Neurology day 2

When I arrived at the hospital, I headed to the doctor's office on the ABIU/Rehab ward to see what my doctors had planned for the morning. I remembered they told me they usually start around 9 am, I checked my watch and there were still some minutes till then so I logged on to a computer to kill some time. I figured I might as well arrange my timetable for the remainder of the week.

Soon it was 9:15 am and neither of them were around. I found out one of them had training today and the other was running late so I checked the teaching schedule for the week and saw there was a lecture starting soon. I went downstairs to the "Student Cluster Room" where there are computers and a small kitchen. I grabbed a tea and sat at a computer to join the lecture online. Five minutes before it was scheduled to start the doctor holding the lecture emailed us to say it had been rescheduled and expressed his sincerest apologies.

I signed up for some outpatient clinics later this week and next week, then headed back to the ward. The doctor welcomed me and asked, "how was the lecture?" I explained what happened and he tasked me with taking a patient's history to present to him. The patient had been in hospital since May 2021 and I was not allowed to look in their file. I needed to get everything there was to know about the patient by asking all the right questions.  

I had a long conversation with the patient and returned to the doctor's office. My doctor gave me some time to gather my thoughts and then I presented the case to him. He gave me some pointers and feedback on how best to present for the next time. 

Next, he asked me to study Guillain-Barré Syndrome (GBS) for us to discuss at the end of the day. After eating lunch, we went through how to perform a neurological physical examination and he taught me a few acronyms to help me remember everything.

Before every physical examination, it is important to:

Wash your hands
Introduce yourself

Ask for Permission or about Pain

Expose patient

Reposition patient

A neurological physical examination can be very lengthy and take up a lot of time. We should examine the mental status of the patient, the cranial nerves, the motor system, the reflexes, the sensory system, coordination, gait and balance. Today we just focused specifically on the upper and lower limbs. 

First, you should inspect for

Scars
Wasting of muscles

Involuntary movements

Fasciculations

Tremor

Then, examine for

Tone 
Power 

Reflexes

Sensation 

Coordination

We went through the steps of how to do each of these things. Then we talked about GBS and the day was done. 

Today was filled with so much learning. This is one of the great benefits of interning at a University teaching hospital because they focus heavily on educating the next generation of doctors, and the atmosphere creates a huge source of inspiration. I came home feeling fulfilled, not exhausted. I have all the motivation I need to study tonight in preparation for all that tomorrow will bring.