Week 8: Creature Of Habit

          As the bucket gradually filled with much of Summer’s abdominal organs, her abdominal cavity steadily emptied, revealing deeper abdominal and pelvic structures lying within. From her liver, gallbladder, pancreas, stomach, and spleen, to her small and large intestines, Summer’s digestive tract was carefully excised (VERY carefully, because one slight nick of her bowel would have resulted in a not-so-pleasant stench). Unraveling Summer’s small intestines revealed them to be greater in length than her full body size…pretty amazing. Finally, we located what we were searching for: two bean-shaped organs, no larger than three inches in length and two inches in width, Summer’s kidneys (really not as large as you might imagine). We were also able to more clearly identify the vessels, nerves, and muscles lining her inner abdominal wall, and we progressed as low as the upper portion of Summer’s pelvis, which we will be dissecting next week. Not only will it be important to learn the anatomy of Summer’s pelvic/reproductive organs, but those organs of a male cadaver as well. So, I expect next week’s lab dissections to keep us all very busy.    

          Although I spent much of this week frantically studying for my last two exams, most of our midterms and finals were last week, so, once again, we resumed covering new information in each class. This week, Behavioral Medicine focused on how to communicate with patients of varying cultural backgrounds and recognize how differing cultures and beliefs may impact the ultimate treatment options we offer them. We additionally learned how to effectively communicate with difficult patients (those who are angry, manipulative, impatient…etc). Gastroenterology (GI) and Infectious Disease (ID) both began this week (in place of HEENT and Dermatology). In GI, we focused on various available screening options for visualizing the GI tract (for example, colonoscopy, barium enema…etc), and why each test should or should not be ordered based on a patient’s complaints. In ID, we focused on bacterial infections (Cholera, Botulism, Salmonellosis…etc) and how to diagnose and treat such infections.  

          As for midterms and finals, I’m officially done…such a relief! My Physiology midterm on Monday went well, and my HEENT final on Wednesday proved to be the most challenging of all of the exams (between the two weeks). I have received grades on all but the HEENT final at this point, and I am very pleased with the results (even the results for the Anatomy lab midterm, which I was very nervous about!), considering how much time I spent studying/lost sleeping. I will undoubtedly be catching up on lost sleep this weekend and studying very lightly (relative to my midterm/final study mode, but probably just as much as I studied before midterms/finals…honestly, it’s just a habit now). I cannot believe that, as of this week, I am more than halfway through the semester. Only seven more weeks to push through…

Question of the week: This viral infection, associated with fever, sore throat, and swollen cervical (neck) lymph nodes, is also referred to as “the kissing disease.” What is the more formal name of this viral infection? 

By the way, how did you do on your midterm? Let’s see:

Midterm answers (in the order asked): Protection, Rest, Ice, Compression, Elevation; Head, Eyes, Ears, Nose, Throat; Skin; Summer; Three; Any six of these: Integumentary (skin), Skeletal, Muscular, Nervous, Endocrine, Cardiovascular, Lymphatic/Immune, Respiratory, Digestive, Urinary, and Reproductive; Gallbladder; False (it is the left heart valve); Appendix; Digestive

Week 7: In The Midst Of Midterms

          Well, I’ve reached the halfway point of my two weeks of midterms and finals, and I am happy to say that I still have my sanity, though I am a bit mentally exhausted. As I said in my last post, this week’s schedule was literally composed of eating, sleeping, and studying (with studying being the priority of the three). I haven’t received any results on the exams I took this week, but I have a general idea of how I did on each exam. My Behavioral Medicine midterm, Anatomy lecture midterm, and Dermatology final all went pretty smoothly. Of course all of the exams had some tricky questions that took a lot of thought, but that is to be expected at this level. Going into this week, I predicted that the Anatomy lab (cadaver) midterm would be one of the more straight-forward exams, but it actually turned out to be the most difficult, by far. I think I did okay on it, but I was surprised with some of the specific structures we were tested on. Some structures that we didn’t find in our cadavers were literally hand-made by the professors. For example, if the cadavers were missing a specific artery or vein, the professors used pipe cleaners (red for arteries, blue for veins) to fashion these missing structures. It’s such a clever idea, but not one that I was expecting! At least I now know what to expect for the final…

          Next week I have one last midterm (Physiology) and final (HEENT), and then I am free (not really, but the stress level should decrease a bit). Two new courses begin next week, since I have completed Dermatology and will complete HEENT next Wednesday. In place of HEENT, we begin Gastroenterology (specialty of medicine focused on disorders of the digestive system), and in place of Dermatology, we begin Infectious Disease (specialty of medicine focused on diseases caused by bacteria, viruses, fungi, parasites…etc). I did enjoy studying both of the original specialties, but I am still excited for the change. The other classes will all resume next week, and continue for the remainder of the semester. In Anatomy lab, we still have much of Summer left to dissect (arm and leg muscles, urinary and reproductive systems, facial muscles, eyes, and brain, which I am most excited for). I also have another standardized patient lab for my Behavioral Medicine course. The news I must break this time around, in my opinion, is much worse than the news I delivered earlier this month, so the story I have to tell should be interesting. The next break I get is Thanksgiving weekend, so (as always) I expect to have a busy month leading up to that.      

It’s midterm week, so why not join in on all of the fun! Let’s see how much you have learned from my blogs thus far:

  1. What does the following acronym stand for? P-R-I-C-E
  2. What does the following acronym stand for? H-E-E-N-T
  3. What is the heaviest organ of the human body, by weight?
  4. In the second week of PA school I introduced you to my first ‘patient.’ What is her name?
  5. The smallest bones of the human body are located in the ears. How many of these bones are in each ear?
  6. There are eleven recognized organ systems of the human body. Can you name at least six of them?
  7. A cholecystectomy is the surgical removal of which body organ?
  8. True or False? The mitral valve, also called the bicuspid valve, is the right valve of the heart.
  9. What is the worm-like structure that hangs from the first portion of our large intestine called?
  10. Gastroenterology is the study of which organ system of the human body?

Last week’s answer: A clinician may find a cerumen impaction in an ear of his or her patient. Cerumen is just a fancy term for earwax. 

Week 6: Eat…Sleep…Study…

          I cannot believe I am saying this, but next week is midterm week. Luckily the exams are spread out a bit between next week and the week after, but there is still an overwhelmingly large amount of information to learn/review for each class. I wanted to make sure to post a blog tonight, just because I know the next few days will be a bit hectic for me. Next week I have three midterm exams (Behavioral Medicine, Anatomy lab, and Anatomy lecture) and one final (Dermatology). The following week I take only one midterm (Physiology) and one final (HEENT), and then I’m halfway through my first semester of PA school!

          Thus far, all of our quizzes/exams for each class have been unannounced. I used to despise “pop” quizzes in middle and high school, but now, it really has been forcing me to keep up with the material for each course, week by week. I have been studying with the mindset that I will be tested in every class at least once a week, and so I am hoping that when I begin looking back at information over the weekend, most of my studying will be a review. It’s nearly impossible to know every detail of information for each class. For example, studying everything we have covered in Dermatology in the past six weeks would entail my reviewing a 400+ page textbook…a bit of a difficult feat to accomplish. For Anatomy lab, we are not just tested on body parts of our own cadavers (I know Summer very well at this point), but those of the other five cadavers as well. So I will definitely be frequenting the cadaver lab over the weekend to make sure I can identify all of the important structures in the other cadavers before Tuesday’s exam. Time management will be vital this weekend. I have made a study schedule to make sure that I delegate a relatively equal amount of study time to each class. Hopefully I am in a good position and confident enough in what I know by next Monday night (thankfully it’s a three-day weekend because of Columbus Day).

          The past two weeks of HEENT have focused on diagnosing and treating disorders of the ears and eyes, both extremely complex organs. I have spent so much time learning the normal ear and eye in my undergraduate studies, so it is so cool to now be able to apply that knowledge for recognition of abnormalities in the structure and function of these two organs. Today was our last Dermatology lecture, which focused on adverse skin reactions that individuals may present with after taking specific medications. Once Dermatology and HEENT finals are completed, we begin studying two new medical specialties for the remaining half of the semester.

          After I post this blog, I’m off to begin my midterm studying. I will temporarily be in my midterm/final regimen of eat, sleep, study. The next two weeks (especially this weekend) will undoubtedly be mentally and physically exhausting, but I’m looking forward to the calm after the storm two weeks from now. So, here goes nothing…

Question of the week: A clinician may find a cerumen impaction in which organ of his or her patient?

Last week’s answer: The worm-like structure that hangs from the first portion of our large intestine is called the appendix. 

Week 5: And The Oscar Goes To…

          So I just got home from the standardized patient lab (the one I wrote about last week), and I have to say that it was a great experience, but it was not such an easy task to accomplish. I’ll fill you in on today’s events (just remember, the ‘patient’ I am going to speak of is a trained, medical actress, paid by the PA program, not a real patient)…

          I arrived at the standardized patient lab at 12:50 pm, ten minutes before my patient’s scheduled appointment. Eleven other students had scheduled appointments as well, and we were each given one of twelve examination rooms to stand outside of and wait for our cue to begin the patient interaction. At 1:00 pm, an announcement was made over a loudspeaker, informing us to knock on the examination room door and greet our patient. For this first appointment, we would have eighteen minutes to take a comprehensive medical, social, and family history. I knocked on the door, entered the room, and greeted my patient, a middle-aged female. She was very friendly and answered openly and honestly to all of the questions I asked her. Based on her medical history, she seemed to be a healthy and optimistic individual. However, once I completed the questions pertaining to her family history, a distinct pattern of familial breast cancer surfaced, and that’s when things changed a bit…

          Without going into too much detail, sometimes breast and ovarian cancers are passed down from generation to generation within a family. The cause of this pattern is the inheritance of a mutated (dysfunctional) gene (a sequence of DNA) called the BRCA gene. If an individual has a BRCA gene mutation, his or her likelihood of getting breast and/or ovarian (prostate in men) cancer is greater than that of the general population. So, once my patient told me that her mother and grandmother both passed away of breast cancer, I was (as expected) placed in a position to recommend that she be genetically screened for the BRCA gene mutation. After several questions were asked by the patient and answered by me, the patient agreed to get the genetic screening test. I ended the eighteen minute session with a few seconds to spare, reminding the patient to schedule a follow-up appointment in three weeks so we can discuss the results of her genetic screening test. At that point the same voice came over the loudspeaker and instructed us to leave the patient and examination room…

          Two minutes later, again, the same voice came over the loudspeaker informing us that it was currently three weeks later, and we had to complete a follow-up consultation appointment within ten minutes (F.Y.I.–the patient tested positive for the BRCA gene mutation). So, again, I knocked three times on the examination door, entered the room, and sat across from the patient, who was still confident, at ease, and very positive. I calmly stated that she tested positive for the BRCA gene mutation, and her demeanor instantaneously changed. To be honest, prior to this interaction, I was nearly certain that the patient would get extremely upset, and so I was prepared to console and comfort him or her. Instead, my patient’s demeanor transitioned (not a smooth transition) from calm and positive to angry with a strong sense of denial. She first questioned the validity of the test, and then expressed her feelings that it was just impossible for someone of her health to have such a mutation. It was then when I knew that a simple hand on her shoulder was not going to get me through the situation. As I continued informing her of potential management options, she maintained an angry, aggravated attitude. But as we spoke more about her options and we established a feasible management plan, her demeanor changed once again, and she calmed down a bit after I offered her much reassurance. As the appointment neared its end, I told her that there is little in medicine that clinicians can “guarantee,” but that one thing I could guarantee her was my support. The ten minutes had elapsed, and I was informed to leave the room.

          Finally, the actors/actresses called us back into the examination room to give us some feedback on our interactions. My actress said that she sensed my nervousness during the first few minutes of the first appointment, but that I seemed to calm down once we eased into the questioning. She also said that my responses to her questions were comprehensible and that I did very well with the empathy aspect of the interaction. Lastly, she said that it was best that I interpreted her feelings (anger and denial) correctly, because not all situations warrant a pat on the back or a hand on the shoulder. So, overall, the experience was great. I don’t think I have ever shaken or perspired so much in all my life, and in such a short amount of time, but I’m certain that will dissipate with more practice.   

Question of the week: What is the worm-like structure that hangs from the first portion of our large intestine called?

Last week’s answer: The left heart valve (also called the bicuspid or left atrioventricular valve) is also referred to as the mitral valve.