Posts tagged discussion

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I have been very busy over the past few weeks and have since had a amassed a pack of questions in my inbox waiting to be answered. This is about the first half of the questions that I have. The remainder will follow in a subsequent mailbag. I apologize for the delay.

Exercise: Superpowers

I was recently asked a similar question during an interview and I think it would be a fun exercise for everyone to switch gears and let your creativity run wild. Leave your answer below or in the comments section.

If you could be a superhero, what superpower would you have?

Exercise: Describe Yourself

I was reviewing some practice interview questions and one question caught my eye. I thought it was simple but challenging, interesting enough a question for the readers to ponder. Leave your answers below or in the comments section.

Q: If your friends were to describe you, what five words would they use?

Question-asker, another opinion: your med student girlfriend probably does enough medicine at school, and would appreciate a non-medical gift! Something to read, a way to relax, a weekend away, a nice meal... — Asked by drosometer

That is probably a good point. A little reprieve from medicine is always a nice touch. You really can go both ways on this.

(With regards to this question).

Reader Responses: If You Were A Doctor.
So after a hundred responses, I categorized everyone’s answers into the following chart. It would appear that most readers want to be some sort of surgeon or internal medicine sub-specialist.
I wanted to take a moment to discuss surgery, not to dissuade but to inform, as it was slowly dawned on us as we entered medical school.
Throughout the country, surgery appears to be the leading career interest for medical students. There is however a growing discrepancy between the number of graduate surgeons we produce and the number of positions that are available. Part of the reason is the economic downturn and the delayed retirement of surgeons; other contributors include the issues of expanded surgery residencies and even political factors. When 30 surgeons must compete for a single position, that is a serious problem.
For many, the salvation is in doing locums for established physicians or to pursue fellowships to brave the drought. The dwindling positions only became a evident within the last few years, long before the current batch of residents would have graduated.
Perhaps in a few more years, the field will open up again. Only time will tell. For now, the reality does not conform with expectation.
As one surgeon described it to me: “The golden age to be a surgeon has passed.”

Reader Responses: If You Were A Doctor.

So after a hundred responses, I categorized everyone’s answers into the following chart. It would appear that most readers want to be some sort of surgeon or internal medicine sub-specialist.

I wanted to take a moment to discuss surgery, not to dissuade but to inform, as it was slowly dawned on us as we entered medical school.

Throughout the country, surgery appears to be the leading career interest for medical students. There is however a growing discrepancy between the number of graduate surgeons we produce and the number of positions that are available. Part of the reason is the economic downturn and the delayed retirement of surgeons; other contributors include the issues of expanded surgery residencies and even political factors. When 30 surgeons must compete for a single position, that is a serious problem.

For many, the salvation is in doing locums for established physicians or to pursue fellowships to brave the drought. The dwindling positions only became a evident within the last few years, long before the current batch of residents would have graduated.

Perhaps in a few more years, the field will open up again. Only time will tell. For now, the reality does not conform with expectation.

As one surgeon described it to me: “The golden age to be a surgeon has passed.”

If You Were A Doctor…

I have been asked many times what sort of career I am pursuing but I have never posed the question to the readers. I would be interested to know what sort of aspirations you have (or for those already in a specialty, your what-if-alternate-universe options). Thus:

If you were a doctor, what kind of doctor would you be?

Unilateral Right Pulmonary Artery Agenesis with Hypoplastic Right Lung.
The diagnosis of the radiographic case is the above. There is an absence of the pulmonary artery due to involution of the proximal embryologic sixth aortic arch and persistent connection of the intrapulmonary artery to the distal sixth aortic arch.
When the ductus arteriosus closes after birth, the intrapulmonary artery loses its blood supply and diminishes in size. As a result, new collateral blood flow is formed to reperfuse the lung. However, due to decreased blood supply, the lung becomes hypoplastic over time. The heart, which usually sits in the mediastinum, sandwiched between the two lungs, grows into the space formed by the smaller lung, shifting laterally and posteriorly.

These patients are typically asymptomatic with nonspecific signs and symptoms presenting in their adolescent years including recurrent respiratory tract infections, dyspnea, and hemoptysis. Others may develop pulmonary artery hypertension, pulmonary hemorrhage, or heart failure.
Many of the responses considered pneumothorax based on the mediastinal shift. In that circumstance, we would see an absence of lung markings where the lung has collapsed. While sometimes the collapse can be very small and difficult to see on x-ray, a mediastinal shift in those cases would not be as marked as the one portrayed. His clinical history and presentation is also not typical.

Unilateral Right Pulmonary Artery Agenesis with Hypoplastic Right Lung.

The diagnosis of the radiographic case is the above. There is an absence of the pulmonary artery due to involution of the proximal embryologic sixth aortic arch and persistent connection of the intrapulmonary artery to the distal sixth aortic arch.

When the ductus arteriosus closes after birth, the intrapulmonary artery loses its blood supply and diminishes in size. As a result, new collateral blood flow is formed to reperfuse the lung. However, due to decreased blood supply, the lung becomes hypoplastic over time. The heart, which usually sits in the mediastinum, sandwiched between the two lungs, grows into the space formed by the smaller lung, shifting laterally and posteriorly.

These patients are typically asymptomatic with nonspecific signs and symptoms presenting in their adolescent years including recurrent respiratory tract infections, dyspnea, and hemoptysis. Others may develop pulmonary artery hypertension, pulmonary hemorrhage, or heart failure.

Many of the responses considered pneumothorax based on the mediastinal shift. In that circumstance, we would see an absence of lung markings where the lung has collapsed. While sometimes the collapse can be very small and difficult to see on x-ray, a mediastinal shift in those cases would not be as marked as the one portrayed. His clinical history and presentation is also not typical.

A radiographic case continued.
The physician gets a look at the lateral x-ray and sees the above image. He asks the patient about breathing or heart troubles in the past that could account for the incongruence of how well the patient looks and what was visible on the x-ray. The patient shrugs it off and says that he does often become short of breath on over exertion and gets colds more frequently. He acknowledges that he knows that his chest x-rays are different and that it has been there for most if not all of his life. “I just live with it.” He is not alarmed by what the physician shows him.
In light of this, what your thoughts on what this incidental finding is?

A radiographic case continued.

The physician gets a look at the lateral x-ray and sees the above image. He asks the patient about breathing or heart troubles in the past that could account for the incongruence of how well the patient looks and what was visible on the x-ray. The patient shrugs it off and says that he does often become short of breath on over exertion and gets colds more frequently. He acknowledges that he knows that his chest x-rays are different and that it has been there for most if not all of his life. “I just live with it.” He is not alarmed by what the physician shows him.

In light of this, what your thoughts on what this incidental finding is?