Sunday, February 28, 2010

Industrial Health

Among the books, papers, and anatomical models in my office I have a small collection of medical art hanging. In the bottom left corner is an industrialized piece by Fritz Kahn that depicts the body as a machine. "Der Mensch als Industriepalast" has recently been given new life in this video animation, "Man as Industrial Palace."

Body Systems

Our newest adventures follow the gastrointestinal tract from top to bottom. Like the chocolate morsel in the animation we are developing an understanding of the chemical breakdown of foods in healthy and diseased individuals. At first, I thought there was no hope of grasping the workings of the liver and this complex array of tubes (If only it were as simple as the animation). Despite its complexity, there are occasional "aha moments" when the on-turning light above my head illuminates a concept I've known before, but never truly understood. Compared to days of confusion, those are usually what constitutes a good day.

We have not yet finished our systematic approach to the body. Looking back at my second year of medical school, however, I feel there has been a significant amount of progress. We are constantly developing a new vocabulary and a working knowledge that were non-existent only months prior. This process definitely has a steep learning curve and it is no wonder that doctors are considered to be among the top 1% of the world's most educated professionals. A daunting reality that is appropriate, considering we are expected to care for the life of another individual.

Board Prep Question of the Week
A 46-year-old female with a history of painful spasms of the fingers in the cold complains of 2 weeks of fatigue, pruritus, and abdominal pain. Her exam is notable for scleral icterus, right upper quadrant pain, and a liver span of 11cm. Her laboratory values are as follows:
AST: 110
ALT: 102
Alkaline Phosphatase: 256
Total Bilirubin: 2.8
Direct Bilirubin: 1.9

An abdominal ultrasound shows no obstruction. A liver biopsy is taken and shows destruction of small interlobar bile ducts. What antibody test will likely be positive?

A. Anti-Scl 70
B. Anti-ds DNA
C. Anti-mitochondrial
D. Anti-smooth muscle

Answer & Explanation

Sunday, February 21, 2010

Second Exam Week Four

Thanks to the help of a few classmates, I came across an understandable metaphor for medical school. It might go down well, but the repercussions can be awful.


Eating pancakes is not normally considered a difficult task and may even be quite enjoyable. Equating five pancakes to a day in school does not seem like much to swallow. From day one you know that is all they ask you to do, eat your five pancakes a day. Things get tough when you decide to put off what you could have done today. As one of my classmates said while preparing for our exams last week, "Eating two weeks worth of pancakes in one night. Can't wait to regurgitate them tomorrow."

It is definitely a feasible task, but along comes all the distractions and enjoyments of life outside of school competing for that pancake eating time. Do we grab a fork or find that comfortable spot in front of the TV? Decisions, decisions... One thing I know for sure, this last week was one of the hardest yet and I couldn't be happier that it is behind me.

Board Prep Question of the Week
A 20-year-old female sees her physician for diarrhea and fatigue with a 20 pound weight loss over the past 6 months. On exam, she is afebrile and has mild muscle wasting, but her strength is normal. Stool studies do not reveal blood, ova, or parasites. A biopsy of the jejunum is taken and microscopically reviewed. The patient is placed on a special diet with no wheat or rye products. The change in diet produces a dramatic improvement. Which of the following microscopic features is most likely to be seen in the biopsy?

A. Crypt abscesses
B. Foamy macrophages within the lamina propria
C. Lymphatic obstruction
D. Noncaseating granulomas
E. Villous blunting and flattening
Answer & Explanation

Sunday, February 14, 2010

Human Network

Rummaging the internet for a bit of entertainment to break the monotony of studying for our exams this week, I came across one of the latest installments of the TED talks and wanted to share it here.

Patients Like Me

Medicine does not have all the answers. Clinicians and researchers continue to investigate how the body functions and how to make it better. Despite decades of data, we are still plagued with devastating illnesses that affect individuals and families alike. Jamie Heywood, after losing his brother to Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Disease, has developed a network for sufferers, families and providers afflicted by various prevalent and rare diseases.

Patients Like Me permits users to create a profile that depicts their illness in measurable terms. In the way a social network functions, one can compare their symptoms, treatments and journey with others who suffer from the same complication. The site functions as a tool for encouragement, but has the potential to help with future outcomes and treatment. The more patients contribute their data, the better the reports become. One can see a spectrum of their disease in a way not possible before. Patients and clinicians can integrate disease progression with the current situation in an effort to find the best approach to treatment. Although it is not solid science, it is a model for clinical data developed by the people who know the disease best, the patients.

Board Prep Question of the Week

A 32-year-old woman with no significant medical history presents to the clinic with visual complaints. On a recent trip to Arizona, she suffered an acute episode of visual impairment. She experienced blurred and double vision, which made it difficult for her to drive. On visual examination, her vision is 20/20 in both eyes. When she is asked to look to the right, her left eye only reaches midline while her right eye shows a beating nystagmus. Testing for visual convergence is intact. Based on the clinical history and physical examination, what is the most likely cause of her complaints?

A. Amaurosis fugax
B. Cataract
C. Multiple sclerosis
D. Optic neuritis
E. Panophthalmitis

Answer & Explanation

Sunday, February 7, 2010

More Than Meets the Eye

Infectious mononucleosis, when symptomatic, you really don't want it unless you are trying to get out of your day job. The image here is a kit for performing the MonoSpot test.

Laboratory Diagnostics

Although we may not be performing the laboratory procedures ourselves in the future, it certainly helps to have an understanding of the equipment available. This week we tinkered with the MonoSpot test, rapid strep test, and Gram staining. The first two are specific indicators of illnesses that can be performed quickly to rule out other causes. The Gram stain is used to narrow down the possible organisms that may be leading to illness.

In a matter of minutes these simple tests can aid in the diagnosis of disease saving time and resources. If for nothing else, it was nice to get out of the classroom for a couple hours to get a change in scenery. After getting through the gag reflex, it was quite reassuring knowing that I don't currently have strep throat.

Board Prep Question of the Week

A 9 year old girl presents with 2 days of sore throat and fevers of 102ºF. Physical exam reveals an erythematous pharynx with a white, creamy exudate covering the left tonsil. Palpation of the neck reveals an extremely tender left submandibular lymph node. Throat cultures were taken and reveal beta-hemolytic colonies on blood agar. Susceptibility analysis show growth is not inhibited by amoxicillin, and erythromycin. Growth is inhibited by bacitracin. Which of the following is the mostly likely causal organism?

A. Rhinovirus
B. Streptococcus pyogenes
C. Streptococcus agalactiae
D. Epstein-Barr virus
E. Candida albicans

Answer & Explanation

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