Wednesday, October 22, 2008

Signs of Anemia?

A group of medical students are having a bedside teaching session with Prof. (MO and HO just happened to be doing work at the table nearby)

Prof: "In a patient that we suspect to have anemia, what clinical signs do we look for?"
A: "Cyanosis."
Prof: "Very good (sarcastically) can get out from the ward now. Make sure you prepare adequately before you come to my class again."
B: "(shivering voice) Capillary refilling time..."
Prof: "(shakes his head) Why you look at CRT in anemic case? You all ah..(sigh) Tell me, in what cases do you need to look at CRT?"
C: "Heart failure..."
D: "Ischemic heart disease..."
E: "Hyperthyroidism..."
F: "Uncontrolled Hypertension..."
G: "Cerebrovascular accident..." (Prof's head shaking non-stop)
H: "Finger clubbing?" (MO: Wow...)
I: "Rheumatoid arthritis?" (HO: What?)

Finally a distinction-looking student said out confidently, "Takayasu's arteritis!" (MO & HO: Woww...)

Prof: "ENOUGH! ALL GO BACK AND READ AGAIN!" Then walked off the ward leaving the frightened group of students.

What happened to the medical students (quite senior batch) ler.
CRT is to access hydration and circulation status. Simple as that.
High-5 diagnoses do not mean they're correct, and most of the time, to quote a famous saying in medical school, you're digging your own grave by saying things that you don't know!

Moral of the story: "Think and answer smartly!" and, "Make sure you master the basics, before aiming for higher level!" ;)


Jing said...

where are they from? lol!!!

宏轩 said...

where where where??
which hospital??

i think the answer should be "jaundice"... better!!!!!!!!
haemolytic anaemia wat!!!!! (huhuhuhuhuuhuhu)

jo an said...

this entry remind me of our uni days when we were medical students. hahaha... think tht's the common all medical students did, going for high tech stuff before even remembering the basic ones. :D

Yuen said...

They could be really nervous/anxious/frightened at that point? I know I "dig my own grave" every now and again during bedside tutes/case presentations....heh.

Hmmm, but with that "impressive" list for capillary refill time? That's going a bit too far ler....

Zzzyun said...

i know!! conjunctival and oral mucosa pallor! betul?

and for the capillary refill.. peripheral vascular disease eg. diabetic foot?

Tiffany said...

Reminds me of what always happen during hospital visits. Hahahaha.......we the 'common' med student.

newlight said...

Patient with anemia will become pale.
Haha, ppl like me just know a bit basic thing but those high five thing, i dun think i know.
But the basic still goyong-goyang o!

Anonymous said...

other's include angular cheilosis and signs of heart failure (high-output heart failure due to SEVERE anemia)

but CRT is plain ridiculous !(for senior med students)

maybe i am being too hard but I do believe that nowadays some med schools accept students with questionable pre-UNI qualifications (ie. students who don't make the grade but were offered medicine)

for example, I know of someone who repeated STPM twice and yet, she failed to achieve minimum grades to be accepted in any local (public/private) med school. However, she was accepted by a 'prestigious' med school in a neighbouring country!

Believe it or not!

confessions of a medical student said...

if suspect anemia, why not look for other signs of anemia, access severity of anemia, and signs to rule out causes of anemia?

i guess, there is so much of 'must know' at med school... and profs, they usually like to go back to basics,.. yes, the very basics, back to anatomy and physiology, most which us, med students often take for granted..

there was once upon a time, where we could impressively vomit out everything,.. and over time, we start suffering from cerebral atrophy and dementia... siGh....

*have to buck up* professionals exam in 4 months! :(

Darren Lee said...

Ha thnx for the comments guys. Ya I think "dig the own grave" is something you must avoid in professional exam. Imagine you vomit out "Takayasu's arteritis" and you actually not quite sure what it is, i'm sure you can predict what is gonna happen next;) (Ya happily jump into the grave!)

It's true enough that med students tend to go for high-5 stuffs, with the thougths that these can bring them to distinction or something but sadly, if basics are not mastered, you hardly can proceed to the next stage.

Shinyin, your way of thinking can bring you far!=) The way to approach anemia is not difficult. Just need to look for:

1. Symptoms in history (easy fatigability, SOB, palpitation etc)

2. Signs (palmar crease and conjunctival pallor)

3. Differentiate types of anemia? (glossitis, angular stomatitis, koilonychia, jaundice etc)

4. Signs suggestive of the causes (Look for liver/spleen/lymph nodes etc)

5. Signs of complications of anemia e.g. heart failure etc.

That's basically the approach and I think with that way you won't miss much in your examination;)

confessions of a medical student said...

thanks darren :) i'll remember them when i see my patients...

peanut said...

eh.. the prof. just walk off.. how cool is that!

for us, if something like tat happen, one can kene kutuk during lecture again, den 1 month after tat when the prof remembered it and he will kutuk again during morning rounds, and kutuk again whenever he sees u...

dunno y, somehow i feel quite happy tat things like tat happen in msia!!!! (sorry, a bit evil nowadays)


Shyang said...

wah...wic med school is tat?

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