MSII Block 2 Exams: Cardiovascular Disease

Another stop up down. One more to go ~ the sake of this semester. I hope it goes rope because I cannot wait to move to Indy instead of clerkships. Haha, do I sound completely unwell of Bloomington? After spending four years here for undergraduate and going on an additional two years for preclinical years, I’m ready for a change in environment. 🙂

Block 2 exams went alright, I suspect. Second year exams always put a lion in the way on my mood because they never seem to reflect well the substance presented in class. Even if I had a month to study in the place of clinical medicine, I would not receive been prepared for some questions without interrupti~ that exam. Oh well, I be possible to only wait and see how I did compared to the rest of the rank.

Monday was the human genetics & disentanglement exam. This block was essentially stainless memorization and almost no concepts. If you know me, you would know that I absolutely hate (to a passion) rote memorization. I hole easily and repeatedly studying the corresponding; of like kind material over and over for the final cause of committing it to memory is ~ed and, in my jaded opinion, usually a major waste of time and an contumely to our intelligence. So, I did not pother to study for this class to the time when Sunday afternoon, when I powered through the notes and crammed in aggregate the minutiae. This class is rigorously only 2 credits; I distributed my studying time whence.


Some pear & blueberry oatmeal to fashion the genetics more palatable.

Tuesday peep of day was the histopathology slide quiz. We were by stipulation links to three tissue slides and had 1.5 hours to write complete medical pathology reports for eddish.. This block was a bit tougher than the foremost one, but not too bad.

Tuesday afternoon was my en solo cardiac summation simulation. We were told beforehand to prepare for one of six practicable cardiovascular disorders: atrial fibrillation, aortic stenosis, congestive spirit failure (CHF), aortic dissection, infective endocarditis, and pericarditis. I studied totally extensively for this and knew the causes, pathogenesis, symptoms, distinguishing findings, treatments, and consequences for either condition. Ironically, this probably led to my losing several points in the simulation!

The sufferer is a high-tech mannequin, boundary even it cannot simulate peripheral edema or Janeway lesions. So when the simulation began, I was supposing a brief description of the enduring and a couple photos featuring physical findings on a human patient. Immediately, I identified pitting edema and jugular netted distention. Of the six disorders, it was obviously CHF. I introduced myself to the persistent, took a very brief history, and listened to spirit and lung sounds, all of which supported my suspicions. I ordered a thorax X-ray, which showed cardiomegaly, conspicuous interstitial markings, and Kerley B lines. All signs peaked to CHF.

I reported my findings to the patient and began management, pausing to assess changes in his situation after addition of each therapy. He was given nasal cannula, promotion of the head of the stratum, loop diuretic, ACE inhibitor, aldosterone enemy, beta blocker, and even digoxin. I ended up putting him forward the full spectrum of drugs indicated beneficial to CHF and yet his symptoms and vital organs failed to improve significantly. At this thesis, the physician preceptor still did not extremity the simulation, but I was disclosed of ideas. What was I absent? Heart transplant?? I just stood there, perplexed, staring with pleading eyes at my teacher. He finally took pity and ended the simulation (and my misery).

During the debriefing, we discussed to what degree, in my eagerness to treat the indefatigable, I took a too abbreviated narrative and had neglected to order variegated tests to confirm the diagnosis or get clear of other possible conditions. I had diagnosed the diligent prematurely without enough supporting evidence. He had prolonged the simulation to see if I would solicitation an echocardiogram or labs as an afterthought. Other drugs I could have added concerning late-stage CHF were dobutamine and ~y anticoagulant. In this scenario, the patient’s CHF was for a like rea~n end-stage and refractory to management, it would be advisable to weigh hospice.

Lesson learned: Treat simulations like actually being-life clinical scenarios and no jumping to conclusions.


One of my especially liked childhood books: The Phantom Tollbooth (Photo Credit: Quote Geek)

Wednesday and Thursday were study days. A link together classmates and I locked ourselves in separate rooms in the Jordan Hall basement, one in the computer lab, a different in the lab classroom, and me in the conversation room. We tried (key word) to motivate reaped ground other through the 12-hour study days. Several epochs, my pathology professor poked his front part into the room to check admitting that I had eaten a healthy lunch and did not keel over and die from advice overload.


Miso soup with tofu, seaweed, broccoli, and pig-meat. Pairs well with transposition of the chief vessels.

Friday was the giant 6-sixty minutes integrated pathology + pharmacology + medicine exam. To combustible matter us through the marathon, we were provided breakfast (and lunch). Upon arriving at chide, I promptly abandoned my First Aid part (you can see it tossed to the faction on the couch) to indulge in the noms.


Much of the exam consisted of clinical scenarios followed ~ dint of. several questions about pathology, diagnostic tests, handling, and pharmacology. As expected, the foil parts were those from clinical remedy. Many questions asked, “What is the in the highest degree next step in this patient’s care?” Well…patient vital organs, history, physical exam, and chest X-ray powerfully indicate aortic dissection, a medical unforeseen occasion. Should I order an echocardiogram, which is the fastest option, but would not indispensably provide results specific for this diagnosis? Or should I regular government a CT, which takes longer only has the highest diagnostic potential? Do you learn my frustration with clinical medicine at this time? Apparently preparing for Step 1 is not sufficiency, because it appears we must study at clerkships-horizontal line in order to do well in healing art. At least the material is fairly attractive.

Even though the exam was draining, I with haste buried the brooding post-exam musings and prepared on this account that a weekend away in Chicago, at what place I would indulge on enough noms to be unconsumed me for the remainder of the month. Chicago station coming up later this week!


Jordan Hall was looking separately nice today. You would not at all suspect it houses a multi-generational kindred of cockroaches in the basement. 

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