Week 21: What A Sight

          All fell dark as I stood across from the patient (a classmate) and raised my opthalmoscope for its first use. Peering through the opthalmoscope, I centered its light onto the pupil of my patient. The pupil began to glow, taking on an orange hue, and I steadily inched closer to my patient’s glowing eye with the opthalmoscope. As one peers through a peephole to determine who just rang the doorbell to his her home, I peered through the pupil’s aperture to examine the back surface of my patient’s eye (the retina). After several (and I mean many, many) tries, I was finally able to view several blood vessels penetrating the retina, the main goal of this week’s eye examination.

          This week in Clinical Skills, we began our two week physical examination of the head, eyes, ears, nose, and throat. Focusing mainly on the eye examination, we learned the technique for measuring visual acuity (using a Snellen eye cart), checking reflexes of the pupil, assessing eye movements and proper muscle functioning, and for using an opthalmoscope. An opthalmoscope is fairly easy to use, but staying focused on the retina (back surface) of one’s eye with the opthalmoscope is not so simple. The more dilated (open) the pupil of an eye is, the more of the retina that’s visible, but since we aren’t dilating each other’s pupils in class, we have very little space (a tiny pupil) to work with and peer through. I’ll definitely need more practice to master use of the opthalmoscope, but I was very happy to at least see some vessels within the retina of my patient this week. It’s the little steps that count…

          The rest of my classes also continued this week. In Clinical Lab Medicine we focused on the value of genetic testing, especially as it relates to prenatal screening for a variety of genetic disorders. The intricacy of some of these tests is unbelievable! In Cardiology, we focused on coronary artery disease and the steps to take when a patient presents with “chest pain.” Though not all chest pain is attributable to a heart attack, we focused on the tests/procedures that would be performed if we did suspect a heart attack in a patient. In Pulmonology (study of the lungs), we learned how to interpret ABGs (arterial blood gases), pulmonary function tests, and the basics of analyzing chest x-rays. Although our Pharmacology class was postponed until next week, I’ve still been studying my antibiotics, used to treat bacterial infections from one’s head to toes.

          Endocrinology ended yesterday and the final went well. Again, the time constraint is always the main issue, especially when some questions are seven to eight sentences long, with lists of symptoms to quickly skim through and analyze. I try to have a diagnosis in mind by the time I finish reading through these longer questions and hope that what I suspect to be the issue is one of my five multiple-choice options. Sometimes it’s not as simple as diagnosing, but rather the ultimate question will ask how to best treat the presenting patient. So, if your diagnosis is wrong from the start, your treatment choice will be inevitably wrong as well. Midterms begin next week, and are spread throughout the next month. Next week, the only two exams I have are my Clinical Lab Medicine and Medical Informatics midterms, so hopefully they both start my month of March midterms off well…

Question of the week: You have determined that Patient A has 20/40 vision in each eye. You have also determined that Patient B has 20/60 vision in each eye. Does Patient A or Patient B have better vision?

Last week’s answer: 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? You should actually refrain from prescribing this patient an unnecessary antibiotic and rather treat him symptomatically. His common cold is likely the result of a viral infection and antibiotics are effective against bacterial, not viral, infections. 

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