#29 What I Learned Today

Essentials of Clinical Practice

In ECP lecture, we discussed the importance of taking a complete physical assessment of the patient as soon as they walk into our office and shake our hand. When preparing for a physical assessment, you should make the patient feel comfortable. This can be done through simple chat with the patient. If we're doing any examination with our hands, simply rubbing them together to warm them up will make the experience more comfortable for the patient. A dentist should also check his or her equipment to make sure that it is in working order; being prepared shows the patient that you are competent and ready. After performing the physical examination, it is important to avoid quickly interpreting the results and jumping to what may be an erroneous conclusion.

A popular way of examining a patient in medicine is done through a SOAP note, which stands for:

• subjective
• objective
• assessment
• plan

Another useful mnemonic for subjective analyzing a patient is by SAMPLE:

• S = signs/symptoms
• A = allergies
• M = medications
• P = past history
• L = last food intake
• E = events leading up to the problem

For analyzing pain, you can use the alphabet mnemonic OPQRST:

• O = onset of pain
• P = provocation
• Q = quality of pain
• R = region/radiation of pain
• S = severity of pain
• T = time pain started or went away
  

Foundation of Evidence-Based Dentistry

In Evidenced-Based Dentistry, we talked about writing PICO questions. PICO is a away of narrowing the scope in regards to a specific topic you want to research, by formatting the question in a structured manner. PICO stands for:

• P = patient population or problem
• I = intervention
• C = comparison
• O = outcome

An example of a PICO question would be: In a patient with moderate plaque accumulation, is brand #1 mouthwash, as compared to brand #2 mouthwash, more effective in removing plaque?

You can then use this specific question to search a journal database to find out the answer to your question.

Gross Anatomy I

Today's Anatomy lecture focused on the kidney and the diaphragm. It's important to note that the venous drainage of the kidney is asymmetrical. The left renal vein is much longer than the right; this is due to the fact that both the renal veins drain into the inferior vena cava, which you'll recall is located on the right half of the torso. The renal arteries are found posterior to the renal veins.

It is important to note that there is some vein and artery overlap going on. The superior mesenteric artery runs over top of the left renal vein. As well, the inferior vena cava initially runs anterior to the abdominal aorta near the diaphragm, but as you approach the posterior portion near the bifurcations, the abdominal aorta runs anterior to the inferior vena cava.

If you take a cross section of the kidney, you'll notice that it was an outer cortex layer and an inner medullary layer. The medullary is ordered in column-pyramid-column arrangements. The pyramids come to a 'point' on the major and minor calyces, where urine flows to the ureter.

The diaphragm has four origins (the sternum, ribs, costal cartilage, and lumbar vertebrae) and inserts on the central tendon of the diaphragm. Its main function is to increase thoracic volume when inspirating. It is innervated by the phrenic nerve, which has both motor and sensory functions. It has surface openings for:

• caval hiatus: inferior vena cava and right phrenic nerve
• esophageal hiatus: esophagus and both vagus nerves
• aortic hiatus: aorta, thoracic duct, and azygous vein

The diaphragm also has arcuating (arcing) ligaments found on its dorsal end. These include the medial arcuate ligament (which houses the psoas muscle), the lateral arcuate ligament (which houses the quadratus lumborum muscle). These arcuate ligaments attach to the vertebral column by the right crus and the left crus.

Gross Anatomy Lab

In lab, we reviewed the structures, nerves and vessels that we've gone over to date.