January 21st, 2003

Nescafe rabbit

Revelation and consideration....

If I ever flunk out of medical school, maybe I can make a living as an ENT test patient.
Today's session: ear, nose, and throat physical diagnosis. Very interesting, mind you, but it was quickly remembered from Neurology last year that my gag reflex is low to absent. Specifically, you can shove a tongue depressor down my throat and follow it up with a little mirror, and even if you mess up and bang around on my palate, uvula, tongue and tonsils with the beast, I won't gag, nor will I cough. I'll just sit quietly while all fifteen of my classmates tug my tongue this way and that, so that everyone but me gets a good view of my vocal cords.
"Oooh, say 'eeee' again! I saw them move!"
"Eeeehhhhhh"
"Cool! Hey, Jim!" "Hey, Rachel!" "Here, Iwona, practise on Nykki. She doesn't gag!"
My tongue is numb. My throat is dry. But I have the awe of all my classmates.
I got to look down Iwona's throat, briefly, and Kara's, after I gagged her ten times with the tongue depressor. Press...and scoop. There's an art to it. An art I do not possess. But I'm pretty decent at peeking into ears. Jim's malleus is hyperemic - it's a big red line down his eardrum - and he has otosclerosis from ear infections as a child. I can see Kara's incus, which is pretty darn cool, and I even got to blow air in and see her eardrum move.
Iwona's nose is most interesting - she has a giant hole in the middle of her nasal septum. We all had to look at that. It's like the two sides of her nose are connected. Jim's cracking jokes about how she must've used cocaine back in Poland - because cocaine use can lead to septal perforation.

We had a meeting today, the AMA kids, talked about the CSAE and the resident work-week.
Those of you with political activist leanings: call your representative people. H.R.3236 has 72 co-sponsors. S.2614, its companion bill in the senate, has only 3. Both bills call for an 80-hour cap to the work week, no more than 24 hours per shift, with 10 hours between shifts. No more than a 12-hour straight workday for ER residents. It may not seem like a big deal - but treating patients after 110 hours of work is not good for the patient, nor is it really conducive to a learning environment.
The CSAE, on the other hand, is more of an internal issue. If you would like to see the details regarding this proposed exam, it's here on the AMSA website. The National Board is not listening to the students' concerns at all, and we've been forced to go the the state medical licensing boards to fight it. I think it's laid out pretty clearly on the site.

It's been an interesting day.
  • Current Mood
    mellow mellow
Nescafe rabbit

I bet you wonder how I knew...

Stopped off at the liquor store to get sake for the sushi we're going to try for. "Heard it through the grapevine" came on. I started singing along, soft-like. Forty-ish black woman behind the counter looks at me, shakes her head, and goes "Oh, no, honey, you're too -young- for that kinda jive." Me: "I grew up on this stuff!" She just laughs. "You got good parents."
Damn straight.
  • Current Music
    92.3 The Fort, Stairway to Seven
Nescafe rabbit

What am I supposed to be learning?

With spirometric measurements volumes are plotted on the horizontal (X) axis and flows on the vertical (Y) axis = flow-volume loop. The flow-volune loop allows the assessment of additional flows such as FEFmax, FEF50%, FEF75% and FIF50%. The decrease of mid-expiratory flow rates is a typical finding in COPD patients and is an expression of flow limitation. Two mechanisms explain expiratory flow limitation in COPD patients: an intrinsic mechanism, i.e., decrease of the caliber of the small airways (inter diameter of < 2mm) by inflammation, fibrosis, and mucus plugging; and an extrinsic mechanism, one due to lack of parenchymal support of the peripheral airways as a consequence of disruption of the elastic network of the lung. An enhanced collapsibility of the flow-limiting airways.
If that made sense to you, congratulations. Because I don't hardly understand word one. Stupid pulmonologists...This woman talked for an hour and a half, and we left dumber for it.
To understand these shape variations of the flow-volume loop, it is important to consider the pressure gradient across the walls of the airway during inspiration and expiration. First, breathing through an external orifice of 6mm reduces peak flows and produces plateaus on both inspiration and expiration. During inspiation the extrathoracic airway has a transmural pressure favouring narrowing because intraluminal pressure is subatmospheric while extraluminal pressure is approximately atmospheric. In variable extrathoracic lesions, during expiration intraluminal pressure is positive relative to extraluminal pressure, thus tending to dilate the airway and obscure the presence of the lesion. When a variable lesion is intrathoracic in location, during inspiration extraluminal pressure (equivalent to pleural pressure) is (-) relative to intraluminal pressure so that transmural pressure favors airway dilatation. During expiration extraluminal pressure is positive relative to intraluminal pressure so that airway narrowing occurs.
WHAT?
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    angry angry