Block III: Cardio and Community Week

Whew... and breathe. It's good to finally have a break. Block III: Cardiology ended Thursday, with a final exam average over 10 points higher than that of the HemOnc-ster. We literally went from the hardest block in the first two years to the easiest (as far as grades go). But as far as importance, this material was certainly the highest yield. Every patient we see in the clinic and hospital will receive a full cardiovascular (CV) exam; and since heart disease is the number 1 killer in the United States, all of us will see patients with CV pathophysiology: strokes, heart attacks, murmurs, palpitations, etc. Nothin' more important than the ole ticker.

Having Cardio right before Community Week #3 is going to turn out to be quite fortuitous. Last year I was frustrated with how little I brought to the table during these weeks here in Boone, NC. I could take a history, perform a focused physical, and I learned how to make helicopters out of Popsicle sticks. But I was annoyed with how little I actually knew. This time around, I feel like I now know at least a little bit about something. With Immunology/Microbiology under my belt, I have a better understanding of the diseases that most kids present with in clinic. Mycoplasma, Group A Streptococcus, otitis media: these are no longer abstract words associated with simple phenotypes. I have (at least basic) knowledge of the mechanisms of these diseases, and a bit of epidemiology behind them. That course allows me to develop more coherent differential diagnoses in clinic.

Cardiology will make the physical exam so much more meaningful. Last year I felt I was just going through the motions. I would listen to the heart in the aortic, pulmonic, tricuspid, and mitral areas over the chest and say, "Yup, there's a heart in there all right." But now I can listen to each beat and attempt to hear other sounds like murmurs, snaps, and thrills. I can ask a kid to take a deep breath and hold it, then listen to physiologic splitting of S2! (As the chest wall expands, a decrease of intrathoracic pressure during inspiration causes increased venous return and right heart volume, thus delaying the closure of the pulmonic valve, essentially... look at me with all this knowledge!). Pathologic splitting can be due to many things, including an atrial septal defect (ASD - fistula between the left and right atria), aortic stenosis, etc. These are the types of things I get to listen for this week!

So my goal for this Community Week is twofold. First, I am going to attempt to perform a full CV exam on as many patients as possible. That will include inspection (simply looking for pathological findings such as cyanosis or "clubbing"), palpation (touching the patient to identify the point of maximal impulse of the heart, i.e. is the heart oriented properly), and auscultation or "listening" with my trusty stethoscope. Hopefully by the end of this I will have that exam down cold. Secondly, I have to write two SOAP notes by week's end. SOAP stands for Subjective, Objective, Assessment, and Plan, and this is the type of note that I will be writing every day next year in the hospital to update a patient's status. Next week's blog will feature one of the SOAP notes I write this week (obviously with much of the information tweaked for patient privacy), and will essentially be my first attempt at documenting patient care. Hopefully in years to come I can look at how awful my first notes were and laugh.

This is nice. It is much easier this time around to focus on learning and preparing for third year. No more haphazard shadowing.

Upon return it's back to the grind with a three week Pulmonary unit, then GI, Thanksgiving, and the Urinary System. It will be Christmas before ya know it!