Cardiology and GI

Its been a while since Cardiology, its funny how the past 3 weeks feels like years ago. Most modules feel like this while in PA school, time seems to fly and last week feels like it happend sooo long ago. 

Cardiology was technically our first 3 week module, and it was a little weird to have two weekends to study instead of the typical one. I honestly think that allowed me and my classmates to be more relaxed during the first week of study... which is a good and bad thing! I felt like I didn't study as much as I should have at the beginning, but I got enough studying in the last 2 weeks to last me a while... Plus I feel that I had a major interest in cardiology and cardiothoracic surgery so it made it easier to retain the info. 

One skill we have been working on since we started the program is ECG interpretation, and I know SO much more than I did when I started... but let me tell you, it is not easy to pick up. It is a skill that gets mastered over time, and as one of our professors says: "you have to practice this skill over and over again in order to become and stay proficient". I really enjoy it, however, it will take me lots more practice until I feel comfortable interpreting them. 

Here is a bit-o-knowledge from Cardiology:
Auscultation (listening with the stethoscope) for cardiac murmurs and bruits is a skill that takes a lot of experience and practice. Of course its not always easy to hear pathology on fellow classmates who are all normal... 

Bruits (pronounced brew-ees) is a sound produced from non-laminar flow (disruption in normal blood flow). This can be due to plaque or a clot. Below is a typical presentation that can cause a bruit. 

Plaque that can cause a Carotid Artery bruit

A typical treatment for a carotid artery plaque (if it is severe enough, and a risk for emboli) is a carotid endarterectomy. As the photo shows, just cut the artery open, take out the plaque, and sew it back up. Some times a shunt will be placed around the plaque in the artery to continue blood flow while the plaque is removed. Clamping off the carotid for surgery can only be done for a short amount of time due to its effect on brain blood flow (that's kind of important!) 

GI Module

I never thought I would have such an "intimate" relationship with the colon and feces as I did during GI. I feel so much more comfortable with poop, bowel sounds, asking patients about their bowel habits, blood, hemorroides, and of course prolapsed rectums! 

One of our guest lecturers (a colorectal surgen) spoke about how "you can learn a lot about a patient by sticking your finger up their butt"... the whole class laughed a lot during that lecture. It was a really interesting module because this is something that will be addressed a LOT in practice. A lot of patients will present with  GI upset from drugs they take, or constipation. And because everyone needs to eat to live... i'd say there is a lot of things that can go wrong. Also there is a lot of people who like to do some weird things and get "items" stuck in their rectum, so they present to the ER for help. (Yep, we got to see pictures of that too!)

Endoscopic Retrograde cholangiopancreatography

 Interesting information regarding the GI tract: Most pathologies can be visually seen with an Endoscope or a colonoscope, making it much easier to diagnose patients without the inconvenience of invasive surgery (although a polypectomy or biopsy may be performed during an endoscopy/colonoscopy) it is hardly traumatic compared to other procedures. 

I also had the opportunity to do some dissection in the cadaver lab for the upcoming anatomy test involving the GI tract. It was really fun, and time really went by fast when I was dissecting. I spent a solid 5 hours in the lab dissecting and I hardly noticed it. I love working with my hands and I enjoy learning about the body hands on. It helped me to understand the anatomy so much better. 

For those wanting to attend Pacific... ask about the opportunity to do some dissections... you don't have to do them, but if you don't, you'll miss out on an amazing opportunity. The program doesn't set aside "scheduled time" for you to dissect, but there is time available during scheduled lab time where dissections can be performed. Plus you get to help dissect out what is going to be on the test, so you get a much better understanding of where the structures are on the cadavers. 

3 weeks of cardiology, and i'm still feeling it!

Cardiology... what can I say?! It was a lot of hard work and memorization, in fact I am positive it was the hardest test we have taken thus far. It included so much material it is really difficult to describe until you actually get to do it. 

I am only posting a brief little bit because I am in the middle of Gastroenterology and I have to study for the upcoming tests on Thursday and Friday... whew this semester is literally FLYING by! 

I just wanted to post a little 'teaser' to get everyone ready for the details of cardiology and Gastroenterology (which has been a lot of fun... there are so many jokes surrounding Gastroenterology... besides the typical "its a 'crappy' subject to study" joke, I think I've learned more about bowels and feces than I ever thought I would need to know!) So stay tuned! 

A day in my life as a PA student.

I had a request to share what a typical day is like for me being in PA school, so here it goes...

7:00am-wake up get ready for school

8:35am-catch train headed for school

8:50am-arrive at school, prepare for class starting

9:00am-class starts (usually lecture) 15min breaks between each hour of lecture. 

12:00pm-break for lunch (depending on the day, get 15-20 min of reading and reviewing morning lecture

1:00pm-lecture starts again, 15min breaks between each hour of lecture. 

5:00pm- class ends for the day, catch train home.

5:30pm- Workout for 30 min and eat dinner, relax by possibly watching some TV shows. (again depending on impending exams... this can change dramatically!)

7:30pm- stay at home and study in office, or go back to school and study in a group. 

9:50pm- (if at school) catch the train home.

11:00pm- get ready for bed

11:30pm- sleep

This is a typical day, however the schedule is always changing, and each module is significantly different. Activities happen in the afternoons sometimes which breaks up the constant lecturing, but those depend on the module and the amount of info we need to cover. 

Most modules we have time set appart to learn the physical exam skills for the specific organ system. 

 The time set aside for skills during class is usually not long enough to memorize the entire physical exam and have it down for the test, so part of my evening study time involves practicing with classmates. 

Funny Story... So picture a classmate and me practicing our cardiac exam just yesterday evening... I was feeling for his PMI (Point of Maximal Impulse) for the gentle tapping of the apex of his heart. 

It involved him laying on his left side, lifting his shirt up and me pressing the palm of my hand just under his peck pressing firmly to feel for the soft pulse. The table was tall and it was difficult to get my hand over him and in the right place, so I got on the exam table on my knees and honestly- it looked like I was wrapping my arms around him... ha ha. 

It made me think think that it takes some really manly men to be able practice on each other in these awkward positions... not only that, but I could just imagine someone walking in on us and wondering what we were doing! ha ha 

I'm deep in cardiology and will give an update on how the module wen't after I (hopefully) pass the exam... wish me luck!

Nephrology... "when good beans go bad"

Alright so Nephrology is over and yes of course after every module I explain how this module was the hardest one so far... I don't want to make a habit of doing that, however... the kidneys are SO complex. If anything this module has given me respect for those nephrologists out there who do this everyday. Acid/base balance is NOT easy, and neither is all the conditions that have almost the same symptoms. The exam seemed to have the same symptoms for almost every case! 

Lets see... Patient presents with: Flank pain, dysuria, hematuria, proteinurea, oliguria, azotemia. What is the most-likely diagnosis? 

Ok so it wasn't that way for every question, but it really seamed that way. Acute Kidney Injury (aka failure) can manifest itself quickly and in so many ways, even in patients who are being seen for a different condition involving another organ system! 

Here is a pretty interesting disease we learned about... Polycystic Kidney Disease. If this dosen't get your attention than nothing will! 

Polycystic Kidney Disease

The next module is Cardiology, and although it is easily one of my favorite topics of medicine, it scares the crap out of me! ECG is something that takes a lot of patience and practice to learn, and its really not easy. Plus all the thousands of diseases of the heart and what is affected by it just seems overwhelming! Oh and to add to the intensity, instead of the usual 2 week module this one is 3 weeks (one week in our module system is seriously like a normal semester's worth of information!) It's like getting butterflies before going on a crazy-huge roller coaster... here goes nothing!

Hematology/Oncology finished and onto Nephrology...

So I was lucky enough to squeeze by Hematology/Oncology and not have to retake the test again... and its a good thing too, that was a REALLY hard test. 

I am slowly finding out that due to the limited time we have in PA school, every second counts... The balance of material studied is so important. It is so important to learn to balance where you will spend the most significant amount of time studying, and memorizing. I am still learning this skill, and i'm guessing that when I get it figured out... I'll be moving on to my second year! Then of course when I get that figured out... i'll graduate! But that's what life is all about!

 I heard a quote today... yes its from extreme makeover weightloss edition (don't judge me, It inspires me to want to work out hard and work harder in school, ha ha) anyway here it is: 
             

"life starts at the end of you're comfort zone"

Yes, PA school is a lot of reaching the end of your comfort zone and stepping off into the wild unknown! It's hard, its fun, its scary... it's life! 

So today we had our first cadaver lab, and it was really a lot of fun. Putting what I saw in pictures and drawings into a 3-D image, then being able to hold it my hands just helped to put two and two together. Interesting fact: I didn't expect the lungs to feel so cool... its a weird spongy feeling that is hard to explain. You'll know what I mean when you get them in your hands. 

Off to digest everything renal... wish me luck!