T6, Wk8, Day 369, 370, Tue & Wed

I completely forgot about blogging yesterday. Midterms, ya know? :)

Today was a pretty darned fun academic day at Logan. We had two hours of Phys Dx, two hours of Dx Imag and two hours of Phys Dx Lab ...doesn't seem like much but still pretty fun. :)

Phys Dx - We concluded material that we're going to be tested on Friday ...geez, what is that material??? I know we started the abdominal region and I remember some stuff about that... I think I haven't been getting enough sleep. I had a hard time today remembering some classmates names - people that sit close by and now this ...let's see ...oh yeah! Cardio stuff, heart sounds, and Peripheral Vascular stuff :)
We hit on Cirrhosis a bit in the abdominal lecture and it was interesting to note that the number one cause of Cirrhosis has traditionally been chronic alcohol abuse but vying for that number one position, according to our teacher, would be prescription medication because Americans consume so much. She also pointed out medication like Crestor as being a leader in the pack since it's so widely prescribed but, eventually, people have to give their liver a break and get off the medication. In another class I heard about the rebound effects of going off Crestor in that the levels of Co-Q10 get depleted. I guess it's something to keep in mind.

Diverticulitis is something else I finally got straight. I've probably heard that word 50 times since I've been in school but never really knew what it meant (maybe I just forgot). Anyway, thanks to the internet I know it's an outpouching of weak spots in the intestines ...colon or large intestines specifically. About 10% of people older than 40 have diverticulosis. The conditoin becomes more comon as people age and about 1/2 people above age 60 have diverticulosis.

DX IMAGING - Always a fun and informative class. Dr Kuhn's classes seem to be the best to listen to via recording while commuting back and forth to school because they're so packed full of information. It can be a bit exhausting in class to catch everything he's going over. I probably just need to be better prepared so it's not like so much new stuff is coming at me. I've noticed he's extremely clear with pretty much everything he conveys. I can be clear in my head but when I articulate sometimes it's like my first day with new feet and I trip over my words and thoughts ...stumble, then try to regroup then forget what the clear thought was I had in the first place.

I read a bit more about those Human leukocyte antigens (HLA) which is a pretty fascinating topic. The list of HLAs began as a result of transplant rejections. I think most people are aware that we have different blood types such as A, B and O and a body with type A blood doesn't really like getting B type blood. With procedures such as transplants we consider things a little more detailed than blood type with something called the Major Histocompatibility Complex (MHC) which plays a role in the bodies immune system. With transplants, we need to be concerned with autoimmunity which is when the body doesn't recognize parts of itself and tries to destroy those parts it doesn't recognize.

I'm really starting to go off on a tangent here ...I just hit the HLA stuff again because I noticed HLA-8 was associated with DISH (diffuse idiopathic skeletal hyperostosis) but, according to Dr. Kuhn, it's not a major association or one that's been very well verified.

He did point out a nice table today which showed HLA-B27 and it's relationship to diseases such as AS, Reactive syndrome and Psoriasis. The percentage of time we'll find HLA-B27 with each dz is as follows

95% - Ankylosing Spondylosis (AS)

75% - Reactive Syndrome

60% - Psoriasis

I keep thinking that the thing *most* related to HLA-B27 is Sacroiliac (SI) joint disease but, I'm wondering exactly what disease they're talking about or if that isn't in fact AS that's being talked about.

PHYS DX LAB - We're spending more time on heart auscultations and I'll need to get plenty of practice and memorization in to do well on our next practical.

The REALLY cool part about todays lab was the last part when Dr. Haun came in with his ultrasound equipment to show us various arteries, the heart, liver, spleen and a few other goodies but then - we got a HUGE bonus at the end of class when he asked if there was anything else we'd like to see and I just had to shout out (as loud as I shout anyway) the name of a classmate who happens to be about eight months pregnant. I've never seen a baby via ultrasound before. And, lucky for us, we did get to see the baby which was amazingly fascinating and interesting. Dr. Haun was quick to point out that we don't practice obstetrics but, I was thinking we do have a heck of a lot of embryology and chiros can deliver babies in some states.

The baby's face was turned away but, by varying the magnitude of the US, we were able to see various parts of the brain, the pons, the falx cerebri, the beating heart, entire vertebrae and even the spinal cord! It was really amazing. It's hard for me to imagine what it must be like if it was my own kid we were looking at since this was so remarkable.

OK, well, I've got a Neuro midterm tomorrow and I haven't exactly gotten the sleep I've needed in the preceding days so I'm going to have to do the best I can tonight. I need at least a little bit of sleep but certainly not too much. I'm planning on maybe taking a nap tomorrow after school then just staying up all night to help do the best I can do on our Phys Dx exam on Friday.

Next Wednesday is our Dx Imaging II midterm and I'd *really* like to do well on that exam. I wonder if Friday will be another day of crashing at 3 p.m. and not waking up until the next morning like last week .....

I'd love more time to study and sleep. However, I am certain I can continue to make headway in simply using the time I have more efficiently and effectively.

I've looked over some previous exams given in Neurology to help get an idea of what to study and it looks like the test have four sections worth of topics.

1. Locations of Lesions - given a set of symptoms, where is the lesion. I made up flashcards last night (two sets of the same thing, actually) to help cover this. Memorize 25 flashcards and I should nail 10 questions on the exam.
2. Arteries in the head - arteries along w/ a little bit of knowledge about CSF should give me the bulk of another 10 questions.
3. Neuromuscular diseases - Looks like another 10 could come from this area.
4. Cranial nerves & some spinal cord basics - final 10 questions.

As best as I can tell, those are the areas I need to focus on. I should be able to get a solid grade on tomorrow's exam with enough work tonight and tomorrow morning.

Almost forgot - for reference, here are a few of the things I looked up today in Dx Imaging

Primary and secondary synovial chondrometaplasia - This is actually a link to
PubMed.gov which I know, as students, we've always been encouraged to use but, until I had the internet available to me in class I've not made much use of the site. Since I got my mobile wifi unit, I think this is the 5th article I've referenced from PubMed :)

synovial chondrometaplasia - just a Google link to a bunch of images ...I'm always on the lookout for similar images to what we're shown in class.

Synovial osteochondromatosis (SOC) - is a benign condition characterized by synovial membrane proliferation. This link is from emedicine (from WebMD) I like that site as well as the MayoClinic website for nice definitions.

Today's picture is a lateral radiograph of a patient with synovial osteochondromatosis of the knee joint.