Wednesday, 28 March 2012

The average week of a fourth year medical student: Wednesday

The average week of a fourth year medical student: Wednesday

7.30- 8.25: The usual excessive pressing of snooze!
8.30-8.45: The equally usual rush to get ready and quickly downed coffee
8.50: *Once again running late!!*

^ I really do wish these things had never been invented!

9.05-12.30:  A morning in the eye hospitals A+E department
Eye hospital A+E is in someways much like a regular A+E in that patients can just self refer and turn up on the day with eye problems and wait to be seen, equally GP's (and because its the eyes: opticians) can suggest to patients that they attend the A+E and refer them.

In some other ways though its very different to a normal A+E, for starters I saw a number of patients today (and during subsquent mornings I have sat in on this department) who had appointments booked for them for a weeksa time to come back and check things are progressing/improving as they should.  This makes it almost more like a clinic or GP appointment system - in regular A+E if a doctor told a patient to bring themselves back into the A+E department to be rechecked they would probably receive some very harsh words from colleagues and hospital doctors!  But I suppose the eye is such a specialised area that there no point telling the patient to get their GP to recheck them in a week because without the special equipment the eye hospital has and years of specific expertise in that area, a GP wouldn't stand a chance of picking up any reasonably subtle but important eye changes.

Saw quite a few interesting patients today but also had a lot of waiting about in between patients due to the nature of A+E and amount of refering to other departments the poor overworked registrar had to do.  Here are the top three most interesting patients:

1. A patient who had herpes zoster (aka shingles) and had been unfortunate enough to get eye involvement with her shingles and was first seen by the eye team last week and now was being followed up..  She had whats called "Herpes Zoster Opthalmicus" which simply refers to the  region that her shingles had appeared (it is in the opthalmic division of the trigeminal nerve) - over the right hand side of her forehead going down to below her eye.  The worrying possible complication of when shingles affects this area is that it can cause eye problems such as uveitis, conjunctivitis, keratitis and ocular nerve palsys although these are reasonably rare.  This patient when she first presented to her GP the previous week was recorded as having something called "hutchinson's sign" which is where there are shingle vesicles on the tip of their nose.  This is significant as the nerve which supplies this area (the nasociliary branch) also innervates the globe of the eye, so patients with this sign are twice as likely to develop eye involvement with their shingles (where as having herpes zoster opthalmicus with vesicle on the eyelids does not increase risk from herpes zoster opthalmicus where the vesicles are just on the foreheard).

Herpes Zoster Opthalmicus

 Unfortunately for todays patient she had got eye involvement and had developed anterior uveitis a week ago.  Uveitis is inflammation anywhere in the uveal tract and the anterior part just means it was affecting the front of the eye.  However after a weeks treatment the patient was actually doing a lot better, but has to slowly come off the eye drops over the next 8 weeks to try and prevent worsening/ recurrence.

2.  A patient with a coldsore (herpes simplex causing a dendritic shaped corneal ulcer) in his eye!! Another unlucky chap as this is reasonably rare as well.

3. An eleven year old who came in with the most swollen eye I have ever seen outside of medical pictures.  Poor poor boy it looked so painful.  Apparently it is an infection probably from within his body although he feels systemically well at the moment.  He was referred straight across the road to the childrens hospital to have IV antibiotics because the doctor wasn't sure if he had slight orbital cellulitis which is serious as it can be both sight and life threatening as it can enter the meningeal cavity (in other words there is a small risk of developing meningitis from it).

The boys eye looked pretty similar to this but without the red scabs this childs eye has

Wednesday afternoons are usually off for "sport", I am probably one of the rarer medical students who does actually use them for this but as I said yesterday BUCs matchs are finished now so this time is now available :) 

12.45- 4.30:  Had a nice lunch out in the sunshine with my rabbit hopping about, met the new next door neighbours because they were peering over the wall watching their cat who was out in this area for the first time.  Made friends with the next door neighbours quickly when they spotted Chunks and exclaimed that they had rabbits too and held theirs over the wall to meet me!

Wrote some of this blog out there and did a little ophthalmology reading but then actually got too hot (remarkably for march!) so I've headed back inside and am ready to do a serious amount of essay work! (I did do some yesterday, but lots more to do).

Till tomorrow!


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