Human Anatomy at Colby

Peter Wirth: MaineGeneral Augusta

February 14th, 2014 · Comments Off on Peter Wirth: MaineGeneral Augusta

Peter Wirth

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Our class had the opportunity to visit the new Augusta campus of Maine General. Medical students first gave us tours of the new hospital. Many of the students were from the University of New England, while some were from other schools on rotation at MaineGeneral. Three students, none of which were from UNE, showed Emma and me around. Each student brought a unique perspective to medical school; one student went to Dartmouth, one was at the University of Oklahoma, and one was Canadian at medical school in the Caribbean. They were all very helpful and honest in giving Emma and me answers about the process of applying and attending medical school.

Both Emma and I are pre-med, so we found their advice to be especially helpful. Since they each had taken a very different route to end up in medical school, their advice underscored the importance of studying what we enjoy during undergraduate years. In addition they told us that at many of their interviews it was not MCAT scores that were discussed; rather, they were asked about their hobbies, their aspirations, and their reasons for becoming a doctor. These students greatly reduced my anxiety and showed me how they all made it work.

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While talking to these students, we were showed around the hospital. We were able to see several wards, as well as the ER, library, and several rooms for residents and students. The hospital is beautiful, new, and state-of-the-art. The hospital rooms were large, comfortable, and inviting. Each room had its own bathroom attached. Some parts of the hospital reminded me more of a hotel than a medical facility.

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Following the tour we began listening to presentations from fellow Colby students, as well as Kent’s Hill high school students. Each topic was very unique and all the students did an incredible job presenting. Some groups presented an interesting case study from the New England Journal of Medicine, while others presented a disease or disorder. Our group presented on a case of a college student who developed a brain infection following a diagnosis of mononucleosis. The audience of students and doctors was kind in their assessment of our presentations and complemented our ability to make sense of a very complex case.

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This trip was helpful for me because it gave us the opportunity to interact with medical professionals (and those in training) in a relaxed environment. All of my questions were well answered and clarified many aspects of the medical school application process. In addition, being able to see these students interact with doctors and other hospital staff was insightful as to how the students were integrated into the healthcare profession.

Overall, this trip reminded me why I was pre-med; it is all too easy for me to get caught up in GPA, lab reports, and exams and forget the main reason why I’m doing it in the first place. Seeing patients and being able to provide a benefit to them and their families is an incredible opportunity that people in the medical profession get to do. Visiting MaineGeneral definitely reminded me why I am pursuing this career path and allowed me to meet students who are like-minded individuals on their way to becoming doctors.

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Tags: Grand Rounds · Maine General

Grand Rounds: Epstein-Barr Virus and Infectious Mononucleosis Induced Acute Post-infectious Cerebellar Ataxia

January 29th, 2014 · Comments Off on Grand Rounds: Epstein-Barr Virus and Infectious Mononucleosis Induced Acute Post-infectious Cerebellar Ataxia

By:  Laurel W, Emma R, Peter W

One month before admission to Massachusetts General Hospital, a previously healthy 19 year old male presented with fatigue, fever, pharyngitis, and lymphadenopathy. A streptococcal pharyngitis (strep throat) test was found to be negative, and a heterophile antibody test (rapid test for mononucleosis) was found to be positive. The diagnosis of infectious mononucleosis due to Epstein-Barr virus (EBV) was made 17 days before admission.

Two weeks prior to admission, the patient presented with additional symptoms, including dysphagia and pain and difficulty hearing in the right ear. A diagnosis of otitis media was made and was treated with prednisone, amoxicillin, and azithromycin. 8 days prior to admission, the patient presented with severe ear pain, a perforated right tympanic membrane, and a bloody purulent in the external auditory meatus. The patient was treated with oral cefurozime and ciprofloxacin (antibiotics). Several days after visiting the ENT, the patient returned for a myringotomy (procedure to relieve pressure in ear by making incision in ear drum). Then, 6 days prior to admission, the patient experienced unsteadiness, slurred speech, and increasing gait imbalance.

Upon arrival the patient had experienced weight loss, decreased hearing, enlarged tonsils, falling, and truncal ataxia. Over the first four days of admission the patient was found to have opacification (indicating fluid in these areas) of right mastoid air cells and middle ear (as shown from MRI and CT scans), impaired ability to perform simple arithmetic, continued deterioration of speech, and balance. The CT scans of the cerebrum and cerebellum showed no abnormalities. The coordination test showed impairment in his motor functions. Slurred speech, clumsiness, ataxia (lack of coordination of movements) and otitis media led to the admission of the patient to neurology services.

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Although Guillian-Barre syndrome is the most common cause of post-infectious ataxia, it is accompanied by loss of reflexes, which were intact in this case. Although cerebral involvement due to executive dysfunction was considered, it could not explain all of the patient’s signs and symptoms. Hereditary and neurodegenerative diseases were ruled out due to lack of family history, normal imaging, and patient’s age. However, the patient’s symptoms, along with the diagnoses of infectious mononucleosis, led to the clinical diagnoses of an upper respiratory tract infection complicated by otitis media. The neurological symptoms also led to the diagnoses of post-infectious acute cerebellar ataxia (ACA) associated with Epstein-Barr virus. ACA is presumed to be an auto-immune response causing inflammation of the cerebellum leading to motor dysfunction.

Plasmapheresis and intravenous immunoglobulin (IVIG) were recommended for treatment as this course is directed at the immune response and therefore more effective. IVIG is administering a solution containing antibodies from the plasma of thousands of people and Plasmapheresis is the process of removing, treating, and returning blood plasma to a patient. Both techniques are common treatments for autoimmune disorders. On the fourth day in Massachusetts General Hospital a five day course of IVIG was begun; the patient responded rapidly and his symptoms improved. After the fifth day of treatment the patient had recovered 90% of his function. He then spent one day in a rehabilitation center and was discharged on the eighth day after admission with a full recovery.
Tracey A. Cho, M.D., Jeremy D. Schmahmann, M.D., and Mary E. Cunnane, M.D., et al. A 19-Year-Old Man with Otalgia, Slurred Speech, and Ataxia. N Engl J Med 2013;369:1253-1261

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