Result of the technical experiment €œof inverse study€

I am going to tell to you what so has gone to me with the technique of inverse study of applied Tom Miller to the Rheumatology. If you do not know of what I am speaking, it reads this entrance where I tell everything you.

My first impression is good. It has been to me entertained, much more that to take a book and to read the disease to me of Churg-Strauss directly.

springboard 2

I begin the 16,22 hours. I am sleepy, but I hold. As when she was student.

As I do not have Internal Medicine books at home to consult, nor notes of Reuma, I will use a page that use often for consultations no-ORL, Not to have to subscribe, I add to the term search €œemedicine to me€ next to the other.

Lame paper and ball-point pen. I write down symptoms of day €œzero€, the €œpresent presentation€.
Underneath, personal antecedents.

To the left, the loss of weight in 2 months.
To the left of this, the pericarditis that it had 6 months ago.
To the left absolutely, which began 9 months ago. Then it already had cutaneous eruption, fever and arthralgias, reason why the symptoms of day €œzero€ are chronic.

I review complementary tests. Reactantes of acute phase elevated€¦ Hemocultures and serologies of negative tiny beasts (as it is a case of Reuma, already imagined it to me).

A pile of antibodies, negatives. This already I like less. If it is a reumatol³gica disease, it could already be some high one, no? If outside specific, better. But not€¦

They are to me arising doubts that could solve reading the subject in the notes, but I am going to wait for a little. The doubts serve as €œhooks to me€ to retain data more ahead.

Examples of my doubts:
- The one of the fibrinogen, he will be specific of vasculitis?
-There is some blessed antibody pathognomonic of the Churg-Strauss?
-In what another vasculitis and reumatol³gicas diseases the FR is high? To see if they put it to me in the examination to confuse€¦

It does not have Ac antiphospholipid€¦ if he had been positive would have thought about lupus (nothing that to see with the Dr. House, is that it sounded to me of before).

It has peric¡rdica inflammation. There are injuries of peripheral nerves and myopathy.

Ups! I see it suddenly. HAUNCH anti-MPO 32 U/ml. We are going to open Google€¦

I look for €œHAUNCH emedicine€. It is an antibody anticytoplasm of neutr³filos, and one is in diverse vasculitis. , As not yet I have done it, the hour has arrived well search a classification of vasculitis. Probably it appears in an agenda or it guides educational, or I can consult it in the same source (book or Medscape). Thus I see the overview of the vasculitis.

** I realize of which already I am putting expensive the patient to him. Middle-aged woman, loaded of inhalers for the asthma, blowing one's nose a nose, already blushed, to each step. Also a brief attack of hiponcondr­a helps me, because I also have asthma and am middle-aged. I erase it of my mind. We follow.

I look for the Spanish Society of Rheumatology, and within its Web, the term €œvasculitis€. I am with an article for patients and I read it ( Perhaps you think that he is insufficient, but I know that it will give a general vision me that can facilitate the later study to me. In this entrance I spoke of the Learning book Medicine to you; in that book the authors recommend that the first reading of a subject is on a simple text.

Nonsubjects to have left you without studying the important data. It thinks what difficult is to follow a class in which they put much matter to you. You finish been annoying and without knowing very well what has explained to you. He is better to look at the first overview.

Of this text coat several data, because the fever, the asthenia and the loss of weight are habitual general symptoms of all vasculitis. There are about 11 types. They are classified according to the diameter of the affected glass, and by the histological type of inflammation (granulomatous or necrotizante). Diverse types are more frequent at different times of life. That is very well, because certainly the clinical cases of the examination contemplate the age of the patient. Kawasaki young and adolescent, very well€¦ Between the 40 and 60 years of life, where our patient enters, most frequent they are the following:
1-PAN (polyarteritis nodosums)
2-PAM (microscopic poliangeitis)
to 3-Buerger
4-Vasculitis de Churg-Strauss
to 5-Wegener
Primary 6-Vasculitis of the SNC

I can avoid number 6, since the symptoms of the patient are not of SNC. So vasculitis could mount a comparative table with the other 5, starting off of a general presentation of vasculitis in a middle-aged woman.

I do not forget the antibody HAUNCH to me. I am going search what is anti-MPO along with the term €œemedicine€.

I have several options, among them to know what is the HAUNCH anti-MPO directly at the entrance on Churg-Strauss. Very well, we go there€¦ (

€¦ To Me it says€¦ €œ[€¦] Churg-Strauss disease (CSD) is one of three important fibrinoid, necrotizing, inflammatory leukocytoclastic systemic small-vessel vasculitides that plows associated with antineutrophil cytoplasm antibodies (Haunches). Of these three conditions, Churg-Strauss disease is the least commonly encountered. The others plows Wegener granulomatosis (WG) and microscopic polyangiitis (MPA).€

Bond, brilliant! It is narrowed the wall. I can begin my comparative table putting the following thing:

Comparative table 1

Now I can put to me to fill up this table and so it finds in the webpage. In your case, it uses your notes or the book of reference that they have recommended to you to study.

It is probable that it must add columns according to are arising different clinical differences between vasculitis, because I have already read it in the page of the BEING: it costs much to distinguish between the different types and is necessary to consider factors as the diameter of the glass affection; affected organs; type of inflammation. So I can add these columns, and my group of comparative table for vasculitis will have this aspect:

Comparative table 2

Well€¦ before plunging me in each of these diseases, I am going to review the antibodies that were negative in the clinical case€¦ because if is specified that they are negative, I know that I will have to study them sooner or later. I can pass them to a separate table that I will be completing in successive sessions of study, and that would have this aspect:

Table autoanticuerpos


After filling up this table, I superficially read the description of the disease of Churg-Strauss. When I finish, they are the 17,56 hours. I have been 1 hour studying Reuma (who was going it to me to say at this point of my life€¦) and half an hour writing this entrance. I decide to finalize the experiment.



  1. I am happy for two reasons. First, because it has been to me funny. And second, because I have realized that I have made a session of ABP, that is to say, of Learning Based on Problems (Problem-Based Learning). It had desire to try of what it consisted.
  2. That the first serious reading on a part of the Rheumatology takes place on a clinical case has a benefit, and is that the imagination begins to put face and other physical characteristics to him to the patient, and therefore, to the disease. This can serve as help to the memory.
  3. My first contact with the Rheumatology took place more ago than 20 years, and I did not review it after the corresponding examination. Therefore this it is my second contact with the subject. In this first contact, that has lasted 1 hour, or I have put the vasculitis in a certain clinical context (general symptoms), I know in broad strokes what criteria serve to classify them (type of affected glass, organs, histology), I have learned the 5-6 name related types of vasculitis to each other by the age rank in which they appear, and I have remained in the memory with 3 vasculitis that present antibodies ANCA-MPO, being the one that this behind schedule disease of Churg-Strauss has occupied me, which or I know that it makes debut with respiratory symptoms in successive buds, presents eosinofilia, high levels of IgE, and other things that I do not write down here because this is not a blog of Rheumatology and I do not want to coil itself more;). He is not bad for 1 hour of study, no?


1. He chooses subjects on which the examination is based to a large extent on responding questions on clinical cases.

2. He reunites the clinical cases that they have exposed to you in Seminaries or practices.

3. Assure to you that you have clinical cases of all the important sections of the subject. Here the life can facilitate you to collaborate with 1 either the more friendly of class distributing the compilation to you of cases.

4. If you need clinical cases, she looks for in trustworthy sources and with basic-intermediate level, that is to say, that sets out clinical cases of the day to day, nonexceptions. Possible sources:

  • The magazine Clinical Medicine (Spanish) contains €œcl­nicopatol³gicas conferences€ that they are basically clinical cases apt for students of Degree. In this connection you can see an index of cases.
  • It asks the professors of the subject in what webpage of confidence or what magazine you can find cases apt for your level. In a fast search I am seeing cases of free access in the page. It can be sufficient to begin.
  • It asks the numbers of history of excellent clinical cases your tutor of practices in your hospital.

5. The USA the clinical cases for the first return in the study of the subject. In the second return, it consolidates knowledge and it reviews schemes.


It proves this method during 1 week. Only with 1 of your subjects. It spends some 2 hours between sessions of conventional study with another subject whose examination is programmed before in the calendar.

Thus you do not have much to lose. If it does not work, you return to the conventional study to the following week. Perhaps but you are surprised€¦ perhaps you begin to amuse itself€¦

€¦ because you are going to learn and you will discover that you are not wasting the time.


Almudena Trinidad

I am otorrinolaring³loga doctor in a hospital of Madrid and Professor Asociada de Medicina in the UAM. I help Medicine students to develop more effective techniques of study to obtain better notes, to remember during more time and to feel like more happy insurances and with its studies.

  • Marian
    Published to 17:31 h, 16 December To respond

    With regard to this entrance, the invitation has arrived today at the institutional mail from the university to the Is Days of Learning Based on problems ( you can here find the information) and I have thought about leaving it this way in case it was of the interest of somebody or in case you have interest in giving diffusion him.
    A greeting and thanks for the blog again.

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