Week 20: Just Unnecessary

          Well, the result of my Cardiology EKG exam was emailed to me last Saturday morning at around 12:30 a.m., and I’m thrilled and extremely relieved to say that the result was great. I’m so thankful that the time I spent practicing paid off (really, I was panicking leading up to the exam). For now, it’s nice to get a little break from EKGs and rather spend time studying for my other classes (until Cardiology starts up again next week). As I said last week, snow days have really been disrupting our lecture schedules, but the professors have been doing well with making up for the lost time…a little too well. This week, the material for several courses was double the amount as would be taught in a given week (to make up for lost time), so, once again, I find myself trying to catch up…trying…

          This week in Clinical Lab Medicine, we doubled-up on lecture time, and learned when to order and how to interpret the lab results of toxicology (drug ) screening, lipid panels, cardiac enzymes (when you suspect someone has had a heart attack), liver function tests, immunological tests, and endocrine function tests (like those for thyroid, adrenal hormones…etc). This class is really the first to begin integrating information we have learned thus far in all of the courses we have taken or are currently taking, so the content requires much critical thinking. Sometimes, what’s most important is knowing when not to order a test, knowing when a test is just unnecessary, especially for the patient. In Pharmacology we continued to focus on the prescription of antibiotics for both pediatric and adult patients. It’s unbelievable how much thought must go into the ultimate decision of what to prescribe to a patient. Once again, what’s just as important, is knowing when prescribing a drug, like an antibiotic is just unnecessary based on the patient’s presenting symptoms. From what I’ve learned, It’s definitely better to be conservative in the prescription of antibiotics.

          Yesterday was our last Endocrinology lecture, which focused on the diagnosis of disorders of the parathyroid glands, bone disorders (which might result from such parathyroid disorders) and lipid metabolism disorders. Next Thursday is our Endocrinology final, so I have a lot of information (as always) to review before then. After the one-hour final, we begin the first lecture of our next specialty course: Pulmonology (the study of lung disorders). I did enjoy Endocrinology very much, but I think I’ll be prepared for the change by next week.

          P.S.: I’m already twenty weeks into PA school…1/3 of the way through my didactic phase…15 months away from my clinical phase…regardless of how I think of it, I just can’t get over this!

Question of the week: Your patient presents with symptoms, which you identify as those of a common cold. The patient requests that you prescribe him an antibiotic to shorten the course of his cold and alleviate the severity of his symptoms. You should undoubtedly prescribe him the antibiotic he is requesting, right?

Last week’s answer: When performing a skin self-examination, the ABCDE rule is often used as an important screening method for detecting potential melanomas. Any lesion should be assessed for Asymmetry, irregular Borders, Color variation, Diameter, and Evolution/Elevation. 

Week 19: Good Or Bad

          Four weeks into the semester and we have yet to have one full week of classes without a snow day. Fortunately, the professors have been making up the missed class time and have also discovered a way to teach us while in the comfort of our homes, even when snowed in. Now, using a program called Zoom, similar to Skype, one professor can speak to us fifty students through a computer/phone/any other handheld device imaginable. It’s amazing and saving us students a lot of extra class time to make up. Alas, snow days are no longer days off, but are now just the same as attending a lecture in a classroom. So, despite yesterday’s snow day, all seven courses were finally held this week.

          The week started with Clinical Lab Medicine, where we focused on the lab results received when we order a metabolic panel for patients. The metabolic panel is a list of electrolytes (sodium, potassium…etc.) and other measurements, like glucose, which provides an indication of the level of these substances in the patient’s body. It’s extremely important to understand how to interpret the results of such a lab test, especially when trying to determine the diagnosis and adequate treatment for the patient. In Clinical Skills, we continued to progress through the physical examination techniques, this week focusing on the dermatological (skin) exam of a patient. Everything from hair quantity and nail appearance to skin color, moisture, temperature, and texture must be assessed, in addition to the identification of any new or concerning-looking growths (like new or changing moles). So far, we’ve learned vitals and skin examination techniques, and only one section remains before our midterm (already!). In Pharmacology, we began our two week study of anti-infectious drugs (antibiotics/antivirals). We haven’t started learning how to dose these medications yet, but I sense a lot of memorization coming my way! In Endocrinology, we focused on the diagnosis and treatment of adrenal gland disorders (Cushing’s syndrome, Addison’s disease…etc.). Only one lecture of Endocrinology remains before our final. I’m fairly apprehensive about this final, just because of the quantity of information there is to master, but hopefully I’m more confident come test time.

          Finally, today was my long-awaited Cardiology EKG exam. I don’t think I have ever been more stressed over a single exam since starting PA school, and I am extremely relieved that it’s finally over. That being said, it was a challenging exam, in part, due to the time limitation. Some EKG patterns can be recognized in a few seconds, tops, but when given a 12-lead EKG, which displays 12 different views of the heart, it can take a good amount of time to fully analyze/diagnose what’s being displayed. I think I paced myself fairly well, but I definitely could have used some extra time. I don’t know the outcome yet, but I can only hope that my interpretations/diagnoses are accurate. I’ll fill you in on the results next week…good or bad.  

Question of the week: When performing a skin self-examination, the ABCDE rule is often used as an important screening method for detecting potential melanomas. What do the letters of this acronym (ABCDE) stand for?

Last week’s answer: Some patients have blood pressures, which rise above normal range only when measured in the setting of a medical office. This is known as “white coat” hypertension. 

Week 18: Thump…Thump…Thump

          All fell silent as I donned my stethoscope for its first use. Wrapping the blood pressure cuff snugly around the arm of my “patient” (a classmate), I was finally prepared to acquire my first manual blood pressure measurement. After inflating the blood pressure cuff to a sufficient pressure, it came time to listen very, very carefully. Little by little, I dropped the pressure of the blood pressure cuff. Little by little, a little more, and more, and finally, two low-pitched thumps interrupted the few preceding seconds of silence. Thump…Thump…Thump. With my stethoscope in place, I continued to drop the cuff’s pressure and listened as the consistent low-pitched thumps continued, until all fell silent, once again. And that was it. I recorded the pressure at which I heard the first two thumps (systolic pressure), in addition to the pressure at which the thumping sounds disappeared (diastolic pressure), put a line between the two numbers, and there it was–my patient’s blood pressure.

          As you might have guessed by now, this week in Clinical Skills, we began our two semester long journey through the procedures that we will perform during a physical examination of a patient. This week was all about measuring and recording vital signs, from blood pressure and temperature to heart and respiratory rate. Interestingly enough, we learned that the physical examination of any patient begins long before a blood pressure cuff swings around his or her arm. From the moment we enter the exam room, we begin our assessment of the patient. Everything from the patient’s sitting position, clothing, facial expression, and eye contact to his or her odor and body movement patterns need to be assessed. In fact, a patient’s assessment may begin as early as our spotting him or her in the waiting room. So, the general survey and vital sign component of the physical exam is not as simple as accurately acquiring four measurements; much of the patient’s psychosocial status needs to be evaluated at this same time as well.

          This week was another short one. All of these snowstorms have really slowed things down at school (not that I’m complaining), but we have been doing well with making up for all of the lost time. The only other course held this week was Endocrinology, in which we focused on disorders of the thyroid gland (hyperthyroidism and hypothyroidism disorders, as well as thyroid cancers). Other than that, it was a great catch-up week. I have been frantically preparing for my EKG exam, which is next Friday. I can’t believe how soon it is! I’m averaging about 100 or so EKG analyses per day, so I’m hoping by next week I’ll be confident enough at exam time. Anyway, I’m trying not to get too used to these consistently short weeks. Next week, if all goes well, all seven courses will resume once again.  

Question of the week: Some patients have blood pressures, which rise above normal range only when measured in the setting of a medical office. What type of hypertension (blood pressure) does this phenomenon describe?

Last week’s answer: Type 1 diabetes mellitus is an autoimmune disease in which the insulin-secreting cells of the pancreas are negatively affected. 

Week 17: When The Storm Hit

          Last week was the calm before the storm. As predicted, this week the storm hit, and it hit hard. Between an unexpected pop-quiz (I guess that’s what they are intended to be) and four new courses beginning in the time span of two days, it’s needless to say that my head is slightly spinning at the moment. However, this overload was completely expected and I’ll likely (hopefully) recover from the backup over the weekend. 

          Four new courses began this week: Informatics in Medicine, Cardiology, Epidemiology, and Clinical Lab Medicine. Informatics in Medicine seems like it will be an interesting course; it’s all about the technology and information databases available to clinicians, from current iPhone applications to electronic health records. This week in Informatics, we focused on the evolution of technology in the medical field from the mid-1900s to present day (mainly computer development). Being that this class is sandwiched between Pharmacology and Cardiology on Wednesdays, it’s like a breath of fresh air, much needed to lighten up my ten hour day. Speaking of Cardiology, this week, we reviewed the structure and function of the heart, various lab tests (EKGs, stress tests, echocardiograms) ordered for analyzing the heart’s functioning, and then began our crash course on EKG interpretation, which will last about two weeks, culminating in an EKG reading exam. I’ve looked at hundreds of EKGs to date, and I intend to review many more before this exam.

          Along with these new courses, Pharmacology, Endocrinology, and Clinical Skills continued. In Pharmacology, we studied the route that a typical drug takes once it’s absorbed into the body, and how this will ultimately affect the dose and frequency of the drug we administer. In Endocrinology, for the first time in a specialty course, an entire lecture was dedicated to a single diagnosis: diabetes mellitus. The prevalence of this condition is unbelievable and there is so much importance in the details, from its initial diagnosis through its treatment and long-term management. In Clinical Skills, we continued to focus on patient communication skills, in addition to the critical thinking skills utilized throughout the diagnostic process. We were also instructed to bring our stethoscopes and blood pressure cuffs to next week’s class. Finally, the physical exams begin!

Question of the week: Type 1 diabetes mellitus is an autoimmune disease in which the insulin-secreting cells of this organ are negatively affected. What is this organ?

Last week’s answer: You would expect a hormone called anti-diuretic hormone to decrease one’s urine output and thereby promote water retention.