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Helenia
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#7541
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#7541
(Original post by Wangers)
If you see a case that is very rare and well fascinating, is it odd to get excited - on a scale of rareities say a couple in a career at tertiary referral level when the patient is deeply in the **** from their condition? I feel odd...

/ 'reflection
Not odd at all, as long as you are also suitably empathetic. I've had one or two of those myself recently (case report time!) You're not on placement at RFH at the moment are you?
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Skwee
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#7542
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#7542
(Original post by clarusblue)
stupid question but can anyone explain what the terminology for writing up a cardiovascular exam is in terms of that "HS I..." stuff? Probably very basic but it's one of those things you don't know until someone explains...
HS - heart sounds.


(Original post by Princess Bubbles)
Been doing cardiovascular examinations today. >D I found it very interesting although I found it hard to identify the different murmurs!
It gets easy (/easier?) after...a couple of years? *lol*
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clarusblue
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#7543
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#7543
(Original post by Skwee)
HS - heart sounds.
So in notes how would you write that they were all normal? And if there was a murmur for example? Thanks
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Skwee
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#7544
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#7544
(Original post by clarusblue)
So in notes how would you write that they were all normal? And if there was a murmur for example? Thanks
Well I suppose different people do it differently, so I can only speak for how I was taught to do it :P personally in a normal patient I go with something like "HS I + II, rhythmic and regular, no murmurs or extra HS".

If there's a murmur I classify it in terms of whether it's systolic or diastolic (more rare), location where it's best heard, shape, whether it radiates anywhere, and intensity.
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clarusblue
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#7545
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(Original post by Skwee)
Well I suppose different people do it differently, so I can only speak for how I was taught to do it :P personally in a normal patient I go with something like "HS I + II, rhythmic and regular, no murmurs or extra HS".

If there's a murmur I classify it in terms of whether it's systolic or diastolic (more rare), location where it's best heard, shape, whether it radiates anywhere, and intensity.
Useful, thankyou!
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Lantana
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#7546
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#7546
(Original post by Princess Bubbles)
Been doing cardiovascular examinations today. >D I found it very interesting although I found it hard to identify the different murmurs!
I find hard to hear some of the murmurs, Me: uh yes I can hear that mitral regurgatation... My head:.. that really faint sound that might just be me moving the stethoscope around

(Original post by planetconwy1)
I have quite a bit of Savings in my ISA & savings account, so they said I can't have a bigger overdraft until I spend that! They don't understand that I am saving it for something important in the future.
This is why my elective fund and my student account are at two different banks :yes:

(Original post by Beska)
Our pre-clins are "normal structure and function" i.e. "put your stethoscope in spot x,y,z and pretend to listen".
Unfortunately when it comes to 3rd year :sigh:
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Beska
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(Original post by Lantana)
Unfortunately when it comes to 3rd year :sigh:
Let's see if I get past january exams first!
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Princess Bubbles
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#7548
(Original post by Beska)
Our pre-clins are "normal structure and function" i.e. "put your stethoscope in spot x,y,z and pretend to listen".
:lol: I'm sure you will learn soon enough!

(Original post by Skwee)

It gets easy (/easier?) after...a couple of years? *lol*
I hope so!

(Original post by Lantana)
I find hard to hear some of the murmurs, Me: uh yes I can hear that mitral regurgatation... My head:.. that really faint sound that might just be me moving the stethoscope around
This is exactly what I'm like!


(Original post by clarusblue)
If you have an iPhone there's a cool app from Littmann called Soundbuilder which I reckon is good, it has a selection of murmurs on there and it has a recording of what it will sound like, where you will hear it and patient position, and an animation of what is happening

There's probably an android or blackberry version as well, or you might be able to find it online
Thanks for the tip. I have an android phone. looked for the app but don't think they have it on android yet but will keep my eyes peeled!
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Supermassive_muse_fan
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#7549
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#7549
(Original post by Princess Bubbles)
Yes that sounds good. I think we use the carotid to get the timings of cardiac cycle. I think it is because this was the first time actually doing it so it was a bit strange!
You're much further ahead than I was at your stage! (only started using pulse same time in second year - didnt realise this was your first time!) I'm sure you'll pick it up just fine as you do more examinations!

My BSc supervisor works with a paed cardiologist, wonder if I can score some clinic time...

Also has anyone used the free CD of heart sounds that you get with the littman steth? Had it for three years now and it's still somewhere on my bookshelf
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GodspeedGehenna
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#7550
(Original post by Supermassive_muse_fan)
I find it helps to feel radial pulse (or any other) at the same time to confirm if murmur is early/pan/late diastolic/systolic and can then use that to work out dysfunction.
This is pretty much what we've been taught but with carotid.
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SMed
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#7551
Full day of endocrinology symposium tomorrow. (doing endo BSc)

:yawn:


And I'm marking posters.

:yawn:
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lekky
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#7552
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#7552
I can't hear anything at all through my stethoscope.. need to buy one of those amplifier ones for people with rubbish hearing! am waiting to see whether i can get help via disability funding first though as they're really expensive.
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Renal
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#7553
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#7553
(Original post by Skwee)
Well I suppose different people do it differently, so I can only speak for how I was taught to do it :P personally in a normal patient I go with something like "HS I + II, rhythmic and regular, no murmurs or extra HS".

If there's a murmur I classify it in terms of whether it's systolic or diastolic (more rare), location where it's best heard, shape, whether it radiates anywhere, and intensity.
That's really good and admirably thorough.

I give it until your second take.

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mrs_bellamy
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#7554
(Original post by Wangers)
If you see a case that is very rare and well fascinating, is it odd to get excited - on a scale of rareities say a couple in a career at tertiary referral level when the patient is deeply in the **** from their condition? I feel odd...

/ 'reflection
I have had a couple like this recently. Two guys with the same 'once in a specialists career' disease in beds next to each other! Both really lovely and not very well, so I also felt guilty for feeling almost excited. It's a tough one, but I guess it's natural. Have also got very excited by some of the amazing signs I've seen while I've been in oncology and palliative care, even though most of those signs are so good because the patients are really sick. (Not sure the signs are anything special to anyone else, but they are exciting for the 4th year medical student. )
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Helenia
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#7555
(Original post by Wangers)
If you see a case that is very rare and well fascinating, is it odd to get excited - on a scale of rareities say a couple in a career at tertiary referral level when the patient is deeply in the **** from their condition? I feel odd...

/ 'reflection
Forgot to say earlier - when my now husband was diagnosed with Hodgkin's, there were a few of my medic friends who, after being suitably lovely and sympathetic, asked me "Does he have signs? Can you feel his nodes?" Fortunately, he didn't mind being a curiosity too much. :rolleyes:
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Supermassive_muse_fan
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#7556
(Original post by Helenia)
Forgot to say earlier - when my now husband was diagnosed with Hodgkin's, there were a few of my medic friends who, after being suitably lovely and sympathetic, asked me "Does he have signs? Can you feel his nodes?" Fortunately, he didn't mind being a curiosity too much. :rolleyes:
I hope he's all better now

(Original post by mrs_bellamy)
I have had a couple like this recently. Two guys with the same 'once in a specialists career' disease in beds next to each other! Both really lovely and not very well, so I also felt guilty for feeling almost excited. It's a tough one, but I guess it's natural. Have also got very excited by some of the amazing signs I've seen while I've been in oncology and palliative care, even though most of those signs are so good because the patients are really sick. (Not sure the signs are anything special to anyone else, but they are exciting for the 4th year medical student. )
Same, renal is the best speciality for rare diseases! During renal block I sat in on a clinic and a patient came in with a rare genetic disease (can we say what it is on here?) and he said 'oh you'll only see it once during your career...'.

Then sat in a yearly outpt review clinic with my supervisor a month ago and saw 5 patients with the same illness all in the space of 4 hours! I think thats been one of the most 'exciting' aspects of Medicine I've experienced.

Obviously as a human you're empathic towards anyone suffering, and some patients had been suffering with said disorder for as long as I'd been alive which really made you think how strong these patients were. But from a scientific point of view, you also need to satisfy your intellectual curiosity and its those doctors who are both interested in the patient... and the disease that do quite well.
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Renal
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#7557
(Original post by Helenia)
Forgot to say earlier - when my now husband was diagnosed with Hodgkin's, there were a few of my medic friends who, after being suitably lovely and sympathetic, asked me "Does he have signs? Can you feel his nodes?" Fortunately, he didn't mind being a curiosity too much. :rolleyes:
I've been an informal OSCE practice model for the last 8 years. Initially it was for people revising for second year exams, now I have membership candidates after my tummy.
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Helenia
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(Original post by Supermassive_muse_fan)
I hope he's all better now
Yeah, this was a while back now - it all started just over 2 years ago, and he finished treatment in July 2010. It made FY1 even harder than normal, but he is fine now.

And he did have some lovely rubbery nodes. :p:

I get excited by weird and wonderful cases, but I also quite like it when I see a truly classical presentation of something, especially if I'm the first one to pick up on it and get it fixed. Did this for a critically ischaemic limb not too long ago, and felt suitably smug for the next day or so.

(Original post by Renal)
I've been an informal OSCE practice model for the last 8 years. Initially it was for people revising for second year exams, now I have membership candidates after my tummy.
Do you ever get fed up of it? And do you let them know you're a doctor?

W was supposed to be a model patient for one of the mock OSCEs we ran for the final years but he was too sick to do it.
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Renal
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#7559
(Original post by Helenia)
Do you ever get fed up of it? And do you let them know you're a doctor? (
Most of this was done in the union and in exchange for pints...
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Helenia
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#7560
(Original post by Renal)
Most of this was done in the union and in exchange for pints...
My understanding is that the drinking and stripping is fairly standard practice on your lot's sports nights out anyway - do you charge extra for the tummy-prodding? :p:
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