A disheveled woman who was talking to herself came into the emergency department yesterday evening complaining that she couldn't eat because her jaw hurt. The resident with whom I was working was more than happy to give me the first go at interviewing and examining her. She said her right jaw hurt and that she was afraid to go to sleep because "the pain is too close to my brain." She also had a strange preoccupation with her ears and told me some story about accidentally inhaling a piece of paper then later pulling that paper out of her ears.
I did a head and neck exam on her but didn't find anything out of the ordinary - her ears were clear, and I didn't feel any creaking in her jaw when she opened it and closed it. After presenting to my resident, she asked me if I had my patient open her jaw all the way. I hadn't. So I went back, and when she opened her jaw wide, I felt a popping on the right side. Classic temporomandibular joint (TMJ) syndrome. We sent her home with ibuprofen.
I learned what TMJ syndrome feels like and how to elicit its sign. I also learned that it can be easy to miss a physical diagnosis in a psychiatric patient. The pain that my patient felt in her jaw and its impact on her life were no less real just because she had fantastical thoughts.
Sunday, February 27, 2011
Thursday, February 24, 2011
Pediatrics physical exam session
Today I got to play with children. We had a pediatrics physical exam session through Foundations of Doctoring, conveniently coupled with the pediatrics section in the Life Cycles block. This session included an interactive lecture teaching us about developmental milestones. Afterward, we had physical exam sessions with two different families, each led by a pediatrics resident.
This experience differed markedly from some of the exams I gave during my pediatrics elective at Warren Village - it's like playing with puppies when the kids think that the exam is pretend instead of real.
The second family was the highlight of the session: a five-year-old girl and four-year-old boy. We all introduced ourselves (seven students in the group), and when I introduced myself, the little girl said, "There's a boy named Tyson in my class!" She then proceeded to draw a picture of me examining her - and write a narrative of it - while the resident was teaching us about the physical exam.
As far as I can tell, this says: "Tiyson Tyson was taking me a doctur and I said thank you and then Leul [her brother] had a turn and Leul said thank you and it was for are nose." I was looking up her nose with the otoscope. And that's me holding either the otoscope or a reflex hammer.
This experience differed markedly from some of the exams I gave during my pediatrics elective at Warren Village - it's like playing with puppies when the kids think that the exam is pretend instead of real.
The second family was the highlight of the session: a five-year-old girl and four-year-old boy. We all introduced ourselves (seven students in the group), and when I introduced myself, the little girl said, "There's a boy named Tyson in my class!" She then proceeded to draw a picture of me examining her - and write a narrative of it - while the resident was teaching us about the physical exam.
As far as I can tell, this says: "
Tuesday, February 22, 2011
Fortune
My fortune cookie fortune today: "You will be successful through innovation and determination." In these stressful times, I'll hold onto that.
Thursday, February 17, 2011
Phase III clinical rotations schedule
I finally received my Phase III schedule! I'm very happy with it:
A few notes. You'll see that my first two rotations are scheduled for the same period of time. Adult Ambulatory Care and Rural Community Care are separate 4-week clinical rotations that are blocked together. I'll figure out later which one is scheduled first. Also, I don't know much about Integrated Clinicians Courses other than that they're excellent opportunities to see all of my classmates in one place and to catch up on lost sleep. The location of each rotation is determined individually around 6-8 weeks before the respective rotation.
04/18/2011 - 04/22/2011 Integrated Clinicians Course 1
04/25/2011 - 06/17/2011 Adult Ambulatory Care
04/25/2011 - 06/17/2011 Rural and Community Care
06/20/2011 - 08/12/2011 Hospitalized Adult Care (Internal Med.)
08/13/2011 - 08/21/2011 Summer Vacation
08/22/2011 - 09/16/2011 Neurologic Care
09/19/2011 - 09/30/2011 Urgent and Emergency Care
10/03/2011 - 10/14/2011 Musculo-Skeletal Care (Ortho)
10/17/2011 - 12/09/2011 Peri/Operative Care (Surgery)
12/12/2011 - 12/16/2011 Integrated Clinicians Course 2
12/17/2011 - 01/02/2012 Winter Vacation
01/03/2012 - 01/27/2012 Psychiatric Care
01/30/2012 - 03/09/2012 Infant/Adolescent Health (Pediatrics)
03/12/2012 - 04/20/2012 Women's Care (OB/GYN)
04/23/2012 - 05/04/2012 Integrated Clinicians Course 3
A few notes. You'll see that my first two rotations are scheduled for the same period of time. Adult Ambulatory Care and Rural Community Care are separate 4-week clinical rotations that are blocked together. I'll figure out later which one is scheduled first. Also, I don't know much about Integrated Clinicians Courses other than that they're excellent opportunities to see all of my classmates in one place and to catch up on lost sleep. The location of each rotation is determined individually around 6-8 weeks before the respective rotation.
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