Sunday, April 24, 2011

COMLEX Level 2 Performance Evaluation

This "vacation" month has been quite useful. I started with an extended hospital stay, added a little at-home recovery time, and will shortly be taking my practical board examination. This test, known as the COMLEX 2 PE, is just the next hurdle on my path to becoming a physician.

Board Exam Number 2

The COMLEX 2 PE tests students' ability to obtain a patient history, conduct a physical exam, and write a patient note within an allotted time of 23 minutes. We are graded in two domains: biomedical/biomechanical and humanistic. The former is a conglomerate of skills performed with the patient, information gathering and written communication of associated findings, while the latter is derived by the patient/actor in response to our interpersonal skills and professionalism. Students must pass both domains to effectively pass the examination. We will interact with 12 patients throughout the seven hour day. Although this is an exam we have prepared for in school and on rotation, it is a standardized board exam and that means high-stress.

Normally, with enough practice an examination such as this should be second nature. In fact, most students return with the feeling that it was not a difficult process at all. The stress comes in the details surrounding the exam. From here in Las Vegas, I must travel 2,500 miles across the country as there is only one test site. The exam itself is expensive, a small investment of $1,100. Then there are the airfares, lodging, and travel expenses to include. The time commitment is not too overwhelming, but requires a couple days off for traveling. It's easy to see why we want to pass on the first time so badly. This is not an exam anybody wants to repeat for a number of sound reasons. In one week's time, it will be behind me and hopefully for good. Unfortunately, I will not know my fate for another two months when scores are reported. In the meantime, I am thinking positive thoughts and trying to enjoy the remainder of my so-called vacation.

Question of the Week
A 46-year-old woman presents with complaints of feeling as if she
has "sand in her eyes" and reports difficulty swallowing such foods
as crackers or toast. Which of the following pairs of tests would
likely yield positive results in this patient?

A. Anti-centromere antibody and rheumatoid factor
B. Anti-Scl-70 antibody and anti-Smith antibody
C. Anti-Smith antibody and anti-double stranded DNA antibody
D. Rheumatoid factor and anti-double stranded DNA
E. Rheumatoid factor and anti-SS-A antibody

Answer & Explanation

Sunday, April 17, 2011

Dreaming of Paradise

While most students are gearing up for spring break, good weather and time off from their workloads, I find myself in a little different scenario. I am spending my "vacation" recovering from surgery and preparing for board examinations...a whole new kind of fun.

A Breath of Fresh Air

Always wanting to take advantage of school vacations and explore foreign environments, I think I am a little bitter this time around. What was intended to be a month of nothingness, quickly became a month of hospitalization and due diligence for the practical portion of board exams. I made it out of the hospital alive, but somehow could not bring myself to study much. That was a good thing, because it was about the only real vacation time I experienced. Now to get back to the books and practicing to be a student doctor on the other side of the country. It has to be done, so I would rather get it behind me early, but I was hoping it wouldn't eat up so much of my vacation.

Why is it that when breaks come, it is so easy to choose the masochistic approach of work and little play? As a medical student, there is always the next step and the next hurdle. When we have time to sit back and get some R&R, we try to do so, but have anxious tendencies about getting things done. Maybe I am the only one that feels this way. This is certainly a Type A personality trait; always on the go, wondering what's next and overboard about everything. I need a real breather. I'm thinking something on a beach; away from this, away from reality and not tied down to a checklist of things needing attention. Maybe when fourth year is over.

Question of the Week
True or False: You can be on vacation and not feel like it is vacation at all.

Sunday, April 10, 2011

Life as a Patient

Finally nearing the end of my hospital stay, I have gleaned a great deal of information and experienced my share of ups and downs. Surgery was a difficult experience as it left me with pain, wounds, and the after effects of anesthesia. Being in the ICU with all of its high-tech glory was much less fun than I remembered from rounds.


Post-Operative Recovery

Fortunately, I was able to avoid catheterization. Nonetheless, the anesthetics had a long lasting effect that disturbed both my gastrointestinal and urinary tracts. Every time I tried to drink fluids, my stomach would have nothing to do with it. I had to keep the emesis container within reach as there was no way of judging how my body would react. It was more annoying than anything as the cottonmouth was rather unpleasant. Between medicated naps and side aches from my freshly placed chest tube, all I could do was wait for the anesthesia to wear off with my barf bag in hand. Learning to adjust to my new wounds and pains was going to take some time, and all I could do was wait. As the clock rolled, I became hungrier and dared to try solids. It tasted good, went down well and sat well...but only for 10 minutes. It was then that I wished I had an emesis bag the most; a simple device I could put on and forget about. Luckily, it became easier to hold the food in and now I had to get my bladder to cooperate. With some serious concentration, faucets running and a friendly coaxing from my visitors, the bladder situation was overcome in due time.


Little did I know that the next few days would be worse. Inflammation, muscle aches, tubes, wires, medications and the list goes on. Now I was starting to understand what my post-operative patients had been experiencing. From one unpleasant experience to the next, I was now on the doctor's schedule awaiting instructions and decisions. My job was to report any problems, stay attached to all my wall connections, exercise my lungs and generally get better. I was happy to hear I was the most stable patient on the ward, which was to be expected as I was also the youngest. The TV was boring, my neighbor's moans annoying and the food not always appetizing. Getting up and walking around the unit was the most enjoyable activity I participated in during my stint. Something we so easily take for granted had now become the highlight of my day. At last discharge is in sight and I can soon recover in the comfort of my own home. This experience, however, has made a significant impact on my perception of health care and the way I intend to approach my future patients. What a great way to spend my vacation month.

Question of the Week
As a new patient on the surgery ward you are asked by the dietitian make your next meal order. Which of the following will have the worst effect on your health and recovery?

A. Turkey roast with mashed potatoes and broccoli
B. Chicken fingers and French fries
C. Meatloaf with mixed vegetables and a dinner roll
D. Shrimp pasta alfredo with garlic bread
E. Chicken salad wrap with clam chowder soup


Answer & Explanation

Sunday, April 3, 2011

Finding Pneumo

Excited to finish my last core rotation and move on to my first elective, I wanted to make a quick stop at the doctor's office for a prescription. Unfortunately, the cough I had was not readily treatable by prescription and would have to be further evaluated at the hospital.

The "Patient" Rotation

Reluctantly, I made my way to the hospital to have the spontaneous pneumothorax treated. A chest tube and days later I still find myself suction tied to my room awaiting a change in pulmonary status. The first time I was given oxygen I almost recoiled as though they intended it for another patient and must have made a mistake. The nurse responded and said, "it's hard to be a patient, huh?" The truth is that I don't know what it is like to be a patient. Over the last few months I have been contemplating what it must be like to be stuck in the hospital bed waiting for providers, asking for medications and not on your own turf. What do patients feel with certain medications? How do they manage to clean up on their own? Is the patient food worse than the food medical staff get? Does it really take that long for call lights to be answered? Now I am learning first hand what patient life is really like.

Because of the suction device attached to the wall, I get a moving radius of 15 feet, almost like a dog tied to a stake in the yard. No walks in the hall and I can't even get to the other side of my room to use the waste bin. Fortunately, I have a window overlooking The Strip and the sun shines in its little square of heaven for a few hours every day. Despite an occasional delay in response to my call light, I've been very well cared for. Perhaps it has helped that I am a medical student and the staff are potentially peers. Perhaps they are just that good and I have been lucky to have such nice help. Either way, every part of this experience is new. There is no doubt in my mind that this short stint of time is teaching me more about medicine than I could ever learn in my medical training.

I am not refusing the experience or wishing it wasn't me. Rather, I am accepting it as an opportunity to learn what the other side of being a doctor is all about. I want to absorb it and unfortunately eat, breathe and sleep it. One thing is certain, patience is mandatory, both with self and others. It is not an easy process with  ups and downs around every corner. I was looking forward to starting a new rotation tomorrow in Emergency Medicine at an out of state facility. Plans have changed and I may no longer have that experience, but I feel it has been replaced with an experience just as meaningful. 

Question of the Week
Which of the following statements is true regarding spontaneous pneumothorax?

A. Primary spontaneous pneumothorax typically occurs in tall, thin, older adults.
B. The definitive treatment of a pneumothorax involves the placement of an intercostal drain.
C. Catamenial pneumothorax typically occurs during the end of menses when a patient is taking oral contraceptives.
D. Hemothorax occurs in up to 20% of patients with spontaneous pneumothorax.
E. Pleurectomy is preferred over mechanical pleurodesis for recurrent pneumothorax.

Answer & Explanation

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