One exam down, only seven more to go. Spring Break has never looked so good. If you are looking for me, I am probably under a pile of books, flashcards, notes, and other reference materials. In the meantime, check out these great resources:
Sunday, March 29, 2009
Sunday, March 22, 2009
Like something out of an episode of "House MD", our first year medical class broke up into small groups to make our attempt at a clinical case.
Problem Based Learning
I was a little unprepared when I was chosen to be the group leader for our first case. We were asked to develop questions and an organized method of investigating a case to obtain a history and physical. Fortunately, we had a faculty physician to guide our steps in the right direction or it may have taken a lot longer to get to the treatment.
Although these are simulations, it is a great way to see how our knowledge base has advanced. The clinical skills may be lacking, but we can still apply diagnostic tests, reasoning, and questioning skills to build a case and develop a differential diagnosis.
Every couple weeks we gather again to work another case and hone the skills we will need next year when we have patient actors. Although House may be make-believe, the process of getting to a working diagnosis is still a matter of clinical processing. It is going to take a lot of practice before we feel comfortable in that position. If you have suggestions in collecting a patient history, SOAP notes or other case building ideas, please leave them in the comments below.
One of the easiest ways to avoid illness is to wash your hands often. It takes little time and avoids the frustration of becoming sick.
Sunday, March 15, 2009
President Barack Obama addressed improvements that will be made in the public health sector, "...Americans can trust that there is a strong system in place to ensure that the medications we give our children will help them get better, not make them sick; and that a family dinner won’t end in a trip to the doctor’s office." [Full text] Our safety potentially lies in the hands of those who regulate our foods, vaccines and medications as well as the physicians who intervene locally.
It is nice to see correlates between medical school and the real world from time to time. We recently started a course that looks at our current public health care, how to produce the greatest benefits for the community as a physician, and how to interpret the information researched by others.
Although the system is not perfect, public health policy has an agenda to provide a safe environment from illness through detecting, reporting and treating diseases that arise among the general population. By tracking the spread of illness and providing interventions such as vaccines or prophylactic support, physicians can impact individuals and communities alike. It is important that public health research be performed in an effort to educate health care providers concerning the diseases they fight.
There are cases highlighted around the world that reiterate the importance of contributing to the overall public health in our communities. Below are some valuable resources for both the aspiring and practicing physician (most can be downloaded in portable document format):
- Center for Disease Control and Prevention - Online health resource
- Guide to Clinical Preventive Services - USPSTF recommendations on screening, counseling, and preventive medication topics including clinical considerations
- Morbidity and Mortality Weekly Report - CDC reports available in text and podcast
- Immunization Scheduler - Children 0 to 6 years, provides personalized dates
- Child Immunization Schedule - 0 to 18 years of age
- Adult Immunization Schedule - 18 years and older
Sunday, March 8, 2009
In conjunction with our Neuroscience coursework, we integrate the use of radiological imaging to visualize cranial structures as this is how we will see them most often. As seen in the image, technology is advancing quickly permitting greater medical flexibility.
After spending the past few months learning the anatomy of the brain, we had guest lecturer Dr. William Orrison, Chief of Neuroradiology from the Nevada Imaging Center, present on neuro-imaging and research. He was the first individual to be scanned with Toshiba's 3T MRI and is currently researching the extent of its capabilities.
The 3.0 Tesla MRI detects 320 lines of data with one turn making it quicker than older devices. Imaging studies use less contrast and produce data that is more detailed than previous machines. With all the data this powerful machine collects, 3-D images can be produced as well as dynamic motion of anatomical structures, diffusion tensor imaging (shown above), and angiography. Shortening scan times from one hour to a matter of minutes and data interpretation to a few minutes time makes this machine the new standard of care.
Despite its arrival last year, this new MRI is being used around the world to change the way physicians use diagnostic imaging. It is an exciting time to be in medicine and especially as a student. The tools of our generation will be vastly different from those of former professionals and I am certain that within the next few years advances will continue to come about, ultimately revolutionizing the practice of medicine.
A CVA or stroke occurs when the brain tissue losses blood and nutrient supply. This is similar to a heart attack and is sometimes referred to as a brain attack. Commonly this occurs as a result of blood clots that block blood vessels to certain parts of the brain. Neurological deficits result that give an individual indications that medical care is needed. There is a small window of opportunity for physicians to medically intervene and such symptoms should be treated as emergent. Diagnosis includes the use of radiological imaging to confirm the presence of a stroke. Imaging techniques may also be used to treat or remove stenosed or blocked vessels.
Sunday, March 1, 2009
Conferences tend to be a great way to gain knowledge, meet others in the field, and learn the latest skills in the field. I had no idea they give out medical degrees too.
As part of the first year curriculum, we are exposed to a medical jurisprudence course that incorporates medical law and ethical questions. Our professor is affiliated with the American College of Legal Medicine, which hosted a mock trial this past week. For someone such as myself, who has never set foot in a courtroom, this was a great opportunity to see the workings of a medically related lawsuit. It included a judge, witnesses, attorneys, evidence and the audience participated as a jury.
Certainly, the identification card which I was given is in error, but it does give me something to aspire to in years to come...the physician part anyway. And with any luck or skill, I won't be the defendant in such a case. If you are looking to attend an upcoming conference, consider these resources:
- CME Mall - One stop source for CME and conferences in the US
- New England Journal of Medicine - Includes a search tool for better specificity
- American Osteopathic Association - CME courses and tools
- American Medical Association - CME resources
- American Medical Student Association - Specific to pre-med students
This is the condition that was in question during the mock trial which is characterized by air located within the cranial cavity. In that case it was a result of neurosurgery, but it can also arise from head trauma or basal skull tumors. When the air is trapped in the skull it is considered a tension pneumocephalus and radiology tests commonly find the frontal lobes of the brain compressed in what is known as the Mount Fuji Sign. Complications include neurological changes, therefore treatment is quick to follow ultimately removing excess air and repairing any bony defects. [Patient Case Review]