Week 23: Spring “Break”

The professor shuffled three index cards, each labeled with one of the three physical exams (vital signs, skin, and HEENT) we have learned how to perform thus far in Clinical Skills. Spreading the index cards face down on the exam table, the professor then prompted me to choose one of the three cards; the exam written on this card would be the physical exam I would have to perform within fifteen minutes on my patient (a classmate). After practicing each exam option many, many times (at home), I knew that both the vital sign and skin exams would take only half of the allotted time to complete, whereas the HEENT exam would require double that time to complete due to the use of much more equipment (relative to the other exams). In the end, I randomly selected the index card with “HEENT” written prominently across it, and so I proceeded to perform the head, eyes, ears, nose, throat, neck, and thyroid exam on my patient. At some points, especially when using the equipment (opthalmoscope, otoscope…etc), the professor would closely watch my exam techniques (luckily I wasn’t shaking from my nerves), and at other points, the professor would listen to my explanations of why I was performing each test and/or what I was examining during each test. At the completion of the exam, I was relieved to be informed that I only failed to mention one detail of the approximately seventy details I had to examine or mention throughout the physical. And so, as quickly as that, I checked yet another midterm off my list.

All of my other classes progressed well this week. In Lab Medicine we began learning how to interpret blood test results. It’s amazing how much information can be interpreted from a simple blood test, once you know and understand what all of the values imply. In Pharmacology we learned when and how to prescribe medications for the eyes, ears, nose, mouth/throat, and skin. In our final Cardiology class we covered an enormous amount of information from valvular heart diseases (mitral valve prolapse, aortic stenosis…etc) to congenital heart defects (like tetralogy of Fallot). Luckily, my Cardiology final is not until the first week of April…I need much time to learn this information, all of which is exceedingly important. In Pulmonology we learned how to diagnose and treat obstructive lung disorders (asthma, emphysema, chronic bronchitis…etc.) and restrictive lung disorders (fibrotic lung disorders, asbestosis, sarcoidosis…etc.). Finally, today in Epidemiology, I completed the second of my two midterms for this week, and so I left class with a huge sigh of relief.

I am thrilled to be able to say that next week is spring break! Unfortunately, I do have another load of midterms the week I return, but I have never been happier to have the extra time off to study…I’m going to need it. One of these midterms includes the second of three midterms for Clinical Skills, that being a standardized patient lab (which my next blog will focus on). Unlike last semester, where our standardized patient labs focused on breaking bad news to our patients (high breast cancer risk and a fatal brain cancer), this semester focuses on actually diagnosing our standardized patients using the physical exam techniques that we are learning. I like to think of these standardized patient labs now as mini, practice appointments. We will not know what the patient’s appointment is for until we knock on the door and walk into the exam room, so we have to diagnose them on the spot based on the symptoms they report. Since we have limited experience with exam techniques, I expect the patient’s complaint to focus on HEENT, like earache, blurred vision, sore throat…etc., but I can never be so sure with these standardized patient labs. The complaints may be a bit more complex than what I expect…so, stay tuned for the next blog (two weeks from now, since I’m off next week), it’s sure to be an interesting one!

While I’m studying for my never-ending midterms and finals, enjoy a midterm of your own:

1. A P.A. prescribes a medication to be taken “tid.” How many times per day will you be taking this medication? Hint: The “t” gives you the answer.

2. True or false: A P.A. will likely use an opthalmoscope to examine your ears.

3. True or false: Anti-diuretic hormone decreases one’s volume of urine output.

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

5. In what setting would you expect “white coat hypertension” to occur?

6. You are performing a dermatological exam on a patient and observe a skin lesion. What rule should you apply to thoroughly examine the lesion?

7. Your patient presents with an earache. What piece of medical equipment will you use to examine this patient’s aching ear?

8. Order these visions from best vision to worst vision: 20/20, 20/200, 20/15

9. Pulmonology is the study of the __________.

10. What does ECG (or EKG) stand for?

Last week’s answer: The hypoglossal nerve controls movement of the tongue.

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