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Surgery Grand Rounds, Pleural Fluid Seminar, PBL, and Clinical Skills

Posted Oct 23 2008 2:04pm
I think that today was my longest day yet, but overall it went well. I actually got here at 6:30 AM so that I could go to a Surgery Grand Rounds talk before class. That was a bit painful, but once I was up and awake, it was definitely worth going to it. The good part is that we got breakfast. Surprisingly, the auditorium was pretty full even at that time of the morning. I guess there are a lot of surgery residents here. Surgeons are very organized. The speaker is the director of the Bariatric and Metabolic Institute here at CCF, which has the appropriate acronym of BMI. He started out by reminding us of how many people in this country are obese (about 300 million overweight and obese people). He is specifically interested in treating metabolic syndrome (aka syndrome X), which describes a cluster of symptoms that tend to go together: hypertension (high blood pressure), hyperglycemia (high blood sugar), glucose intolerance (inability for cells to use insulin to take up blood sugar from the blood), elevated triglycerides (high blood fat levels), and low HDL cholesterol (that's the good kind, so you don't want it to be low). He is a surgeon, so of course his solution to the problem is to treat people by basically stapling their stomachs and re-routing their digestive tracts to bypass parts of their intestines. The results he showed look pretty good, but still, that is some pretty heavy-duty surgery (no pun intended!).

I was kind of sleepy during the seminar, but it was a pretty good one. We are still working on the lungs, and they are surrounded by two membranes called pleura. So the space between them is called the pleural space, and it has some liquid in it, which is the pleural fluid. See, I told you that medical school is not rocket science! Basically we spent most of the seminar discussing how and why this fluid forms, what it does, what happens when there are problems with it, etc. It's both fascinating and disgusting at the same time. Just so you know, you can get some really nasty stuff like pus in your pleural space (this is called empyema), and when that happens, the pleural fluid, which is normally whitish or clear, will turn yellow. This can happen if you have an infection. Sorry if I grossed you out, and hopefully you aren't eating while you read this.

PBL went a lot better today than it did on Monday. Everyone did a good job with their presentations, we got through the case on time, and we weren't as short with one another. My new learning objective is about the effects of carbon monoxide on the body. I'll be presenting that on Friday. I told you that the cases are getting more complex, and today we found out that even though Monday's problem was resolved, the patient has a new problem now. It's a lot more fun when the cases are harder. I think we still have a pretty good idea about what is wrong with the patient, but I like that the cases are getting more challenging.

In the afternoon, we did our clinical skills class, and it was really fun today. The skills we are working on are all related to the lungs and chest, so we practiced several techniques for the lung and chest exam. One thing we did was to check that the sound and vibration from our standardized patient's voice are transferred equally well on both sides of his chest. This entails getting the standardized patient to say "ninety-nine" multiple times. When you consider that these poor guys have to be examined by eight medical students each during the course of one afternoon, you have to admire their patience with us. We also percussed his chest and back. Here, you have you middle finger down firmly against the skin, and you tap it with the middle finger of your other hand. It sounds hollower over the lungs and duller over the liver or muscles. (You can try it yourself on the walls of your house if you want. If you do it right, you will hear that your percussion sounds hollower where there is no stud, and duller where there is a stud.) Finally, we listened to the man's lungs in several places using our stethoscopes. After the physical exams, we did practice interviews where we took the "patient's" medical history. So we had to ask them about what surgeries they have had, illnesses, medical problems, social and personal factors, etc.

Like I said, it was a good day, but I am exhausted and very happy to have tomorrow off.
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