Frustration

So I was planning on writing my next post about how I actually find pathology interesting and rather fun (at least, in med school relative terms), or about the awesome time I had at my local drug/alcohol abuse shelter preceptorship last week, or about my 3 hours on rounds for my general preceptorship yesterday, but then this morning I got so mad that I just gave up.

In our pathology course, we have these lovely little group activities about once a week called TBLs. The TBLs are essentially set up to be group sessions wherein the entire class gets together in an auditorium (in groups) and various cases are presented by the professor. Along with the cases are questions that are supposed to relate the cases to what we're learning in class. We answer the questions on our own, then discuss with a group, then answer again. Supposedly, we learn how to apply basic knowledge to a more clinical setting this way.

This is all a fine and dandy proposition IF the questions posted have anything to do with a) what we've learned or b) legitimate clinical medicine. Unfortunately, thus far the professors have proven that really, what we need to know to do well is what they're thinking--it's a test on how well you can read the teacher's mind. We had a case today in which a good 10 symptoms and labs pointed to a diagnosis of Hemolytic Uremic Syndrome (I could explain, but if you go google it I'm sure you'll find something satisfactory). Literally, EVERYTHING about the case pointed that way--but the answer was not HUS, it was actually TTP (another blood disease)--and the only thing we were supposed to use to come to this conclusion was the fact that the lady was confused upon arrival. Supposedly, confusion = neurologic symptoms and HUS only affects the kidney. This is, of course, after they tell you that the main lab used to confirm TTP was negative. But oh--you should know that it could be a false negative, and the fact that she had any neurologic symptoms means it can't be HUS.

Wait. WHAT???

It's not just frustrating because the questions and answers are asinine. It's not just frustrating because I'm 100% positive that, were the exact same question on the boards, the answer would be HUS. It's frustrating because I know there will be questions on our exam that look like this, and I'll probably fail even though I know my pathology cold just because I can't read what the professor was thinking when they wrote the question. Ugh. It's awful.

In lay terms, it's kind of like having a question like this:

A normally healthy 25 yo male trapeze artist arrives in your ER after a tragic circus accident in which the blindfolded knife-thrower got startled by the elephant and lost control of the blade, which ended up 6 inches deep into the trapeze artist's aorta. Your patient's labs show massive blood loss, low serum iron, tachycardia and hypotension as well as neutrophilia. As he gasps for air, he informs you that he also was recently on tour in Africa, bitten by a mosquito, and later developed a high fever. His family history is significant for males who all died young due to massive bleeding after insignificant accidents, as well as beta-thalassemia and sickle cell disease, and his PMH is significant for allergic rhinitis and asthma, for which he takes Zyrtec. As a child, he had leukemia that was treated with radiation therapy and resolved.

What killed this patient?

a) Massive blood loss due to knife wound
b) Inappropriate clotting due to hemophilia
c) hepatic failure resulting from portal hypertension due to his splenomegaly from sickle cell-related hemolytic anemia
d) malaria
e) Histoplasmosis
f) aplastic anemia due to the radiation therapy he received as a child
g) None of the above--he was faking and just has a case of the sniffles--could you please refill his allegra?

Answer: E, histoplasmosis. You see, histoplasmosis is mostly spread by breathing in spores from bird droppings--the elephant in question lives right next to the birdcage in the circus animals' cage room. Said elephant stepped in the bird poop and the trapeze artist breathed in the spores a few weeks ago and contracted the infection in his lungs. Untreated, he has now developed a massive pneumonia, which killed him. Knife wound notwithstanding.