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.

Weeks 37 & 38: Stuck In The Middle

Note: The “patients” I speak of are paid actors/actresses, hired to simulate real patient encounters for us students.

Last Wednesday, at 1:30, I found myself standing in front of examination room #12, waiting for the cue to knock on the door and meet my first patient for the day. When instructed to enter the exam room, I knocked three times, entered the room, and introduced myself to my patient, a middle-aged female, who seemed relatively at ease. When I inquired what brought her to the office, she stated that a few nights ago, while watching her favorite television show, the right side of her face drooped and the entire right side of her body (arm and leg) became paralyzed for a short period of time. My immediate thought was that this patient experienced a temporary stroke (called a transient ischemic attack). After asking a variety of questions to get a more detailed description of the patient’s symptoms throughout the event, in addition to her past medical history (including a long history of smoking), it became more clear that a transient ischemic attack was indeed the most likely diagnosis. I performed a neurological physical exam to assess her muscular strength, sensory capabilities, and to ascertain the presence of all of her reflexes. The entire neurological exam takes quite a while to do (too long for a twenty minute appointment), so I had to tailor the exam a bit more to her main complaint. When I was warned that two minutes remained for my encounter, I quickly completed the patient’s physical exam and provided my impressions and recommendations. The patient was very concerned that she had experienced a stroke, and actually asked me if this was the case even before I began stating my impressions. I tried to calm her down as best as possible and explained that the form of stroke she had experienced was a temporary one, and to avoid future cases of the same episode, she may consider smoking cessation to minimize her risk for recurrence. At 1:50, I was instructed to leave the exam room, and, as quickly as that, my first appointment was complete.

At 2:00, I knocked on the door of exam room #9 and introduced myself to my second patient, an older female who appeared to be in a bit of discomfort. Once again, I asked this patient what brought her to the office, and she reported that she was experiencing frequent migraine headaches. She reported a history of migraines since adolescence, in addition to a family history of them, so my diagnosis was fairly clear from the beginning of the encounter. I proceeded with the neurological exam, and completed the physical components that I thought were most pertinent to this patient’s complaint (assessment of her cranial nerves). This encounter was a bit different than those of the past in that all of the patient’s responses painted a clear picture of a classic migraine headache. So, most of my questions were tailored to ruling out other, more serious, causes for her headaches (at worst, a brain tumor). My ultimate advice for this patient was that she should discontinue the current medication that she was taking to try to alleviate her discomfort, and I would rather prescribe her a stronger medication, specifically targeted to prevent the onset of her migraines (and all of the symptoms associated with them). At 2:20, my second encounter ended, and yet another patient encounter was complete.

I remember my first simulated patient lab one year ago, when I couldn’t hold my pen still from my uncontrollable anxiety and hand-shaking. At last, I found that during these two encounters especially, those nerves dissipated. This time, both patients reported (during feedback sessions) that I seemed very calm, unrushed, and confident throughout my questioning and while performing my physical exam techniques. It only took five or six encounters, but I finally feel like I’m getting even more comfortable with the patient communication and especially with eliciting all of the information I need during the limited amount of time provided for each appointment. My last two encounters of the semester are next month, so hopefully I get similar feedback after those (I’ll always be a bit nervous though! The cameras in the exam rooms don’t help…).

The past two weeks, as apparent by my skipping yet another weekly post, have been unrelenting to say the least. I’ve had midterms/finals for a handful of classes (Clinical Skills, Pharmacology, Health Promotion/Disease Prevention, and Hematology/Oncology), in addition to my physical exam practical (where the professors observe us performing the neurological exam on one another), and the two patient simulations. In other words, I haven’t had much time to breath. Honestly, I’ve lost count of how many classes I’m taking at one time, something like nine or ten. Last week, a new specialty class began, Psychiatry, and we focused on diagnosis of depression and a variety of other mood disorders. This week, a second specialty course began, Neurology, and we focused on the diagnosis and treatment of stroke, in addition to the methodology of localizing in what region/vessel of the brain the stroke occurred based on the patient’s presenting symptoms. In Pharmacology, we discussed a variety of psychiatric drugs (like Xanax), including anti-anxiety and sleep-aid medications. I only have two more finals next week, General Surgery and Obstetrics, and then I am FINALLY done with midterms and finals for a long while. Next Friday cannot come soon enough…

Here’s your midterm for the semester:

  1. Late in pregnancy, a female’s cervix may dilate as much as ____ centimeters leading up to delivery.
  2. Your 65-year-old patient complains of right-sided hearing loss. What do you suspect is the most likely cause of your patient’s hearing loss?
  3. You are performing a prostate exam on your 52-year-old patient. You estimate his prostate size to be 3.6 centimeters. This is the average size of a male prostate, right?
  4. True or false: Butter is an example of a saturated fat.
  5. Bonus question: How many days are there between today (Friday night) and the first day of my rotations: 317, 219, or 178 days?

Last week’s answer: Were you able to count down from the number 100 by intervals of 7? This is one of several components of the frequently used mini-mental state exam. This question assesses the patient’s attention and calculation abilities. Don’t worry if you couldn’t complete the count-down task. A variant used to assess attention in those who struggle with numbers is to ask them to spell the word “WORLD” backwards.

Weeks 35 & 36: Doubling Up

Well, it was bound to happen. After thirty-four weeks of consistent blog posting, I couldn’t find even one hour to spare last weekend to write about my thirty-fifth week of PA school. With the thesis project to balance on top of everything else, time was a bit sparse this past week. But, the great news is that my group successfully made our first research deadline (this past Tuesday), so all the time spent/hours of sleep lost paid off in the end. Approval of our research concept is still pending, but our next deadline is not until late November, so I’m thrilled that I can devote the bulk of my time now to studying. I’ll catch you up on the events of these past two weeks…

In the past two weeks of Pharmacology, we focused on drugs used in the treatment of thyroid disorders and conditions of the gastrointestinal system (diarrhea, constipation, nausea/vomiting…etc). This week, we learned how to calculate doses of drugs for pediatric patients, most of which must be dosed based on the child’s weight. We also began practicing how to write these prescriptions out on prescription pads. Much care must be taken at this step to avoid any ambiguities and ensure that the pharmacist and, more importantly, the patient correctly carry out our instructions. In Surgery, we focused on the surgical correction of gallbladder and liver abnormalities (gallbladder stones and cirrhosis of the liver). We had our midterm for this class last week, and it was one of the tougher exams that I’ve taken thus far in PA school, but not the worst. In our final class of Hematology/Oncology, we focused on the diagnosis of various platelet/clotting disorders (hemophilia), and our final for this specialty is in a couple of weeks. Next week, we begin our next two specialty courses: Psychiatry and Neurology. The past few weeks of my Health Promotion/Disease Prevention class have focused on educating patients about nutrition and exercise, tobacco/alcohol abuse cessation, and screening/treatment for sexually transmitted diseases. Today, we completed our final class of Obstetrics, and focused on management of premature births and postpartum care of both the mother and her newborn. So, yes, my brain is a bit saturated at the moment. I don’t think I’ve crammed so much new information into my head all at one time before…

Next week, midterms begin! I start with my Pharmacology midterm on Tuesday, and I have the first (of two) standardized patient labs of the semester (for my Clinical Skills class) on Wednesday. Thus far in Clinical Skills, we have mainly learned the techniques of the neurological and psychological physical exams, so I definitely expect the patient complaints to center around these two systems. Maybe they will present with muscle weakness of the arms or legs or with loss of sensation in a specific area of their body…who knows, I can never really predict accurately. Next week’s blog will focus on these two patient appointments (should be interesting, as always).

It’s unbelievable that I’m already six weeks into this semester, and clinical rotations are just around the corner (233 days away). Without going into too much detail, our clinical phase lasts fifty-two weeks and consists of eight rotations, some of which are four weeks and others eight weeks. One of the eight rotations is an elective, which means we can select a specialty of our own interest. I have a few in mind, including pulmonary medicine and endocrinology, but I definitely have some things to think about in the upcoming weeks…

Question of the week: Can you count down from the number 100 by intervals of 7? See how far you can get, and I’ll explain the significance of this test next week. Starting counting! I’ll start you off…100…93…86…

Last week’s answer: Unsaturated fats (like oils) are a healthier form of dietary fat than saturated fats (like butter).

Week 34: Little Pinch

I rubbed my abdomen, just a few centimeters to the left of my belly button, with an alcohol swab provided by my professor. With the site now clean, I popped the cap off of a syringe (an empty one), also provided by my professor, and centered it’s needle over my sterile abdomen. A bit hesitant, but determined, I gradually applied pressure onto my abdomen with the tip of the needle, and, just like that, I had successfully injected myself…

This week in Pharmacology, we continued to focus on treatment of diabetes, specifically relating to the dosing/prescription of insulin. The administration of insulin is through the use of a syringe, which therefore requires patients to self-administer the medication via daily injections. Since we will ultimately be explaining to the patient how to administer the insulin and self-inject it, our professor saw it fitting to have us all experience what the injection truly feels like. Honestly, the injection didn’t hurt! The needle was very, very thin, so all I felt was a little pinch.

All of my other classes have been going well. This week in Surgery, we focused on surgical procedures/treatments used to cure a variety of gastrointestinal disorders, from tumor removals to correction of various forms of hernias. My midterm for this class is Wednesday (mainly the reason for this late post!), so I’ve been focusing on this material for the bulk of my weekend. In Clinical Skills we began to learn the techniques of a neurological physical exam. There are many different components to this physical, but a good portion of the exam is a review from last semester, which makes things a bit easier. We had eight hours of Hematology/Oncology this week alone, so we covered many new topics, from anemias to leukemias and lymphomas. In Obstetrics, we focused on techniques used to monitor a fetus in the first hours and days following his or her birth (no new birthing videos to talk about this week though!).

Luckily, I found a bit of time to relax tonight to write about my week. It’s so difficult to just make time for myself, but I’m trying my best. October is going to get a little more chaotic, but after these next four weeks, things should calm down…should.

Question of the week: Which form of dietary fat is healthier: unstaturated fat or saturated fat?

Last week’s answer: The approximate size of the male prostate is 2.5 centimeters (in length).

Week 33: Traversing A Different Canal

I put on a pair of gloves and stood in front of my patient (a fake, but anatomically correct model). With the patient turned onto his left side, I readied my finger for entrance into his anal canal. Yes, the model was forced to endure the often-dreaded rectal exam, and lucky for him, it was my first time performing this exam. Lucky for me, my first time was not on a real human being. It only took less than a minute to access the rectum of the patient, feel the contours of his prostate, and complete the digital rectal exam. Next time I perform this exam, it will likely be on a live patient…but that’s still eight months away.

This week was another hectic one (what else is new!). We doubled up on three courses, so that made my schedule a bit more chaotic. In this last week of Geriatrics, we focused on various conditions associated with aging, including incontinence, pressure ulcers (in bed rest patients), polypharmacy (the effects of prescribing too many drugs to a single patient), and dementia. Next Thursday is my Geriatrics final, and then we move on to our next specialty, Hematology/Oncology (the study of blood disorders and cancer). In Surgery we focused on the management of trauma patients, like those who present to the emergency department with gun or stab wounds to the chest and/or abdomen. We also learned how to identify and surgically repair various breast conditions, in addition to gastrointestinal abnormalities. In Obstetrics, we continued to focus on the events leading up to and during normal pregnancy. The videos of childbirth have been disturbingly graphic, but uplifting at the same time. I give much credit to anyone who has ever given birth to a child! In Clinical Skills, we continued use of the models to perform rectal/prostate exams, in addition to vaginal exams. The models are not very giving at certain times…the speculum I used to examine the cervix of my female model actually got stuck on its way out of the vagina…again, luckily these are just fake models. We also practiced the steps of delivering a baby with a different pregnancy model. I’m ready to progress to using each other as patients again next week. I think the models have had enough of me too!

This semester has been a bit different from the others with the added component of the thesis work that we’ve been doing. Now, instead of eating, sleeping, and studying, I have to consistently add research to the list of things to do. Now that my group is a few weeks into the research process, I can confirm that our topic entails the study of anterior cruciate ligament (ACL) injuries (this is one of the ligaments that support the knee joint), relating to their prevalence in college-level athletes. I’ll leave it at that for now, but once more details are solidified, I’ll give a bit more information.

Question of the week: The approximate size of the male prostate is _________ centimeters.

Last week’s answer: The most common cause of hearing loss in a patient over the age of 65 is cerumen (wax) impaction.

Week 32: The Models

It’s amazing how quickly time seems to go by when balancing the load of eight classes on your shoulders. I’m two weeks into the semester and already losing track of time, but luckily managing to keep up with the material as best as possible. Ideally, I would be able to dedicate two hours of study time to each class over my weekends. Unfortunately, a sixteen-hour study day does not seem feasible to me…at least at the moment!

My last new course, Pharmacology, began this week. The biggest difference in Pharmacology this semester will be the need to learn dosing regimens for all of the drugs that we cover, so I expect that my math skills, which I really haven’t used since undergrad, will be very often used moving forward. This week in Pharmacology we focused on drugs prescribed for diabetic patients, specifically those with type II diabetes (the category of diabetes associated with weight gain). It’s not so much only the drugs that matter in the treatment of this condition, but what’s even more important is the promotion of diet and exercise to supplement the drug therapy used. In Surgery, we focused on post-operative treatment of patients, like how to determine the amount of fluids and nutrients patients should be given intravenously (IV) based on their overall weight and hydration status (even more math!). This week in Geriatrics, we had several different lecturers visit our class to speak about their specialties in reference to the treatment of elderly patients. One lecturer was an audiologist (hearing specialist) and the other was a physical therapist, both integral players in the care of such patients. In Clinical Skills, we learned how to perform a gynecologic exam as well as a physical exam of a male’s genitalia, including assessment of hernias. I know what you’re thinking…no, we did not use real human patients OR each other to practice these exams! We used plastic/rubber models to practice the techniques required of these physicals. The first time I perform these techniques on real patients will be during my rotations this summer. Next week we learn how to perform rectal and prostate exams…luckily, using the models as our patients once again.

Speaking about time flying by, the first big deadline for my research class is right around the corner. This is the one and a half year-long class, in which time we (in groups of four) complete our thesis project, required to graduate from the program with a Master’s degree. The first deadline is our concept project in which we present the concept of our research study in the form of a written paper and an oral presentation. I’ll say more about the concept of my group’s topic as the research progresses this month. Right now, I think we have an interesting topic that will keep us busy over the next year!

Question of the week: What is the most common cause of hearing loss in a patient over the age of 65?

Last week’s answer: Late in pregnancy, a female’s cervix may dilate as much as 10 centimeters leading up to delivery.

Week 31: Home Sweet Home

          Well, classes have officially begun, and I surprisingly feel like I never left school back in May. Did I really have an entire summer off? Merely a three-day school week, and those three months have already become a blur. Three days of classes, yet my weekend already warrants a twelve-hour study schedule…something I guess I’ll have to get used to early on in the semester! But, I’m actually happy to be back, and ready to take on these new courses.

          In the three days of classes I had this week, six new courses began including Surgery, Clinical Skills, Geriatrics, Health Promotion/Disease Prevention (HPDP), Obstetrics/Gynecology (OB/GYN), and Research. In Surgery, we began by focusing on the history of surgery from ancient times to present day, in addition to complications that may ensue in the first week after operating on a patient. The first half of the semester will focus on general surgery, and then we will cover specific surgical specialties including orthopedic surgery, ophthalmic (eye) surgery, and cardiothoracic (heart and lungs) surgery. I’m super excited to learn about all of these surgical techniques! In Clinical Skills (the physical exam course), we learned how to physically examine a pregnant patient, from determining the extent of cervical dilation prior to the patient’s giving birth, to detecting the heart rate and position of the developing fetus using abdominal ultrasound. In Geriatrics, we focused on the aging process and changes that occur in the structure and functioning of various body systems as one ages, in addition to the nutritional advice that we should offer such patients. For our OB/GYN course, we spend seven weeks of the semester learning about each component (obstetrics and gynecology) of the specialty. This week we began the obstetrics (pregnancy) component, where we focused on the events of conception, how to measure the size of the mother’s pelvis to ensure ease of delivery, and various recommendations for medical screening tests in women (Pap smear, mammography, bone density…etc). So, this first week of PA school was unusually jam-packed, but semester three is definitely notable for it’s speed and LARGE quantity of content.   

          Luckily, this week went well and didn’t come as much of a shock as the first week of my first semester came one year ago. In fact, if I had a first week like this last year, I probably would have lost my mind! It’s amazing how much of a difference one year makes. My goal is to keep up the blog posts on a weekly basis, but as is already apparent, I may be posting on a different day each week, whenever I need a good break from the books. Already one week down…just fourteen more to go…

Question of the week: Late in pregnancy, a female’s cervix may dilate as much as ____ centimeters leading up to delivery.

Pre-semester quiz answers: True; Eardrum; Blue; Inflammatory bowel disease; False

The Middle (Continued): Didactic Phase, Semester Three

          Not so long ago (at least that’s how it feels), I posted my final blog to conclude my first year of PA school. And now, I find myself (unsurprisingly) thinking…where did my summer go? As expected, my time off flew by, and two weeks from now I’ll be starting my third semester of school. This summer was one of the best I have ever had, free of any obligations, and only requiring a light amount of studying in preparation for the first couple of weeks of this upcoming semester. Yes, it’s been such a relaxing, stress-free summer, but it’s time to start talking about what’s coming my way for the remainder of this year…

          Semester three – from what I’ve heard some upperclassmen say, it’s the most intense of the four semesters. This semester, I’ll be taking eleven new courses, luckily only having to balance eight courses at one time (since the specialty courses only last about five or six weeks each). The final five medical specialties we will cover this semester include Geriatrics (branch of medicine focusing on the care of elderly patients), Hematology/Oncology (study of blood disorders, in addition to malignant (cancerous) disorders), Rheumatology (study of disorders affecting muscles, joints, and their associated attachments like ligaments and tendons), Psychiatry (study of mental, emotional, and behavioral illnesses), and Neurology (study of nerve disorders, including disorders of the brain). I will also be taking the second (of three) Clinical Skills courses. Last semester, this course focused on the techniques used for physical examination of half of the human body systems. We will learn how to physically examine the other half of the human body systems this semester (and, of course, more standardized patient labs are coming my way). Other courses include Pharmacology II (a continuation of the Pharmacology course I completed last semester), Surgery, Women’s Health (Gynecology/Obstetrics), Health Promotion/Disease Prevention (this course focuses on recommendations we must make to patients regarding screening tests, vaccinations, dieting/exercise…etc), and our first Research course. To graduate from this PA program with a Master’s degree, we must all complete a group research project with three or four other students. We have these final two years to conduct our research study, and so we begin our first research-conducting steps this semester.

          So, as usual, it looks like I’ll have another jam-packed semester. Honestly, this list of courses makes my first two semesters look easy, and they were anything but that! Nonetheless, I’m getting excited to begin my last year of intense schooling (and studying), hopefully forever. It’s absolutely crazy to think that only thirty more weeks of classes stand between me and my final year of rotations. We’ve been warned that there’s at least double the amount of information to learn throughout this second year of PA school, so there’s little time to waste. With all that being said, once again…I’m ready…let’s do this.

My third semester begins Wednesday, September 3rd. Until then, have some fun with this pre-semester quiz:

1. True or false: Pre-hypertension is classified as having a blood pressure within the range of 120-139/80-89.
2. “Tympanic membrane” is the fancy term for this structure within the human ear.
3. An individual who exhibits “cyanosis” might have fingernails of this color, in place of pink.
4. Ulcerative colitis and Crohn’s disease are two components of IBD. What does the acronym IBD stand for?
5. You are about to treat one of your patients for a middle ear infection. He admits to having a penicillin allergy. True or false: It’s safe to prescribe this patient amoxicillin for his middle ear infection.

Week 30: Calm After The Storm

          After nine classes, a countless number of exams, and an even more countless number of hours studying, I’ve reached week thirty of PA school, completing my first year! This afternoon, I bubbled-in my final answer on the last exam of the semester, and exited the same classroom that I first entered not so long ago, back in September. A mere nine months have passed by and I cannot believe how much new information I’ve been taught…it’s unbelievable.

          Relative to last semester, this semester was definitely more challenging, but all of my finals thankfully went well. The written exams (Clinical Lab Medicine, Clinical Skills, Pharmacology, Informatics, and Nephrology) were all generally fair. For my Clinical Skills practical (when I have to perform a physical exam on another student, in front of a professor), I was observed performing the cardiovascular physical exam, which is much simpler and quicker to perform than the lung and abdominal exams, so I was happy to have randomly chosen that exam. Overall, the endless marathon of studying did pay off, and I think I managed the stress a bit better than last semester around this same time. It wasn’t that I cared any less this time around, but I had more of an attitude of whatever happens, happens (especially after surviving that Cardiology final back in March). Honestly, there’s only so much one can learn in such a limited amount of time, so it’s all about trying your best and finally hoping that your best effort will be enough.

          So, to sum up this semester, I would say it was definitely chaotic, and obviously kept me super busy, but I probably wouldn’t have done anything differently. It’s absolutely crazy to think that one year from now I’ll be starting my rotations, practicing on real patients, in real medical settings. And although it feels like I’ve learned so much up to this point, there’s still an enormous amount of information that I’ve yet to learn. Next semester (semester three) has been regarded by most students as the most difficult one of the four…so I guess this year of school was only a warm-up for things still to come. But, luckily, I have three months to relax, and only one-half of a textbook to study (we have an exam in Clinical Skills the first week we return, just on everything we learned this semester). This will likely be my last summer off until I retire, so I’m going to make it a great one!

          Thank you to everyone who’s been reading this blog. You all don’t know how much of a difference it makes knowing that people are supporting me and truly care to read about my experiences as they unfold throughout the course of this three year (now only two!) journey. I’m certain that there will be many more stories to tell over the next two years. For now, these blog posts are to be continued…(start checking for new posts mid-August!)

Here are the answers to your final: True; Nephrons; Tricuspid valve; Lithotripsy; False (Prednisone is a steroid)  

Week 29: The Final Stretch

          Note: The “patients” I speak of are actors/actresses hired and trained to simulate real patient encounters. 

          Today, at 11:15 a.m., I found myself standing in front of examination room #9, the same room that stood before me not so long ago. When given the cue to knock on the exam room door and meet my first of two patients for the day, I would once again cast my PA school training wheels aside. When prompted, I knocked on the door, entered the room, and found my first patient, a short, older female sitting a bit hunched forward on the exam table. After a brief introduction, I asked the patient what brought her to the office today, and she answered that she had been experiencing left abdominal pain for about two weeks. As I elicited the history of this complaint, it became clear that the patient was a bit nervous about the possibility of colon cancer, being that her mother had passed of this diagnosis several years ago. After much questioning, I proceeded with an exam of the patient’s abdomen, and so I listened to her bowel sounds, assessed the size of her liver and spleen, and palpated (touched) several abdominal areas, including the area of pain. The patient noticeably flinched when I placed pressure on her lower left abdomen, the site of pain, but this was an expected reaction. When I completed the exam, I inquired about screening tests (specifically colonoscopies) that the patient had in the past, and she reported that her last colonoscopy showed signs of diverticulosis (formation of pouch-like structures in the colon). This colonoscopy finding fit well with my overall impression, and so it was most likely that the patient was experiencing a bout of diverticulitis (inflammation of one or more of these pouches). Being that she did have a fever, I reassured her that her discomfort was likely due to this (diverticulitis), rather than a structural abnormality like colon cancer, but I did recommend another colonoscopy so that we can be certain of the diagnosis. The patient seemed content with the plan, and with that, my first twenty-minute appointment was complete.

          At 11:45 a.m., I knocked on the door of exam room #10, and entered to find my second patient, a middle-aged man, sitting upright on the exam table. Once again, I questioned the reason for this patient’s seeking medical care, and he reported that he has been experiencing episodes of wheezing and overall difficulty breathing when he vigorously exercises. The first diagnosis that immediately came to mind was exercise-induced asthma (narrowing of the airways provoked by exercise), and so I focused my history questioning accordingly. After eliciting a thorough history of the complaint, I proceeded to perform a lung exam on the patient, in addition to a cardiovascular exam (these two systems always go hand-in-hand, so I listened to his heart just to be safe). This patient’s main concern was that he would have to stop exercising forever, and since exercising was one of his favorite stress-relievers, this prospect was a bit depressing for him. Again, I tried to reassure him as much as possible, and explained some of the options available for him if he were to be diagnosed with exercise-induced asthma after further testing. I also stressed that he would likely not have to completely eliminate his daily exercise regimen, but would more likely just have to modify his exercise habits. This seemed to comfort him, and with that, I completed my second appointment of the day.

          After six patient encounters (two last semester and four this semester), I definitely feel that I have come a long way in my interviewing techniques. I feel my nerves before and during each encounter dissipating a bit, and I find myself being more fluid with my interview techniques. Yes, there are questions that I always need answers to, and so structuring the interview is important, but I find that what works best is allowing the patient to guide the order of the interview, and this really is what allows him or her to narrate his or her own story. I won’t have another standardized patient encounter until next semester, but I know that I’ll never forget the feedback and knowledge acquired from these first-year encounters.

          With fourteen weeks behind me, only one week remains until I complete my second semester (and first year!) of PA school…well two weeks. Like last semester, the school mandates a “study week” between the last week of classes and finals week, so next week just serves as a make-up week for us. So, the next time I post will be two weeks from now (I’ll be the happiest person alive in two weeks). Six finals stand in my way of a three-month bout of freedom. I remember saying this last semester at a similar time, but I wish we could flash-forward to May 15th

While I wrap up this semester with all of my finals, good luck on your final:

1. Vitamin K combats the action of warfarin. So, true or false: Vitamin K promotes blood clotting.

2. The kidneys are composed of microscopic components called _________.

3. The heart valve located between the right atrium and right ventricle is the __________ valve.

4. Your patient is experiencing flank pain, which you attribute to the presence of a kidney stone. What is one procedure that may be used in the treatment of this patient’s stone?

5. True or false: Prednisone is an antibiotic.

Last week’s answer: Furosemide (Lasix) is a diuretic.