Neurology Is Almost Over! And Differential Diagnoses

Let’s see, today is Tuesday.  I’m working a night shift tonight which means I have most of today free and will be off tomorrow at 11am.  Thursday is a long day, (7am-8pm) but it’s my last day of neurology.  I have Friday and Saturday off and on Sunday I start my next month in the ICU.  EEKKKK!!!!

I can’t believe that this month has come and gone and that I completed 1/12th of my intern year!  I have loved this month so much.  I love the people I work with; all the upper level residents are the nicest and coolest people ever, all the consultants (what Mayo calls attendings- meaning the head doctors in charge) are kind and patient and love to teach.  I’m so grateful that I’m doing my intern year at Mayo.

Mayo has amazing care process maps that are all evidence based and incredibly helpful when you're an intern and don't know anything (like me!)

Mayo has amazing care process maps that are all evidence based and incredibly helpful when you’re an intern and don’t know anything (like me!)

We’ve had a few really difficult cases on the service this month.  Often, the diagnosis has not been obvious and we’ve had to really sit and think things through.  Our attending taught us this mnemonic which I found very helpful: VITAMIN CDE.  I’ve used the mnemonic CITIMITV but I think vitamin cde is way easier to remember!

IMG_3649

It stands for:

V- Vascular

I- Infectious

T- Traumatic

A- Auto-immune

M- Metabolic

I- Inflammatory

N- Neoplastic

C- Congenital

D- Degenerative

E- Epilepsy  (this one is specific for neurology)

I think this is a great way to piece out differential diagnoses if you have no idea what’s going on with a patient.  When you separate out everything into categories and think, “what metabolic things could cause her symptoms?  What inflammatory things could this be?”  it helps guide your decisions about what tests you should order, etc.

One of our senior residents always asks, “how will this change management?” which I LOVE.  Before we order a test we stop and think, “will this test change what I do for a patient?”  For example, a few days ago I had a patient with a stroke.  The CT scan done in the emergency room showed a small stroke in a certain area of the brain, but the patient had some strange findings on physical exam that didn’t fit with the location of the stroke.

Different stroke locations and symptoms- I find this very helpful for localizing strokes!

Different stroke locations and symptoms- I find this very helpful for localizing strokes!

 

We thought about doing an MRA or MR-Angiogram, which is an MRI that can specifically look at all the blood vessels in the brain and neck.  The patient had multiple vascular risk factors, and we were worried that some of the arteries in his neck might have narrowed enough to cause a stroke or cut off blood flow to other areas of the brain that we didn’t see on CT scan.

So, my resident and I talked about whether it would change our management of the patient.  If the MRA was positive, the patient might be a candidate for surgery and we might also change the medications they were on.  If the MRA was negative, we wouldn’t do anything different.  We knew that the vessels in the neck were the most likely to be compromised, and that a carotid ultrasound can see those vessels very well.  An ultrasound in 398349834 times less expensive than an MRI so we decided to do the ultrasound first.  If it was positive we would go ahead with the MRI.  If it was negative, we wouldn’t do the MRI.  Instead of just jumping into a $3000 MRI, we thought about it first and I really appreciate that.

Neuro has been a pretty relaxed month in terms of hours.  Most weeks I’ve worked around 60 hours which is not a lot at all for a resident.  Next month in the ICU, I’m expecting to work much closer to 80 hours per week and be exhausted.  I’m really going to have to figure out how to fit in exercise next month- it will be a challenge no doubt!

I even had time to get get an eye exam and order new contacts!  I had to go back to work after getting my eyes dilated- that was rough!  I couldn’t see anything for a few hours!  ***( I didn’t drive- Kyle picked me up and brought me back to work)

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I still plan to keep blogging as often as I can!  If you have any suggestions for blog topics, I’m all ears!  My life is pretty simple these days, and I don’t know how many “I went to work and then I went to the gym and then I went to bed” posts I can write :-)

Have a great day everyone!!

26 thoughts on “Neurology Is Almost Over! And Differential Diagnoses

  1. Hey Andrea! Glad to hear you enjoyed your Neuro stint! I am currently in the process of applying to medical school (12 secondaries just flooded in over the weekend). Can you do a post on tips for the application process – secondaries, what to do in your application year (maybe certain activities), scheduling and preparing for interviews, and maybe even dealing with rejection? (Hopefully I won’t have too much of the last one.) I appreciate you taking the time to read this – thanks!

  2. hi andrea! I would love it if you could do a blog post about what it’s like to be a doctor (or even med student) looking the way you do — meaning, beautiful, blonde, generally small. I just wonder what it’s like to have that kind of presentation when the stereotypes may be working against you. I bet other med students were probably jealous of you and patients might question how good you are because of the fact that you present as a cute young girl. obviously this is meant to be a compliment, i’m just curious about how that has gone.

  3. It’s always fun to hear about your “boring” days!!

    You could post on some of the challenges/difficulties you’ve experienced. I know for me one of them has been being flexible with change. Other topics could be how to accept/embrace criticism, how to give feedback, being a woman in medicine, etc! It’s always interesting for me to hear perspectives of my colleagues!

  4. Everyone of your posts makes my day! I’m in the process of applying to medical school and awaiting interview invites! I would love tips on how you prepared for those, made time to travel if you were still in school, how you dressed, hard questions and how to answer them, and any other tips that obviously worked for you! Thank you Andrea, you are so awesome!

  5. Hey Andrea!
    I love these types of here’s-what-I-did-today posts! They are by no means boring. Keep updating us on how everything is going and different medical things you are learning. I absolutely love your blog & get so excited when I see that you have posted something new! I can’t wait to hear more :D

  6. Honestly I love these posts…giving us insight on how your schedule is going and what the month consists of and things you’ve learned along the way. :) Good luck on your ICU month!

  7. I seriously LOVE reading all about what your days are like. It’s super interesting to me. If you’re looking for different subjects to write about, I have one! This may sound like a dumb question, but I would like to know if a person has to be SUPER smart to become a doctor. I know that I can work hard and be dedicated, but science has never been a strong subject for me…I’m so glad you’re having a great internship so far!!:)

  8. Pingback: » My Healthy Attempts In Residency Thus Far A-DOCTOR-IN-THE-HOUSE

    • Oh I hated neuroanatomy class but LOVED the neuro rotation- I bet you like it when you see patients in the clinic!!!

  9. I just wanted to say, as an MS3, this post was very helpful! Please keep up these sorts of posts! I also hope to do my training at Mayo!

  10. Hi Andrea! Thank you so much for sharing your life with us! I honestly find this very inspiring & encouraging, and reading your blog posts is one of the main ways I’ve managed to cope in med school thus far : )

  11. I love your quick and easy recipes! I am about to be a PhD student who will also be pressed for time, so seeing how you manage your schedule has been really helpful!

  12. I’d love to hear about how you transitioned to wearing suits every day! I find it so hard to find good suits for women that are professional but don’t look like you’re a grandma or from the 80s. What kind of suits do you have and where do you shop?
    Rachel recently posted…July RecapMy Profile

    • Hey Rachel! I love wearing suits everyday- I feel so professional! I think it’s hard to find good suits too! It’s so annoying that all men’s suits are good quality wool and almost all women’s suits are polyester and rayon! The only places I’ve found women’s suits that are wool and aren’t ridiculously expensive are J Crew and Brooks Brothers. I LOVE Brooks Brothers suits. I bought 2 on sale when they had a suit special where if you bought the jacket, you got the pants free. I also just bought a J Crew suit on E Bay believe it or not and it’s perfect!! Lots of my classmates like Ann Taylor, but I don’t think they fit me that well. Hope that helps!!

  13. Pingback: » Weekly Meal Prep: Residency Addition A-DOCTOR-IN-THE-HOUSE

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