Work and play

This morning I met with Dr. Chen (oncologist) to go over our group presentation on CRC. He was incredibly helpful. He not only helped me improve my section on the oncologist’s approach to the case, he also modified the rest of the presentation. He also helped us obtain numerous laboratory studies, including CBC, serum CEA, chemistry panels and imaging studies: paneoscopy, colonoscopy, chest Xray, CT scan, ABD U/S, and colonoscopic biopsy. He contacted various departments to gather as all the pertinent data. I could not believe how generous he was with his advice and assistance. I was excited to learn a logical and comprehensive structure of a case presentation. The general flow for a cancer case presentation should be:
1. Chief complaint (include pertinent history of present illness)
2. Physical exam
3. Clinical impressions
4. Differential diagnosis
5. Lab studies
6. Imaging studies
7. Rule in and rule out DDX based on findings
8. Treatment (surgery, chemotherapy, radiation) and rationale
9. Follow up and treatment-induced changes
10. Survivorship

After lunch, my new preceptor Dr. Liao, a neurosurgeon brought Nicole and me to the ICU. He showed us how to read a CSF monitoring machine. There was a wave representing the mean intracranial pressure, another wave represented the arterial pressure. On this patient, Dr. Liao performed an emergency craniotomy to remove an intra-cranial hematoma 1am-5am this morning.

He then presented different intra-cranial shunts, including epidural, sub-arachnoid, intra-dural, and brain parenchymal devices. He taught us that the cranium includes 4 types of material: brain, fluid, blood, and something else. When one of the four component increases in volume, the other three components decrease or get compressed. For instance, if there is a tumor or bacterial abscess (something else), volume of blood and CSF will decrease while the brain tissue gets compressed. He also showed us that slight changes in CSF volume increases intracranial pressure slightly. However, once above a small volume threshold, intracranial pressure increases exponentially with small increase in fluid volume. This is because the skull is rigid and allows for negligible expansion.
We worked hard over the weekend on the case presentation, so we decided to go out tonight. It was lots of fun, Taipei 101, Ding Tai Fong, and night market. We’ll all sleep very well tonight after all the good food, sight seeing and strolling pass stands and little shops all night!