Thursday, June 28, 2007

Secondary Causes of Hypertension....GO!

24 year old Japanese male, admitted for HTN. In a guy his age, has to be a secondary cause.

DDx was as follows:

Patient also had raised ICP (papilloedema), secondary to a Colloid cyst; Dr. M was thining possible Benign intracranial hypertension (formerly known as Pseudotumor cerebri.)

So, as it turns out, the guy is just from Guam, where everyone seems to have high blood pressure. Pt's father died @ 40yrs from MI, all siblings also have HTN. So it was a simple familial/environmental thing, but as Dr. M put it, this is "real internal medicine; none of that 'when can we send them back to the nursing home?' stuff". I found it quite the interesting case. Didn't enjoy being pimped on the causes though (was one of our SAQs back in first sememster when we did CVS - didn't do so well then either lol).

Today's pimp question from Dr. A: Name the 6 classes/types of Cardio-protective drugs/agents:
  1. ACE-I/ARBs
  2. Beta-blockers
  3. Statins
  4. Heparin/Lovenox (LMWH)
  5. TPA/Thrombolytics
  6. ASA/Aspirin
(I was going to put links to all of them...then realized that I use wikipedia for everything, so you can look them up yourselves, if interested :-D)

In other news, ACLS class is tomorrow and Saturday. I should go prepare for that...O:-)


Tuesday, June 26, 2007

Ambulance Driver teaches cardiac conduction pathologies...

A hilarious yet informational post about normal cardiac rhythms as well as the different types of heart blocks...Sex, Relationships and the Cardiac Conduction System

"Pretty soon, despite all signals from Virginia that she ain't happy, Sidney has convinced himself that he is indeed the master of this relationship. He wears the pants. He's got a toupee, he's wearing the Mister T starter kit, he's driving a red Miata, and he's got a pneumatic little twenty-year-old secretary named Mitzi who giggles at all his lame-assed jokes and says things like "Ooooh Mr. Sinus, you are so cute! I just adore older men. They're so...experienced.""


Whew, that was a close one...

So we've had a patient for a while now, came in about a week ago for a acute exacerbation of chronic asthma. He seemed to be doing fine, so we discharged him late Thursday night. Friday morning at rounds, I find out that he was admitted at 4am that morning. ER complaint showed acute shortness of breath, the regular. But to the admitting doc, he complained of a small amount of abdominal pain as well. He's a pretty large guy, so the exam was negative. At the rounds meeting, we determined that he might be drug-seeking, and that we wouldn't give him any IV narcotics. The doc decided to do some tests and get a CT of his abdomen anyway, just to cover his bases. Defensive medicine, as it's called.

Turned out her had a perforated diverticulitis...that was a close one.


Monday, June 25, 2007

My last post about drinks...I swear O:-)

Mexican Jumping Bean. How did I not see this one before?! Instead of Vanilla and instead of Caramel, it's Mexican chocolate (that sounds like it would be a good nickname for the Mexico Medical Student...please let me know if you object :-D) and Hazelnut. There was also some powder strewn about in the cup, but I have no idea what it was (I'm pretty bad at recognizing flavors...I just love enjoying them:-P).

ANYWAY. We've been seeing a lot of Community-acquired Pneumonia recently. It's been getting the Infectious Disease guys pretty worried. Speaking of which, why the hell do we need an ID consult on every patient who has some type of infection? If Mrs. Random has a UTI and we decide to put her on some Levaquin, why should we have to wait for them to come and see her? Apparently some of the Hospitalists stopped doing this a while back, and they started bitching to the Chief of Medicine...whoops.

Saturday, June 23, 2007

Ooey Gooey Caramel

Today, I decided to go change it up a bit, and so instead of my Chilly Willy Vanilly, I went for its cousin, the Ooey Gooey Caramel. It's pretty much the same, but instead of vanilla flavoring, it's got caramel. And then the inside of the cup is lined with caramel syrup. And it tastes really, really good.

Just thought I should let you all know :-)

Friday, June 22, 2007

Auscultation, anyone?

Heard my first real, live crackles today. Was really awesome. Was my first time working with Dr. M, who is actually a really good teacher. When looking at labs, etc, he'll essentially just start saying out loud everything he is thinking, which helps me learn how to interpret them and such. Same with x-rays, and he explains things very well.

Did you know the BNP test is only like 5 years old? Before that, apparently there was no real way (besides clinical aptitude) to distinguish between pneumonia infiltrate and CHF edema in the lungs...

I really suck at making up title's for blog posts...

Sunday, June 17, 2007


Haha, so I'm my own 1000th visitor. Only someone like me would do something like Taking a page from the little medic's book, some interesting google searches that got me to this stage:
1. Urigrow. Fitting, as I posted the video online.
2. A&E manchester royal infirmary 2007
3. what to expect neck exam
4. EMT-B summer UK
5. ACLS PHARMACOLOGY (why all caps?)

I wonder what the next 1,000 will bring? (that's me being hopeful, there lol)


Friday, June 15, 2007

Because Cal tagged me...

Two names you go by:

Two things you are wearing right now:
Black shirt (kinda faded though - boo!) and grey slacks. Was also wearing a white with black/grey pattern tie. I got complemented on it ;-D

Two things you would want (or have) in a relationship:
haha ummm...
good times (e.g. lots of laughing)
lots in common

Two of your favourite things to do:
shadowing, apparently lol
driving my dad's bmw 530i

Two things you want very badly at the moment:
not to sound like a broken record or anything, but the opportunity to do some h&p's, start some IVs, etc.

Two pets you have had:
never had any pets. :-(

Two people you would like to do this:
i'm gonna take the little medic's route and say anyone who wants to.

Two things you did last night:
ooh, let's see if I can remember...
watched the daily show&colbert report
tried to catch up on my RSS feeds (and failing horribly...)

Two things you ate today:
umm...turkey sausages in the morning
a 7-layer crunch wrap that i put in the fridge from last night

Two people you last talked to:
my mom (oh snap, that reminds me that I need to call her - thanks!)
my younger sister (both on phone)

Two things you are doing tomorrow:

Two longest car rides:
the rides to and from the airport usually seem pretty long, although it's only 2 hours or so
we've done some family road trips to many different states, so those were pretty bad...

Two favourite holidays:
ok see, we've got totally different definitions of holidays.
my answers would be Christmas and my birthday (which isn't really a holiday - but I get good presents for both :-D)
but if you mean VACATIONS, the cruise we took to the bahamas was fun, and going to paris with the st andrews crew

Two favourite beverages:
juice (particularly orange) - just ask my mom/sister, they yell at me about how much i drink
Chilly Willy Vanilly - just had one actually; they sell it in the coffee cart outside my hospital - sooo good! and great name, too :-)

Medical Specialty Aptitude Test

1emergency med42
2orthopaedic surgery41
5occupational med40
7nuclear med40
9aerospace med39
10general surgery39
11med oncology39
12family practice39
16radiation oncology39
20preventive med38
21thoracic surgery38
27plastic surgery37
30general internal med37
32colon & rectal surgery37
34allergy & immunology36
35physical med & rehabilitation36
36infectious disease35

Thursday, June 14, 2007

Week 1, Part 2

8.30am - Arrived on 7W
8.35am - Dr. S arrives on 7W (first time I have arrived before a Hospitalist :-P); Rounding begins. This time, was equipped with my Sanford Guide (2003, need to get a new one), my PIMP Protector, and my sister's Oxford Clinical Handbook. All of which came in useful. We saw quite a number of patients, some of which who were very nice and polite, and others who were, as Dr. S put it, "bitches". I just smiled like a good little medical student :-). Let's see...notable cases: a lady with a new onset of back pain from an old L1 compression fracture, as well as an unkown pain in the mesogastric area of her abdomen. History of shingles (Herpes Zoster), coronary artery disease s/p 3 stents placed about 5 years ago, renolithiasis stuck in renal pelvis (but asymptomatic), an ovarian cyst, and rheumatoid arthritis. Dr. S orders a test for rheumatoid factor, ANA & ESR to see if abd. pain might be rheumatoid in origin; MRI of back to look for any possible new fractures leading to her back pain; MRA of abdomen to look for atherosclerosis of mesenteric arteries, possibly leading to abdominal pain. Was quite the interesting case. Dr. S called her a bitch. :-P
Saw a 90 year old lady with Alzheimer's, who had been prescribed sleeping medication q4hrs PRN. Nurse (at care facility) had given it q4hrs instead, as well as ativan (wtf, why?), and patient sort of just nodded off...for a few days. Was starting to wake up today, A&Ox1(name)
We were called for a consult on a young lady who had had gastric bypass surgery 3.5 years ago, and now is having abdominal pain. Bariatric surgeon went in, lysed some adhesions, but didn't find anything else that could be causing the pain. So called for a Med consult. We (and when I keep saying 'we', I mean Dr. S, with me following like a sheep...or a shadow :-P) figure it's an infected blind loop, and call for a GI consult to do endoscopy so we can biopsy the sac.

Finally asked Dr. A and Dr. S what they do after rounds, while waiting for consults. They say mostly the admits/consults pile up, so they don't really get a break. Usually lunch is their first stop, though.

Am looking forward to working with Dr. C tomorrow (she's the same race as me...always fun lol)

8am - Working with Dr. C today. She only had 5 or so patients, but was on call. I just realized that me describing my day week after week will get boring after a while, so maybe I'll continue, maybe I won't. Saw some diverticulitis patients, lobar pneumonia (possibly community-acquired, possibly aspiration). Had my first (well, first with the Hospitalists) drug rep visit. Some nice ladies from the companies that make Lovenox (enoxaparin, a LMWH - low molecular weight heparin) and Lantus (insuline glargine) came in and brought us lunch (Sanofi Aventis, I believe). Apparently, Lovenox is now approved for STEMI patients. Fancy that. I got a free lunch and a pen and a clickie-sharpie, both with LOVENOX written on them. Awesome.

Got the weekend off (err...will take the weekend off?), and am working with Dr. C again on Monday, 8am.

Wednesday, June 13, 2007

Week 1, Part 1

8.15am - Start 'rounding' with Dr. R, Hospitalist. See a number of patients she already had from previous days, so no full workups. Some interesting cases, including Acute Renal Failure secondary to Rhabdomyalosis after running a marathon. And a homeless patient who had been in hospital for several months (since February), who tried to drink his own urine. Twice. While IN hospital.
Only saw a handful of patients. Dr. R assured me that this is not the normal case, and she normally has twice as many.
Side note: She kept introducing me in this manner: "This is Dr. AMiB (well, my last name), he's actually a medical student who's shadowing me today." This got me confused, because didn't someone who went through a normal US school and residency have students with them on rounds, and know how to introduce them? I tried correcting her every time, but she kept doing it...i dunno.
11am - 'Grand Rounds' is what I'll call it, it was more a meeting, really. Went down to the Hospitalists office, met with the 2 other docs who were in hospital at the time, the Medical Director (also a Hospitalist), and the Case Managers from the different floors. Went over all the patients they had, and let the case managers know what is going on and what the plan of action and time frame would be. (Heard of a case of Necrotizing Fasciitis!)
After GR, saw a couple more patients, then Dr. R...left, the hospital. I was quite confused, really. I understand that being on call means coming in and admitting any Medical patient the ER decides to admit, but after rounds, what is there really to do? (At the time of this writing [Tuesday night], I have no idea what Hospitalists do for the majority of the day. I plan to ask tomorrow.) Hopefully I will find out or find something to do, because leaving at 12 after a few hours of seeing patients is kind of boring, really. Don't get me wrong, I enjoy the patients I see, but because I'm not allowed to go see patients by myself, should I just literally follow the doc wherever they go?! Most of them take care of personal things, or work on charting. This is time that could be spent wisely seeing interesting patients, but guess what?! Can't do that. (I'm not still bitter - I promise! :-P)

7.15am - Arive in OR
7.30am - Dr. C, Neurosurgeon, arrives in OR
9.35am - After 2 hours or prepping the patient, first incision is made. The patient was an elderly gentleman, struck by an auto. He had a mechanical heart valve, and was on Plavix (clopidogrel), a commonly used anticoagulant. He had a broken shoulder, open tib-fib fracture, as well as pretty severe head bleeding (due to the Plavix). Also, he has a Type 2 odontoid fracture. His C1/C2 joint is unstable, and his C3/C4 joint has rotatory dislocation. Also, the facet joints all the way down his C-spine are opened/problematic. At the C6/C7 joint, there is subluxation and the thecal sac is endangered. He is 10 days post-incident, and Dr. C believes he is ready to have surgery. An Occipitocervical Fusion is performed, fusing the occiput of the skull all the way down through C7. Graft taken from the right iliac crest, as well as allograft bone marrow was put near the rods to hopefully fuse them. The patient will have absolutely ZERO range of motion in his neck, as if he were permanantely in a halo. I really hope they caught the guy who did this.
3.15pm - After nearly 6 hours in open surgery, and 8 hours in the OR, Dr. C starts closing and I head out. I had had an amazing vantage point, standing at the head of the patient, looking straight into the posterior cervical incision. Dr. C was to my right, and a Trauma NP was to my left, assisting. I didn't even have to scrub in, since I was on the non-sterile side (I hate being sterile, and would've died if I had to have been standing there for this long). All in all, was an amazing day. Not many people my age or in my class can say they've seen what I've seen, and while I bitch and moan about what I don't get to do, sometimes (like these), I realize how lucky I have been.

8am - Started rounds with Dr. A, the Director of the Hospitalists group that does the Internal Medicine call for out hospital (the guys I'll spend most of the summer shadowing). Saw a number of interesting patients, most of which I can't remember at this time, except Necrotizing Fasciitis! Dr. Adrian says he hates that diagnosis, since it grosses him out, but as a student, I can't help but find it cool. So sue me (no seriously though, don't - I have no money, being just a lowly student! :-P)
Dr. A was an Attending at the same teaching hospital where he did his residency, and is very skilled in the way of Academic Medicine. He introduced me properly, as "AMiB, one of my medical students", and gave me my first real dose of PIMPing. For those of you not from the medical profession, here is a definition of pimping:

The term pimping is common slang in medical education to describe the process of attending physicians asking physicians-in-training (i.e. resident physicians or medical students) difficult questions — some would say just questions in general. This is usually used in a derogatory fashion by those being on the receiving end of questions, as in, "I got so nervous when Dr. Smith pimped me about the causes of pancreatitis!" According to The Art of Pimping by Brancati, German surgeon Walter Karl Koch first recorded "Puempfrage" questions in 1889 to be used while seeing patients with his students in Heidelberg. In America, Abraham Flexner noted on his visit to Johns Hopkins in 1916 that Osler (likely William Osler) used rapid-fire questions on his students.

And let me tell you - it sucked. I'm taking this as a sign of how little I know, although I believe Dr. A was asking me questions that I wasn't really supposed to know the answer to (the only one I got right was looking for splinter haemorrhages in cases of Infective Endocarditis). Wow, I just realized how overboard I'm going with these links. Oh well.
We had a few admits in the ER, including a homeless man in alcohol withdrawal and associated seizures, who chose to use the ER bathroom floor instead of the toilet to take a dump. How nice of him!
Also, a patient with renal failure, probably due to an unknown obstructive uropathy (wheee I love big words :-D), and a really nice lady with cellulitis of the arm.

Near 1ish, Dr. A told me he was going to step out for a bit, and to go grab lunch. He said he'd call me when the next admit came in. So I went to the Physician's Lounge, grabbed some of the free pastries and coffee they had there, and just sat and watched TV while I waited for a phone call. Eventually it came in, and we met up again in the ER. We admitted the cellulitis lady, went up and saw a patient who had been in surgery during morning rounds, and then that was essentially it. He said I didn't have to stay till 6, as I had probably seen plenty of good patients. I agreed, and said I would head home. But I kind of wanted to see what he would have said if I had wanted to stay the whole shift. Would I have just sat in the Physician's Lounge again? Maybe done nothing in their windowless office (it's in the basement, definitely not their fault lol)? I dunno. Will see when I go with Dr. S tomorrow. Apparently, Dr. A says that if I thought his pimping was bad, I just have to wait until Dr. S's. I'm a bit scared. Will bring my PIMP Protector with me!

OK, so I've decided to post this first half of the week, just to see if you guys like it, and just so you don't think HIPAA has dragged me off the face of the earth (which they may well do after this post! :-/) Please leave feedback in the comments, lettering me know if the style of the post is good. I thought that small, daily posts would have been too annoying, so decided to go for a Weekly one. If y'all think it's cool, I will probably continue like that for the summer. So...yeah. Here goes!

Friday, June 8, 2007

And so it begins...

Medical Student Observer forms filled out...check!
Immunization Records up to date...check!
PPD Tuberculosis skin test...negative! (that's a good thing)
Doctor(s) who are willing to let me shadow them...check!
Hospital badge so I don't get kicked out of the hospital...check!

So, looks like I'm all set! Once I get the go-ahead email, I'll head in on Monday for my first day. The shifts are 6am-6pm, but it doesn't seem like any of the docs start before 7 or 7:30. We'll see how long I actually last on the shifts, but I'm gonna try and stick em out.

Also, Dr. C is doing a surgery Tuesday morning that he's willing to let me watch, so I'll probably be in for that too.

We'll see how this all goes, I'm pretty much playing by ear as it is.

Tuesday, June 5, 2007

A Ray of Hope...

Looks like there may be some opportunities for me after all...not as much 'doing' as I'd like (or any at all), but I think at this point, having sat at home doing nothing for so long, I'll just be glad to get back into the hospital...

Wish me luck, have a couple meetings tomorrow to sort it all out!


Saturday, June 2, 2007


So I just got my American Heart Association ACLS (Advanced Cardiovascular Life Support) Provider course materials in the mail.

"Through the ACLS course, providers will enhance their skills in the treatment of the adult victim of a cardiac arrest or other cardiopulmonary emergencies. ACLS emphasizes the importance of basic life support CPR to patient survival; the integration of effective basic life support with advanced cardiovascular life support interventions; and the importance of effective team interaction and communication during resuscitation. "

More info here:

Looks like there's a lot of work involved before the class actually begins. Better get to it...

Will keep you updated once the course starts (June 29th/30th) :-)