Sunday, 4 March 2012

Differential Diagnosis Of...

After the nice break for study week we were straight back in with cervical cancer this fortnight.  It was quite a light case compared to the last two, which should be nice, but just gives me a feeling of unease that I've missed something.  Our PBL facilitator is a consultant at the hospital and normally rips it out of us each week.  He talks really quietly, and it's not unless you listen carefully you realise he's just said something sarcastic about what an utter moron you are for deigning to offer such a ridiculous answer.  It's good practice for next year on the wards, but until now every facilitator we've had has been sickeningly sweet and lovely.  Well, with the exception of my last one of course, whose reply to me being 10 minutes late for class and hopping in on crutches was "I've sprained my ankle and I still managed to cross London with three tube changes to get to my lectures on time and I didn't need crutches".  Well bully for you.

Our current facilitator doesn't like fluffy stuff, hard science and management plans only please.  It's not enough to know what drug to give in a situation, we have to know dosages and timings as well.  Don't get me wrong, I love him and wouldn't have anyone else.  I feel like I learn so much more, it's just taken a bit of adjusting too.  He always prepares a slideshow of real life cases he's seen relating to the topic for the fortnight, and we play a what's wrong and what would you do game.  Gynae though, is really far from his speciality and he's been eerily quiet this time.  We'll give an answer to a question and cast a sly glance his way to see if he's about to erupt or if we've done well.  He's just been sitting there nodding silently.  His only contribution was to dissolve into fits of giggles and ask us differential diagnoses for a female with pneumoperitoneum.  We hesitently suggested trauma or infection.  Parachuting apparently, something he remembered from his med school days.  The air goes up and out through the tops of the fallopian tubes.  I just have images of fimbriae flapping in the breeze.  I know, I know, there's fluid, but that doesn't make such a pretty picture.  Colposcopy is apparently more likely to cause this through the same mechanisms though.

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