Having no idea what to expect, I showed up in the urgent care for my overnight family practice rotation. After meeting my attending physician, we visit with a few patients and then the education begins. Questions from all angles start coming in rapid-fire succession. Without the right answers I resort to shaking my head, making an educated guess, or simply admitting that "I don't know." When all is said and done, I am humbled, corrected and educated on the spot.
Hands down this is more exciting and enjoyable than sitting in a stuffy classroom ad nauseam. Seeing a disease or injury paints a picture that so many pages in a book could not. Treatment protocols and drug regimens make sense revealing associations that were previously difficult to grasp. This is just the beginning and there are plenty of mistakes to be had along with the rewards of a job well done. In this moment of certain insecurity it is difficult to freely explore the medicine I know and stumble along the way. Fortunately, at this point in the game there are safety nets that prevent me from screwing things up too seriously. Now if I could just figure out how to quickly change my sleeping habits and consistently provide the correct answers to my preceptor's questions, I might feel a little better about this upcoming year.
Board Prep Question of the Week
A 64 year old man with a history of hypertension, well controlled on medication, reports feeling increasingly tired over the past year. He reports some weight loss without any changes in diet or exercise. He also mentions that he has been having very thin stools but no frank blood. He takes no medication. Physical exam shows a pale, thin man in no acute distress, with a mildly elevated heart rate. Rectal examination is positive for occult blood. Hematocrit is 24%, but all other laboratory values are within normal limits. Which is the best next step in diagnosis?
A. Abdominal x-ray
D. Exploratory laparoscopy