Tri-6, Wk10, Day 380 --- T-Minus 11 Days

Dr. Donna Mannello says, "Acute cholecystitis is noted here in the right upper quadrant, pancreatitis - epigastric, appendicitis - right lower quadrant, diverticulitis - left lower quadrant" I've been listening to that phrase for well over a half hour now. I've been using the repeat buttons a lot and listening to small bits at a time until I think I've got them or, at least well exposed. :)

Dr. Mannello is a super, super nice lady who teaches Physical Diagnosis at Logan. A group of us guys, after class, decided she's pretty much the female equivalent of House, M.D. She comes from a family strewn with medical doctors and once related a story to us about how happy her family was when she was accepted to medical school and their subsequent chagrin when she told them she wanted to become a chiropractor.

We've got 11 days left before our third exam in Phys Dx II. I'm not sure if it was midterms or the looming thoughts of upcoming Comp boards or the realization that in a little over a year I'll be finished with this program and have to predominately rely on myself in order to help my patients but, I've pretty much been studying round the clock for the past few weeks.

I remember in my not so distant past that I generally used to think of women before I'd fall off to sleep but now I think about Neurology, Part II boards, physiology, Phys Dx, Dx Imaging and whatever else I've been imbuing myself with throughout the day. Of course, there was a cute female medical student on YouTube demonstrating abdominal palpations so, maybe I could combine the best of both worlds. ;)

A mystery Tri-10 sent me props via comment on the 90% I got on the written portion of our Dxi midterm which was very much appreciated so, if you're reading this then I'd like to say thank you :)

I've noticed something interesting about listening to my Physical Diagnosis lectures over and over. In a class like Diagnostic Imaging if I listen to the class lecture over I'm not surprised by many new things. I might not remember everything from the first listening but I at least realize that I heard the stuff before. With Dr. Mannello's lectures, I keep hearing new things that never seemed to penetrate my brain in previous exposures. Even with 3, 4 and 5 exposures, I keep hearing new words and ideas. I guess that could partly account for why my Dxi grade is so solid and my Phys Dx grade is like a leaking ship but, I'll keep at it.

We have a study guide for phys dx provided by our teacher. It's numbered with 40 different points she wants us to know for the exam but, there's only going to be 30 questions on the exam. Then I'm looking at some of the questions on the study guide which reference certain tables to know in the book. 12 tables are referenced that we need to know. Then I look at one of those tables ...take a fun table like diarrhea for instance, and I notice 11 different types of diarrhea along the left hand column and 5 different categories of things we need to know about each one listed across the top. So....that one question on the study guide actually means we need to know/memorize/learn 55 things to know that table ...that one of twelve different tables. To be sure, there is much to learn.

BUT - I still have 11 days left. AND - a nicer table like, Tender Abdomens only has 8 things to know. :) I need to keep in mind how impressive someone like Dr. Mannello is and all the knowledge in her head, how she's like House and how I'd like to have the same knowledge. This is my opportunity to learn this stuff. I mean, really - when else in my life will I ever have this much time to devote to diarrhea?! While that may sound a bit funny (and I suppose it is) I also have to keep in mind *why* I'm learning this stuff. It's because I'm going to have actual people with actual issues that will be looking to me for help and if that's their issue then I need to know about it.

A question I started asking myself last trimester when I didn't feel like studying was "How good of a doctor do you want to be?" That question had a way of helping me get re-focused.

The home stretch of this semester looks pretty clean and rather do-able. We only have 17 exams between now and becoming a Tri-7! Let's see.... in addition to those exams I need to knock out one more hour of community service for Professional Development, make a couple Goal Poster's for Patient Communication, take one more Comp Board, sign up for one more specialization technique, register for Irene Gold, and ...that's all I can think of right now.

Today during lunch I was able to volunteer and complete a research project to give myself an extra 3 points towards my EENT grade. There's only one other study available but it requires 10 visits and I don't think I want to devote that much time to getting an extra 3 points for Pediatrics. The study I participated in today was being conducted by some MD we've got on campus who doesn't actually teach a class so I'm not sure what his role is with the school. He's a very nice man who was doing a study dealing w/ the heart. He had some kind of EKG machine hooked up to his computer. The study came with a questionnaire which ask all about your life which got me thinking about my life. In addition to school, about the only other things I'd like to add into my life would be Karate, Lifting and Piano which, is pretty much what I've always worked on getting into my life. I guess running would be another thing but that maybe could fall under the umbrella of lifting.

The preceding would cover professional and personal aspects of my life. Considering social aspects, the first thing that comes to mind would be finding someone special to share everything with.

It's past my bedtime but I don't feel much like going to bed. Tomorrow is the day we get out at 11 a.m. but two of our three classes have been cancelled (I think Part IV, National Boards is going on) and the remaining class cancelled it's first hour so that only leaves the second hour. I have 50 minutes of class tomorrow. The strange thing even with that hour is that we're meeting in the classroom instead of the lab so we're not going to be doing any of the PT stuff. I'm not really sure what we'll be doing tomorrow or why we're still supposed to go in for one hour, one class, ....

Have I learned anything?

Right Upper Quadrant - acute cholecystitis, i.e., gallstones

Right Lower Quadrant - acute appendicitis

epigastric region - pancreatitis (or problems w/ stomach and duodendum)

Left Lower Quadrant - Diverticulitus

Yep and I even know a few specialized test such as the Psoas & Obturator test to help check for appendicitis.

Signs -

starts w/ a "B" aka rebound test - done on same side of appendix, quick release

Rovting sign - done on opposite side (LLQ)

Kehr sign - ....can't remember but have seen it a couple times and at least remember the name.

Dance sign - no bowel movement, could be a sign of intussuseption, probably on the left side (lower left quadrant)

Cullin Sign - ecchymosis around the umbilical

Grey Turner sign - ecchymosis on the flanks

Well, I'm learning a bit ....

School is my job and I only have to work an hour tomorrow. Regardless of when I get to sleep I'm still going to leave early as if I still had my first hour class otherwise I'll get mired in rush hour traffic. One or two hours of PT - I can still read my book and figure out what to read on my own based on what we did last week.

Not sure what to leave as a pic ...I know - how about that cute MD student? Hmmm, now I know I need some sleep but, obviously, I haven't studied enough and need to cram more academia in my brain before bed so my reverberating circuits will be academic based. I think I need a drink ....(hence, today's pic)