MondayIL: Shifting dullness is a term for, essentially, how the bubbles in your intestines float around when your abdomen is filled with fluid, called ascites. If a patient with ascites is lying on their back, the intestines float to the top of the stomach and you will hear dullness on either flank from all the fluid. If the patient turns onto their side, the intestines float up to the other flank and now the center of the abdomen will sound dull. Hence, shifting dullness!
Similarly, balloting the liver is a procedure to feel the liver in a patient whose abdomen is so filled with fluid that you can't find the non-floating organs amide the deluge. It involves creating a fluid pressure wave by rapping on the stomach that pushes the liver back and, as the liver rebounds, you press again to feel the liver directly. You have to time it just right so that as the liver sloshes back on forth, you feel it on one of the "forths."
Muehrcke's lines are white lines on fingernails that are indicative of hypoalbuminemia (low albumin levels).
Lastly, in Medical Ethics, we read about the crazy choices made and actions done at Memorial Hospital in New Orleans after Hurricane Katrina. via this Pulitzer Prize winning, if somewhat one-sided, New York Times magazine article. When you have a long while to kill, it's worth a read.
TuesdayIL: The Active Compression Test of O'Brien is a physical exam maneuver used to diagnose a SLAP lesion of the shoulder. Today we had physical therapy students from another college at our school come and teach us some musculoskeletal exam maneuvers. Though I think it was great to have some cross-disciplinary education going on, it would have been nice to do this either 16 months ago, when we learned about the extremities in anatomy, or three weeks from now, when we go over musculoskeletal pathology. At the moment, remembering all the anatomical terminology involved in things such as O'Brien's test is like trying to remember words from high school French.
WednesdayIL: 15 minutes is really not enough time to do even a focused history and physical on a patient. I'm amazed that that's the length of a typical office encounter nowadays. Today was my final practical exam of sorts for FCM, our how-to-be-a-doctor class. We had to do four back-to-back 15 minute encounters with standardized patients experiencing a variety of fake medical problems. This is supposed to be in preparation for the 12 similar encounters we do as part of our Step 2 board exams at the the end of next year. Though you can find out an awful lot in 15 minutes, to cut out so much of the comprehensive exam seems to go against everything we've learned over the past two years about properly screening for other problems during a visit. Hopefully as we get better and more efficient, we'll just learn to do more in less time.
ThursdayIL: The word jaundice comes from the French word "jaune" for yellow. Been a long time since I've done my French colors... should have known that one.