Note Taking on Your iPad

I must confess upfront that I am a Mac-o-holic. If I'm not on my iPhone or my iPad, then I'm working on my MacBook. I've had several people ask me how I use my iPad to take notes - and until recently I didn't have a great answer. I primarily used it to read text books and articles - but now that I've discovered Notability, I also use it to take notes.

Notability is a pretty wonderful app with good ratings and I haven't been disappointed with it yet. Now, of course, every app has it's flaws... but for what I use it for - I love it. It allows you to write out your notes on a "sheet of paper" and create a PDF or email it to yourself. You can also import PDFs (great for note taking on PDF'd ppts that you get in class. With the current version you can only import PDFs, but they are working on adding .doc and .ppt files to the mix soon. It also syncs with Dropbox to back up all of your notes or import files.

I have added some screen shots below. I'd love to hear if anyone has found something better out there - shoot me and email or add a comment.

And best of all, as of now, the app is only 99 cents!

There are several customizable features - pen and highlighter color and thickness as well as the addition of voice notes.

The mini window allows you to write smaller notes, thus getting more on each page (this will come in handy if you wish to print out your notes).

Disclaimer: I was not asked to write this review, nor do I receive anything if you buy it. Just wanted to share!


2C + 2MB = 4P + 4MO

Cranial nerves. I found this "equation" that helps me to remember where the cranial nerves arise from:

2C + 2MB = 4P + 4MO

The 1st 2 cranial nerves [Olfactory (I) and Optic (II) nerves] originate in the Cerebrum, the next 2 [Oculomotor (III) and Trochlear (IV)] cranial nerves arise from the Midbrain, the next 4 [Trigeminal (V), Abducens (VI), Facial (VII) and Vestibulocochlear (VIII)] cranial nerves arise from the Pons and the last 4 [Glossopharyngeal (IX), Vagus (X), Accessory (XI) and Hypoglossal (XII)] cranial nerves arise from the Medulla Oblongata.

Source: Problem Based Neurosurgery by Sam Eljamel


Gov't Loan Forgiveness: Do You Qualify?

You qualify for loan forgiveness based on public service if you work for the state, federal gov't, or a non-profit hospital. Get the details here: Loan Forgiveness Document

Also see the Federal Student Aid website for more information.



Mnemonic Site

Board Mnemonics Site. Some are super helpful. Some are ridiculous. Enter at your own risk.

Mnemonic: is any learning technique that aids information retention. Mnemonics aim to translate information into a form that the human brain can retain better and even the process of applying this conversion might already aid the transfer of information to long-term memory.

Source: http://en.wikipedia.org/wiki/Mnemonic


Financial Aid, Handling PA School Debt

Financial Aid packages for PA school are rarely the bearers of good news. There are some students that get their education paid for through various avenues, but the majority of students take out loans. It is scary to think about being in debt, in some cases, more than $130-40K. At some point it feels like Monopoly money, you just keep signing on the dotted line and the "owed" amount just keeps growing and growing.

I'm not sure how all PA schools handle this, but mine gave a few talks on potential scholarships or loan repayment options - but no one really sat us down and had a "money management" talk with us. Financial aid services make you fill out an Exit Interview for the loans you borrowed, which is helpful - but I always wanted to know more. What are my repayment options? Should I consolidate? What are the pros/cons of consolidating? What happens when I get my first job - should I start saving for retirement and investing in my 401K or should I pay back my loans first? How do I save for a house/kids with a large loan payment per month? Should I hire a financial advisor?

I had (and still have) so many questions about the process. I found this site created by the Association of American Medical Colleges (AAMC) and it helped to answer many of my questions. They created a section called "FIRST" which stands for Financial Information Resources, Services, and Tools. On the left-side bar there are options for you depending on your stage of the process. This is geared primarily toward medical student, however, most the information is extremely relevant to PA students. They also have a section called FIRST Videos that contain videos and podcasts on important questions you may have regarding financial aid. The only way you can handle the enormous debt of PA school is to understand how to handle it. Knowing is half the battle... 



Surgical Tubes & Drains

Tubes and Drains. Most of the time you don't go over these in PA school. People just keep referring to "JP drains" and "NG tubes" - but if you've never worked in a hospital - you probably have no idea what these are. I will go over some of the more common tubes and drains. If you see one on a rotation and aren't sure what it is or what it does - ask!

Jackson-Pratt (JP) drain:
  • used to drain surgical wounds and keep bacteria/blood from building up
  • usually attached to suction bulb
  • if you are asked to "strip" these tubes - it means you need to pull along the length of the clear tube filled with blood [this prevents clotting]

Blake drain:
  • similar to a JP drain
  • has a more narrow internal section so it is less uncomfortable for the patient when pulled out
  • has a blue line along the tube (this is how you can tell the difference between a JP and a Blake)  

Penrose drain:
  • yellow-colored tube used to drain large abscesses
  • no suction

Nasogastric Tube (NG Tube):
  • tube leading from nasopharynx to the stomach
  • used to drain stomach of fluids
Gastrostomy tube (G-Tube):
  • goes from the stomach to outside of the body
  • kind of like a permanent NG tube
  • used for feeding pts with obstructions or ileus

Jejunostomy tube (J-Tube):
  • primarily used for feeding

GJ Tube/Moss tube:
  • has 2 ports (1 to stomach, 1 to the jejunum)
  • acts like 1 G-tube and 1 J-tube
  • often used for pts at high risk for aspiration

  • a biliary tube shaped like a "T"

Source: First Aid for the Medical Student


Is Twitter Worth it?

Great blog post on Academic Life in Emergency Medicine, topic = Twitter! How can Twitter help you as a PA student? Why bother getting involved in it? Is it a waste of time? Check out this blog to find out: Mini-Guide to Twitter: Why Should I Join?

You can find me on Twitter: @B_Belcher

Photo source: http://technmarketing.com/web/11-things-to-avoid-when-using-twitter/


Hypoparathyroidism, The Signs

Hypoparathyroidism. It is on the NCCPA's list of diagnoses on the PANCE exam. Two signs associated with hypoparathyroidism are Chvostek's and Trousseau's Signs. Chvostek's sign is a twitching of facial muscles in response to tapping over the area of the facial nerve. The Trousseau's sign is hand/finger spasm that results from ischemia, which can be induced by pressure applied to the upper arm from an inflated BP cuff.

As I was looking through this week's NEJM email I came across and article with videos of each of these signs. Watch it! Once you see it, you won't forget it. I would also read the case, it is very short. That plus visualizing the "signs" will help it stick.

Photo source: http://www.medicinenet.com/hypoparathyroidism/page2.htm
Source: http://www.nejm.org/doi/full/10.1056/NEJMicm1110569?query=TOC




Definition: immune-mediated inflammation of blood vessels
Classifications: by size of the vessel, anatomical location, and immunological findings

Large Vessel Vasculities
  • Giant cell arteritis 
    • usually > 50 yo
    • inflammation of the temporal, vertebral, or ophthalamic arteries
    • increased ESR
    • histology = segmental
  • Takayasu arteritis
    • inflammation of the lg arteries branching from the aortic arch
    • downstream ischemia causing blindness
    • undetectable pulse in upper extremeties
Medium Vessel Vasculities
  • Polyarteritis nodosa
    • segmental nectrotizing inflammation of any vessel (most often kidney, heart, and liver)
    •  affects young adults
  • Kawasaki disease
    • acute vasculitis
    • primarily coronary vessels
  • Thromboangiitis obliterans
    • aka Buerger's disease
    • acute and chronic inflammation
    • inflammation that can spread to veins and nerves
Small Vessel Vasculities
  • Wegener granulomatosis
    • either acute or necrotizing
    • prominent lung involvement
  • Churg Strauss Syndrome
    • necrotizing granulomatous
    • affects vessels and surrounding tissues (usually heart and lungs)
    • numerous eosinophils
  • Microscopic polyangiitis
    • usually affects the skin
    • most caused by immune responses  

Photo source: http://www.wegenersgranulomatosis.net/5_autoimmune_vasculitis.php
Source: Hardcore: Pathology, Carter Wahl


Gross Anatomy Videos

University of Michigan Medical School has a wealth of medical resources online. One of the ones that I used most throughout school was the dissection videos. 


PA-C, Finally

So I graduated, took the PANCE, passed... and now I'm a PA-C. Some how "Physician Assistant, Almost There" was no longer an appropriate title for my blog. I thought long and hard before changing it to "Physician Assistant, Finally There" and decided to make the change subtle because I don't really want much to change about my blog now that I'm a certified. I hope to keep the blog alive as the same resource it has always been. I'm always seeking new websites/apps/books that will increase my medical knowledge and I will always have a desire to share them with YOU, my future colleague.

Thanks for all of the continued support and emails. I hope that this blog can continue to be a great resource for all that visit.


Have You Backed Up Your Data Lately?

Have you backed up your computer lately? If you are like me, the majority of your "PA life" is on your computer... notes, e-text books, audio recordings, resume, cover letters, fun pics documenting the year, etc... What would you do if you couldn't turn on your computer tomorrow? Personally, I'd cry. I bring this up because it happened to a couple of my classmates in PA school and I felt horribly for them. I think it only makes it worse when people say after the fact that they should have backed it up. Ha. Hindsight is 20/20. SO, here is my pitch to you to back your stuff up NOW.

If you have a Mac - life is easy. You just need an external drive that is bigger than your hard drive and Time Machine does all the hard work. You just need to remember to plug it in! It even reminds you every 10 days that you haven't backed up in a while.

Pro of Time Machine: it backs up your entire computer, including your operating system
Con of Time Machine: you are reliant on an external hard drive - if that fails - you're out of luck

If you have a PC or would like an alternate to Time Machine there are some online back up systems available. Carbonite, Mozy, Centurylink are a few of the more popular ones. I suggest Googling them to see which one fits your needs/budget.

Pro: Runs in the background and constantly keeps things up to date. File accessible from iPhone/iPad, etc.
Con: Cost. Carbonite runs about $153 for a 3 year subscription. Security. Each of these companies say that their information is super secure, but it is alway a little weird to give all of the information from your computer to an outside entity.

The last alternative is to back up your most beloved files on a CD or DVD.

Pro: Cheap.
Con: Limited space unless you use lots of CDs/DVDs to back up. Can be wasteful if you are changing your files regularly.

I am in no way, shape, or form receiving financial reimbursement from any of the online storage companies that I mentioned in this blog. Just some suggestions.