9th semester notes

Here’s the link to the notes I’m writing this semester. Currently it’s only paediatrics and neurology, and I don’t think I’ll write any other notes during the semester. After they’re done, I’ll upload them to the website as usual, but while I’m writing them, they’ll be available in that folder. If I decide to write any other notes they’ll be in that folder, too.

To access them you must log in with your Microsoft Office user from POTE. That means neptuncode@tr.pte.hu, with the password being the same as your Neptun password.

If you get an error message saying that you don’t have access you’re probably logged in as your private user. Log out of your private user and log in with your POTE user.

Neuroembryology topics

I’m still going to finish the neuroembryology topics. Only 3 left!

Statistics

I usually post some website statistics after each exam period, but I forgot to do it after the last one. I’m sorry to those of you who like the statistics, but I won’t post them now. I’ll remember to do it after the upcoming exam period, though.

Neuroembryology progress

Last updated on October 6, 2020 at 12:33

25 out of 25 topics done so far

I won’t be able to finish all topics until the exam period starts again next week. If there are any topics you want me to prioritize, tell me and I can do them first.

1. From the ovulation until the implantation
2. Formation of the trilaminar germ disk and the folding
3. Differentiation of the mesoderm. Development of the serous membranes and the body cavities. Malformations
4. Development of the skull. Growth of the bones. Malformations
5. Development of the blood vessels. Malformations
6. Development of the face, formation of the nasal and oral cavities. Malformations.
7. Differentiation of the pharyngeal arches. Malformations
8. Differentiation and derivatives of the pharyngeal pouches and clefts. Malformations
9. The intestinal tube and its derivatives (with the exception of the pharyngeal gut). Malformations
10. Development of the respiratory system. Malformations
11. Formation and derivatives of the heart tube. Partitioning of the cardiac chambers. Malformations

12. Development of the kidney and the urinary tract. Malformations
13. Development of the female genital organs. Malformations
14. Development of the male genital organs. Malformations
15. Formation of the fetal membranes and the placenta. Fetal circulation
16. Neurulation. The structure of the neural tube. Development of the spinal cord
17. Development of the brainstem and the cerebellum
18. Development of the diencephalon and the telencephalon. Development of the commissural pathways and the fornix
19. The placodes, the neural crest and their derivatives. Development of the peripheral nervous system
20. Development of the visual system
21. Development of the acoustic and vestibular system
22. Development of the endocrine glands. Malformations
23. Malformations of the nervous system
24. The external appearance of the embryo and the fetus. The signs of maturity in newborn
25. Causes of the congenital malformations (with examples!)

Introducing learning objectives in biochemistry

I’ve taken the liberty to rewrite most of biochem 1 to keep up with the (barely) changed lectures, and to try to explain things better. I’ve also added learning objectives to the beginning of each topic. The purpose of these learning objectives are to show what types of questions you should be able to answer after knowing the topic. The summary is moved to the bottom of the topic and includes short answers to the learning objective questions.

Announcing neuroembryology notes

Now that I’m (finally) done with biochem 1 I need a new project, and I’ve decided that it is going to be the embryology topics in neuroanatomy (all 25). If I finish in time I’ll try to do the histology topics as well, but no promises. I haven’t started either yet, but I’ll post the topics as I finish them.

Have a good summer!

Public health 6 experience

Public health final ✔ and 8th semester ✔ as of yesterday. I don’t remember as much as I would like to, but I do remember at least some of the questions they had.

We were like 20 something students having the exam at 8 yesterday, so I was expecting to have to wait for a while to get called. I wasn’t completely ready at 8 sharp, still cleaning the desk and getting dressed. But then I get a call on Teams.

I answer, being greeted by Prof. Csaba Varga and a co-examiner. They ask me to show ID, and to give them a quick look at the room. Then, they ask me if I’m ready. Prof. Varga draws the first topic from the “A” envelope:

21. Ecological studies. Immigrant studies

This was the same topic where I’d done poorly on my A-chance, so I laugh as I draw it again. I did read up on it after the A-chance, so I thought I would have a good grasp on it now. The examiner asks whether I would like a question to get started, but I tell him that I’m fine.

  • Me: Ecological studies are also called correlational studies. They’re analytical and observational studies.
  • Examiner: They are?
  • M: Yes
  • E: *Visibly disagreeing with what I’ve said*

Good start. From his response I could tell that he disagreed that they’re analytical studies. I don’t remember how we got there, but eventually he asks me:

  • E: So with an ecological study, do you already have a hypothesis or do you construct a new one?
  • Me, changing my answer: You construct a new one
  • E: Yes.
  • E: What kind of data can you use for an ecological study?
  • M: You use mortality, incidence, prevalence, etc. You use populational data like this instead of data on individual cases.
  • E: Okay, what else?
  • M: *Can’t think of anything else
  • E: Could you give me an example of an ecological study?
  • M: Okay, I remember in the lecture there was an example where they looked at how the incidence of suicide was different between different religions in old Germany, or something.
  • E: Mhm. So if we made an ecological study where we compared the amount of salt purchased and the incidence of hypertension in a population, what would be the problem with this?
  • Me, after some thinking: Well areas with higher socioeconomic status would purchase more salt, so that could be a cofounding factor?
  • E: Hmm, could be.
  • M: I can’t think of anything else
  • E: So, not all salt bought is consumed. For example, salt is used on icy roads, etc. So it doesn’t correlate perfectly to salt intake. However, it would be a good estimate. Okay, tell me about immigrant studies
  • M: So immigrant studies compare the incidence and prevalence of disease between immigrants to a country and the host population of that country, to evaluate the effect of genetic factors and environmental factors.
  • E: Could you give me an example?
  • M: So in the lecture there was a study where they compared the incidence of gastric cancer between Japanese immigrants into the US and the native population of the US. After 2 generations the incidence of gastric cancer of the Japanese immigrants increased to reach the incidence of the native population.
  • Examiner, visibly disagreeing: Was the cancer rate higher or lower in the Japanese immigrants?
  • Me, correcting myself: It was higher
  • E: And after how many generations was the incidence equalized
  • M: After 2 or 3, I think.
  • E: After 2, yes.

There was more back-and-forth to get to the correct answers than I made it seem here. I can’t remember any other questions he asked here. Before moving on to the next topic, he asked the co-examiner whether he had any questions, which he didn’t. The professor says “This was good”, which surprised me, actually.

He reaches into the “B” envelope, holds it up to the camera, and draws another topic out.

55. Prevention of infectious diseases: vaccination, chemoprophylaxis

I was so glad I didn’t get a topic about bacteria or parasites in ph4, because my micro knowledge really sucks.

  • Examiner: What’s the difference between vaccination and chemoprophylaxis?
  • Me, after taking a few moments to think: Well, vaccination is something you give to everyone, while chemoprophylaxis is something you give to someone you expect to be exposed to the pathogen if they’re already exposed
  • E: Are all vaccines given to everyone?
  • Me, realizing my mistake: No, there are travel vaccines and stuff like that..

In the end I couldn’t find a good explanation. I guess I should’ve mentioned that vaccines cause prevention for much longer, or something.

  • E: How would you prevent malaria, for example?
  • M: Well I believe there is a recent vaccine against it, but chemoprophylaxis would be more important.
  • E: Who gets the chemoprophylaxis?
  • M: Everyone who are expected to be exposed. Travellers, for example.
  • E: So the whole native population of endemic areas should take chemoprophylaxis?
  • Me, realising my mistake: No, of course not..
  • E: What would be better preventative measures for the native population?
  • M: Well there are insect nets, insect repellants, etc.
  • E: What else?
  • I can’t think of anything
  • E: Killing the mosquitoes for example.

Obviously..

  • E: What types of vaccines do we have?
  • M: There are live attenuated vaccines, where the pathogen is modified to be less pathogenic, or where they use bacteria which are similar to the bacteria, like using mycobacterium tuberculosis bovis in the BCG vaccine
  • E: It’s “mico”-bacterium. Not “maicoh”-bacterium.

Okay

  • Me: Okay, micobacterium tuberculosis.
  • E: Wait, go back. There is another classification of vaccines.
  • Me, pretending to think but actually knowing I don’t know the answer: …
  • E: Active and passive

Isn’t it active and passive _immunization_, and vaccination is a type of active immunization?

  • M: Okay, so passive is when you give IV antibodies.
  • E: Okay. What is anatoxin?
  • Me, after taking a few moment to think: I don’t know.
  • E: What kind of vaccine do we have against diphtheria?
  • M: It’s a toxoid vaccine.
  • E: Yes, that’s the same

I’ve never heard the term “anatoxin”..

  • Me: Okay, so toxoid vaccines are used when the disease is caused by a toxin rather than the pathogen itself. The toxin is inactivated so that it’s no longer pathogenic. These vaccines don’t have to be refridgerated, which is a plus. They don’t give herd immunity, though.
  • E: What were the biggest epidemics in the middle ages?
  • M: Well there’s the black death, at least
  • E: And what’s the scientific name of it?
  • M: The bubonic plague. Caused by yersinia pestis.
  • E: Yes. And what was the other major epidemic?
  • M: I don’t know.
  • E: It was water-borne
  • Me, guessing: Cholera?
  • E: Yes.
  • E: What was the first country or empire to use vaccination?
  • M: Are you thinking about Edward Jenner and the smallpox vaccine?
  • E: No, there was someone much earlier than that.
  • M: I have no idea
  • E: It was the Chinese empire

I learned a lot today

  • E: Do you have any questions, co-examiner?
  • Co-examiner: Yes, I have one question. Which STD can be prevented by a vaccine?
  • Me: Well I’ve noticed that not all sources count it as an STD, but it has to be HPV.
  • Co: Yes, but now that you mention it, why do you think it’s not always regarded as an STD?
  • M: I don’t really know. (Doesn’t HPV only transmit sexually?)
  • Co: It has to do with the mode of transmission, but it’s okay. You answered my original question.
  • E: Okay, let’s move on to the last question.

He holds up envelope “C” and pulls out the last topic.

86. Epidemiology and prevention of breast cancer

I begin by saying that it’s more common in women, to we all laugh. I talked about the risks of age, obesity, high oestrogen exposure, BRCA, screening, etc.

  • E: How is the socioeconomic status related to breast cancer risk
  • M: High socioeconomic status increases the risk.
  • E: Yes. Why?
  • M: Well high socioeconocomic status is related to obesity and low physical activity
  • E: Yes but that’s not really it. Think about carreer women who have children late or no children, or who choose to not breastfeed. But you already talked about that, so it’s okay.
  • E: You said we use mammography in older women, but what can we use in younger women?
  • M: We can use clinical breast exam and self-examination
  • E: Okay but what else. Which modality
  • Me, guessing: Ultrasound?
  • E: Yes. Why do we use ultrasound instead of mammography?
  • M: Well maybe because tumours in young women are different than tumours in older women?
  • E: It’s related to the tissue structure, yes, something like that. Co-examiner, do you have any questions?
  • Co: No, no questions.
  • E: Okay. Then please leave the call, then we will discuss your grade and call you up again in a few minutes.

They called me up after a few minutes, told me I had gotten a 4, and that was it.

Final words

I was done at 08:32, so it took around half an hour. He always showed the paper slips with the topic name, which is nice. He often didn’t give a reaction to my answers, which is annoying, because you don’t know whether you said something wrong or not. I was given multiple chances and hints when answering his questions, though, and he didn’t stress me at all during the exam.

So that’s all for fourth year for me (except derma..). The feeling of relief hasn’t reached me yet, but maybe it soon will.

Thank you to everyone’s best wishes, and especially thank you to those who joined me in the virtual library <3

I have some plans for greek this summer, but I won’t reveal them until later. I will return with some statistics at the end of the exam period, as is tradition by now.

Good luck to those who still have exams left, and to those who are already finished: congratulations!

Urology experience

Had urology yesterday. Sometime last week (Friday?) the urology department made a team on MS Teams called “Exam 06.08”, and added the five students who were signed up that day. Also added were Dr. Ákos Pytel, Dr. Miklós Damásdi, Dr. Dániel Bányai and Dr. Kinga Villányi. Naturally, we expected that one of these would be our examiner. Perhaps Dr. Villányi, as she edited the team description after being added.

The day of the exam, just a couple of minutes before 9:00, Dr. Pytel adds Dr. Lehel Péterfi to the team, who ended up being our examiner. One of the students started the meeting the department had scheduled already, and the examiner joined in a few minutes past 9. Next to him sat a young co-examiner.

The examiner introduces himself and warns us that the exam will be recorded. We start by showing ID’s to the camera. Dr. Péterfi tells us that we will each get at least 20 minutes preparation time. He holds up 3 bunches of topics in random order, and tells the students to give him 3 numbers between 1 and 15. I told him number 3, so he picked the third topic from the left. I chose another two numbers to get my other two topics; the other students do the same. He’d hold up the slip of paper with the topic name and give you time to write it down.

The students whose last name was the first in alphabetical order chose topics first and so on, and they were also the first to start. According to the alphabetical order, I was 4th. My exam started approximately 10:40. The exam took place in the meeting, so all of us could hear the other students’ exams.

The recording of the meeting is available to me, so it’s easy for me to write down my whole exam. Even though it hurts to watch and hear myself talk. Appearantly I say “uhh” every second word. Nice!

15. Evaluation and management of urological emergencies: Renal colic, suprapubic pain, acute scrotum, gross haematuria, anuria, and urinary retention

  • Me: I’ll start with topic about urological emergencies.
  • Examiner: Yes, it’s quite an important topic, even if you’re not a urologist, you have to know this.
  • M: So a urological emergency is a condition which causes severe pain, could be life-threatening, or have high risk for permanent disability, or organ loss, which is why it has to be acted on immediately.
  • M: The first one in the topic name is renal colic, which is a severe paroxysmal from the flank area, which can radiate to the groin, to the abdomen, to the testicle, to the perineum, etc. It’s most commonly due to ureter or kidney stone, but like the previous student said it can also be due to nephroptosis. It is very painful on percussion and the patient often has an urge to move around. So, the main etiology here is stones. We should do an ultrasound or CT to visualize the stone.
  • E: What you’re telling me is good, but try to make it a little more systematic. So we have a patient, he has typical renal colic. What are you going to do?
  • M: I would do imaging to look for the stone.
  • E: Examining. You should examine the patient before imaging. What kind of imaging should we use?
  • M: Ultrasound
  • E: That would be the first. Good. What would you expect on the ultrasound.
  • M: You could see the stone and its acoustic shadow.
  • E: No. Does the stone cause the colic?
  • M: Uhh..
  • E: It’s a tricky question.
  • M: No, the colic is due to the spasm of the ureter muscle.
  • E: Yes, the colic can be caused by the stone if that stone is in the ureter. So if the stone is in the kidney the colic is not caused by that stone which is in the kidney; the pain is from the other stone, which is in the ureter. So what do you see there, if some stones are in the ureter? What happens?
  • M: We could see dilation of the ureter proximal to the stone.
  • E: Yes!
  • M: And hydronephrosis.
  • E: Well, lets hope no hydronephrosis. Usually in acute pain there is no hydronephrosis. A hydronephrotic kidney has been suffering for such a long time, so there’s no pain. You’ll see dilatation in a kidney with normal parenchyme. So yes, you’ll see dilatation and you might see stones. That’s good about the ultrasound; let’s go further. What else can you do for examining?
  • M: You could do a CT.
  • E: Yes! What kind of a CT would you do?
  • M: I would do a CT urography.
  • E: That would be the best, but usually you cannot do that, because the radiologist is going to tell you: “Make an appointment tomorrow or in the next two months”. So then what are you going to do.
  • M: Uhmm..
  • E: There is a special name for that kind of CT, where they use very low radiation.
  • M: Uhmm….
  • E: It’s good for looking for stone. It’s like a very good ultrasound. You don’t give contrast. You started saying the name.
  • M: *Thinking*
  • E: It’s called a low-dose CT. Anyway. So you made a CT, but there is something else which you should do.
  • M: You should examine the urine.
  • E: Yes! What do you expect in the case of a stone colic?
  • M: Haematuria
  • E: Yes. Okay. In case of renal colic the biggest problem is differential diagnosis. Could you tell me some diseases which you must differentiate it from? It’s not a renal colic but it goes with the flank pain.
  • M: For example pyelonephritis.
  • E: Yes, for example. How would you differentiate it from colic?
  • M: In pyelonephritis there would be fever, pyuria, leukocyte casts in the urine.
  • E: Yes. Very good! Is there anything else in the differential?
  • M: Well a tumour could compress the ureter
  • E: No. Usually a tumour would compress it so slowly that it doesn’t provoke pain. Instead it would cause a hydronephrosis.
  • M: Uhm.. Well if there was trauma, but then the patient would know about that..
  • E: You know, the simplest way to think about this is what other organs are around the kidneys.
  • M: Okay, so.. Acute appendicits could be in the area..
  • E: Very good. You have to differentiate it. How would you do that?
  • M: In acute appendicitis you would have tenderness in the McBurney area. You could also do an ultrasound of the appendix.
  • E: Well, would there be any dilatation of the kidney?
  • M: No.
  • E: Would there be any haematuria?
  • M: No.
  • E: Exactly. The same pain without dilatation and without haematuria should raise the suspicion of the pain originating from somewhere else. Okay, how would you treat a renal colic?
  • M: It’s a severe pain, so at least NSAIDs or even opioids. You should also use spasmolytics.
  • E: Good. What would be the best spasmolytic? That’s a tricky question because it’s not a drug.
  • M: *Thinking*
  • E: It’s something for your own knowledge and practice. The best spasmolytic is not a drug.
  • M: *Still thinking*
  • E: It’s heat. Applying something warm around the muscle. It’s a very good spasmolytic. Something warm around the kidney, or a warm bath; it helps enormously. Let’s go further. Tell me something about the haematuria. There are so many topics that I might just choose some of those.
  • M: Okay, so gross haematuria can have many causes. Genitourinary trauma, bladder cancer, acute glomerulonephritis, tubulointerstitial nephritis, papillary necrosis, stone.
  • E: Okay. Very good. What could a gross haematuria cause to your patient? Let’s say there’s a male patient who’s got some problems with urination already because of age. This haematuria would aggrevate this situation. Why?
  • M: Well if he loses a lot of blood he could get anaemic.
  • E: Yeah. He could even get hypovolaemic shock. But I was thinking about urination. We’re urologists, let’s hope we won’t have to save his life. What happens if there’s a lot of coagulum in the bladder?
  • M: Okay, then the blood clots could obstruct the lower urinary tract.
  • E: Yes, yes. That can cause total retention. What do we do in this case?
  • M: So in case of total retention we would have to insert a catheter.
  • E: Yes. Good answer. What kind of a catheter would you insert in haematuria?
  • M: We would start with a Foley catheter.
  • E: No, that would not be the best. The best would be a special catheter.
  • M: Oh, sorry. The three-way catheter.
  • E: Exactly. We want to wash the blood out, and it’s much easier to do with that one. Yes you’re right. Okay. If we’re not able to insert a catheter, what is the next option?
  • M: If we’re not able to insert a three-way catheter or any catheter?
  • E: No, no. I jumped to the urinary retention question. What if you’re not able to treat the urinary retention with a catheter?
  • M: A suprapubic catheter.
  • E: Yes. What would be those problems where you cannot insert a catheter?
  • M: If the urethra is totally obstructed.
  • E: Okay, what else?
  • M: Uhm..
  • E: You had a collegue who just answered this question already. There was a condition in which we don’t use catheters.
  • M: Uhh….
  • E: Transurethral catheters, I mean.
  • M: *Still thinking*
  • E: It was infections. Acute prostatitis for example, you don’t want to use a transurethral catheter. You don’t want to create an abscess or something, so you use the suprapubic. Okay, I’ll give you a 4 for that. Let’s go to the next topic.

18. Congenital anomalies of the gonads and vesicourethral unit (bladder, urethra)

  • Me: I’d like to start with cryptorchidism. The definition is that one or both of the testicles fail to descend into the scrotum. It’s relatively common – it happens in approximately 1% of male newborns. Some risk factors include prematurity and low birth weight. The diagnosis is made clinically after birth that one or both testicles are missing in the scrotum. The testicle could be palpated if it’s in the inguinal canal or in the abdomen, but if it can’t be located by physical examination it should be located by imaging, to differentiate it from ectopic testis. Most cases spontaneously resolve within 6 months after birth, but if they don’t, surgery is needed.
  • Examiner: Good. Can you use any drugs for them?
  • M: Uhm.. Could you use testosterone?
  • E: They used that back in time. There is some hormone therapy you could use but it’s not important. Why is it important to locate the testis if it’s in an ectopic place? What problem could it cause?
  • M: If it’s in an ectopic place then it obviously won’t fix itself, so surgical relocation into the scrotum is needed.
  • E: Wait. If the testis is in the inguinal canal you could relocate it if the artery is long enough, but if it remains in the abdomen there’s no chance to move it down. What do you have to do and why?
  • M: You have to surgically relocate it to the scrotum
  • (he just said that you can’t do that lol)
  • E: No, you have to completely remove it. Why.
  • M: Because that testis has a high chance of becoming cancerous.
  • E: Yes. Anyway it’s not going to be functional in that place, so to prevent cancer you should just remove it. Please go further
  • M: Okay, we have bladder exstrophy
  • E: That’s such an ugly disease, yeah.
  • M: Yeah it does not look pretty. I don’t have much to say. The bladder is herniated out through a defect in the abdominal wall. There’s often an associated defect in the pelvis.
  • E: Yes. One congenital anomaly rarely comes alone.
  • M: It’s also associated with epispadias.
  • E: Yes. What is epispadias?
  • M: It’s that the urethral orifice is on the dorsal side of the penis.
  • E: Yes. And how would you call the other way around?
  • M: Hypospadiasis.
  • E: Yes.
  • M: So the treatment for bladder exstrophy and epispadiasis is surgical, but hypospadiasis only needs to be treated if it’s symptomatic.
  • E: Well, usually the patient’s parents want us to fix it either way. Uhm, what else.. You know what, I’ll give you this. This was a small question but the other one was large, so. Let’s move on.

33. Non-tumorous diseases of the penis and urethra

  • Me: Okay, so there’s a lot to talk about here. I can start with paraphimosis.
  • Examiner: Good!
  • Me: .. Which is actually also a urological emergency. It means that the foreskin is retracted but cannot be returned to its original position. This is a problem because it will cause swelling of the glans, which will further worsen the problem. In worse case, if left untreated it can cause necrosis. The treatment is local anaesthesia or regional anaesthesia and try to manually reduce it. If that does not work then a surgical incision of the tight part is performed, or in worse case circumcision.
  • E: Good.
  • M: Okay, that’s all I have to say about that. There’s also priapism, another emergency. So priapism is a non-sexual erection which lasts for more than 4 hours and is not relieved by ejaculation.
  • E: It’s not relieved by any way, but yes.
  • M: So we have low-flow and high-flow varieties.
  • E: Very good! So what does it mean?
  • M: Low-flow means that the problem is decreased venous outflow, while high-flow means that there is increased arterial inflow.
  • E: High-flow is usually due to trauma, yes. The venous can be caused by different means. Okay. What do you do.
  • M: The initial treatment would be to aspirate blood from the corpus cavernosum. If that doesn’t work then you have surgical opportunities.
  • E: I hate those surgical opportunities but yes. There are some drugs you can use, but whatever. Question. How would you differentiate between the two types?
  • M: Well the high-flow is often due to trauma, so if no trauma has happened before then low-flow is more likely. But I suppose the best way would be doppler ultrasound.
  • E: Doppler ultrasound is a good way but not the best way.
  • M: Uhm..
  • E: The logic is there. You’ve told me that there is arterial blood in high-flow and venous blood in low-flow. How do you differentiate between the two types of blood. What do they contain?
  • M: Okay, you could sample the blood maybe, look for oxygen differences.
  • E: Exactly! You make a blood gas analysis of the blood which you just aspirated with a very large needle. Okay! Good. One more question. What is the Peyronie disease related to the penis?
  • M: Peyronie disease is an idiopathic disease where you have formation of fibrous plaques in the tunica albuginea. It causes painful erections, abnormal curvature, erectile dysfunction.
  • E: Okay. I’m not asking anymore. It’s a five.
  • M: Thank you so much sir! Have a good day.
  • E: Have a good day!

Epilogue

So, another success story for me. All in all a very good exam experience, especially because of the preparation time, which is so important for me to calm down and collect my thoughts before the exam. My exam took 20 minutes, and the other exams took roughly the same amount of time. The examiner was very nice as well, he did not mind having to re-iterate or repeat questions, and I though he asked very fair questions overall. I didn’t get my grade until this morning, which is always stressful.

I though everyone would draw one topic from each “group” of topics as I have separated them, but as you saw I didn’t get any cancer topics, but another student that day got 2 cancer topics. So I don’t know what’s going on.

For ms. Worldwide urology was the last exam of this semester. I still have public health final. I have it on monday. Not because I think I need one whole week of studying for it, but because I’d rather just study 50% of the day for a week than to stress all day like I have been the last weeks. I am home, my surgery practice starts in July, so I have no rush to finish the exam period, really.

I was supposed to start studying PH again today, but this post took so long, so I’m probably going to start tomorrow. I’ll go over all the PH lectures and all my notes again, trying to fix any mistakes.

Good luck for your exams!

Orthopaedics exam experience

Finally some good fucking news

Had ortho just now. I had professor György Szabó, like almost everyone does. Ms. Worldwide had the exam before me, and she was called 09:20. Her exam finished at approx. 09:45. She had the sciatica and chronic osteomyelitis topics, and it went very well for her.

I was called soon after. The co-examiner was sitting next to prof. Szabó. We say good morning and I introduce myself. I was sitting in the same room as Ms. Worldwide was when she had her exam, which he notices as soon as he sees my camera feed. I can tell that he’s confused, and he asks me whether I have some kind of custom background on or something, but I explain to him that Ms. Worldwide is my girlfriend and that I’m in the same room as she was. He asks to see my ID, but didn’t ask to see my room.

He then starts to ask whether I’m nervous (which I was. A lot). He asks me what would be the worst that can happen. I tell him that I could get good topics but forget everything and fail, so that I have to repeat the exam later. “So what?”, he says. “What kind of doctor do you want to be?”. “A cardiologist”, I reply. “So when you’re a famous cardiologist in Norway, do you think anyone will ask you about your orthopaedics exam as a fourth year student? Even if you fail, how long do you think that’ll bother you?”

He also asked me whether I thought that he’d ever failed as a student. I answered no, but replied that he had, multiple times. He told me that he failed his A chance in anatomy, and only passed on the B chance after “Promising the examiner that he would never become a surgeon”. “Of course I promised him!”, he told me, and laughed. He tells me that there’s nothing to worry about and that we’re just going to have a friendly conversation between colleagues.

He shows me that the topics are spread out on the table, and tells me that he will point to each one once and I will say stop to choose that topic. I had to do that twice. He asked me whether I was happy with the topics, to which I reply “no”, but he tells me that he will help me, and that it will be fine.

55. Rehabilitation following limb amputation, ortheses, orthopedic shoes

Something to note is that when he read the name of the topic he just said “Rehabilitation after limb amputation. Orthopaedic shoes”. So he skipped the “orthoses” part.

I start talking about how limb amputation was performed more commonly some time ago, before oncological advances allowed for the use of limb-sparing surgery for bone cancer, but that limb amputation is still sometimes performed today.

I explain how it’s very energetically “expensive” to use a prosthesis, and that training strength and balance is important. I explain the concept of stump conditioning. He asks me how long I think it takes for the swelling to go down, whether it’s days, weeks, or months. “Weeks or months”, I say. “What does the patient do while waiting for stump conditioning. Do they have to lie in bed and wait?”. I reply that they could use crutches or wheelchair in the meantime. “Crutches are good, but wheelchair is not. Why?” “Because then they don’t use the healthy leg”. “Yes”, he replies. “What else can they do in the meantime?”, he asks.

I try to think but can’t think of anything. He mentions that there are temporary prosthesis, which I didn’t know. He asks me about where amputations are performed, and where it is “best” to perform them”. I say that they’re performed at the level of the knee, which he says is wrong. I say they’re performed above the knee, but he tells me that that’s not the best place to amputate. “Below the knee”, I say, which is correct.

He asks me about amputation of the upper limb, and where it’s best to perform. I say “below the elbow”, but he disagrees. He asks me how functional a upper limb prosthesis should be. “As functional as possible”, I say. He asks me how functional I think they are. “Not fully functional”. “Exactly”, he says. “There are some million-dollar prosthesis which are connected to the brain and allow for finger movement, but almost nobody gets those. Why would normal people get a prosthesis then?”. I can’t really think of anything. If not for function, then what?

He asks me about people look at people with amputated limbs in the store. “Peculiarly”, I say. “Exactly. So what does that tell you about another function of the prosthesis”. I don’t really get what he’s getting at, but after some time of thinking he tells me that prosthetics are also important for cosmetic reasons, and for the patient’s own psychology.

He ends the topic by telling me that there are three important components of rehabilitation after limb amputation. “Function, cosmetics, and psychology”. “Let’s skip the orthopaedic shoes and go straight to the next question. This topic was a 3.”

42. Scoliosis with known etiology, treatment of

I start mentioning the causes of neuromuscular, congenital, post-traumatic, etc. I then start to compare neuromuscular to idiopathic scoliosis, saying that neuromuscular often involves pelvic deformities, etc. He stops me and asks me why I’m talking about idiopathic scoliosis, when my topic is about secondary scoliosis.

He asks me about a medical synonym for idiopathic. He freeze and start to get really nervous that I’m going to fail at this topic, as he’s seemed displeased with what I’ve said so far. However, he notices that I’m getting nervous and reassures me by saying “There’s no reason to be nervous! We’re just having a friendly chat as colleagues! Don’t think of this as an exam”. He helps me by saying “You’re going to be a cardiologists. Think about idiopathic diseases in cardiology. Think about essential.” “Do you mean primary?” “Yes!”, he says. “Primary, idiopathic, essential; it’s all the same. Idiopathic means that we’re idiots and don’t know what causes it. But this topic is about secondary scoliosis, scoliosis with known causes, so you shouldn’t talk about idiopathic scoliosis.

He obviously didn’t really need to tell me that, and I wanted to tell him that I was just trying to compare secondary and idiopathic scoliosis, but I didn’t get to tell him before he started to ask me other questions.

“What is the treatment of congenital scoliosis?”. “Surgical resection of the abnormal vertebrae”, I say. “Hmm”, he replies. “So when would you do the surgery? The baby is born yesterday. Do you do the surgery now?” “No”, I reply. “When would you do the surgery then?”

I stop and think, but he says “The child is now one year old and has begun to walk. Do you do the surgery now?” “I don’t really know exactly when you would do the surgery”. I don’t really remember how we got there, but eventually he arrived at the conclusion that would only do surgery if the scoliosis is severe and conservative treatment is insufficient. He asks me “What if I’m a stubborn father. My child has severe scoliosis, but I accept how he looks. How would you convince me to do the surgery?” I tell him that severe scoliosis involves a high risk for cardiopulmonary complications, and that surgery is important to prevent it. He is satisfied with this answer.

Last words

He tells me that the second topic was also a three, so the total will be 3. He asks me whether I am satisfied, to which I reply “Yes, of course”. I thank him, he wishes me a nice day, and I leave the video call.

I don’t know if this post got it across properly, but prof. Szabó is literally the nicest and kindest examiner I’ve ever had. Literally. I was so nervous for the exam but during the exam I was much less nervous, thanks to him calming me down before and during the exam. He also only seemed interested in the very basics. My exam took only around 20 minutes. I wish all examiners at POTE were like this.

Some words of advice for those having the ortho exam: Talk about your topic in this order: epidemiology, etiology, clinical features, diagnosis, and treatment. He really appreciates it if you follow this order. I think that applies to most subjects, actually. Make it a habit.

Unfortunately my fantasy of him only giving out topics which have been covered in the lectures didn’t turn out to be true, but it didn’t matter much. I’m sure that if you draw one of the topics which were covered in the lecture and you mention only what was said in the lecture, you’ll be okay.

Anyway.

Oral exam failing streak: broken ✔

Insides: dead ✔

Urology: Monday 😩

Orthopaedic notes

Ortho notes are done. According to earlier students the nice professor is only interested in what was said in the lecture, so I’ve based the notes mostly on those.

As anyone who have studied orthopaedics would know, the topic list is a mess. I’ve tried to arrange the topics according to the lectures (and I have taken a few liberties), and I’ve written less in those topics which are not covered by the lecture. I’ve used orthobullets and the orthopedics book as additional sources.

I’ve heard from a student who had the exam that there were not 67 topics on the table when the professor chose one randomly, but rather around 25. I’ll live in the fantasy that the professor only chooses among those topics covered in the lecture. Hopefully.

I have the exam on Wednesday. Don’t forget to pray for me 🙏

My Public Health final experience

Had public health final this morning. At around 09:00 Prof. István Kiss called me on teams, after having examined a few other students. In the voice call were me, Kiss, and a co-examiner I didn’t know.

He is sitting outside on his terrace, and as the exam starts he says that it starts to rain. After moving under the roof, the co-examiner asks me to show ID.

Kiss says that he has three envelopes, and that he will draw topics from me. He showed me as he reached into the envelope and drew a topic. My first topic was

21. Ecological studies. Immigrant studies

He wants me to start to talk about the topic. I begin by explaining that ecological studies are studies where we look at ecological factors like geographic and demographic factors and try to relate them to risk factors and disease. I give him the example of John Snow and the water pump contaminated with cholera, and how he used the geographical information of the cholera-infected people to determine that the water pump was the source.

Prof. Kiss responded by saying that my description of ecological studies was not correct, and that John Snow’s study is not an example of an ecological study. I immediately panic a little inside. It was the first question of my exam and I had already answered wrong. Searching my thought for alternative explanations of ecological studies yields no results.

I stay quiet for a while, trying to think of something. After a few minutes of silence I seem to recall that ecological studies are on the populational level while other studies are on the individual level. He tells me that it’s correct, and wants me to once again try to explain, from the beginning, what ecological studies are. I try, but can’t really find an explanation he is satisfied with.

Eventually he asks me about the strength and weaknesses of ecological studies. I say that conclusions drawn on the populational level can’t always be applied on the individual level, which is the ecological fallacy. He asks me for an example of this fallacy. I don’t know any, and can’t think of any.

He tells me that he will give me a research question which can be solved by an ecological study or by an individual-level study, and asks how I would conduct the studies. The question is “how would you determine whether fluoride intake protects against dental caries?”

I tell him that it could be determined with a field trial, where you have two groups and give one group extra fluoride intake and measure the differences in caries incidence between the group. With an ecological trial, it could be determined by looking at the difference in incidence of dental caries in two populations, where one has higher fluoride intake than the other. He asks how I would measure the difference in fluoride intake between the populations. I say that a major source of fluoride is in drinking water, so we could measure the differences in fluoride in the drinking water of the two populations.

We finally move on to immigrant studies. I explain how they allow to compare how genetic and environmental factors influence the incidence of a disease by comparing immigrants and their descendants to the general population.

He asks the co-examiner whether he has any questions, which he doesn’t. Prof. Kiss reaches into envelope number 2, and picks out my second topic:

57. Epidemiology and prevention of airborne bacterial infections

I begin by listing airborne bacterial infective agents, diphtheria, haemofilus influenzae, pertussis, meningococcus, tuberculosis, pneumococcus, legionella, etc. He asks me about prevention of these agents. I say that many of them have vaccines, but general hygiene is important, like hand washing, staying away from symptomatic people, staying at home if you have symptoms, etc.

He says that he will asks more specifically about some of them. First he asks about TB and it’s prevention. I say that it’s a prevalent disease in developing countries, and the BCG vaccine is the most important preventative measure. He asks me what type of vaccine it is, and I say live attenuated.

He asks me about pertussis, and what the causative agent is and the symptoms. I say bordetella pertussis, and that it causes whooping cough. I asks about prevention, and I say the acellular pertussis vaccine. He asks me why it’s lethal, and this is where I get stuck. I try to guess some causes, and I did say respiratory failure and breathing problems, but I never said apnea, which I think is what he wanted to know?

We move on to diphtheria. He asks me about the causative agent and the symptoms. I say corynebacterium diphtheriae, and that it causes pseudomembranes in the pharynx, with fever and pain. He asks about why it’s lethal. Once again I’m stuck, and after some poor guessing he tells me that he has to stop the exam here. He tells me about the diphtheria toxin, and how it causes kidney problems, myocarditis, etc. I knew of the toxin of course, but I couldn’t recall it. The vaccine is even against the toxin, which should’ve reminded me of its existence. Oh well.

So I failed ph final. Didn’t even get to draw the third topic. Shit happens.

I’ll update my notes to correct the part about ecological studies and add more about the symptoms of the infectious diseases. I’ll also look at other students’ exam experiences and try to make sure all questions are answered in the notes. I’ll do that on Monday probably, as I have surgery tomorrow and trauma on Monday, and I’ll probably retake ph on Wednesday.

Is Greek Doctor on an oral exam failing spree? Stay tuned to find out!

I tried, I really did..

Last updated on May 18, 2020 at 21:12

I really tried to study for public health final by just reading notes. I tried for 2 days, before I had to admit to myself that I didn’t learn anything by just reading. So I had to make my own, like always. Public health 1 + 2 done, public health 6 next.

If only I could learn by only reading notes like everyone else appearently can..

Edit: Public health 6 is now also done