Tuesday, January 13, 2015

WILTIMS #235-8: Mega-post

Apologies for the lack of posts over the last week. Though I was still adding things to my "to blog about" list, I simply couldn't find the time to fact check, expand on and edit everything. So here is the first of what will likely be a new trend of occasional mega-posts.

FridayIL: 11-beta-hydroxysteroid dehydrogenase-2 converts cortisol to cortisone which prevents it from overwhelming the mineralocorticoid receptors to which they bind equally well as to their own glucocorticoid receptors. Isn't pharmacology fun?!

Sunday: This was the day when we were taught how to do a breast and pelvic exam on and by expertly trained women. Even though they are generally not trained as medical professionals, they know everything about the gynecological exam and, more importantly, how it feels (both physically and emotionally) to be the patient. I can't imagine not having this service and having to do one's first real gyn or breast exam on an actual patient. It almost seems unethical. Anyways, here are some of my takeaways:

SundayIL: Bad technique is bad. No kidding, right? More specifically, bad technique causes pain. Patients are bad at speaking up about pain and will just bite their tongue and go home. The results of the pap smear and physical findings of the gyn exam are usually normal. After a few repetitions of this, patients start to associate pain with normal results and think that pain is normal. Pain, when proper technique is used, can be a sign of something wrong, and if patients don't speak up about it, dangerous pathology can go missed.

There is a very small range of acceptable terminology associated with the breast and pelvic exams. Unlike nearly every other time in medicine, you can use too colloquial of terminology in this setting. Normally, you strive to cut down any technical jargon, but when you are touching personal areas, you might want to stick with "examine" over "look at," "touch" or "feel." You should avoid accidentally using euphemisms like "down there." You should, whenever possible, use unusual palpation techniques, so as not to evoke any association with the types of touching that a sexual partner might use. There's a lot of thought that needs to go into doing these exams in a respectful way.

MondayIL: Egophony literally means to sound like a goat. In medical terms, this is when you ask the patient to make an "e" noise and when listening through a stethoscope you hear an "a" in certain regions. The change is due to the physics of sound propagating through an extra dense layer of tissue or fluid, typically at the border around a pleural effusion or area of consolidation.

An ideal alveolar-arterial (A-a) gradient can be estimated by the formula (age / 4) + 4. This measurement is useful in differentiating the different causes of hypoxemia.

Today: Today's facts might seem a little out of left field compared to the topics of recent posts (except for Sunday's, which is also an exception). All of today's facts were taken from my preceptor experience, where I follow around a doctor in a real office and pretend like I know anything about medicine. It's terrifying and stressful but sometimes wonderfully rewarding and motivating.

TIL: Endovenous ablation is a procedure where a laser is used to essentially seal up insufficient and/or varicose veins in the legs. This can relieve some of the pain and most of the associated cosmetic defects with these overwhelmed veins.

Frozen pelvis is when the normally free-floating organs of the female pelvis become fibrotically linked and stick together. A common cause of this condition is endometriosis, when pieces of menstrual tissue float up the fallopian tubes and implant in the abdominal cavity.

Whereas pneumothorax, hydrothorax, hemothorax and chylothorax are, respectively, air, water, blood and lymph in the chest cavity, hemithorax just means half of a thorax. Relatedly, my preceptor is a troll.

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