Written Communication Section Example Questions

(This is copied word for word from the GAMSAT paper I have, my camera is being a douche today)

Task A

Consider the following comments and develop a piece of writing in response to one or more of them.

Your writing will be judged on the quality of your response to the theme, how well you organise and present your point of view, and how effectively you express yourself.

Comment 1
Riches are not and end of life, but an instrument of life.
Henry Ward Beecher

Comment 2
That some should be rich, shows that others may become rich, and, hence, is just encouragement to industry and enterprise.
Abraham Lincoln 

Comment 3
Few rich men own their property. The property owns them
R.Ingersoll

Comment 4
He who knows how to be poor knows everything
Jules Michelet

Comment 5
Wealth is not of necessity a curse, nor poverty a blessing. Wholesome and easy abundance is better than either extreme; better for our manhood that we have enough for daily comfort, enough for culture, for hospitality, for charity.
R.D.Hitchcock. 

Struggling!

AAAAAHHHH

I have been really struggling with motivation for revision this week so sorry about the lack of posts, but I double promise to update them every day now!

Being a doctor is all I have every wanted to do, and I wont stop, EVER,  but after finishing exam period at uni, and coming home to stay with the family over the summer holidays, Im just finding it hard to get back into the hardcore revision mood again.

This week I have been focusing on the Written Communication section of the GAMSAT.
I did study English Literature at A-Level and that has given me a good grounding in how to structure and write essays; and my Dad would describe me as pretty opinionated, and I LOVE to have a good debate!

What Have I Been Doing? 

I have been going through some themes, and then coming up with points, evidence to back my points up, and learning some quotations about really broad themes that I could tweak a little and potentially use in most essays.
Just a little thing I learnt in school like years and years and years ago was to
PEE ALL OVER THE PAGE

Point - make your point
Evidence - provide an example and evidence to back up that point
Explanation - explain what the evidence proves

(Yeah I know it is super simple!)

I thought it might be helpful in structuring the paragraphs in the essays, incase you have a lot of ideas, this will force you to adapt a strict structure to follow in the exam, as you do not have a lot of time!

So far some of the issues I've been essay writing on are:

The inevitability of death - lovely I know, but it's  good topic to really let you get your deep thinking cap on.
Wealth and Riches - the whole, can money make you happy, obsession of wealth and riches etc.

GAMSAT Revision - Physics

I have just finished the Physics section of my revision for the GAMSAT!
Bearing in mind the last time I studied physics was at GCSE level, for those of you reading and not from the UK that is when I was 16! So a good 4 years ago and the level of Physics they say they expect is A-Level.

Here is an overview of the topics that I have covered for the GAMSAT, when I say covered I mean a basic understanding and being able to use the equations associated, as well as doing practice problems for each of them:

Motion - Including Newtion's Laws of Motion
Velocity, Distance, Speed equations
Change in velocity equations and problems
Distance time graphs and how to use them to solve problems

Centripetal acceleration - understanding what it is, what forces effect it, and equations
F=MA 
Tension
SOHCAHTOA - comes in handy for physics problems
Forces on an inclined plane - perpendicular and parallel forces

Work and Energy
Work, Force, Distance triangle
Momentum and its conservation
Gravitational Acceleration
Torque, Force, Distance Equation
Springs - Hookes Law and equations
Harmonic Motion

Fluids - volume of fluid displaced, column of water problems
Density of fluids
Static fluid pressure
Thermodynamics
Magnetism - Coulomb, forces between 2 charges
Electrostatics - Calculating the electric field at a certain point and equations

Circuits - and their components, Ohms Law
Voltage
Capacitance - Calculating the capacitance of a capacitor, charge density, strength of a field
Resistors - in parallel and in series
Joules Law

Waves - properties of different waves, velocity, frequency, wavelength equations
Different types of waves
Construct interference and Destructive interference
Relationships between frequency and wavelength
Diffraction
Dopler Effect and equations
Refraction and Reflection

Radioactive decay - different types and what happens in each of them
Half Life


Bit of a dry post there! :( But I just thought I would write an exhaustive list of what I had covered incase you had no idea where to begin! Oh and all this took me about 2 weeks, on and off revision, not consistent at all because I hate physics!

Now onto chemistry! HUZZAH

Last Day of Work Experience! :(

I've just had my day of work experience at the surgery today! :( Nooooo! :( The Dr I've been shadowing has written me a lovely reference letter for me to add to my work experience record that I will need for my interview for Nottingham med school.

I'll just give you an overview of some of the more interesting cases that I've seen in my last few days:

1- Patient came in with a BAKERS CYST, which is where the joint capsule of the knee joint can burst out into the space behind a knee, with the patient presenting with a large cyst behind the knee. It may be caused by an injury from playing sport or rheumatoid arthritis.
Treatment was undertaken at the local hospital where the cyst was drained using an ultrasounds guided needle as there are major arteries located behind the knee. A steroid was also injected into the knee to provide relief from swelling.






2- It may seem like a boring one but I have never ever actually seen GOUT in a patient before! This elderly came in with gout of the finger! It was looking very swollen and you were able to see yellow crystals underneath the skin. These were uric acid that had crystallized under the skin are are formed under certain conditions such as heat and dehydration which will effect the way the body metabolizes uric acid.




3- a 43 year old overweight  male came into the surgery because he wanted to get checked over after an incidence he had on Tuesday afternoon. He said he had been walking his dog and he suddenly got really severe heart burn that radiated down his arm and shoulder and into the back of his throat. When the Dr asked him to described the pain he described it as "dull and heavy" and that was was "sweating buckets", the patient also had to take the following day off work because he was exhausted. The episode lasted for 10 minutes and the patient was convinced it was just bad heartburn.
BUT, from the patients history, smoker, obese and with a family history of heart attacks, and the description of the pain, dull, heavy on the chest radiating down his arm chest and shoulder, I thought the patient had suffered a heart attack and not realized.
The patient was sent for an urgent ECG in the next room and his ECG showed an ST ELEVATION, which is where the ST segment of the heart activity is abnormally high and is a sign of a heart attack, the T wave was also inverted, which is a sign that the Bundle of Hiss down the center of the heart has been damaged.
We had to straight away send the patient in an ambulance to hospital for an urgent angiogram to locate and treat the blockage in the heart!
IT WAS SUPER COOL

Image 2 shows a ST elevation
Image 5 shows a T wave depression 

An Afternoon in Minor Ops

Now I wouldn't consider myself squeamish at all, I love a bit of blood, guts and pussy wounds, but when it comes to skin things, and skin tags and peeling skin, I feeling like vomiting. So it was my lucky day when I got to observe Minor Ops and all the delights of removing bits of skin haha!

Even though I wanted to vom, it was actually really interesting to watch, and I guess I got used to little bits of skin towards the end!

The majority of the cases in minor ops were the removal of a SEBORRHEIC KERATOSES, which is basically a non cancerous growth of the skin, the skin may have suffered a trauma or infection, causing the body to heal itself, and in the process the body may have produced a little bit too much skin, and so causing this little crusty lump on the surface of the skin. They tend to be removed when they irritate the patient, so if they catch on their clothes, and more commonly in women underneath the bra strap.

Here is a step by step of how the little lump was removed:

1- Inject the site with local anesthetic. The local anesthetic may sometimes be mixed with adrenaline, to prevent excessive bleeding from that area. You can clearly see the effect of the adrenaline on the skin because it blanches the skin (leaves a little white patch).

2- The lump of skin is scraped off using a curette, which is a surgical instrument used for scraping biological tissue. It is a little hand tool with a circular blade.

3- The wound is then cauterized using a hot needle to prevent the skin from re-growing and to stop the bleeding. The smell of burning flesh is horrid by the way! It stinks!

4- Vaseline and a dressing are applied to the wound - all sorted! Above is an example of one! (yums)


The second most common thing that came into minor ops were little round scars that needed to be removed because they bleed when they are caught and itch. This patient had a nice little round scar on her leg, that kind of looked like a little wart, but wasn't.
The process was different to the removal of the keratoses, and involved stitches!

1-The site was injected with local anesthetic.

2- The scar was then removed using a scalpel, ensuring to cut along the skin creases. If you were to cut against the skin crease the skin might not heal as well. 2 incisions were made on either side of the scar and the scar was then lifted up off the skin and cut away!

3- The wound was then stitched up using 6 stitches. It may seem unsual to have so many stitches for such a little wound, but due to the pressure in the legs from constantly standing etc, the skin as to be pulled as tight and as close together as possible or the wound may leak!

4- The patient was advised to rest the leg for a good 48 hours to ensure it healed properly.



So all in all a really interesting day, which as helped me to slightly get over my fear of pulling bits of skin off! Although I think I might feel different when I'm doing it myself, just watching other people do it makes me feel funny!

More Summer Work Experience

Just a quick post about getting summer work experience.
I've literally just got an e-mail saying my interview for volunteering at a hospice went well and I can start in 2 weeks time! :) One of the resident Dr's that works there actually offered to have me shadow her and the rest of the doctors because I'm nearly a graduate and a bit older than a lot of the students that apply for work experience (the students that have just finished A-Levels).
So it is definitely worth send an e-mail to any local hospices in your area to see if they take on students for work experience! I'm sure volunteering in a hospice will be challenging and upsetting at times but I will let you know how it goes! :)

Remember, don't give up on getting work experience! Even if you are unable to get work experience shadowing a GP etc, it's not the end of the world, try your hand at befriending the elderly or young adults with learning difficulties, this will show the medical schools you can communicate effectively even in challenging circumstances. Look for any dementia day care centres that run arts and crafts sessions, or memory cafe's that need helpers.
The medical school want to see you have some kind of understanding  how challenging a medical career can be, and that you have tried a wide range of volunteering roles, not that you have just observed a GP.

Chronic Pain - How Do You Treat It?

There have been a few patients over the past few weeks come in with a complaint of chronic pain, wether it be all over the body, chronic neck pain or chronic headaches. The problem is how do you treat a pain that has no real cause?! (or one that we cant observe).

Patient A
Has had chronic headaches that last from 30seconds to 5 minutes that are felt around the temple region. A common cause of headaches is neck pain, however it's not the case here.
 It could be Temporal Arthritis, which is an inflammatory disease of the blood vessels involving the large arteries of the head, but the patient did not have prominent temporal arteries on palpation of them.
So it was decided to prescribe the patient a drug to help with her chronic pain:

AMITRIPTYLINE - A drug that can be used for tension headaches, migraines and depression. Side effects include drowsiness and a dry mouth. But you would only take the drug at night due to it's sedating effects.

An interesting fact from the Dr - 99% of all headaches aren't brain tumours, and 90% of brain tumours don't present with headaches!


Patient B
Has suffered from chronic head, neck and shoulder pain for 15 years. She is currently taking

PREGABALIN - is an anticonvulsant drug as well as being used for neuropathic pain, and has been shown to be effective in treating chronic pain such as fibromyalgia. Side effects may include dizziness and drowsiness in some patients.
 The patient has found that it hasn't cured her pain, just taken the edge off it.
So it was decided to change her treatment and try a different drug, this time it was DUALOXETINE, the patient will be slowly weened off Pregabalin over a week and then start taking the new drug to see if it helps! :)

Cutting Down On Unnecessary GP Appointments

From what I have seen during my work experience, GP's are under a lot of pressure a lot of time time, from consultants, to nurses and patients wanting time to speak to their GP. Many of the patients that have booked an appointment to see the GP have sometimes, not reeeally needed one. They just wanted to talk to the GP for reassurance, which is where the social and communication side of being a GP.
But in order to cut down on certain appointments, such as just coming in to have you BP taken, the surgery have bought out a new self check BP machine, where you pop in whenever you want, take 3 readings 2 minutes apart and hand your readings into reception, which will then go onto your record. If your BP needs attention (too high or low) then you will then be booked in to see the GP to discuss further options!






















So I thought I would try it out on my break, the staff call it the cows backside, because it looks like your helping a cow give birth :)

There's the machine on the left and my 3 readings on the right which aren't to shabby!

Two Days with the Phlebotomist

I spent Thursday and Friday of this week doing something a bit different form observing Dr B and spent 2 days with with phlebotomist (she was so lovely!).
Basically she runs the clinic and people just come in for bloods all day long! Before I started I had the opinion, "oh I can only watch blood being taken so many times!", I was wroong and I learnt some handy tips about taking blood!

A phlebotomist is a support worker or healthcare assistant (HCA) who collect blood from patients for examination in the lab. 

Things and Tips

• It is surprising how many patients come in with a huge phobia of needles and having blood taken. The blood taking process lasts no longer than 30-60 seconds, depending on how much you need to collect. Patients always say they have had a bad previous experience with having blood taken, and have had nurses that have been rough, left bruises and left them with a really negative experience. A lot of patients also don't like the "idea" of a piece of metal being inserted into their body. But Hannah (the nurse) pointed out that you need to focus the patient on the positives of the blood taking process, such as after it's finished and your chatting away and it wasn't really that bad etc. Otherwise they will just carry on being petrified of needles!
• As a doctor you don't receive a great deal of training in terms of taking blood, so be proactive and take some time to shadow a phlebotomist for the day and improve your blood taking skills.
• Feel for the veins, don't just go for the ones that you can see. Hannah said practice feeling and bouncing and rocking the veins for some fat juicy ones. 
• Problems you face taking blood: the elderly, who's veins have lost their elasticity, they have fragile, weak veins, arthritis may mean they cannot fully extend their arm for locating available veins. 
• Practice makes perfect! 

Now I'm at home practicing feeling my mums veins! 

GAMSAT Example Questions

Sorry about the lack of posts over the past few days, I've been a busy bee! Anyways, I managed to get my hands on some sneaky GAMSAT mock papers and I thought I'd show you what kind of questions you will encounter in the exam. 

 In case you cant read the text:
Newspaper reads: Labour to end something for nothing culture
Caption reads: Don't panic man, they're talking about the unemployed.

Q- The illustration above suggests which of the following?
A-In the midst of movement and chaos, keep the stillness within you.
B- Workers are often paid peanuts.
C- There are people who get paid for doing almost nothing
D- Unemployment gives rise to labour movements.

The speech in the picture reads: " Screaming Eyeball was a good movie but Bludgeon of Death was a great movie".

Q- The joke in this cartoon arises from the speaker
A- comparing good and great films
B- attempting to compare such different films
C- not seeing a greater difference between the films
D- expressing admiration for such bloodthirsty films

I'll post the answers if you somebody leaves a comment asking for them! :) 

Question to My GP - Why Did You Want To Be a Doctor?

It's a biggun - this question will be in your medical school interview, and people will ask you all the time!

WHY DO/DID YOU WANT TO BECOME A DOCTOR? WHY NOT ANY OTHER HEALTHCARE PROFESSION? 

Everyone will have their own reasons of course but I asked this question to the GP I am shadowing and these are the points he came up with:

• He wanted the responsibility for the patients health and the long term relationships that you can build with patients. 
• He was more interested in the diagnostic side of medicine, using your brain to solve a case, rather than doing something like radiography where you are performing a task. He didn't want a task based job, he wanted one where he could use his brain more.  
• Medicine is a constant learning curve, you never ever stop learning new things.
• Not that being a doctor is a superior job compared to roles like a health care assistant, but things like taking bloods, etc just wasn't for him, he wanted a big more.
• As a doctor you receive the clinical training that nurses and other roles don't. 
• He also wanted to get involved in the teaching side of medicine

Another question you might be asked in your interview is "Why not being a nurse?"

DO NOT SAY NEGATIVE THINGS ABOUT NURSES

It takes people with different levels of responsibility to work together to create effective teamwork in order to treat a patient. Also success and ambition mean different things to different people. Somebody might be more than happy taking bloods all day, or undertaking x-rays all day and thats fine! But you might want more, and thats fine as well, you should respect that fact everyones idea of success, job satisfaction etc are different. 

Some Interesting Cases in the Surgery!

Another day of GP shadowing today and I saw some pretty interesting things!


1- Potential Bladder Cancer Case  80 year old male presented with blood in urine, although there was no more visible blood in the urine today, a dip stick test showed that the urine sample was full of microscopic blood drops.
Diagnosis depends on the patients age sometimes:
Somebody of my age (20's) = they would want to exclude infection first
Somebody 50-60+ = You would want to rule out any chance of bladder cancer as it is easily treatable when caught early. The patient presented with 2 kidney stones but they were non obstructive, so the patient was referred for a cystoscopy, which involves passing a flexible camera down the end of the penis to view the bladder and see if there are any polyps on the bladder wall (done using local anaesthetic of course)
If anybody presented with blood in the urine, the first steps are to perform a blood test and an ultrasound of the bladder.

2-Lady With CRAZY High Blood Pressure  47 year old female had been taking blood pressure readings at home for years and failed to bring to the attention of her GP that her blood pressure was dangerously high.
We're talking 200/122! 
She is being seen weekly until her BP in under control.

3-Super Cool Fracture  Male patient came in today about his problems with fully emptying his bladder and problems with the flow of his urine, BUT the interesting things about this patient was that he has a permanently fractured odontoid peg that doctors discovered after he electrocuted himself on his boat a few years ago, and have said it is too risky to operate on.
You can see in the photo an x-ray of a patient with their mouth open and you can see the odontoid process quite clearly. The process is a projection of the axis and allows us to rotate our head.

4-Necrotic Toes 
80 year old female came in a few weeks ago after stubbing her toe, and the nurses thought it was a haematoma, so dressed her and sent her on her way. 2 weeks later the patient was back complaining that her toe wasn't healing, and on removal of the bandages it was very clear that the injured toe as well as the adjacent toe was necrotic. 
The nurses took her blood glucose just as an off chance and it came back as 22.4!! The lady confessed she hadn't been to the doctors in 13 years and that she had a terrible diet of chocolate and sweets, obviously she has developed type 2 diabetes but not presented with any usual symptoms and so went however many years with uncontrolled diabetes! The wound she sustained from stubbing her toe then obviously did not heal properly due to the decreased blood flow to the feet from the diabetes. The lady had both the toes amputated at the local hospital later that day. One of the major complications of diabetes is the development of PAD - peripheral artery disease, which is the blockage or narrowing of arteries, in particular the ones in the legs.
I wont upload a photo of necrosis, it aint pleasant!

Got Me Some Books!

While I was on Amazon ordering my UKCAT books I decided to order a few more books to help with med school bits and bobs:



Medical School Interviews - http://www.amazon.co.uk/Interviews-Questions-Analysed-Includes-Multiple-Mini-Interviews/dp/1905812051/ref=sr_1_2?ie=UTF8&qid=1372946398&sr=8-2&keywords=medical+school






Get Into Med School, Write the Perfect Personal Statement - http://www.amazon.co.uk/Get-into-Medical-School-statement/dp/1905812108/ref=sr_1_2?s=books&ie=UTF8&qid=1372946468&sr=1-2&keywords=get+into+medical+school




I shall you know if they are any good after I've had a read!

Work Experience Day 5 - Whats It Like Being a GP?

GP shadowing is going really well, with a huge variety of patients coming in everyday, but I'm just struggling with the 6am wake ups! I've been going to bed at 10pm (which is super early for me), and then when I get home at the end of the day I need an hour nap!

I also had a good chat with Dr B (Dr I'm shadowing), about the hardest parts about being a GP.

1-Patients expect you to know a lot about everything, compared to a specialist who only has to know a lot about their area.

2-The volume of work to do everyday, the lack of time, and the demands on you from nurses,social services and the hospital, if a patient is discharged from hospital because staff don't know whats wrong with them, they will go straight back to the GP, and a good proportion of people who come in with an appointment don't necessarily need one for medical reasons, they just want reassurance. Which is where the "social worker side of the job" comes in. 

3- The stresses on the GP's to take back working 24 hour shifts. Working 24 hour shifts were originally taken away from GP's, and in the Cornwall area given to a private group named SERCO, and now it turns out they are pretty poor and and government want to give the 24 hour shift back to GP's. Dr B said working from the early morning doing appointments, then doing visits and the huge amount of paperwork, then to go onto working nights you become exhausted and its not possible to work both days and nights. 

4-The demands from patients wanting resources. As a GP you cannot investigate everything because you cant afford to do so. You can't go ordering head scans and every test under the sun willy nilly, and GP's are also under pressure to save money (the NHS has to save £20billion this year).

 For example a 80 year old woman had been on long term drugs as a preventative measure against osteoporosis. The recommended duration of treatment is 5 years, but she has been on these drugs for 10 years and was wondering why she had suddenly been taken off them. Dr B explained the recommended duration but she wanted to go back on them, but she cant, not without good reason. She had already been on them for double the recommended duration, but we simply couldnt given them to her without good reason, and outside of the guidelines,  because it is expensive! Imagine if we put every post menopausal woman on preventative treatment for osteoporosis and to prevent fractures, that would cost thousands of pounds for every fracture you would save. 

Home Visits

Today was quite a sad day for home visits. We went to visit and elderly lady with schitzophrenia and end stage cancer of the gullet, she was not aware of her cancer diagnosis. Upon arrival she was all alone in the house, bed bound and extremely weak and pale. She said she has nurses come in 4 times a day to get her up and feed her, but apart from that she is basically laying bed bound in a dark room waiting to die. The reason for the visit was because her carer said she had fallen and hurt herself. But the patient had no recollection of the fall and was adamant that she didnt need anything else and was fine. (apart from being so weak she was able to move). And so myself and Dr B (after checking her over) had to leave because there was literally nothing we could do. There seemed to be no plan for her care, having her go into a nursing home would be so much better for her because at least she would get the company and the interaction with staff etc. But she literally spends all day laying in a dark room! :( Very upsetting today! 

GP Surgery Day 2 - An Elderly Population

Today I traveled down to one of the surgery's partner clinics in a tiny little village about 10 miles toward to coast in a very wealthy but to a part of Cornwall with a HUGE elderly population.
I sat in on consultations for most of the day as well as doing home visits to patients who were not able to make it to the surgery.

The surgery was tiiiiiny! It consisted of one consultation room, a tiny waiting room and a little dispensary as the town did not have one! (cute)

Few facts about today:

Average age = 72
Most Common Reason for Appointment = Arthritis, chest infection, heart issues and sore knees!
Procedure I Saw Most of Today = Cortisone steroid injections in the knee.
Most Prescribed Drug Today = Amoxicillin + Flucloxacillin
Youngest Patient = 62 female with sore knees after having both half knees replaced.
Oldest Patient = 98 year old man with a chest infection
Most Interesting Case = 77 year old male with an atrial flutter, which can been identified by a "saw tooth" looking pattern in an ECG trace

Example of a "saw tooth" pattern in ECG

The doctor supervising me mentioned that he hardly "cures" anything anymore, it is more managing the wear and tear seen in the elderly that come into the surgery, trying to manage their symptoms and pain.

Aaaaaannd on a negative note, I've managed NO revision today, been busy napping this evening.