Wednesday, January 23, 2013

Stuff Teachers Say

In adult PPD should be interpreted same is BCG vaccinated and unvaccinated people.

You all had 7th grade algebra right? I assume so because you are all here. Don't worry, all math will be multiples of .08 so don't bring a calculator.

Dis ting will cause dat udda ting to start make doing ta ting.

Responding to a test challenge: I clearly stated that "The ciliary epithelial cells produce antimicrobial peptides like beta-defensins." On page 6 it states that "the Primary granules in neutrophils contain myeloperoxidase enzyme, lysozyme and alpha-defensins." The statement indicating that neutrophils  produce alpha-defensins is again reiterated in the same page.  I appreciate the fact that you did a literature search and found an article from 1995 demonstrating defensin production from macrophages.  This is  an outdated report.  There are more than 292 research articles reporting the production of alpha-defensins by neutrophils. I have pasted the PubMed link below. The challenge is denied.

Squamous cell carcinoma that is limited to the penis has an excellent prognosis - about 95% three year survival. Of course, you have to amputate the penis and use prosthesis. Carcinoma that has nodal involvement has only 30-50% three year survival.

It's called erythrovirus because it affects the mad poetic cells. Get it? He-mat-o-poietic.

Now, some experts have suggested that the reason the rates of gonorrhea have gone down so rapidly and remained so low in West Virginia is because I left there, but that's not true.

Estrogen lives in fat cells. Lucky me, because I have a lot of estrogen working really well to give me a good grip of the ground.

I heard a group of you were playing a drinking game while watching a recording of my last lecture. You were each taking shots every time I said 'electrocardiogram.' Electrocardiogram! Electrocardiogram! Electrocardiogram! Happy studying.

Bleeding is not common, but it is frequent.

You don't have to memorize this, I just want you to know it.

Now, we don't know if this data is statistically different. We are only trying to show whether there is some difference.

Upper endoscopy is 95% specific, but only about 50% specific.

Thursday, January 17, 2013

The Last Didactic Semester

With the last year of purely didactic medical school two weeks underway, a few fun issues have surfaced.

1.) Board study. In June we take the exam which is the culminating event of the entire two years of lectures, 80 hour study weeks, and the constant looming presence of next week's test. At the same time we have a normal amount of coursework that we continue to balance around. And it is a balance. Doing better than most students on the boards can cover a less than desirable class rank, but not vice versa. If I score as well as a Harvard or Stanford medical student, so the thinking goes, there is no reason for a residency director to conclude there is any real difference between us in terms of the prestigious nature of the schools we attended. It comes down to deciding which residencies (specialties) are available for me to apply to. Since I don't want any doors shut on me before I find my calling, it behooves me to do as well as I can on this test.

The test is a nine hour ordeal with fifteen minute breaks every two hours and a one hour lunch. It covers the anatomy, biochemistry, immunology, microbiology, histology, physiology, pathology, genetics, and pharmacology of the blood, lymph, endocrine, respiratory, circulatory, digestive, excretory, reproductive, neural, and psychological systems. Additionally, it covers statistics, study design, ethics, law, and the healthcare system.

2.) Over the next few days, there is a lottery system that will decide where we will go for the next few years for clinical rotations. There are highly sought after tracks. Some people own homes and want to stay around here. Others are tired of living in a rural area and want to rotate in the big cities. Some have families in areas that have only two or three tracks. Not everyone will get what they want and those who put down their first choice for the same track will be randomly chosen to go to that place or somewhere else. In the contracted hospital system that services this area as well as five other cities, there is no student input on which city they will get sent to from month to month. Even with that, there is no telling where you will be for the next two years until two months before the start date. I'd almost rather shoot for a noncompetitive, stable rotation site to avoid moving around and commuting so much.

3.) This month we are studying the reproductive system and have begun performing pelvic, breast, and rectal exams. I knew in the back of my head somehow that this would happen eventually, but it always seemed to be in the impossibly distant future. It's not something I've looked forward to, but it is a necessary component of my education and so I've tried to put on my adult-sized gloves and do my best. I'm thankful for the cooperation of the volunteers who let me try.