more they will want you to demonstrate that you a) really know what the job entails and b) have made a concerted effort to further your knowledge of the subject. To get a job in neurosurgery for example, which is not only niche but had a completion ratio of 4.9 in 2013(ii) you’ll need to have gone to courses relevant to neurosurgery and have achievements related to the specialty such as a neurosurgical elective, attachment or taster experience(iii). Some specialties assess commitment in a variety of situations e.g. the radiology interview this year had stations on the general overview and future of radiology as a career, a CV based demonstration of commitment to specialty as well as a station requiring the interpretation of images. General Practice on the other hand which in its very nature is very broad, at no point allocates marks specifically for commitment to specialty (or anything else on a CV for that matter) as it is entirely dependent on an exam (SJTs and clinical questions) and skill-based stations at a selection centre. The person specification* details what is expected and desirable as demonstration of commitment in each specialty. So, how do you actually show you’re committed to a specialty? It may be pretty obvious but try to get a consistent and well-rounded CV. Consider: • Joining a student committee or group for your specialty. If there isn't one at your university, find some like-minded people and start one • Asking the firms you work for if you can help with an audit/research even if data collection doesn’t sound very interesting • Finding a research project (e.g. as part of a related intercalated or higher degree) • Prizes and examinations relevant to the specialty • Developing a relevant teaching programme • Selecting your selected study modules/components, elective and dissertation with your chosen specialty in mind • Going to teaching or study days aimed at students at the relevant Royal College Remember it’s not just what you’ve done but also what you’ve learnt from it; get into a habit of reflecting on what each activity has helped you achieve or understand. This is where most people who appear to have the perfect CV come unstuck: There will always be someone who has more presentations and publications etc. etc. but don’t be put off that it means they are a dead cert for the job. Whatever you do, make sure you have EVIDENCE that you’ve done it. Become a bit obsessive. Trust me, you forget a lot and nothing counts if you can’t prove it. Assessing commitment to specialty aims to highlight who really understands and wants a career in that specialty. From my own recent experience however, just identifying experiences explicitly related to a specific specialty ignores the transferable and clinically/professionally/personally important skills one has that would make them a successful trainee. I’d be very interested in your views on ‘commitment to specialty’: for example do you think the fact someone has 20 papers in a given specialty means they are necessarily the best for the job? Or are you planning to take a year out post-FY2 to build on your CV to gain more experience? Let us know! References *See person specifications for specialty-specific details at http://specialtytraining.hee.nhs.uk/specialty-recruitment/person-specifications-2013/ i. http://www.foundationprogramme.nhs.uk/download.asp?file=F2_career_destination_report_November_2013.pdf ii. http://specialtytraining.hee.nhs.uk/wp-content/uploads/sites/475/2013/03/Specialty-Training-2013.pdf iii. http://specialtytraining.hee.nhs.uk/wp-content/uploads/sites/475/2013/03/2014-PS-NEUROSURGERY-ST1-1.02.pdf
Dr Lydia Spurr
over 7 years ago
"Stroke Series" video 1 of 7: Hypertensive haemorrhage and lobar haemorrhage are two distinct forms of haemorrhagic stroke. This video discusses the imaging characteristics of hypertensive haemorrhage, the underlying pathology (Charcot-Bouchard aneurysms) and the relevant differential diagnosis.
about 8 years ago
"Stroke Series" video 2 of 7: Lobar haemorrhage and hypertensive haemorrhage are two distinct forms of haemorrhagic stroke. This video discusses the imaging characteristics of primary lobar haemorrhage, the underlying pathology (cerebral amyloid angiopathy) and the relevant differential diagnosis.
about 8 years ago