Dear Reader,
Welcome to the Cambridge Widening Access to Medicine Society monthly newsletter 😊. We hope you're enjoying the last few weeks of the academic year and are looking forward to the summer holidays! In this month's newsletter, we will be exploring why doctors examine urine from patients, busting the myth that all medical students do is study, the issue of providing unnecessary screening and surgery to breast cancer patients and exploring how reading 'The Guardian' can help you in interview. Food for Thought: an example interview question Why is analysing a patient's urine useful for a doctor? Winnie, our university outreach officer, discusses how she would approach the question.
A urine test (urinalysis) assesses the components of a patient’s urine. This can include examining urine visually, chemically and microscopically. Urinalysis tests are very common and are a non-invasive method of checking a person’s health. Firstly, a urinalysis is very useful in confirming a potential pregnancy. The hormone which is being tested for is human chorionic gonadotropin (hCG). Once a fertilised egg implants into the uterine wall, hCG is rapidly produced which can be found in both the urine and blood of the mother. In A-level biology, you may have come across how a pregnancy test works. The process is an enzyme-linked immunosorbent assay (ELISA) which identifies a substance through a colour change. When urine of a pregnant individual is applied to a test strip, hCG will bind to primary, mobile monoclonal antibodies which are conjugated to dye enzymes. These hCG-antibody complexes will move along the strip, carrying the enzymes with them until they reach immobile complementary antibodies that are bound to dye substrates. An antibody sandwich will form which enables the enzymes to bind the substrates, resulting in a colour change (blue line). Excess primary antibodies will move to the control zone further along the test strip to trigger another colour change, which is required to show that the test is functioning correctly. Thus, a positive test will show two blue lines. If there is no/too little hCG in the urine, the primary antibodies will move past the secondary, complementary antibodies to the control zone where they will bind tertiary antibodies that trigger a colour change. Here, only one blue line will show. A urinalysis is also useful in the later stages of pregnancy as it can reveal gestational diabetes if there are high levels of sugars in the urine. Additionally, if higher levels of proteins are found in the latter stages of pregnancy in combination with high blood pressure, this may indicate preeclampsia.
A urinalysis is useful for diagnosing problems such as infections or kidney issues. It can also uncover the need for further investigation of more serious diseases such as diabetes or liver disease. For example, a high concentration of urine can simply indicate dehydration. An abnormal concentration of ions such as Na+ and K+ may suggest kidney issues. Excessive glucose in urine is a common sign of diabetes and crystals in the urine (crystalluria) may indicate kidney damage. Bilirubin (the yellowish pigment component of bile) in urine is suggestive of liver or bile duct disease. Moreover, urinalysis can confirm whether a patient has a urinary tract infection if pathogens and/or white blood cells are present in the urine. Another reason for conducting a urinalysis is to screen for drugs. These are just a few examples of how analysing urine can help inform a doctor of a patient’s overall health, help diagnose an issue or monitor a medical problem. Myth-buster Myth: "All medical students do is study."
Medical students have a reputation for being hardworking and dedicated to their degree. This is true, however there is so much more to medical school than just studying! With 5 or 6 years of university and several more for training, medicine is much more like a marathon than a sprint. Therefore it's crucial to have a good work-life balance to avoid 'burning out'. Our hobbies outside of medicine allow us to relieve stress, meet new people and generally become more well-rounded individuals!
Most universities have a wide variety of societies and clubs to join, at varying commitment and/or skill levels. When I started university I was worried that I wouldn’t have time to keep playing musical instruments, which was a big part of my life - I was quickly put at ease when I joined the MetVet Orchestra, which meets a couple of times per term and is a fun way to meet new people who share my passion! There will also be lots of opportunities to try out new things; for example, rowing is very popular at Cambridge and most people are complete beginners when they start. So rest assured that you can make time to do things you enjoy while studying for your degree! Behind the Headlines Kieran, one of our co-presidents, has written a fantastic summary of an article he read about how some breast cancer treatments may have been unnecessary. https://www.theguardian.com/society/2022/jun/09/overdiagnosis-some-breast-cancer-treatments-may-have-been-unnecessary-study-suggests
Breast cancer is one of the most common causes of death in the UK, and it may at first seem like greater screening could only be a positive thing. This article illustrates some of the issues with this myth of screening. Breast cancer screening is commonly done through mammogram, essentially a localised X-ray of the breast tissue, this allows the detection of tumours which cannot be felt (‘palpated’). Detection of a tumour will normally lead to a biopsy, and this may lead a woman to undergo a mastectomy (mast=breast, ectomy=removal), a difficult and invasive procedure. Inevitably, as for any surgical procedure some of these will go wrong, and some women will suffer complications as a result. This could be justified if removal of a tumour would prevent breast cancer - however the majority of these tumours will never become cancerous, they are benign (gentle) and will likely stay like that for the majority of the patient’s lifetime. It is because of this that any screening program must be trialled, ideally with two identical populations, with one receiving the screening and another not. Through this (and clever statistical testing) you can determine whether the screening will reduce mortality more than it will increase it. Mammogramography is a little murky, with evidence both in favour and against but is recommended for some groups of people.
Not all screening programs pass this - some private companies advocate for regular (even yearly) full body CT scans, but overwhelmingly these lead to unnecessary surgical procedures, and do not serve to decrease mortality on a population level. Companies will advertise using individual anecdotes about people having tumours removed before they became a problem, but the majority of these would never cause a problem - furthermore the radiation from a CT increases your risk of future cancer! We call tumours discovered in a scan for another condition ‘incidentalomas’ (incidental = found by accident, oma=tumour) and while some may become dangerous the vast majority never will, deciding when to operate is a complex decision which will be unique to each patient and should be discussed by their doctors. Hopefully you can now understand why sometimes it is better to leave a tumour in! Link of the Month Buraq, a member of our general committee, describes how helpful certain news websites were for him to become more aware of the current global health situation and developments. https://www.theguardian.com/society/health https://www.newscientist.com/ When preparing for interview, I think it is important to make sure that you have at least a brushstroke idea of what the current global health situation is like and what advancements are pushing healthcare forward. Keeping up with daily health news is a good way to do this in an easily digestible manner that wont take up too much of your time. The Guardian health section is packed full of new stories everyday, so there is definitely room to pick and choose the ones that interest you! I would recommend reading one or two a day, and then writing a two sentence summary of that article that you can then refer to when practicing for interview. If an article particularly interests you, then it might be nice to spend a little more time delving into the topic a little more - for example a recent article about the Monkeypox outbreak might pique your interest and you could browse the net for further information such as this, this or this. This will give you a nice repertoire of cases that you can bring in when asking any interview question! The Guardian is free, however I have also linked the New Scientist magazine, which will contain similar scientific advancements, but framed around the various A-Level content that you will be covering in school. The aim of this is that all of the information should be understandable and thus it might make your life a bit easier. Whilst The Guardian is free, New Scientist magazine is a paid subscription (£9.99 monthly) but there is a free 4-week trial period before you decide if its for you!
That's the end of the newsletter this month and if you have any questions, then as ever, please just email us at access@clinsoc.co.uk! Have an amazing month and good luck for all with exams! Love, CamWAMS 2022 Committee
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