Week 22: Traversing The Canal

          Peering through the aperture of my otoscope, I entered the ear canal of my patient (a classmate). Traversing the canal (after about one or two centimeters), I eventually found the structure I sought to examine. The structure, namely the tympanic membrane (ear drum), glowed, illuminated by the bright light of my otoscope. There it was, my patient’s pearly white, transulent, and definitely uninfected ear drum, the first of many ear drums that I will likely examine.

          This week in Clinical Skills, we proceeded to practice the techniques of an HEENT (head, eyes, ears, nose, and throat) physical exam, with a major focus on ear, nose, throat, lymph node, and thyroid exams. There was a lot of new techniques to learn, but after much practice, I am starting to get used to the variety of tests and hands-on procedures. Next week is our first of three midterms for this class. For next week’s midterm, I will be paired with another classmate, who will pose as my patient. With a professor present, I will randomly choose one of the three physical examinations that we have learned thus far (vital signs, skin exam, or HEENT exam) to perform on my patient. I will perform the randomly selected physical exam while being observed and evaluated by the professor. The physical exam must be performed within fifteen minutes, and in that time I must mention and complete all of the techniques associated with that physical exam to score the maximum amount of points. So this component of the midterm is mainly concerned with assessing our hands-on examination skills. One of the other two midterms is a typical written/multiple-choice exam, and the last of the midterms is a standardized patient lab, which we haven’t received much detail on yet.

          Besides Clinical Skills, this week in Pharmacology we finished learning how to treat infections of the human body, from head to toe (those infections treated with antibiotics). So, as predicted, the list of drugs/doses that I have to memorize quickly grew within the span of the four hour lecture. Overall, the class offers a great review of many of the diseases we learned how to diagnose last semester in our specialty courses, but there is of course always a strong focus on the ultimate treatment of the conditions (assuming they were properly identified/diagnosed from the start). In Cardiology, we focused on hypertension (high blood pressure), from its initial diagnosis to the final management of patients with the condition. In Pulmonology, we focused on the diagnosis and treatment of respiratory tract infections (bronchitis, pneumonia, whooping cough, tuberculosis…etc).  

          This week was a chaotic one. Two, expected, midterms in one week is more than bearable, but when you throw three pop-quizzes, a twelve-hour school day, and a couple of 5:00 a.m. morning wake-ups to the mix, it makes a once seemingly bearable week a bit more exhausting. Luckily all five of these exams (the expected and unexpected ones) all went smoothly. The only thing pushing me through this next week is that spring “break” is in sight. In fact, it’s only one week away! Next week I only have two midterms: the Clinical Skills midterm and a midterm for my Epidemiology course. Unfortunately, we must turn all clocks one-hour forward this weekend. It’s not so unfortunate that it will feel as if I am awakening at 4:00 a.m. Monday morning, it’s more so unfortunate that I will be losing an hour of study time on Sunday. But, what can I do…

Question of the week: The hypoglossal nerve controls the movement of this body structure.

Last week’s answer: Patient A, who has 20/40 vision in each eye, has better vision than Patient B, who has 20/60 vision in each eye. A vision of 20/40 implies that Patient A, when standing 20 feet away from a Snellen eye chart, can read the same horizontal line of similarly-sized letters, that an average patient, with normal sight, can read when standing 40 feet away from the chart (a further distance). A vision of 20/60 implies that Patient B, when standing 20 feet away from a Snellen eye chart, can read the same horizontal line of similarly-sized letters, that an average patient, with normal sight, can read when standing 60 feet away from the chart (a further distance). In general, the lower the second number, the better the vision. 

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