Our First Heart Murmur, Ascites and Micro Midterm

October 14, 2014 § Leave a comment

Our first microbiology midterm approaches and I can’t wait for it to be over. There are two microbiology midterms this semester and this one is the “easy one”, since it covers basic lab topics and facts we have learned. For the next one, we will be tested on systemic bacteriology, which includes names of bacteria, their morphology (form, structure) and diagnosis and treatment of diseases associated with infections by those bacteria.

I’ve been a bad student these past two days and skipped lectures in order to get some time to study. I really didn’t get into a good study groove until Sunday night and I need more time than what is allowed in my hectic schedule. Yesterday, Skjalg and I left school after our pathology practical (which ended at 13:00) and headed straight to the library. We missed our weekly immunology lecture and our elective, Social Media in Medicine (which ended up being cancelled, lucky us!). Then today, we skipped the microbiology lecture in order to create a 3-hour study gap between our internal medicine practical and our next classes (Hungarian for me and pathophysiology for Skjalg). I really don’t like skipping lectures – it’s the only way I keep track of where I should be – but right now this midterm is the main priority.

In internal medicine practice today we got to listen to our first heart murmur and learn how to investigate ascites. We had just had our lecture on heart murmurs this morning and were very lucky to get to listen to one immediately after, especially since heart murmurs are quite rare (according to the doctor we follow around). The patient with the heart murmur actually had an artificial murmur. He/she had had an aortic valve replacement some years before and the murmur was being generated by that mechanical replacement valve. When we listen to the heart sounds, there are are supposed to be two that we can hear (there are two more, but those are really only in children or pathological situations). These sounds are normally a sort of tapping sound and when there is a murmur, there is a sort of whooshing sound between the two tapping sounds.

The patient with ascites was very friendly and informative (which we were able to gather after translation by a Hungarian-speaking student in our group). He/she had had a double leg amputation due to issues related to diabetes and it was a bit hard to watch the patient struggle to turn around in the bed during our physical examination (he/she had to use a rope tied at the end of the bed to first sit up and then lie down on the instructed side). The appearance of the patient’s abdomen was almost identical to image on the wikipedia page I linked to above. We learned how to tap around the abdominal area, first starting at the umbilicus (belly button) and then radiating outward, and noting the change in the sounds created by our tapping. The patient had to turn to different sides so that we could observe the change in sound as the fluid moved.

The tapping method we use to determine the location of the fluid/size of organs, etc. Termed percussion in clinical practice.

The tapping method we use to determine the location of the fluid/size of organs, etc. Termed percussion in clinical practice.

When the patient was lying on his/her back, we also investigated the wave-like movement of the fluid by placing one hand on one side of the abdomen and then pushing gently with the other hand on the other side. It really felt like a wave moving inside of the patient!

Now I am home and ready to study! Need to get at least 3 hours of good work in for me to feel like I’ve been good today. After that? Bed, up at 6, gym and then library. I’ve already received permission to miss tomorrow’s physiology TA class and will be skipping tomorrow morning’s patho lecture and immuno practical *bad Buda-B!*. I’m going to have a lot to make up for with these missed classes – hopefully it will be worth it!

Here are some shots from yesterday! Gotta enjoy Fall while it lasts!

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