A small percentage, a big problem (oh, and good news)

One of the most frustrating things in medicine are the tests that come back showing that a symptom can be one of two things. The first "thing" may be "sucky" but it won't kill you. The second "thing" is both "sucky" and can kill you. Hmmmm. There are diseases and situations in medicine that come up that are horrible to miss in a patient. An obvious example would be missing a heart attack in someone who shows up to the emergency room with chest pain. My example from today? A woman had sudden onset pleuritic chest pain, shortness of breath, and coughing. Later, she developed hemoptysis.

The two things at the top of my differential are: pneumonia (sucky) and pulmonary embolism (sucky and can kill you).

So, we order a chest xray. And what comes back? A pattern that could either be pneumonia or a pulmonary embolism. Sheesh. And, may I reiterate, missing a pulmonary embolism would be very ungood. The problem here is that the chance of pneumonia is MUCH higher than a pulmonary embolism. Statistically, this woman has a higher probability of having pneumonia. But since I can't rule out a pulmonary embolism, her higher probability isn't doing much for her right now.

I'll let you know what happens. The tests come back tomorrow.

Good news from me? I did pretty well on my USMLE Step 1. Not stellar, as in I won't get into plastic surgery (lucky for me I don't want to do face lifts all of the time). However, the score is pretty competitive. I wanted a 230.... But I got a 229. So close damn it! But, I am still happy with the score. Of course, a freaking 260 would have been awesome, but you know, not many people ever are able to score that high.

In case you are curious, below is a graph of fourth year students from 2007 who matched (matching just means that the students were placed into that specialty) into different fields and what their Step 1 scores were. The numbers on the graph represent the median score of those who matched into that specialty. The bars represent the two middle quartiles. The two extreme quartiles were excluded from the graph. (yes, the graph looks like crap... Click here for the link to the original .pdf that has the info. This graph is Chart 10 on page 11. Or, you can just click on the chart in this post and it will open in a new window as a bigger picture.)




I know that I DO NOT want to do plastic surgery, otolaryngology (anyone who knows me will know that this would be the LAST field I would EVER do), dermatology, radiation oncology, or radiology. I don't need to worry about those high scores... I am somewhat interested in orthopedic surgery, so that could be in the running.

Anywhoo, I should go off to slumberland.