Week 28: Once In A Blue Moon

          It finally happened: an entire week without big exams and stressful studying. Of course, as predicted, three pop-quizzes filled this once-in-a-blue-moon large gap between exams, but only one of the quizzes was truly unexpected (the quiz on Monday, the day after Easter…you know, the day after the first Sunday of the semester that I actually took a break from work). But, with only two weeks of classes remaining, there’s no time to complain…

          This week in Clinical Lab Medicine, we learned how to diagnose and interpret the lab results of cultures sampled for bacterial, viral, and fungal infections (and how to treat the infections after interpretation of the results). The lecture was a good review of the Infectious Disease specialty covered last semester, but just condensed into four hours (instead of seven weeks). In Pharmacology, we continued to focus on cardiovascular drugs (diuretics, beta-blockers, calcium-channel blockers…etc), and when the use of each drug is indicated and/or contraindicated. In Nephrology, we focused on the diagnosis, staging, and treatment of kidney failure (both acute and chronic). Next week we will be covering renal malignancies, so that lecture will undoubtedly relate to personal family experiences endured not so long ago.

          Next Friday will be the second of the two standardized patient labs of the semester. Like the patient lab earlier in the semester, I will have two patient appointments, twenty minutes each. The patients are likely to visit with chief complaints pertaining to the respiratory, cardiovascular, and/or gastrointestinal systems. I’m assuming this, since these are the systems that we have most recently learned how to examine. Maybe the patients will present with a cough, or chest pain, or persistent diarrhea? It’s difficult to predict this time around because there are so many potential complaints for each of these systems. Stay tuned for those two stories next week!

          It’s official: May 15th is the last day of classes for this semester. That day cannot come soon enough. Only seven final exams (and likely a few more pop-quizzes) stand in my way of that day.   

Question of the week: Is furosemide (Lasix) an antibiotic, diuretic, steroid, or antihistamine?

Last week’s answer: Lithotripsy is a procedure used in the treatment of kidney stones. The procedure aims to blast a kidney stone with shock waves of such high intensity, such that the stone is broken into smaller pieces and thus easier for the patient to naturally pass. 

Week 27: Eye Of The Storm

          After five weeks of endless midterms, finals, pop-quizzes and projects, I finally have some time to breathe this weekend and upcoming week…and I couldn’t be any happier about this. From that tumultuous Cardiology final to my first two practice patient appointments, I definitely accomplished at least two feats that I felt were nearly impossible. Especially with this semester, it’s very easy to get caught up in the endless studying and exhausting schedule, but nothing rejuvenates me more than surrounding myself with family and friends, and this weekend will involve just that.

          As usual, we covered a lot of new material in each course this week. In Clinical Lab Medicine, we completed the topic of blood transfusions. In Clinical Skills, we learned how to perform the last of our physical exams for the semester, the abdominal exam. The abdominal exam is fairly involved, and entails everything from listening to the patient’s bowel sounds with a stethoscope to feeling the patient’s liver, and estimating the size of structures like the liver and spleen. In Pharmacology, we completed our study of pulmonary drugs and began to learn about drugs prescribed for cardiovascular purposes, especially those used to treat high blood pressure. Aside from drugs, one of the most important aspects of blood pressure maintenance is the promotion of lifestyle changes in patients with high blood pressure. It’s amazing how much of an influence weight loss and simple diet alteration can have on decreasing one’s blood pressure, even prior to (or without) initiating drug therapy. In Informatics, we focused on the newest HIPAA regulations and the affects that electronic health records can potentially have on patient confidentiality. Finally, our last specialty course of the semester, Nephrology/Urology, began this week as well, and we focused on imaging studies used to visualize the kidneys, diagnosing and treating inflammatory kidney disorders, diagnosing and treating kidney stones, and how to correct electrolyte/fluid disturbances (high/low sodium, high/low potassium, high/low water level).

          Overall, this week wasn’t too bad. The one exam (Clinical Lab Medicine), and the one final (Epidemiology), both went well, though they were challenging…unsurprisingly. With only three weeks of this semester remaining, I plan on taking it a bit easy this weekend, because I’m sure these final weeks of the semester will be just as exhausting as the five weeks that recently passed.

Question of the week: Lithotripsy is a procedure used to treat this kidney condition.  

Last week’s answer: After identifying a heart murmur in your patient, you believe that the murmur is derived from the heart valve located between the right atrium and right ventricle. You conclude that the heart murmur is derived from the tricuspid valve.

Week 26: Lub-Dub

          Lub-dub…Lub-dub…Lub-dub—the sounds of a beating heart, sounds generated by the impeccably coordinated opening and closure of the heart’s valves, sounds I must become very accustomed to listening to from this point on. This week in Clinical Skills, we learned how to perform a cardiovascular physical exam, from identifying and assessing pulses to listening to the soothing melody of the heart, something I’ve been waiting a while for. Just as with the lung physical exam, it’s important for us to learn the sounds of a regular heart before being able to identify heart murmurs (abnormal heart sounds)…and there are many. Luckily, there are a lot of internet resources that have examples of what the abnormal heart sounds sound like, but for now, it’s more important to learn how each murmur is described in writing (at least for testing purposes). I’m sure it will take a lot of time, patience, experience, and heart-listening, before murmur identification becomes a bit easier…

          This week was definitely more manageable than last week (the Cardiology final-induced stress). In Clinical Lab Medicine, we focused on blood transfusions and the risks associated with them. An extremely high amount of caution needs to be taken when administering transfusions, especially double and triple-checking that the blood of the donor (giving the blood) and the recipient (receiving the blood) match, otherwise the resulting reaction can be catastrophic. In Informatics in Medicine (I haven’t spoken much about this course), we have been focusing on phone and other hand-held device applications frequently used in the medical field, in addition to the use of electronic medical records. I only have this course once a week for one hour, so, as I said at the beginning of the semester, it’s a breath of fresh air. Today in Epidemiology (another course I rarely mention), I (and four other classmates) presented a group project in which we had to critique a published medical article. Our topic focused on the potential side effects of azithromycin (an antibiotic), specifically in patients with cardiovascular risk factors. I think the presentation went smoothly, but we haven’t received any feedback from the professor just yet.

          Yesterday was my Pulmonology final, and it went well. I find that, at least with Pulmonology, if you know the signs/symptoms that a patient is experiencing, his or her age, and the results of his or her chest x-ray (if they had one performed), all of those pieces of information tend to fit nicely together into the ultimate diagnosis/treatment plan. It’s like solving a mystery. Next week I have two more exams, one of which is my Epidemiology final, and then, I think I may not have another big exam for a couple of weeks. But, I’m sure there will be several pop-quizzes to fill in that too-good-to-be-true gap…

Question of the week: After identifying a heart murmur in your patient, you believe that the murmur is derived from the heart valve located between the right atrium and right ventricle. Are you considering the heart murmur is derived from the tricuspid valve, pulmonic valve, bicuspid/mitral valve, or aortic valve?

Last week’s answer: Nephrons are the microscopic components, which comprise the kidneys.

Week 25: Rock Bottom

          After twenty-five weeks of PA school, I can confidently say that this past week was one of the toughest, if not the toughest, to get through. The stress that I felt leading up to my Cardiology final exam on Wednesday pushed me a bit over the edge, both mentally and emotionally. I’m not certain where all of the nerves surfaced from, but for some reason, I just couldn’t help but feel a bit discouraged going into the exam, knowing all of the information I had to master in such a short amount of time. And so, after five days completely dedicated to studying for one course, Cardiology (I’ve never focused on one course for so many days straight before), I woke up at 5:00 am Wednesday morning (the day of my Cardiology final), incredibly nervous about the exam that would come eight hours later…

          At 2:00 pm, I flipped over my Cardiology final exam packet, pencil and pen all of the while shaking in my right hand, and answered each question to the best of my knowledge and intuition. At 3:00 pm, I submitted my exam, and walked out of class having completed the toughest exam I have taken thus far in PA school. No amount of additional studying could have prepared me for that exam. Needless to say, I drove home from school devastated, extremely scared that all that I’ve been working towards would be lost after this one exam. Arriving home from school, I forced myself to begin studying for my next final, all the while very distracted. At 6:00 pm I poured myself a glass of wine with dinner, well deserved and needed following the preceding, tumultuous five days. And then, at 9:00 pm, my Cardiology final exam grade arrived via email, and my grade was an absolute miracle. With a hefty curve to increase the class average, my grade well surpassed my initial expectations, and I was stunned by the result. In fact, my final grade in Cardiology was better than any other specialty course final I had taken in the past. Don’t ask me how…I’m still confused…but thrilled and relieved.

          Aside from the craziness leading up to the Cardiology final, all of my other courses proceeded as usual this week. In Clinical Lab Medicine, we continued to focus on analysis of blood test results, specifically analyzing patterns that reveal various forms of leukemia and disorders of hemoglobin. In Clinical Skills, we learned how to perform the pulmonary physical exam on a patient. When lungs are nice and clear, all you can really hear is air, but it’s always important to get accustomed to hearing normal lung sounds before learning how to recognize and classify the abnormal sounds. In Pharmacology, we focused on drugs used in the treatment of pulmonary disorders, with a strong focus on asthma control. In our final class of Pulmonology, we focused on diagnosing and treating lung cancers in addition to sleep apnea and other lung disorders that affect oxygen levels in blood. Next week is our Pulmonology final, and then we begin our final specialty course of the semester, Nephrology/Urology (study of kidney and urinary disorders).

          This week was an eye opener for me. Yes, I did hit rock bottom, feeling discouraged at some times and ridiculously nervous at others, but I never realized how much this all means to me until walking out of that Cardiology final on Wednesday. I thought this was all over for me, and it was one of the scariest notions I had ever felt. But, I made it through this week, and so I’m confident that I can push through these last five weeks of the semester to come.

Question of the week: Nephrons are the microscopic components, which comprise this organ.

Last week’s answer: False. Warfarin prevents blood clotting.