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.

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