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How to write a medical schoolessay. First Year ●Introduction, 3 paragraphs and a conclusion. ●In the exam you will be aiming for 800-1200 words. ●Introduction is around the same size as a paragraph. ●Conclusion can be 2 or 3 sentences. Structure ●Plan the essay from 5 to 10 minutes depending on the length of the exam. ●The way you write a FAB essay will be different from HOM or MIMs. ●You can target your essay style to each module and depending on the question you can normally guess which lecturer is going to be marking it. ●Answer all parts of the essay question ●Avoid starting sentences with “This” ●Outline all your arguments in the introduction ●Points should not be introduced in the conclusion ●Diagrams are useful ways to reduce word count General Tips ●Link the end of each paragraph back to the question ●Tables are acceptable forms of conveying information ●Only use semi-colons if you know exactly how to use them ●Avoid convoluted sentences ●Simplicity in conveying information is keyClinical Anatomy Essays ●You will outline what you’re going to discuss: ●Potentialdiagnoses ●Steps you’re going to take ●Discuss the PATIENT Introduction ●What is theircondition? ● Why do you think this is a diagnosis that is likely? What in the description indicates this? ● What is a potential differential diagnosis? ●Describehow theyarepresenting ●If you were the consulting doctor, what would you expect to see? ●“A patient saves himself when falling by grabbing a branch of a tree and sustains a nerve lesion of the upper limb. On Introduction investigation, there is some doubt as to whether there is damage What do you think is the key to the lower brachial plexus or a more peripheral nerve lesion. information in this question that Discuss the possible findings and describe the ways in which you you would have to discuss in the might distinguish between the two” (2005) introduction? What actually happened to the patient? - Fallenfromaheight What is the lower - Thismotion willcause what? ▯ brachial plexus? Hyperabduction of the upper limb Nerve injuries would show what symptoms/ signs/ what would be damaged? ●“A patient saves himself when falling by grabbing a branch of a tree and sustains a nerve lesion of the upper limb. On Introduction investigation, there is some doubt as to whether there is damage What do you think is the key to the lower brachial plexus or a more peripheral nerve lesion. information in this question that Discuss the possible findings and describe the ways in which you you would have to discuss in the might distinguish between the two” (2005) introduction? What more peripheral History, Examination, nervesmay be Investigations to determine the affected? difference. ●“A 71-year-old man is brought to the Accident Department with sudden onset of severe lower abdominal and back pain. He is a heavy smoker with a history of hypertension. He has a rapid pulse, low blood pressure, and a pulsatile mass in the abdomen. What is Introduction the most likely diagnosis? Describe the anatomy of the structure involved. How would the treatment differ in elective (planned) vs. What is this question asking of you?emergency situations? Which surrounding structures may be affected and what might be the postoperative complications?” (2019) Elderly man with history of smoking and hypertension: Sudden onset indicates what? - What does this make him vulnerableto? Cluesto AAA(abdominal aorticaneurysm) ●“A 71-year-old man is brought to the Accident Department with sudden onset of severe lower abdominal and back pain. He is a heavy smoker with a history of hypertension. He has a rapid pulse, low blood pressure, and a pulsatile mass in the abdomen. What is the most likely diagnosis? Describe the anatomyof the structure Introduction What is this question asking of you? involved. How would the treatment differ in elective (planned) vs. emergency situations? Which surrounding structures may be affected and what might be the postoperative complications?” (2019) Discussthesurroundings of the aorta. Discussthe anatomyofthe aorta. 1. HISTORY TAKING 1. If the question has possible differential diagnoses you want to start by takinga history andaskingquestions that wouldhelpto distinguish them. GENERAL 2. If the patient is brought in, they could be unconscious, so, who are you STRUCTURE getting the history from? 1. Witnesses OF 2. Paramedics 3. Ask relevant questions. PARAGRAPHS 1. Is there a family history of certain conditions? 2. Ask about things that might make the person more vulnerable or atriskofthesuspectedcondition –e.g.doyou smoke?forLung Cancer. 3. E.g. Pain. 1. Sharp or dull? 2. Constantorintermittent? 3. Doesitworsenandunderwhatconditions? 4. What makes the pain improve? 5. Forhowlong? 4. May be trying to identify whether it iscongenitalor acquired. 2.EXAMINATION 1. LOOK 1. Skin 1. Canyou see bruising? GENERAL 2. Redness? STRUCTURE 3. Bleeding? 4. Scars? OF 5. Rashes? 6. Jaundice? PARAGRAPHS 7. Anaemia? 8. Cyanosis? 9. Clubbednails? 10. Oedema? 2. Softtissue 1. Canyou see swelling? 2. Atrophy of muscle? 3. Bone 1. Is the bone misaligned? (fracture or dislocation) 2. Is a nerve injury causing disfiguration? (e.g. wrist drop) 2EXAMINATION 1. Feel 1. Feelforbloating/tensingup 1. Are they guarding? GENERAL 2. Feelforlumps STRUCTURE 3. Enlarged nodes? 4. Is the abdomen rigid? OF 5. Feelforsweat 2. Sensation PARAGRAPHS 1. Test forsensory nerve function 1. 2pointsensation 2. Pressure 3. Temperature 4. pain 2. Tinel’ssign 3. Movement 1. Test formuscle function andmotornerve function 2. Canmentiontestsyou know such asFroment’ssign 3. INVESTIGATIONS After mentioning all the investigations 1. X-rays you wouldperform –ONLY use ones 2. MRI that are relevant in that scenario –you 3. Ultrasound can mention some potentialtreatment GENERAL 4. CT methods but you’re not expected to 5. Contraststudies know this as well. STRUCTURE 6. Angiograms OF 7. ECG PARAGRAPHS 8. Blood Pressure 9. Endoscopy 10. Fullbloodcount 1. High wbc = infection 11. Urinesamples 1. Cloudy= infection 2. Blood? 3. Glucose? 12. Blood tests 1. Liverfunction test 2. Kidney function test 3. Test forcardiac enzymesHelpful acronyms Come up regularlyPulse Pain Arterial injury signs Palor Paraesthesia - Remember if they’re losing blood they will have hypovolaemic shock Paralysis Perishingwith cold Site Investigations for Lumps: Size • Site = where is it? How deep is it? Shape • Shape = rounded? Irregular? Surface • Surface = smooth or rough? Sounds • Sounds = use a stethoscope–bowel sounds? Blood sounds (bruit) ? Surroundings • Surroundings = what surrounds it–if it’s a tumour you must consider lymphatics Potential Lumps: • Hernia • Cancer • Benign Mass • Lipoma • Saphena Varix • Aneurysm • Enlarged nodeSensory Motor Autonomic Mixed Nerve Injury Consequences Reflex TrophicGeneral Anatomy Essays When given a generalanatomy essay you may feela bit stuck on what to talk about. • If so, these 7 S’s will help you at least cover all bases Statement 1. Statement= What is it? 2. Source = How did it develop in embryology? Source Structure 3. Structure= Micro-level structure (cellular level, histology) and Macro- level Situation Surrounds 4. Situation= Where in the body is it – at what vertebral level 5. Surrounds= What structures surround it? Supply 6. Supply = Nerve (autonomic and somatic) supply, Arterial supply, Venous Surgery supply and Lymphatic supply 7. Surgery= Any clinical aspects. This would include any Vascular supply is related to Exocrine (enzymes - into gut) andtructures near the pancreas the endocrine function of the Endocrine (hormones - into but most importantly the pancreas. blood) secretion biliary system. Give an account of theanatomicalrelations and vascularsupply of the pancreasto include itsmajor functionsandthebasisofits embryologicaldevelopment. 2008 You can choose to interweave each of the aspects of the essay by discussing the embryological Example development of the pancreas and biliary system and then include how that is relevant to the exocrine function of the pancreas. - The previously describedformat of the 7S’sisa goodplan forwhen you really do not know how to approach the question. - However, you do need to target your answers to the specific question and exactlywhatthey’reaskingyou.Although referencing furtherreadingexcellent, FLOWCHARTS it is not essential for a - Helps make things more first. concise - Shows you understand They also like it when you the entire process bring multiple topics in fromacrossdifferent modules. E.g. mentioning HOMEssays consequences for the Lungs in a Heart focused essay. M essays Canoutline allyourpoints in the introduction HOM essay intro: ● Reference thephysiological significanceof the process you are describing ○ e.g. an essay title may be ‘Describe the physiological mechanisms of blood pressure control ○ Must then consider why it is important to control blood pressure? Why does the body do this? To ensure adequate perfusion of all tissues - blood pressure is the principally regulated variable in the cardiovascular system, equally high blood pressure can damage delicate vessels e.g. in the brain Compartmentalisation can help structure - shows that you are in control of the content and have sensibly assimilated it to answer the posed essay question. HOM essays ● HOM is a subject that naturally is easier to categorise ● e.g. short term vs. long term control of blood pressure ● Local(paracrine, metabolic, myogenic) vs central mechanisms(neurogenic vs. endocrine) that determine blood flow to different tissues ● Feedback responses vs. feedforward 3 ways to get a first in a HOM essay 1. Extra reading 2. ‘Drawstringeffect’ - pulling together content across different topics e.g. kidneys in a blood pressure essay as well as the heart 3. Experimental evidence - lots of examples from nerve/ muscle topics and a few notable ones are covered in each of the other topics. Must, therefore, talk about haemorrhage. Describes the importance of controlling Discuss the physiological response to the loss of1L of blooblood pressure. Why does the body have to respond to blood loss? Haemorrhage can arise under a number of traumatic or pathological states e.g. penetrating or blunt trauma, gastrointestinal bleeding, AAA. The greatest challenge presented by haemorrhage is the decrease in blood pressure. Blood pressure must be regulated within a defined range to ensure adequate perfusion of tissues and to prevent hypoxic damage but equally, below a threshold that will damage delicate microvascular structures such as those in the brain. The physiological response ExampleHOM to haemorrhage can be considered in a number of categories - physical, neural, endocrine and ingestive factors . In this essay, I will discuss the integrated cardiovascular, respiratory and renal introduction responsesto haemorrhage. Already indicating to the examiner how the question will be addressed. The answer has already been categorised into various paragraphs with this sentence alone.Donotneedtomention Only pick an essay if you every molecule involved haveenoughvariationin They love an example of but do mention some. yourexamples. CLINICALRELEVANCE Drug targeting Cancerand Diabetes Diagnosis MIMs Essays with sequencing Signalling essays are OM essays great for flowcharts They love when you mention the techniques they use to get theirdata. E.g. PCR Layout of the essay paper: ● MIMS Essay paper is a bit different to the other two: ● 3 essays instead of 2 ● 40 mins/essay instead of one hour each ● Time constraint can make it very difficult to plan and complete 3 essays well -Essay 1 is always based on Michaelmas Term content (1st term) -Essay 2 is always based on Lent Term content (2nd term) MIMSessays -Essay 3 is always synoptic (you can bring in content from the entire year) -Planning is EXTREMELY important, not only in the exam but before -e.g., know all michaelmas topics well to an mcq level, but focus your essay writing efforts to a select few topics you favour -These topics come up every year in essays MIMS essay intro: ● Important to define any key terms in the questions ● Keep it short and sweet ● e.g: To what extent do the structures and polymers of biopolymers depend on the stereochemistryof their monomeric components Define stereochemistry, and other relevant Describe these key terms that you’ll use terms, a diagram could really helpsave words MIMSessays throughout the essay, and time e.g. optical isomer, chiral carbon MIMS essay body: ● e.g: To what extent do the structures and polymers of biopolymers depend on the stereochemistryof their monomeric components ● Three paragraphs each centred around a good example of a biopolymer ● Each example has to be relevant but illustrate a different point/argument MIMSessays 1. α-D-glucose and β-D-glucose polymerise differently due to different positions of an-OH group in their structure (they form glycogen and cellulose respectively, with vastly different properties) 2. Chiral carbon in amino acids responsible for differences in bonding and secondary structure 3. Argue against statement: e.g. other factors affect structure of biopolymers, e.g. glycogen affected by different proportion of α,1-4 and α,1-6 bonds 4. Reach a balanced conclusion -Don’t include anything you haven’t mentioned in your previous paragraphs -Summarise your arguments -Keep it concise as to not repeat yourself MIMS essay general tips: ● Diagrams are an easy way to boost marks and save words/time, try to include some in each essay ● They can also convey more molecular detail, raising your grade ● Includingexamples from outside lectures make you more likely to secure a first ● In-depth molecular detail needed to secure a first MIMSessays Planning: ● Which topics from each term you’ll focus on/avoid ● What examples/diagrams you’ll use for each topic ● Plan each essay for 5-10 mins tops and have 30 mins dedicated writing and drawing time ● Plan which out-of-lecture examples you’ll include for each topic ● Practice time management and writing essays under timed conditions to mimic the exam.Questions?FEEDBACK FORM