David has a torn ACL and was wearing a brace - but it didn't seem to slow him down much - a good time was had by all. A brief synopsis of the itinerary included: a trip to Stonehenge, Oxford, Les Mis, Book of Mormon (just opened here), The London Dungeon and the Eye on David's birthday March 17th, Tosca at the Royal Opera House, and The Avett Brothers (one of our favorite bands!). Add in a few museums and double deck bus rides and many trips to the pub - and you can see why I haven't had time to write. I did faithfully attend classes, but not much evening studying was done.
When everyone left, I knuckled down to study and tried to catch up to Clay :) We studied hard all weekend and just finished two days of our "diploma" test - whew.
To cap off the studying and test preparation - Clay, the newly crowned "Bard of Bloomsbury" wrote a poem for our classmates to study by - I think you will enjoy as well.
Tropical Medicine From A to Zed
By Clay Block
Where you go, please be wary
Of Amoebic
dysentery.
What does it look like, You may ask?
Why, an ulcer, shaped like a flask.
From a dispar cyst however,
One can’t distinguish, no matter how clever.
But if a red cell has been ingested,
Then answer “histolytica” when tested.
When thinking about Bacillus
anthrax,
Confine yourself to the basic facts:
It’s a gram positive rod that forms spores,
That hatch under your skin causing swollen black sores.
Inhale them and catch the pulmonic form,
But never eat them, cold or warm.
Cause in the intestines it will be killin,
Even on cipro or penicillin.
Chagas comes from
trypanosomes
Found in many American homes.
Inside the Triatomine with his mates
Until the bug bites and defecates.
And then the unlucky girl or guy
Rubs the feces into an eye.
And wakes up with the eye all swollen,
Followed years later by megacolon!
The things about Dengue
to understand
Is more than the print of a hand
Left on the back of viremic victims.
Know also the following dictums:
The first time gives fever, rash and achin
So fierce you think the bones are breakin,
But the next episode is a lock
To bring on hemorrhage and sometimes shock.
Behold the dreadful Echinococcus,
It looks tame, but is really noxious.
The family dog, so fine and loyal
Lapping up sheep bits left on the soil,
Acquires a worm and with licks delivers
Eggs that migrate to lungs and livers,
Such that decades later you find,
Massive cysts of the hydatid kind.
All DTMH students should be caring
That Falciparum
means “sickle bearing.”
Referring, perhaps, to gametocytes
That appear after anopheles bites?
Or is it the schizonts with knobby bits
That stick in the brain and bring on fits,
Making the coma deeper and deeper,
And calling forth the grim reaper?
I give Giardia loads
of respect
It is everywhere, and prone to infect
The uncautious traveler who dares to drink
Directly from the kitchen sink.
Soon after this protozoa
Will really make you have to goa!
And even after tinidazole,
The diarrhea may last ‘til fall!
Did you know that Hansen’s
disease
Might be transmitted by a sneeze?
Or from handling an armadillo,
Unless after you scrub yourself with brillo.
So that months later you won’t begin
To suffer in your nerves and skin,
Numbness, weakness and nodosae
All from those pesky m.leprosae.
Do you prefer Isospora
belli
To cyclospora, and if so, why?
Both cause stool to flow like water
Get better with Septrin, at least they ought ‘er.
Both are red on ZN
stain,
And with HIV come back again.
Whereas crypto and microsporidia
Are really much worse coccidia!
The Jigger flea,
tunga penetrans
Is quite a scourge of the lands.
Don’t neglect to wear your shoes,
Or this tiny flea may choose
To make her nest beneath your nails
Causing no end of screams and wails
As the doctor extracts fleas and eggs
Next time cover your feet, I begs!
You’d not have gotten Katayama,
If you listened to your Mama,
She gave you such fine advice,
And even repeated twice:
In Lake Malawi do not submerge
No matter how great the urge
To swim and frolic with the snail
Or on return you’ll surely ail!
Don’t underestimate the Leptospire
Who lurks among the muck and mire
Through mucus membrane or minor abrasion
It takes full advantage of occasion
To cause fever and havoc among
Kidneys, liver, and the lung.
Unless at first you dialyze
The patient may hemoptosize.
In the whole world, one out of three
Is infected with M.
tb
So if the cough goes on for days,
Or if, when the patient weighs,
The scale reads less, then please ask
The patient to don a mask
And take his 4 drugs as directed,
And then find who else may be infected.
Although it may seem a bit polemical
N. meningitidis can be epidemical.
The dusty wind of the dry season
Is postulated to be the reason
The Neisseria, normally quite innocuous
Becomes an invasive diplococcuous.
If you find yourself in such an outbreak
Have some oily chloramphenicol to take!
While we may think of Onchocerca
and loa together,
And simuliam and chrysops like birds of a feather.
I would however make the claim
That oncho larvae are to blame
For terrible damage done to skin and eyes
And causing the groin to hang to the thighs
Whereas the loa adults cause calabars
And cross the eye without leaving scars.
Malariae, vivax and ovale, while Plasmodious,
Are generally thought to be less odious.
And even though P. knowlesii
Is known to make the patient die,
It hardly earns a single mention
Regarding diagnosis, treatment, and prevention.
The London school leaves no doubt,
P. falciparum is what its about!
Coxiella burnetti is the agent of Q fever
If she says its rickettsial, don’t believe her.
Its more closely related to legionella
Or, if you prefer, say Franciscella.
The Q is for Query cause no one knew
The cause of an illness that mimicked the flu
It lives in sheeps and is passed on by a tick.
A single organism can make you sick.
As much as everyone hates scabies,
We’d all prefer to have that than Rabies!
A viral infection, often in dogs and bats
but really any mammal, including housecats
can transmit it with scratch,
bite, or lick
So if exposed, get vaccinated quick
Once hydrophobic its already too late,
Even the Milwaukee protocol can’t change your fate.
Schistosoma
mansoni and haematobium,
Deserve every bit of opprobrium.
Japonicum, Intercalatum, and Mekong,
Are no better, don’t get me wrong.
It’s just that those three aren’t as prevalent,
And therefore seem a bit less malevolent.
They are all bad news for gut, liver and bladder,
But if in your spine, the news gets badder!
Though Glossina gives T
brucei in the Gambia,
And also gives it in the the Zambia.
It seems that West African sleeping sickness
Is not prone to progress with quickness.
The eastern form in distinct contrast
Will make you sick extremely fast.
West gives you Winterbottom’s adenitis,
While east gives eschars and lymphangitis.
Ulcers are so
common in the tropics,
As to show up as exam topics.
Tropical ulcer caused by anaerobes and spirochaetes
Is usually found on ankles and feets.
Think Buruli if it is painless and slowly enlargin,
Especially if there is an undermined margin.
STI ulcers like syphilis and chancroid,
Can be treated but are best to avoid!
About Vibrio
cholera, let there be no confusion,
Oral rehydration is the most vital solution!
To avoid death and stay free of fault,
Give a spoon of sugar and a pinch of salt
As quickly as your patient will drink
You can’t give too much too fast, I think.
Give antibiotics to shorten the course
And try not to implicate your peace keeping force.
The filarial worms, Brugia and Wuchereria
Aren’t spread by flies at the cafeteria.
You get them from night biting mosquitoes,
That munch on you like you munch doritos.
It would not amount to melodramatics
To say dancing worms really wreck the lymphatics.
On the upside, mass drug administration
Is slowly improving the situation.
Xenopsylla cheopis,
the rat flea,
Is no friend to you and me.
He fills his stomach with Yersinia pestis
The proventriculus clogs blocking digestis.
Then he bites and he bites spreading plague as he goes.
You know where he’s been by the trail of bubos.
To reduce your plague mortality stats,
Kill first the fleas and then the rats!
About Yellow
fever, I’ll say this:
Offer vaccine, or be remiss,
To all whose travel may take them around
Anywhere yellow fever has ever been found.
It might keep their organs in working order
And they’ll have less trouble at the border.
But if over sixty you’d be advised
To let them go unimmunized.
When a human child is deprived of Zinc,
Everything gets worse, I think.
The diarrhea just won’t abate
And sight and smell deteriorate.
Memory declines as does cognition
With low zinc and malnutrition.
So supplement zinc and improve the diet.
The kids will grow if you’ll only try it!
so after the first day of testing, we were all a bit demoralized by how hard the Royal College of Physicians had made the test (who made them Royal anyway?) So Clay wrote another poem which resonated with the class. I'll end with this - thanks for reading and I hope you have enjoyed a peek at our time here - it really was fantastic. We have many new friends from around the world and a new perspective on medicine.
What I Should Have Studied from A to Zed
By Clay Block
I prepared to be tested on amoebic colitis,
And learned many life cycles of bugs prone to bite us.
But I should have spent more time on lactic acidosis
And even more on diabetic ketosis!
I memorized how we’re sickened by Bacillus species
And just what we get from triatomine feces,
To think of time wasted gives me such pangs
I should have been reading ‘bout Bothrops and Boomslangs!
It would have been nice to treat Chagas with Nifurtimox
But there was never a chance to fill in that box
Instead, Chikungunya was heavily stressed.
I felt the whole time I was at the wrong test!
Dengue, I admit, did come up quite a bit,
But the knowledge I had just didn’t fit.
I confess that I felt slightly faint when
The history said “Dengue” but the rash said “it ain’t”
For all the effort I spent on ecchinococcus ,
It was entamoeba coli they used to shock us.
I planned on being asked about multilocularis.
But 10 items on enterovirus? Please spare us!
With p. falciparum I felt quite at ease
I was all ready to treat it with good ACTs
When I should have been learning to prophylax this ill
In a newlywed traveler on the birth control pill.
Giardiasis, as common as we all know it is,
Appeared only fleetingly on this quiz,
I would loved to have seen gnathostoma
Or been shown a picture of Kaposi’s sarcoma..
No doubt Hepatitis E is fair game
But for everyone to have jaundice does seem a shame.
And was the lymph node enlarged by histoplasmosis?
One thing is certain and that’s I don’t know this!
I had no idea what an invigilator does?
The reason I’m asking is just because
I think I may have made a crucial mistake
By invigellating a cholera outbreak.
Do Japanese encephalitis virae
Attack the sulci or the gyrae?
And what else causes such head aching?
I know one thing: that’s test taking.
Katayama was conspicuously absent
And this was much to my lament.
And even worse my knowledge of Kala azar
Didn’t take me very far.
Leishmaina major, minor, or tropic?
Who would pick this for a topic?
They all cause skin sores and all that,
But don’t recur and destroy your palate.
I studied measles and they gave me mumps.
Its left me feeling way down in the dumps.
I guess I should not expect to earn a diploma
If I can’t tell toxo from tuberculoma.
I knew about neonatal tetanus prevention
But when did “normal immunoglobulin” get a mention?
I went to class and stayed awake for the lecture
But my answers today were mostly conjecture.
O’nyong’nyong means “weakening of the joints”
Had I known, I might have earned points
I should have been learning about where it lurks
And not wasting my time on Onchocercs.
Podoconiosis, I won’t tell any lies,
Was, when it appeared, a sight for sore eyes.
At least this is the diagnosis I am hopin
Caused the swelling in the Ethiopin!
It turns out Q fever was right to include
But for celebrating, I’m not in the mood.
Sure you can inhale it from an animal part
But one right out of 100 is not even a start.
Had I given any thought to Rubella
I would now be a happier fella.
A virus that came up maybe once in 3 months?
I didn’t study it and now am the dunce.
Sure people in the tropics can suffer from stroke
But not to ask about ulcers that start with a poke
In your foot by a thorn causing Madura?
Shouldn’t they be asking how to cure ya?
Treponemal diseases we were most surely shown,
I just wished they’d asked something I’d known.
About trypanosomes the same can be said,
They just didn’t ask the stuff I had read.
On genital ulcers that get passed around
I did my homework and was prepared to expound
But when it came to cervical cancer
And which age to vaccinate, I knew not the answer.
Vitamins I really do appreciate
But to treat pellagra do we give B-8?
I tried to prepare with great efficiency,
But somehow neglected this deficiency.
About Wolbachia, was I alone in vain
In hoping that I would be be asked to explain
How this little bacteria
Is so crucial to wuchereria?
They skipped xenopsylla and went from the rat
Straight to the plague? How’d they do that?
And I wished they’d shown us an Xray
Of a calcified bladder we’d have known all the way.
It’s a good thing we took pause
And learned to recognize (I think)Yaws
Don’t think this makes me some sort of hero
Basically it means that I’ll score one above zero.
Zoonoses, anthroponoses, parasites and vectors
Information overload from handouts and lectors
My preparation was anything but tactical
And now its time to go take the practical!
Good luck everyone, sorry the first effort did not turn out
to be very relevant. Oh well. There is always next year.
Clay
