WILTIMS #159: The beginning of the end

Today included our last didactic lecture of the first year. We have a neuroanatomy practical final tomorrow morning which begins two weeks of the typical hellish exams. I think tomorrow will be my final WILTIMS post of the year!

The other activity today was a behavioral health conference where we watched a psychiatrist interview a patient, for probably the eighth time this term (five of those times were in smaller sessions led by a student). Something I've learned from these encounters is that you never know if the important information will come out 5 or 45 minutes into the interview.

You can't explicitly ask the patient about every possible delusion or symptom. Most of the time is spent getting a feel for the person and trying to hit upon the biggest aspects of their current and past mental disturbances. The most out-there story might not be elicited until near the end of the time and by the most innocuous of questions. Learning the knack for stumbling upon those triggers is truly more art than science.

TIL: Certain bone fracture patterns are characteristic of child abuse. Since juvenile tendons and ligaments are proportionally stronger compared to bone than in adults, traction (pulling) or torsion (twisting) injuries can result in nasty fractures along the epiphyseal-metaphyseal junction (the ends of long bones near the growth plate). One such pattern is called a bucket-handle fracture, seen to the left.