Pathophysiology and Clinical Lab. Diagnostics I + II

 In my opinion this is the most important subject of the third year, the skills you learn here will be the ones you will use everyday as a doctor. The first 6 weeks will focus on ECG, the vast majority of the two semesters will be about lab diagnosis analysis and the final 6 weeks with finish with haematology How to pass NB! They changed a lot 2017/18. See under "The Exams" below for updated information. Try to collect the theory from as many different teachers as possible, it is rare one will give you all the information in the limited time you will spend with them Learn the standard values for everything with the correct unit, there are many different standards but as long as you are within an acceptable range you will be okay Some examiners may ask you to come back to redo sections of an exam that you did not do well at ECG One of the two important topics in the final, if you cannot read and/or explain an ECG then you are likely to fail Drill a logical sequence for reading the every tracing this way you will not forget to check everything The one I used (but it is not the only way) was:
 * 1) Arrythmic or not
 * 2) Heart rate
 * 3) Origin of impulse
 * 4) Axis
 * 5) PQ time
 * 6) QRS time
 * 7) <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">QT time
 * 8) <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Regular T waves or not
 * 9) <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">ST elevation or depression
 * 10) <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Pathological q's
 * 11) <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">R progression

<p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">If there is anything wrong with any of these I would investigate further <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Practice makes perfect here, try to do as many as possible, get your teacher to give you more realistic examples than the ones in the green folder and make sure you see examples in your Internal medicine practice <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">If you get an MI do not forget to indicate where it is <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Not all the ECGs have a clear-cut answer sometimes it can be borderline or in between two diagnosis, this can be an acceptable answer in the exams as long as you can justify it <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline"> <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Lab Questions <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">The other important topic in the exams that can lead to a quick fail if you get things wrong <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">When studying the lab questions it is not enough to memorise the answers, ask yourself why every piece of information is given and how it came to be plus if it can be linked to another topic <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">There are the answers written by students but they are usually just a simple explanation and diagnosis, while this is the essential knowledge it is not enough to get the higher grades <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline"> <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Haematology <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">This is the least important topic of the subject, it is very difficult to get a detailed understanding of Haematology in just 6 weeks <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">There are only 8 slides to have in the final: Try to separate between marrow and blood smear first, an easy way to to see if there is fat in the slide
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">4 blood smear
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Normal
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">CL
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">CLL
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">CML
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">4 marrow smear
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Normal
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">CL
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Megaloblastic anaemia
 * <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Myeloma multiplex

If you easily find a plasma cell then is is almost guaranteed to be myeloma multiplex

If you see lots of black dots it is almost guaranteed to be CLL<p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">In the exam the questions relating to this are highly variable, some teachers will just ask for the diagnosis and that is all, others will ask detailed questions about the grouping and characterises of many diseases. In pathology you will have a lot more detail in this subject, try to use that knowledge <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Some examiners will ask you to name cells in the slide so have a good knowledge of erythropoietic and granulopoietic cells and how to identify them <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">If you get things wrong here it will not necessary fail you as it is considered a minor topic by most examiners <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Topics <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Again this is considered a minor part of the exam by most examiners <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">The topics in the lectures can be very similar to pathology, immunology, genetics and microbiology so it may be a good idea to get a different perspective but they are much more condensed <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Similar to the lab diagnostics in which you could be asked to explain you answers in detail <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">The topics you will get will not only be what you will talk about, your answers could lead to the examiner asking about any topic from the whole year <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">There are student notes but they will only give you the basics and you will need to be able to explain them in more detail in the final

The exams
<p class="MsoNormal" style="line-height:16.5pt;vertical-align:baseline">EDITED: They changed a lot 2017/18, here it is: <p class="MsoNormal" style="line-height:16.5pt;vertical-align:baseline">Midterms: Semi final: Final:
 * <p class="MsoNormal" style="line-height:16.5pt;vertical-align:baseline">1st semester - 2 midterms: 1st ECG tracing with theory + 2nd One lab question
 * <p class="MsoNormal" style="line-height:16.5pt;vertical-align:baseline">2nd semester - 1 midterm: Hematology MCQ & identification of cells on projected pictures
 * MCQ on computer that needs to be passed to go to oral. This replaced the oral topics.
 * ECG tracing
 * 1 lab question
 * MCQ on computer that needs to be passed to go to oral. This replaced the oral topics.
 * ECG tracing
 * 2 lab questions (1 from each semester)
 * 1 hematology case. The slide was just to help you diagnose the case patient, no questions regarding the slide itself.

Difficulties
<p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline"> <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">This topic is more about your ability to understand and work with information rather than simply memorising it <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Every examiner has a personal style and they will conduct the exam according to that style, some are only interested in the correct diagnosis and will only ask theory questions if you get that wrong. At the other end of the spectrum there are those who think the diagnosis is largely irrelevant and detailed theory is the most important <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Preparing for the latter type of examiner is the best option <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Each teacher also teaches in their own way and gives information that that think is important, if you get an examiner different from your teacher they may have a different opinion, try and get information from as many teachers as possible to help with this <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">There are some unique topics that pop up every now and again but there usually isn't enough time in the lectures to go through it in detail, you will have to do this on your own <p class="MsoNormal" style="margin-top:4.8pt;margin-right:0cm;margin-bottom:6.0pt; margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Some lectures are a copy of other subjects, if you feel confident in these already then do not bother going, you will be very bored

<h2 class="MsoNormal" style="margin-top:12.0pt;margin-right:0cm;margin-bottom: 12.0pt;margin-left:0cm;line-height:16.5pt;vertical-align:baseline">Conclusion I believe that more time should be spent this subject in the official curriculum instead of some less useful subjects and as it is very important I would give this the most time to study for the semi and final exam if possible