Had my Pneumovax jab this afternoon. It wasn't really bad although it was a mega huge needle poked into my right arm. I wonder how am I gonna deal with it tomorrow in clinic. I will have my mock clinical exams tomorrow afternoon. Hope it's gonna be very helpful and productive.
Right now, I am currently polishing up my essays (overly anxious with the standards). However, as of now, I just wanna get away with it. With tomorrow, I must make sure that I have all the algorithm in place so I can visualise the sequence of history taking. Hope the mnemonics developed for us will come handy.
Basically the exam is set up in a real clinical setting with real patients (although they were told what and what not to do). As much as I'm scared with the pharmacology bits of this clinical exam, I am not that worried as the BNF's are available in each cubicle. What I'm worried about is to put the puzzle pieces into a clear picture - gathering differential diagnosis followed by a hopefully a definitive one. By which later correct intervention can follow.
Let see what mnemonics have I got so far??
Well, I need to make sure I address the right question, the right way and easy for the patient to understand. Eg. duration of pain may be a very deceiving. It could be duration of an episode of pain, or duration of the pain that the patient has been experiencing. Tricky? Well Sani, you better come prepared!!!!
Right, mnemonics?
With medical history, it's not easy to ask a patient by just asking "Do you have medical history?". To a layman, answers could simply be anything about history history (such as those war kinda thing), or involved in the making of medical history perhaps? But rather, I should be asking what's known as the system based question. This is according to the body systems, hence CRAGCELD. For instance, I would be asking "Mr X, have you ever had any problems with your heart before? Anyone in your family having heart problems that you know of?" Those kinds of questions. At least that will lead me to a narrower spectrum of answers, rather than beating around the bush of no where.
C- Cardiovascular (I am sure many patients will come with this condition, so hopefully I will obtain an exact answer, not just heart condition)
R- Respiratory - probably I am going to use "difficulty in breathing and asthma" for my question
A- Alimentary - stomach. Should I ask... "do you eat alot?" hahaha maybe not. Perhaps, any irritation would be right innit?
G- The genito-urinary. Urine infection? Difficulty to pass urine?
C- Central Nervous system - brains. ARE YOU MAD?? hahah. Well maybe like migraine, and things like that should be a good trailing question.
E- Endocrine - not too hard. Diabetes? Plus, the signs are normally spot-able
L- Locomotor - gait problems, MSK problems
D- Dermatology - eczema, rashes
Awful lot to ask in a nick of time!!!
Medication history - this is a nightmare. Imagine fiddling and flipping through the BNF with trembling cold hands, and with eyes over your shoulder!!! OOH LA LA!
All I am saying, I am back to the anxious mode!!!!!!!!
Oh, I didn't know that many of the past students actually took Beta Blockers (used in the treatment of high blood pressure to slow down the heart rate) before exams!! Hahhaha
Oh well, let's just get the battalion of knowledge be prepared in my cranium, so they can stick in the frontal an temporal lobes. Hehhe
Oh, an another set of mnemonics, it's the management one. COPPPPERSS
C- Chiropody : basically simple routine care.
O- Orthotics : whether the patient needs pair of orthotics to help with the problem.
P- Pharmacology : any medication that I should think of to prescribe eg. Pain relief, antibiotics?
P- Physical therapy : maybe the need of ultrasound, laser therapy.
P- Patient education, such as giving advice.
P- Paddings and strappings including dressings.
E- Exercises such as stretching of compartments.
R- Referral, thinking whether to refer to other medical colleagues, eg vascular surgeon, GP, radiology etc.
S- Shoes
S- Surgery
Arrrgh.......
