FoCP week 6: Musculoskeletal System and Dermatology

What would have been a long week ended up appearing pretty short for me because I didn't attend the sessions on Monday because I fell ill with a slight fever and cold. Thanks to the rain the entire weekend, I woke up Monday morning feeling a lil' heavy in my head and what with my sneezing every five seconds that I've been going through even during the weekend, I decided that it wasn't conducive for me to go to the hospital. Plus, it would be very irresnponsible of me to expose my fellow coursemates and potential patients that I was suppossed to see to a variety of germs. (It turned out I wasn't the only one absent on Monday and as the week progressed, more and more of my coursemates came down with variations of flu and cold and fever. The weekend was really aweful!)

Having said that, the week proved very compact with a lot of things to be learnt and practised seeing as it combined both the musculoskeletal system and dermatology. While there wasn't much to cover in dermatology, the musculoskeletal system proved a tad harder seeing as there were lotsa joints to be examined.

Back in my second year, I found orthopaedic pretty interesting because it was pretty much in the physical spectrum of medicine. Unlike the respiratory and cardiovascular systems where one has to use the stethoscope to examine the lungs and the heart that lie internally, orthopaedic centres around arms and legs, all of which the functions (and dysfunctions) can be easily elicited with just moving them around. In the easiest sense, orthopaedic is pretty simple and straightforward and the way I see it, it makes more sense because if there's anything wrong, I could see it the problem with my naked eyes and thus I'm actually considering a career in it.

Its simplicity has led to many jokes being made about orthopaedic surgeons and common ones are: 'huge in the arms, small in the head' and 'hands the size of a gorilla's with the intelligent to match'. Having said that, there's more to medicine than simply having a good brain to remember all the complicated stuff. An essential part of medicine is about helping the patient without causing more pain and you'd find that bit really hard in orthopaedics.

While I found it easy to perform the examination on my young and healthy friends back in my second year, it certainly wasn't easy to examine a patient's joints without causing them any pain as I had to pull and tug at the patient's arms and legs to assess the stability of the tendons and ligaments. To make things harder, most orthopaedic patients brought in during that week were older people in their 60s and 70s who already had arthritis and its variations. In the end, all of us, moi included, ended up not using all our strength in pulling and tugging at our patients' legs and arms. Like seriously, we all felt really bad to see our patients grimacing at even the slightest touch. I mean, it's kinda cruel to use a full force on a crippled granny half my size!

Other than that, the challenge in orthopaedic lied in remembering the list of things to do in the physical examination itself because with two arms and legs, we'd then have to deal with twice the number of muscles and bones and joints to assess.

Dermatology, on the other hand, was pretty mild. Aside from learning about several common skin diseases and how to differentiate one from the other, it was pretty straighforward. My only problem with dermatalogy was (still is) the gross photos of rashes and lesions I had to put up with. Here are some examples for your enjoyment:


Lupus



very classic psoriasis - a patch of well-defined redness (or erythematous, dermatologists love this fancy word =p) with silvery scales



eczema - a patch of redness with ill-defined border



basal cell carcinoma - a type of cell cancer presenting with a raised papule with rolled edge and shiny pearly top...less dangerous because it doesn't metastasise (and that means 'spread')

actinic keratosis - pretty benign but has tendency to become neoplastic (cancerous)



Bowen's disease - tend to develop from actinic keratosis before worsening to become squamous cell carcinoma



squamous cell carcinoma - ulcerated and very malignant as it can metastasise



melanocytic naevi - just a fancy name for your common mole



malignant melanoma - pay attention to your moles. if any starts to grow bigger and become raised and irregular, rush to your dermatology. malignant melanoma can metastasise!

All skin cancers have increased prevalence in those with excessive exposure to the sun but lucky for Asians, the risk is pretty low. I guess living under the sun for generations helps getting the skin accustomed to the damaging rays. Natural selection is not just a dream of Darwin's. The risk is only higher for those with skin type I; fair-skinned, blonde hair, blue eyes; caucasians to be exact! Finally, here's a collection of diseases where being an Asian doesn't pose much risk, yay!!!

Learning the pathology aside, something worth nothing was how difficult it was for patients with skin conditions to get about with their social lifestyle. Not only having scaly lesions and rashes on their faces endeared them less to the society, having the conditions made it hard for them to keep their jobs. One patient I met was sent to work in the cellar after his Lupus caused him to have a butterfly-shaped red patch on his face thus making him less presentable to work at the reception counter in a hotel. When his rashes started to spread, he ended up having to just stay at home and not being able to join his two sons doing physical activities like swimming at a public pool. To add salt to injury, the sorts of ointment or cream they'd need to apply to heal those rashes were either really smelly, or would leave stains on their clothes, or both.

Anyway, that was all there ever was in the week. No weird patients trying to hide their conditions or old women offering me to show her breasts. Not a bad week but yeah, I still favour orthopaedic more than dermatology.