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    Hi all

    I'm a third year medical student, and coming up are my first clinically-focussed exams -- by which I mean exams where we need to know the signs and symptoms different conditions present with.

    I don't really know the best way to approach this. I've made my notes, with a summery of the history and examination findings for each presentation, but actually learning it I really don't know where to begin. Each condition has so many signs/symptoms, and without actually having seen a lot of the conditions I'm finding it quite abstract and very difficult.

    Anyway, I imagine this is a problem many medics have faced over the years, so any advice of the best way to cement this into my head would be greatly appreciated!

    JBTP
    • #1
    #1

    I don't think it is mentally possible to remember every possible sign and symptom for every core condition and I am not sure that would ever be expected. It sounds like you have a good basis for core learning and reference already which is a nice position to actually be in! I'm soon to take finals and I still haven't finished my third year notes...

    Patients rarely actually present with a logical collection of symptoms and there is a lot of overlap in symptoms between conditions. Once you have that core knowledge about conditions I found it easier to instead think about core presentations and that is what I made flash cards on. I honestly think you will go mad if you try to fully memorise every sign and symptom rather than focusing on what differentiates conditions and the common presenting symptoms.

    For example a patient presents with breathlessness so my immediate thought is what sort of things could cause this? Could it be cardiac like heart failure or could it be lungs like asthma or COPD or could it be something else? This very much guides my next questions and helps rule in or rule out possible causes. I'm not waiting until I have generated a huge tick list of symptoms and then seeing which list it fits on.

    In my clinical exams so far we have never actually had that much emphasis placed on getting the diagnosis, they are much more interested in seeing a logical history and examination with relevant findings followed by relevant investigations to again rule in and rule out things it could be. If you get the correct diagnosis that is great, but what they want is a safe f1, not House and a safe f1 considers more than just the one obvious diagnosis.

    It also helped me because it made me think about my notes in a different way. Reading my notes has never been helpful for me - I always have to do something with them. Usually this involves a combination of thinking about how people present then checking my notes to see if there is anything else I would ask or look for. I also do as many practice questions as I can get my hands on and then check my notes if I haven't remembered something or add to my notes if the answer wasn't already there. I also found it very helpful to go to the wards and ask the juniors who would be good to practice histories and examinations on and again checking my notes afterwards to see if I missed anything important.

    Hope that helps!
    • #2
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    Pretty much what Anon #1 said. I don't think you need to be able to gather a list of symptoms and then work out the diagnosis. At this stage you're going to need to take the presenting complaint (e.g. SoB) and work out common differentials. From asking about red flag symptoms in the same system, and indeed from others, you'll be able to rule in/out various common causes. If you can generate a list of sensible differentials based on the key questions you're asking in year 3, you're doing well. Indeed if you look through A&E/AMU admission notes you'll see juniors writing out 3 common differentials for that PC, so you're doing almost as much as them!
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    Hi Anon 1 and 2, thank you for your reply it's really helpful. I don't think I was quite clear, I was talking about the written exams. I don't know about other medical schools, but certainly at Imperial half our year mark is made up of a multiple choice style paper where they might give a case presentation and we have to give the diagnosis, or the first investigation, or the organism causing it etc -- it just seems so much! Any advice on this sort of thing?
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    (Original post by jbtp)
    Hi all

    I'm a third year medical student, and coming up are my first clinically-focussed exams -- by which I mean exams where we need to know the signs and symptoms different conditions present with.

    I don't really know the best way to approach this. I've made my notes, with a summery of the history and examination findings for each presentation, but actually learning it I really don't know where to begin. Each condition has so many signs/symptoms, and without actually having seen a lot of the conditions I'm finding it quite abstract and very difficult.

    Anyway, I imagine this is a problem many medics have faced over the years, so any advice of the best way to cement this into my head would be greatly appreciated!

    JBTP
    There is no great answer here, try and remember the commonest ones first, make a list of obvious signs you may be expected to know, as a fellow third year, some that come to mind

    Cardiovascular; infective endocarditis, anaemia, murmurs
    Respiratory; make a table of your four tests on examination and think it out
    Abdomen; cholecystitis, pancreatitis, obstruction, appendicitis

    Basically, in your head, try and think if you saw a patient what you look for from that (I'll want to rule out Atrial Fibrillation, so would look for an irregularly irregular pulse)
 
 
 
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