Comparative tables. Technique of study 3/8.

A frequent Medicine complaint is difficult that it turns out to retain the differences, the sometimes small thing, that is between a disease and another one. This happens generally within a same subject or organic system, that is as the agenda in many faculties usually is organized. I suppose that this will happen in other sanitary and nonsanitary races. Whenever there is to study similar phenomena, this difficulty will appear.

We are going to put an example with a subject that I know well, the Otolaryngology. Many think that he is simple to study it and in addition has less credits than other subjects. But when finally you feel to study, it is possible that you begin to notice strange things in certain subjects. For example, the average otitis. Ah, what easy the acute average otitis. Inflammation, pain, fever, a classic one as so many things finished in €œ- itis€. Later the serous otitis come. Simple also. Nonpurulent snot, hipoacusia. Aha, it is easy, the acute one hurts, the serous one not€¦ except for sometimes.

Next the chronic average otitis. A little while, before you have read that the serous otitis can last a few days, but also several weeks and until months. You reread it. Well, clarified, a serous otitis can be chronic. But, a little while€¦ two are types of chronic average otitis, the simple one and does the colesteatomatosa€¦ Perforations€¦ seem that the serous otitis are differences according to the perforated zone of the membrane€¦ is perforated? No, because€¦ the cholesteatoma does not attend with hipoacusia chronic. Just as the serous one. I return to read. €œUm, I am going to mark it to again review it before the examination€, you think.

If you do not study in time, the crisis is served.

WHERE IT IS THE MENTAL FAILURE?

When you say that it costs to you to retain shades on differences between similar diseases, in fact what it happens is that you are not dedicating sufficient attention to him to those differences and you entertain yourself in the similarities. In clinical subjects it is fundamental to learn to compare diseases to each other, in what they look like and what are different.

Ever since I began the residence, I knew this clearly one of a way intuitive. Before, as student, it suffered trying to memorise and to remember details of each disease and being failed sometimes. Although the notes would be saved, everything forgot to me immediately and was very frustrating.

In 2012 I discovered the solution to this problem in a course online gratuitous, and nevertheless very valuable. This MOOC continues offering itself in Coursera and you can look around envelope he in this connection. Unfortunately, to date of 31 of May of 2015 it does not have summoned more editions of the course, perhaps but they let to you look at the material if you register yourself in the page.

SOLUTION: PONLE EASY TO YOUR MIND COMPARING AND TO CONTRAST

In this course I learned things of common sense, but, what peculiar, things that you do not bring to bring back to consciousness until somebody explains them to you.

The books normally set out each disease to you linearly: name €“ concept €“ epidemiology €“ physiopathology €“ natural history €“ clinical €“ diagnostic tests €“ treatment. The classes are also organized linearly.

The subject begins. Review of physiology and semiotics, and in a few classes, diseases. With the first organization you clarify yourself, with second also. From third, you begin to have certain confusion. Thus one behind another one. If you have several similar diseases to each other, you end up mixing data.

The key is in extracting, of the linear presentation, the information to emphasize, and to construct a typical profile of disease. To learn to read as an expert:

  1. Epidemiology: To what type of person affects: young, women, old, men? smokings, hypertensive?
  2. What temporary evolution has: acute, subacute, chronic, appellant, episodic?
  3. Clinic: what TYPICAL symptoms and signs have, and what don't typical symptoms and signs HAVE?
  4. Physiopathological mechanisms

An expert is taking care of a patient and he does not think €œHas hipoacusia without pain and the free conduit, this is a serous otitis€. It is more probable that This patient thinks €œhas a problem of average ear, and I must make specific which is€, and begins to think about parallel, whereas clause different diseases, looking for most probable and thinking what must make to confirm the diagnosis.

The patients usually go counting a set of symptoms that aim towards a concrete syndrome, or a main symptom. Between the causes he can have multiple diseases. On that will ask you in the examination.

HOW I ORGANIZE THE INFORMATION TO LEARN WITH MORE FACILITY?

The information must be placed in a table comparing each disease with other 2 or 3 similar ones with which there is to make the diagnosis differential.

Syndrome Epidemiology Temporary evolution Typical clinic
Disease 1
Disease 2
Disease 3

Another example with otorrino: acute faring­tico syndrome. The patient has pain throat in rest and when swallowing, and dysphagia. In the examinations it is necessary to know how to distinguish the estreptoc³cica cause of the viral inespec­fica and mononucleosis, because in real life, the estreptoc³cica bacterial tonsilitis requires antibiotic, but in mononucleosis the antibiotic can cause a cutaneous eruption to you. And in inespec­fica viral pharyngitis he does not have to occur antibiotic (it is political question of MIR and of rational antibiotic use).

How we compared these 3 diseases, the 3 causes of acute faring­tico syndrome? Removing data from the text, but typical data, and placing them thus:

Acute pharyngitis Epidemiology Temporary evolution Typical clinic
Estreptoc³cica tonsilitis Children 5-15 years Acute · Without previous rhinitis· Fiebre>38º· Plates pus (criteria of Centor)· High jugular adenopathies
Inespec­fica viral pharyngitis (catarrhal) Children and adults Acute · He associates rhinitis, cough, that is to say, cold generally· He can not have fever
Glandular fever Young adolescents and adults Acute and subacute · Tonsilitis with plates that can imitate the bacterial one· Hepatomegaly!

· Esplenomegalia!

· Multiple, typical adenopathies in later cervical triangle

· Fatigue, general affectation

 

In this extraction of typical data it is where the hard part of the study is placed, but the benefit that brings is that it helps you to memorise data, to begin to relate them to each other and to be resisting time and time again the typical characteristics of each disease. Of this table already extractions the following details: multiple adenopathies and in later cervical triangle? Mononucleosis. Symptoms without previous cold? streptococcus. Extreme Fatigue? Mononucleosis. You are focusing attention on the differences. The similarities already you know them, pain throat and general malaise. It is not necessary to review it.

It is that an adult cannot have a estreptoc³cica tonsilitis? Yes, clearly, but he is not the typical thing. In the adults, 90% of the faringoamigdalitis are viral. And in the children, 60%. In real life, it is necessary to think first about the typical thing. Only later, if some data do not square, in the infrequent thing. But they put a clinical case to you in the examination of estreptoc³cica faringoamigdalitis, is easier that it is in a boy. The students we must ask the typical thing to them, not infrequent it.

You can make tables to each other comparing more diseases, but 3-4 is recommended at the most to work in a single sitting. In the example of the acute faring­tico syndrome, you can make another table comparing the typical data of inespec­fica viral pharyngitis with the primoinfecci³n by HIV and mononucleosis; another table comparing estreptoc³cica, bacterial tonsilitis nonestreptoc³cica, and Plaut-Vincent; and so on.

To the tables you can add columns with the physiopathology, the complementary tests and the treatment. But it spends your time in selecting similarities, next typical data and later differences.

WHAT SEEMS TO YOU THIS TECHNIQUE? ALREADY YOU USED IT IN YOUR STUDIES? WHAT RESULTS GIVE YOU?

IT LEAVES YOUR IMPRESSION IN THE COMMENTARIES

Other entrances on study techniques:

Almudena Trinidad
almudena@hshanemd.net

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.

2 Commentaries
  • Marina
    Published to 15:41 h, 30 July To respond

    Hello!
    Itself your blog, but never had decided to me to write a commentary.
    Advice seem to me some very practitioners, and now that I begin the clinical courses of the race, this one in particular seems to me very very useful, I will nothing else put it in practice to begin 😉
    Thank you very much by your work. I know that you are professor in the UAM and to remove time to write these advice says much on you.
    A greeting.

    • Almudena Trinidad
      Published to 09:55 h, 01 August To respond

      Hello, Navy!
      Thank you very much by your words of praise. I am convinced that it is going to help much the technique to you of the tables, during the race and later. it has helped me much already of associate.
      I have liked much your blog. It sounded to me of name but it had not read it. You have a great empathy, that is fundamental to be good professional. And much grace has done me who you think exactly just as I of the Robbins and the Sisinio, 25 years after I attended 3º of race. The Robbins was my favourite book.
      You do not lose of view the blog, because around summer home my challenge to number one, also the challenge of the students: to take it to the day and to publish every week in him. If with himself, I will know how to teach to a student to take his subjects to the day. 😉

      A greeting and until soon.

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