Weeks 41 & 42: Count Back From Ten

At last, Thanksgiving break is near, and I cannot wait for the extra time off to relax and to try my best to catch up with the seemingly endless load of work that I must complete prior to the end of this semester. It’s amazing how little time remains in this semester (three more weeks!), and how many more exams I must get through before I truly experience a month of freedom. But, before I get too caught up in what’s to come in my near future, let’s look back at the events of the last couple of weeks…

One of the highlights of the past two weeks was the long-awaited approval of my research group’s thesis concept. The presentation of the thesis topic went very smoothly and the first four chapters of our thesis paper require only minimal editing before we ultimately sign an agreement with one of our professors who will mentor us throughout the remainder of the program and help us conduct the study that we have designed. I know I keep promising details on the thesis, but I will write a whole post about it soon enough. In Pharmacology, we switched focus to drugs used for procedural sedation and anesthesia. With these drugs, it’s extremely important to know their dosing regimens (based on patient’s weight), in addition to the speed at which the drugs begin working and how long they last. You never want a patient to awaken from sedation before a procedure is complete…that would be a very bad thing. Some drugs act within seconds. Before a patient reaches the number nine, after he or she begins counting back from ten and the drug has been infused, he or she has already drifted to sleep. We also learned how to calculate the necessary volume of IV fluids to administer to a severely dehydrated pediatric patient, when he or she presents to the emergency department (also based on weight). Unfortunately, we are expected to perform these calculations in our heads, without a calculator, so I’ll undoubtedly be practicing a lot before our Pharmacology final. In Surgery, we completed our Orthopedics midterm, which was thankfully much easier than the General Surgery midterm and final. I definitely needed that confidence booster. The Orthopedics midterm focused on the diagnosis and treatment of upper limb (arm and hand) fractures, and so the final will focus on fractures of the spine, pelvis, and lower limb (leg and foot). In Clinical Skills, we have been learning how to perform comprehensive physicals on specific populations of patients, like older patients and pediatric patients. It’s very different performing physicals on infants (the class demonstrations have been on dolls); everything is obviously much smaller and the patient is extremely delicate.

The specialty courses have all continued as well. We ended Psychiatry by focusing on the diagnosis and treatment of substance abuse disorders (alcoholism/drug abuse) in addition to childhood psychiatric disorders (depression, anorexia, bulimia…etc.). I took this Psychiatry final on Thursday and checked yet another specialty off my list. In Gynecology, we have been focusing on abnormalities of menstruation (painful, frequent, absent…etc.) in addition to gynecologic surgical procedures and imaging. We haven’t had Neurology for a couple of weeks, but we continue with this specialty next week. Yesterday, we began our final specialty of the semester, Rheumatology (study of joint disorders). Since we only have two weeks of Rheumatology, each class is six hours long, to compensate (usually each specialty is spread out over four weeks). So, needless to say, we learned a lot of Rheumatology yesterday, including the diagnosis and treatment of osteoarthritis, osteoporosis, gout/pseudogout, rheumatoid arthritis, and fibromyalgia. As I said a few paragraphs back, luckily I have time over Thanksgiving break to catch up with all of this!

I would offer a glimpse at what the last three weeks of my semester look like, but I’d rather not think about it myself. Let’s just say I have 13 more exams (including another standardized patient lab, a couple of papers, and quizzes that I know of) to get through between now and December 19th. It’ll be an extremely bumpy ride to the finish line, but I’m way to close to give up now.

Question of the week: True or false: Alcohol is a stimulant.

Last week’s answers: The most frequently fractured bone of the human body is the clavicle (collar bone).

Weeks 39 & 40: Nuts And Bolts

Finally, the seemingly endless month of midterms and finals has come to a close, and it feels great to be able to relax and de-stress a bit before the next round of exams begin (in two weeks, but I’ll take what I can get!). I took two finals last week, General Surgery and Obstetrics, both of which went well, one of which was the toughest final of PA school thus far (General Surgery), but it’s all over and that’s all that matters. As usual, things got a bit hectic again last week, so let’s catch up on the events of the past two weeks…

Several of my courses have begun focusing on orthopedic (bone/muscle/joint) care, including my Pharmacology, Clinical Skills, and Surgery courses. In Pharmacology, we have been learning when and how to prescribe simple analgesics (aspirin, Tylenol…etc.) and stronger opioids (Vicodin, Percocet…etc.) for acute and chronic pain relief. The difference with these drugs, relative to other drugs that we have learned about thus far (especially the opioids), is that these tend to be highly addictive and are controlled substances monitored at the state level, so extreme care needs to be taken to avoid patients developing an over-dependence on these drugs. In Clinical Skills, we have been learning the techniques of an orthopedic physical exam, which include examination and assessment of the stability and strength of joints (shoulder, elbow, knee, ankle…etc.) and muscles. This physical exam is fairly extensive and it seems like it will take a while to get used to some of the required techniques, but I have a few weeks to master them (hopefully master them!). Surgery has shifted focus from general to orthopedic surgery. In the past two weeks, we covered everything from interpreting x-rays to treating fractures of nearly every bone throughout the arm and leg. Orthopedics is a bit different from other specialties we’ve covered, in that it’s often apparent what problem the patient has at the time of his or her presentation. For example, it’s pretty clear that if half of a broken bone is protruding from a patient’s right forearm, something probably needs fixing at that location (the pictures we are shown in class are quite interesting, as you might imagine). Also, surgically fixing most of these fractures and orthopedic traumas really resembles carpentry work, from the machines/drills utilized to the nails, pins, bolts, and washers placed through and around the fractured bones for reinforcement, I really don’t see much of a difference…

Aside from the Orthopedic focus, my other classes have all continued. The past two weeks of Psychiatry have focused on diagnosing anxiety and personality disorders in addition to diagnosing and treating schizophrenia. In Neurology, we had a nice review of one of our first lectures of PA school, the diagnosis and treatment of headaches, with an emphasis on meningitis and headaches caused by bleeding in and around the brain. Since Obstetrics ended last week, we began the second component of our Women’s Health course, Gynecology. Thus far, we have learned how to diagnose and treat patients with menopause, infertility, pre-menstrual syndrome (PMS), vaginal infections, and sexually transmitted diseases. Next week, we begin a new specialty course, Rheumatology, the study of joints and their associated structures (you know, because balancing nine courses at one time just isn’t enough). At this point, with the amount of information we’re learning on a daily basis, I would never want to know what would happen if I missed even one day of classes!

Once again, I’m amazed at how quickly time is progressing. I’m already 40 weeks into PA school, and so only 20 more weeks remain in the didactic (classroom setting) phase of the program. The end is in sight, especially the end of this exceedingly chaotic, jam-packed, semester (only 5 weeks to go!!!). I’m slowly getting there…

Question of the week: What is the most frequently fractured bone of the human body: The clavicle (collar bone), femur (thigh bone), humerus (arm bone), or tibia (shin bone)?

Last week’s answers: 10; Cerumen (wax) impaction; No it’s not, the average size is 2.5 centimeters; True; Two Fridays ago, there were 219 days between that day and the start of my rotations. As of tonight, there are 205 days.