Can an average student get into medical school?

Ok i am going to give you the most important advice of your whole pre medical career. I was just like you and i made every mistake in the book. I want you to listen carefully. I can tell that you are a smart person and i want you to make the right decision.

Cynical side:

1.) You have to ask yourself why do you want to become a physician. Be honest with yourself. The top reasons that people become physicians is money, prestige, parental pressure, sex and a passion for healing. Notice i put a passion for healing low on the list. All of those reasons are bad reasons. The only reason to become a physician is because you are absolutely fascinated by disease processes and disease treatments. Thats it. You can get money easier doing something else, parents are often misguided, you will get laid less as a doctor than your local personal trainer and you can heal people in many different ways.

2.) If you just want to heal people there are many other ways to do it. These days you have a ton of mid level provider options. Like physician assistant, nurse practitioner and nurse anesthetist. You can also heal people mentally by becoming a therapist.

3.) Math is going to come back over and over again in pre med. I was like you. I was brilliant at English but horrible at math. I struggled like sh*t in math related classes. You are going to see math in Chem 1, Chem 2, Physics 1, Physics 2, Calc 1, Calc 2 and Statistics. These are all pre med classes that require a TON of math.

4.) Is it worth struggling like crazy in order to achieve this goal? There are going to be nights where you cry because you studied 3 times harder than your pre med peers but only get a C or a D. This is because your brain is brilliant but it does not have a natural aptitude for math. Your self esteem will tank and your stress levels will rise. You GPA will suffer even though you are out working your peers. College advisors will act as if you are lazy even though you are working your butt off.

Optimistic Side:

1.) Life is about challenges. If you choose to keep on with pre med you are operating at a severe disadvantage. But life is about conquering obstacles. This is how we grow. Studying twice as hard and doing just as well even though you are an underdog will feel amazing. So the journey might be worth it.

2.) That first year Chem class is when most pre meds drop out. Many people do badly on that first test of General Chem 1. Its ok. It may not be indicative of your true potential. You may just have to change your study habits and do more questions.

3.) This may be a fluke and you may go on to ace the other pre med classes. Giving up too easily is never a good thing

Conclusion:

I would say finish the Gen Chem class. Put your all into it. I mean 100%. Study like a maniac. If you still get a C or fail the class then switch your major. Your talents would be better spent elsewhere where you can really shine. You can always graduate take about a year off and learn pre med chemistry on your own. Learn it well. Then go back and take those math related classes. This is what i did and i did great after i taught myself for about 8 months after i graduated. If you have any more questions dont hesitate to ask me. I am here for you.

Check out my blog and my E book

Big Picture Thinking vs Medical School Thinking

My Kid Is a Doctor

The question was posted on Quora by William Boyce

Definition Of Love For Medical Students

Definition : A Serious Disorder Of The Heart Due To Relationship Between A Male and A Female Which Can Sometime Cause Death Of 1 Or Both Depending On The Resistance Associated.

Types:
– 1 Way
– 2 Ways

Age And Risk Factors : Usually Occurs After Puberty But Recent Studies Revealed That It Can Happen In Any Age Group Even In Children.

Sites Affected: Brain And Heart

Etiology:
– Time Pass
– Desired To Be Loved
– Money And Beauty

Symptoms:
– Tension
– Sleeplessness
– Daydream
– Tachycardia
– Insomnia
– Phone Addict
– No Concentration

Investigation:
– Diary
– Album
– Books
– Mobile (Most Confirmatory)

Prevention And Treatment:
– It is a non preventable Condition Especially In The First Attacks
– Marriage Is The Best Solution For This Condition

Medical Student Syndrome

Medical student syndrome “MSS” also named medical student disorder, medical student disease and hypochondriasis of medical students is a condition frequently reported in medical students nowadays.

MSS is a constellation of psychiatric symptoms that affect the mood and behaviour of a medical student, especially during the first year of studying medicine.

While Medical students are learning medicine they read lists of symptoms for different diseases daily. Although they are completely healthy, they feel that they are suffering from the symptoms of specific diseases and they have it.

For example: If a medical student is reading about swine flu he may feel its symptoms and do unnecessary laboratory tests to confirm his wrong diagnosis.

Now the disease included millions of non medical students who can easily search in the internet about any disease and believe in having its symptoms.

If you suffered from this syndrome before share with us your experience through writing your comment here.

Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia

 

by Kelemu Abebe Gelaw, Amlaku Mulat Aweke, Feleke Hailemichael Astawesegn, Birhanu Wondimeneh Demissie and Liknaw Bewket Zeleke

Abstract

Background

A cesarean section is a surgical procedure in which incisions are made through a woman’s abdomen and uterus to deliver her baby. Surgical site infections are a common surgical complication among patients delivered with cesarean section. Further it caused to increase maternal morbidity, stay of hospital and the cost of treatment.

Methods

Hospital based cross-sectional study was conducted to assess the magnitude of surgical site infection following cesarean Site Infections and its associated factors at Lemlem Karl hospital July 1, 2013 to June 30, 2016. Retrospective card review was done on 384 women who gave birth via cesarean section at Lemlem Karl hospital from July 1, 2013 to June 30, 2016. Systematic sampling technique was used to select patient medical cards. The data were entered by Epi info version 7.2 then analyzed using Statistical Package for Social Sciences windows version 20. Both bivariate and multivariate logistic regression was done to test association between predictors and dependent variables. P value of < 0.05 was considered to declare the presence of statistically significantly association.

Results

Among 384 women who performed cesarean section, the magnitude of surgical site infection following cesarean section Infection was 6.8%. The identified independent risk factors for surgical site infections were the duration of labor AOR=3.48; 95%CI (1.25, 9.68), rupture of membrane prior to cesarean section AOR=3.678; 95%CI (1.13, 11.96) and the abdominal midline incision (AOR=5.733; 95%CI (2.05, 16.00).

Conclusions

The magnitude of surgical site infection following cesarean section is low compare to other previous studies. The independent associated factors for surgical site infection after cesarean section in this study: Membranes rupture prior to cesarean section, duration of labor and sub umbilical abdominal incision. In addition to ensuring sterile environment and aseptic surgeries, use of WHO surgical safety checklist would appear to be a very important intervention to reduce surgical site infections.

Keywords

Surgical site infection cesarean section

Background

A cesarean section is a surgical procedure in which incisions are made through a woman’s abdomen and uterus to deliver her baby. Cesarean section (C-section) may be necessary when vaginal delivery might pose a risk to the mother or baby when there is prolonged labor, fetal distress, or when the baby is presenting in an abnormal position. However, cesarean section can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications [1]. Since 1985, the international healthcare community has considered the ideal rate for cesarean section to be between 10% and 15%. Since then, cesarean sections have become increasingly common in both developed and developing countries. Due to this the worldwide continuous rise in the incidence of cesarean sections, the number of women with postpartum infection is expected to increase .

Pregnant women are at risk of infection during labor and delivery. Among surgical patients in obstetrics; Surgical Site Infections (SSIs) are the most common nosocomial infections, accounting for 38% of hospital acquired infections .

Although C-sections are performed in a sterile environment, the risk of surgical site infection always exists. Use of prophylactic antibiotics has been shown to significantly reduce post-cesarean infectious morbidity. The latest American College of Obstetrician and Gynecologist (ACOG)committee opinion recommends administration of antibiotics within 60 min of cesarean section and that where this is not possible the antibiotics be administered as soon as possible .

Most cesarean sections heal uneventfully within a predictable timeframe. However, for a small proportion of patients, the wound will develop complications. As a result, Surgical site infections are the most common post-operative complications even in hospitals with most modern facilities and standard protocols of preoperative preparation and antibiotic prophylaxis .

The average expected surgical site infections rate being 6–27% after C-section. These rates are increased in the presence of other risk factors such as gross contamination of the operative site, prolonged and premature rupture of membranes, obstructed labor, prolonged operative time, emergency operations, altered immune status, which are common in resource poor countries [5].

Risk of surgical site infection in developing countries is more than the developed countries (especially in sub Saharan Africa, the average wound infection rates are 2 or 3 times higher than developed countries) due to malnutrition, anemia, poverty and environmental pollution; poor preoperative preparation, wound contamination, poor antibiotic selection, or the inability of an immune-compromised patient to fight against the infection. These are avoidable in most circumstances by altering host, microbial and environmental factors in favor of the host .

cesarean sections carries a risk of infection 5 to 20 times that of normal delivery. It is the single most important risk factor for postpartum maternal infection which account for approximately 10% of pregnancy-related mortality. Contamination of the wound is present to some extent in all incisions thus adding significant morbidity and mortality .

Most of (15 to 80%) of post cesarean section infections may actually occur after initial discharge from the hospital. As a result, it is stressful for women from low income settings who develop a surgical site infection. Because these women often have very little practical experience on wound management and have to cope on their own at home .

Recovery from cesarean section is more difficult for women who develop postoperative infection. These infections may affect the pelvic organs, the surgical Wound and the respiratory and urinary tracts. Patients with surgical site infections have a 2–11 times higher risk of death than those without surgical site infections and 77% of deaths associated with surgical site infections are directly related to the surgical site infection. Further it caused to increase stay of hospital and the cost of treatment . Post cesarean Wound Infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to cesarean delivery in developing countries .

Surgical site infection surveillance with feedback of surgical infection rates to surgeons is one of the successful strategies to help reduce surgical site infection. All hospitals with surgical services are recommended to undertake surveillance of surgical site infection . Surveillance is common in high-income countries for a wide-range of surgical procedures but in sub-Saharan Africa including Ethiopia very few studies have been done on surgical site infections surveillance systems. In Ethiopia, surgical site infection after cesarean section still constitutes a problem. This can be explained for many reasons as many lack of budget, poor hygiene and nutrition, untrained staff, poor hand washing practice.

Therefore, proper assessment of magnitude and risk factors that predispose to surgical site infection after cesarean section is essential for developing targeted interventions to reduce its occurrence and complications. And it also helps in reducing hospital costs and length of patient stay in the hospital.

Methods

Study settings

The study was conducted at Lemlem Karl hospital which is a general hospital in Maichew, Tigiray region from July1, 2016 to August 30, 2016. The hospital is located within the city of Maichew away from 665 km Addis Ababa. According to 2007 Ethiopian central stastical agency report, the total populations of Maichew were 23,419. Of this 11, 204 were males and 13,395 were females. In this hospital l9, 200 patients visited per year. It awarded from Ethiopian hospital quality assurance in good documentation, clean and green hospitals in 2016. There are one hospital and two health centers. The Gynecology and Obstetrics department had 3 l beds. There were 1819 deliveries per year and 24 average cesarean sections per month. There were 9 midwives (5 diploma and 4 B.Sc), one Obstetrician and one emergency surgery surgeon.

Study design

Hospital based cross sectional study design was conducted using retrospective chart review.

Source population

The source population was all charts of women who gave birth via cesarean section at Lemlem Karl hospital.

Study population

Study populations included in the study was selected charts of women who gave birth via cesarean section at Lemlem Karl hospital from July 1, 2013 to June 30, 2016.

Eligibility criteria

Inclusion criteria

  • All cards of women who underwent cesarean Delivery during the study period and having a diagnosis of SSI within 30 days of cesarean section at Lemlem Karl hospital.

Sample size determination

The sample size was determined by using a single population proportion formula. The following assumptions were applied: p, prevalence of 50%(since there is no local data), d is the expected margin of error (5%), Z, the standard score corresponding to a 95% confidence interval and α, the risk of rejecting the null hypothesis (0.05). Accordingly the required sample size became 384.

Sampling technique

Total of 847 women who have gave birth via cesarean section were recognized over three years at Lemlem Karl hospital from July 1, 2013 to June 30, 2016. From them using systematic sampling technique in every two interval 384 patient cards were identified and traced using registration number.

Data collection instrument/process

Data were collected by using pretested checklist from July1, 2016 to August 30, 2016. All the variables of interest were assessed accordingly and the checklist was prepared in English. Two data collectors, who have diploma in midwife, were participated in the data collection process. Orientation was given to the data collectors on how to conduct the data collection. Using card number of patients, data collectors traced and collected data from randomly identified charts of cesarean section cases using checklist.

Data analysis

The data were check for completeness, inconsistencies, and missing values and then coded, entered using EPI- info version 7.2. Then cleaned and analyzed using SPSS version 20. Descriptive statistics were computed to determine frequencies and summary statistics (mean, standard deviation, and percentage) to describe the study population in relation to socio-demographic and other relevant variables. Data were presented using tables, graphs and figures. Variables with P value <0.25 in bivariate analysis were transferred to multivariate analysis. Multiple logistic regressions were done to test the presence of association between predictors and dependent variables. P value ≤ 0.05, at 95% confidence interval was considered as cut point to declare the presence of statistically significant association.

Data quality control

Orientation and appropriate supervision were done to data collectors by supervision made by the principal investigators. And completeness and consistency were checked every day during data collection. Checked was done on 10% of the total sample size in the same hospital on previous records. Appropriate modifications were made after analyzing the pre-test result before the actual data collection.

Operational definitions

  • Post cesarean section Surgical Site Infection: An infection which is developed after cesarean delivery on the operational site which is diagnosed by clinician.

  • Prolonged hospital stay; defined as hospital stay lasting more than 7 days.

  • Prolonged operation time; defined as cesarean section lasting more than one hour from skin incision to last skin stitch.

Results

Socio demographic Characteristics of women underwent cesarean section at Lemlem Karl hospital 2013–2016

Among the total 384 mothers included for the study operated for delivery during the study period in Lemlem Karl hospital. The mean (±SD) of the mothers’ age was 27(±5) years. The minimum and maximum age in years were 16 and 43. Majority of mothers age ranged from 20–34(89.3%) and ≥35 (6.9%). 228(59.4%) were come from rural area, 347(90.4%) Tigiray, and 334 (87%) were orthodox.

Obstetrics, medical and operation characteristics of women underwent cesarean section in Lemlem Karl hospital 2013–2016

Majority of mothers (86.5%) were Para 1 up to 4 and 52 (13.5%) was Multipara. Almost all mothers (98.4%) had antenatal care follow-up, only two mothers had gestational diabetes mellitus. Fourteen (3.6%) mothers were developed pregnancy induced hypertension; there was one mother who had cardiac diseases. Seven (1.8%) case were HIV reactive and 6 of them on Antiretroviral therapy.

Most mothers operated at term pregnancy 303 (78%), 326(84.9%) were emergency cesarean section, 306(93.9%) operation were done with on labor. among mothers who was on labor before operation, 64(21.1%) were stayed more than 24 h. Meanwhile157 (51%) mothers were membrane ruptured prior to cesarean section. Most of mothers356 (92.7%) were operated thirty up to sixty minutes and mean operation was 56 min.

Of 384 studied participant, 33(8.6%) had history of cesarean section and 304(79.2%) were given spinal anesthesia. Most of cesarean section did by junior students191 (40.7%). Almost all (99%) mothers were taken antibiotics prophylaxis. On post operation hematocrit determination, 329(85.7%) were greater than thirty and 55(14.3%) were less than equal to thirty. The most common abdominal incision were Pfanestile281 (73.2%) .

Magnitude of surgical site infection following cesarean section in Lemlem Karl hospital 2013–2016

The Magnitude of surgical site infection following to cesarean section was 26(6.8%). For twenty cases of women the SSI were detected before discharged and six cases were after discharged. Fourteen (53.8%) case stayed at hospital more than seven days.

Factors associated with surgical site infection following cesarean section

There were five variables in binary logistic regression which had p value of ≤ 0.25; and became candidate for multiple logistic regression; duration of labor, rupture of membrane before cesarean section, types of anesthesia, post-operative hematocrit and types of abdominal incision.

In the multiple logistic analysis; duration of labor, rupture of membrane prior to cesarean section, and types of abdominal incision were significantly associated (p < 0.05). Mothers who were on labor for more than 24 h before cesarean section were 3.48 times more likely risk for surgical site infections than those less than 24 h AOR=3.48; 95%Cl (1.25, 9.68). The chance of developing surgical site infections that had rupture of membrane before cesarean section was 3.68 times more likely than intacted membrane (AOR=3.678; 95%Cl (1.13, 11.96). Mothers who had midline abdominal incision were 5.73 times more likely to develop surgical site infections as compare with pfannenstiel abdominal incision AOR=5.733; 95%Cl (2.05, 16.00)

Discussion

The prevalence of surgical site infection following cesarean section in this study was 6.8%. This finding was lower than that found in Jimma referral hospital 11.4%; however included all obstetrical procedures (cesarean sections, abdominal hysterectomies and Destructive Vaginal Deliveries), unlike this study was focus on cesarean sections . The finding was again lower than the value obtained from limbe, Cameroon which was 19.4%. The discrepancy in the results could be due to the fact that it was included both surgical and maternity wards .

This study approximately similar to others study done in three selected sub Saharan country (Democratic Republic of Congo, Burundi and Leone) which was 7.3% and Guwahati, Assam which was 6.03%.

This finding much lower than finding on Zimbabwe which was (29%). This difference might be it was cohort prospective study and was done in two big referral teaching hospitals in the countries where as this research was done general hospital. Overcrowding in the wards is a precursor of infection .

This study is also low compared to study done in Kenyatta hospital, Kenya which was 22%. This is probably due to the time of prophylaxis antibiotics were given before skin incision in our set up but in Kenyatta hospital 97.2% were given after operation. Giving prophylactic antibiotics before cesarean section has been a normal step for cesarean section surgeries as it obviously decreases morbidity rate of maternal infections after operation especially when compared to giving antimicrobials after umbilical cord clamping. Interestingly, giving prophylactic antibiotics before cesarean delivery has no major effects on mothers or newborn babies. Study in Kenya had post discharge surveillance method of monitoring SSI after hospital discharge .

On the other hand this prevalence is higher than research done in Guangdong, china (0.7%); Oman, Saudi Arabia (2.66%); the possible reason may be; be due in the study area(china)it was account for almost 70% of births in some urban areas but in this study majority were rural areas(low socioeconomic status) .

Prolonged labor was noted to be an independent risk factor for surgical site infection in this study. Women with labor duration greater than 24 h had 3.5 times more likely developing post cesarean wound infection (AOR=3.48; 95%Cl(1.25,9.68). It is further supported by other studies in Cambodia. This could be attributed to as duration of labor increases, the number of vaginal examinations also increase and repeated vaginal examinations increase the chance of iatrogenic contamination during examination .

This study also indicated that significant association was noted between rupture of membrane prior to cesarean section and surgical site infections. Mothers with ruptured membrane prior to cesarean section were 3.7 times to more likely to have surgical site infection those mothers had no rupture of membrane (AOR=3.69; 95%Cl(1.13,11.96). This is in line to study done Dhulikhel hospital Kathmandu University, Nepal. This might be; when the membranes rupture, the amniotic fluid is no longer sterile and this may act as a transport medium by which bacteria may come into contact with the uterine and skin incisions thereby leading to risk of developing surgical site infections .

The size of incision is matter for infection in this study also mothers who had midline abdominal incision 5.7 times more likely to develop surgical site infections as compare to pfannenstiel incision (AOR=5.733; 95%Cl(2.05,16.00).it is in line to finding in Nnewi, Nigeria .

Conclusions

The result obtained for the surgical site infection following cesarean section is lower than other previous studies from developing countries but it is higher than studies done in developed countries. Independent risk factors were identified for increased risk of surgical site infection on this study, Such as, prolonged labor, rupture of membrane before cesarean section and types of abdominal incision. Therefore to reduce surgical site infection the hospital infection control system as well as surgical site infection surveillance program has to be established. In addition, sterile environment and aseptic surgeries, use of WHO surgical safety checklist would appear to be a very important intervention to reduce surgical site infections.

Declarations

Acknowledgements

We would like to express our deepest heartfelt thanks to Mekelle University for allowing the conduct of this study. Our especial thanks go to Lemlem Karl hospital staffs for their support during the data collection process.

Funding

Mekelle University.

Availability of data and materials

The data that support the findings of this study are available but some restrictions may apply to the availability of these data as there are some sensitive issues. However, data are available from the corresponding authors upon reasonable request.

Authors’ contributions

KA was involved in the conception, design, analysis, interpretation, report and manuscript writing. AM and FH were involved in the design, analysis, interpretation and report writing. BW and LB were involved design, analysis and interpretation of the data. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical clearance was obtained from Mekelle University, College of Health Science Institutional Ethical Review Board (ref. no: ERC 0779/2016). Support letter was obtained from department of midwifery to Lemlem Karl hospital. Purposes of the study were explained to the hospital medical director. Personal patient information was not recorded, after finishing the data collection the patients’ document return to card room, the information used for study purpose only.

References

  1. Research, D.o.R.H.a. and W.H. Organization. WHO Statement on cesarean section Rates. 2015 http://www.who.int/mediacentre/news/releases/2015/cesarean-sections/en/.
  2. Watts DH, Krohn MA, Hillier SL, Eschenbach DA. The association of occult amniotic fluid infection with gestational age and neonatal outcome among women in preterm labor. Obstet Gynecol. 1992;79(3):351–7.View ArticlePubMedGoogle Scholar
  3. ACOG. Antimicrobial prophylaxis for cesarean delivery: Timing of administration. Committee Opinion. Obstet Gynecol. 2010;465:791–2.Google Scholar
  4. SSA. Adherence to Surgical Care Improvement Project Measures and post-operative surgical site infection. Surg Infect. 2012;13(4):234–7.View ArticleGoogle Scholar
  5. John J. Post-operative morbidity following cesarean delivery. J Hospital Infect. 1995;22:1035–42.Google Scholar
  6. Flangan M. Pregnancy-related mortality in the United States, 1991–1997. Obstet Gynecol. 2003;101(2):289–96.Google Scholar
  7. Conroy K. Infection morbidity after cesarean delivery:10 strategies to reduce risk. Obstet Gyneacol. 2012;5(2):69–77.Google Scholar
  8. Goutrrup F, Hollander. An Overview of Surgical Site Infections: Etiology, Incidence and Risk Factors. EWMA Journal. 2005; 5(2): 11–15Google Scholar
  9. Aloive B. Wound infection after cesarean section. Wound Infection after cesarean section. 1984;5:359–70.Google Scholar
  10. Larsen JW. Guidelines for the diagnosis, treatment and prevention of postoperative infections. Infect Dis Obstet Gynecol. 2003;11(1):65–70.View ArticlePubMedPubMed CentralGoogle Scholar
  11. Gido T. Surgical site infection following cesarean section in Kano, Nigeri. Ann Med Health Sci Res. 2012;2(1):33–6.View ArticleGoogle Scholar
  12. AM. SEaE. Surgical site infection surveillance. J Hosp Infect. 2000;45:173–84.View ArticleGoogle Scholar
  13. Demisew Amenu TB, Fitsum Araya. Surgical site infection rate and risk factors among obstetric cases of Jimma university specialized hospital, Southwest Ethiopia. Ethiop J Health Sci. 2011;21(2):91–100.Google Scholar
  14. Ngowe Ngowe M, Toure A, Mouafo Tambo F. Prevalence and Risk Factors Associated with Post Operative Infections in the Limbe Regional Hospital of Cameroon. Open Surg J. 2014;8:1–8.View ArticleGoogle Scholar
  15. Chu K, Maine R, Trelles M. cesarean section Surgical Site Infections in Sub-Saharan Africa: A Multi-Country Study from Medecins Sans Frontieres. World J Surg. 2015;39:350–5.View ArticlePubMedGoogle Scholar
  16. Talukdar DRK. Surgical Site Infection Following Emergency LSCS – to Find out the Incidence, Risk Factors and Commonly Associated Bacteria. Scholars J Appl Med Sci. 2015;3(8A):2794–801.Google Scholar
  17. Maruta A. Surveillance of Surgical Site Infections following cesarean section at Two Central Hospitals in Harare. Zimbabwe: Master Thesis; 2015.Google Scholar
  18. Kabau Ddm. Incidence and determinants of surgical site infection after cesarean delivery at Kenyatta national hospital. [thesis]. In press 2014.Google Scholar
  19. Dhar H, Al-Busaidi I, Rathi B, A E. A Study of Post-cesarean section Wound Infections in a Regional Referral Hospital. Clin Basic Res. 2014;14(2):211–7.Google Scholar
  20. Shrestha S, Dongol A. Incidence and risk factors of surgical site infection following cesarean section at Dhulikhel Hospital. Kathmandu University Med J. 2014;12:2.Google Scholar
  21. Olowe OA, Titilolu FT, Bisi-Johnson MA, Mosanya JT. Antibiogram of Surgical site infection in a Tertiary Health Care Facility in Osogbo, South Western Nigeria. Current Trends in Technology and Science. 2014;3(2):93–7.Google Scholar
  22. Featured Image: memphissurgery.com

 

101 Things You Wish You Knew Before Starting Medical School

Simple enough, here are 101 things you wish you knew before starting medical school.

  1. If I had known what was going to be like , i would never have done it.
  2. You’ll study more than you ever have in your life.
  3. Only half of your class will be in the top 50%. You have a 50% chance of being in the top half of your class. Get used to it now.
  4. You don’t need to know anatomy before school starts. Or pathology. Or physiology.
  5. Third year rotations will suck the life out you.
  6. Several people from your class will have sex with each other. You might be one of the lucky participants.
  7. You may discover early on that medicine isn’t for you.
  8. You don’t have to be AOA or have impeccable board scores to match somewhere ”“ only if you’re matching into radiology.
  9. Your social life may suffer some.
  10. Pelvic exams are teh suck.
  11. You won’t be a medical student on the surgery service. You’ll be the retractor bitch.
  12. Residents will probably ask you to retrieve some type of nourishment for them.
  13. Most of your time on rotations will be wasted. Thrown away. Down the drain.
  14. You’ll work with at least one attending physician who you’ll want to beat the shit out of.
  15. You’ll work with at least three residents who you’ll want to beat the shit out of.
  16. You’ll ask a stranger about the quality of their stools.
  17. You’ll ask post-op patients if they’ve farted within the last 24 hours.
  18. At some point during your stay, a stranger’s bodily fluids will most likely come into contact with your exposed skin.
  19. Somebody in your class will flunk out of medical school.
  20. You’ll work 14 days straight without a single day off. Probably multiple times.
  21. A student in your class will have sex with an attending or resident.
  22. After the first two years are over, your summer breaks will no longer exist. Enjoy them as much as you can.
  23. You’ll be sleep deprived.
  24. There will be times on certain rotations where you won’t be allowed to eat.
  25. You will be pimped.
  26. You’ll wake up one day and ask yourself is this really what you want out of life.
  27. You’ll party a lot during the first two years, but then that pretty much ends at the beginning of your junior year.
  28. You’ll probably change your specialty of choice at least 4 times.
  29. You’ll spend a good deal of your time playing social worker.
  30. You’ll learn that medical insurance reimbursement is a huge problem, particularly for primary care physicians.
  31. Nurses will treat you badly, simply because you are a medical student.
  32. There will be times when you’ll be ignored by your attending or resident.
  33. You will develop a thick skin. If you fail to do this, you’ll cry often.
  34. Public humiliation is very commonplace in medical training.
  35. Surgeons are assholes. Take my word for it now.
  36. OB/GYN residents are treated like shit, and that shit runs downhill. Be ready to pick it up and sleep with it.
  37. It’s always the medical student’s fault.
  38. Gunner is a derogatory word. It’s almost as bad as racial slurs.
  39. You’ll look forward to the weekend, not so you can relax and have a good time but so you can catch up on studying for the week.
  40. Your house might go uncleaned for two weeks during an intensive exam block.
  41. As a medical student on rotations, you don’t matter. In fact, you get in the way and impede productivity.
  42. There’s a fair chance that you will be physically struck by a nurse, resident, or attending physician. This may include slapped on the hand or kicked on the shin in order to instruct you to “move” or “get out of the way.”
  43. Any really bad procedures will be done by you. The residents don’t want to do them, and you’re the low man on the totem pole. This includes rectal examinations and digital disimpactions.
  44. You’ll be competing against the best of the best, the cream of the crop. This isn’t college where half of your classmates are idiots. Everybody in medical school is smart.
  45. Don’t think that you own the world because you just got accepted into medical school. That kind of attitude will humble you faster than anything else.
  46. If you’re in it for the money, there are much better, more efficient ways to make a living. Medicine is not one of them.
  47. Anatomy sucks. All of the bone names sound the same.
  48. If there is anything at all that you would rather do in life , don’t go into medicine.
  49. The competition doesn’t end after getting accepted to medical school. You’ll have to compete for class rank, awards, and residency. If you want to do a fellowship, you’ll have to compete for that too.
  50. You’ll never look at weekends the same again.
  51. VA hospitals suck. Most of them are old, but the medical records system is good.
  52. Your fourth year in medical school will be like a vacation compared to the first three years. It’s a good thing too, because you’ll need one.
  53. Somebody in your class will be known as the “highlighter whore.” Most often a female, she’ll carry around a backpack full of every highlighter color known to man. She’ll actually use them, too.
  54. Rumors surrounding members of your class will spread faster than they did in high school.
  55. You’ll meet a lot of cool people, many new friends, and maybe your husband or wife.
  56. No matter how bad your medical school experience was at times, you’ll still be able to think about the good times. Kind of like how I am doing right now.
  57. Your first class get-together will be the most memorable. Cherish those times.
  58. Long after medical school is over, you’ll still keep in contact with the friends you made. I do nearly every day.
  59. Gunners always sit in the front row. This rule never fails. However, not everyone who sits in the front row is a gunner.
  60. There will be one person in your class who’s the coolest, most laid back person you’ve ever met. This guy will sit in the back row and throw paper airplanes during class, and then blow up with 260+ Step I’s after second year. True story.
  61. At the beginning of first year, everyone will talk about how cool it’s going to be to help patients. At the end of third year, everybody will talk about how cool it’s going to be to make a lot of money.
  62. Students who start medical school wanting to do primary care end up in dermatology. Those students who start medical school wanting to do dermatology end up in family medicine.
  63. Telling local girls at the bar that you’re a medical student doesn’t mean shit. They’ve been hearing that for years. Be more unique.
  64. The money isn’t really that good in medicine. Not if you look at it in terms of hours worked.
  65. Don’t wear your white coat into the gas station, or any other business that has nothing to do with you wearing a white coat. You look like an ass, and people do make fun of you.
  66. Don’t round on patients that aren’t yours. If you round on another student’s patients, that will spread around your class like fire after a 10 year drought. Your team will think you’re an idiot too.
  67. If you are on a rotation with other students, don’t bring in journal articles to share with the team “on the fly” without letting the other students know. This makes you look like a gunner, and nobody likes a gunner. Do it once, and you might as well bring in a new topic daily. Rest assured that your fellow students will just to show you up.
  68. If you piss off your intern, he or she can make your life hell.
  69. If your intern pisses you off, you can make his or her life hell.
  70. Don’t try to work during medical school. Live life and enjoy the first two years.
  71. Not participating in tons of ECs doesn’t hurt your chances for residency. Forget the weekend free clinic and play some Frisbee golf instead.
  72. Don’t rent an apartment. If you can afford to, buy a small home instead. I saved $200 per month and had roughly $30,000 in equity by choosing to buy versus rent.
  73. Your family members will ask you for medical advice, even after your first week of first year.
  74. Many of your friends will go onto great jobs and fantastic lifestyles. You’ll be faced with 4 more years of debt and then at least 3 years of residency before you’ll see any real earning potential.
  75. Pick a specialty based around what you like to do.
  76. At least once during your 4 year stay, you’ll wonder if you should quit.
  77. It’s amazing how fast time flies on your days off. It’s equally amazing at how slow the days are on a rotation you hate.
  78. You’ll learn to be scared of asking for time off.
  79. No matter what specialty you want to do, somebody on an unrelated rotation will hold it against you.
  80. A great way to piss of attendings and residents are to tell them that you don’t plan to complete a residency.
  81. Many of your rotations will require you to be the “vitals bitch.” On surgery, you’ll be the “retractor bitch.”
  82. Sitting around in a group and talking about ethical issues involving patients is not fun.
  83. If an attending or resident treats you badly, call them out on it. You can get away with far more than you think.
  84. Going to class is generally a waste of time. Make your own schedule and enjoy the added free time.
  85. Find new ways to study. The methods you used in college may or may not work. If something doesn’t work, adapt.
  86. Hospitals smell bad.
  87. Subjective evaluations are just that ”“ subjective. They aren’t your end all, be all so don’t dwell on a poor evaluation. The person giving it was probably an asshole, anyway.
  88. Some physicians will tell you it’s better than it really is. Take what you hear (both positive and negative) with a grain of salt.
  89. 90% of surgeons are assholes, and 63% of statistics are made up. The former falls in the lucky 37%.
  90. The best time of your entire medical school career is between the times when you first get your acceptance letter and when you start school.
  91. During the summer before medical school starts, do not attempt to study or read anything remotely related to medicine. Take this time to travel and do things for you.
  92. The residents and faculty in OB/GYN will be some of the most malignant personalities you’ve ever come into contact with.
  93. Vaginal deliveries are messy. So are c-sections. It’s just an all-around blood fest if you like that sort of thing.
  94. Despite what the faculty tell you, you don’t need all of the fancy equipment that they suggest for you to buy. All you need is a stethoscope. The other equipment they say you “need” is standard in all clinic and hospital exam rooms. If it’s not standard, your training hospital and clinics suck.
  95. If your school has a note taking service, it’s a good idea to pony up the cash for it. It saves time and gives you the option of not attending lecture.
  96. Medicine is better than being a janitor, but there were times when I envied the people cleaning the hospital trash cans.
  97. Avoid surgery like the plague.
  98. See above and then apply it to OB/GYN as well.
  99. The money is good in medicine, but it’s not all that great especially cnsidering the amount of time that you’ll have to work.

100. One time an HIV+ patient ripped out his IV and then “slung” his blood at the staff in the room. Go, go infectious disease.
101. Read Med School Hell now, throughout medical school, and then after you’re done. Then come back and tell me how right I am.

Photo Credit: Background vector created by Macrovector – Freepik.com

The Best Movies For Doctors And Medical Students

The list contains more than 100 films , each medical student and doctor should see

Enjoy !

1- Patch Adams

2- Wit

3- Philadelphia

4- Terms of Endearment

5- Leaving Las Vegas

6- The Doctor

7- Awakenings

8- The Fisher King

9- Something the Lord Made

10- And the Band Played On

11- One Flew Over the Cuckoo’s Nest

12- The Painted Veil

13- The Race for the Double Helix

14- Article 99

15- People Will Talk

16- Malice

17- Sicko

18- John Q

19- The Men

20- My Left Foot: The Story of Christy Brown

21- Red Beard

22- My Own Country

23- The Hospital

24- Britannia Hospital

25- Bringing Out the Dead

26- The gifted hands of Ben Carson

27- Pathology

28- Syndromes and a Century

29- Doctor Dolittle

30- Doctor Zhivago

31- Dr. No

32- Persona

33- House Calls

34- The Barbarian Invasions

35- The Death of Mr. Lazarescu

36- High Anxiety

37- No Way Out

38- Whirlpool

39- Spellbound

40- The Abominable Dr. Phibes

41- Dr. Phibes Rises Again

42- Doctor Detroit

43- Red Angel

44- Tales from the Gimli Hospital

45- Nurse Betty

46- Night Nurse

47- Doctor in the House

48- Doctor at Sea

49- Doctor at Large

50 – Carry On Nurse

51- The Kingdom

52- Stitches

53- Medicine Man

54- The Great Moment

55- Oh Doctor

56- The Island of Dr. Moreau

57- Tombstone

58- Dead Ringers

59- MASH

60- Extraordinary Measures

61- Obsessed

62- dragonfly

63- City Of Angels

64- Dr. Jekyll and Mr. Hyde

65- Malice

66- Alien

67- The Last King of Scotland

68- The Andromeda Strain

69- Coma

70- Anatomy

71- Anatomy 2

72- Flatliners

73- Dr. Giggles

74- The Dentist

75- Cold Prey 2

76- Sick Nurses

77- Dark Floor

78- Visiting Hours

79- Rabid

80- Infection

81- Blessed

82- Death Knows Your Name

83- Body Parts

84- Re-Animator

85- Extreme Measures

86- Dead Ringers

87- The Clinic

88- Return of the Living Dead: Rave to the Grave

89- Shutter Island

90- Jacob’s Ladder

91- Outbreak

92- Repo! The Genetic Opera

93- Frankenstein

94- The Grudge

95- Boo

96- John Q

97- No Strings Attached

98- Bad Medicine

99- Doc Hollywood

100- Hysteria

101- Lorenzo’ s oil

102- My sister’s keeper

103- The Lake House

104- Living proof

105- The Impossible

106- The Elephant Man

107- The English Patient

108- Just Like Heaven

109- Django Unchained

110- Errors of the Human Body

111- The World War Z

112- Las Confesiones Del Doctor Sachs

113- American Mary

114- Side Effects

115- The Diving Bell and the Butterfly

116- Restoration

117- Gabrielle

118- The Good Doctor

119- Contagion

120 – The Physician

121 – St. Giuseppe Moscati: Doctor to the Poor

122- Elysium

123- Gattaca

124- Blade Runner

125- Brazil

126- Cloud Atlas

127- A.I. Artificial Intelligence

128- Eternal Sunshine of the Spotless Mind

129- Beautiful Mind

130- Forbidden Planet

131- Inception

132- Prometheus

133- Robot & Frank

134- The Fifth Element

135- City Of Joy

136- Blindness

137- The Sixth Sense

138- Master & Commander (Paul Bettany amputation scene!)

139- Nine Months

140- Arachnophobia

141- Outbreak

142- Molly (a personal fave)

143- Nell

144- Cider House Rules

145- The Fugitive

146- Young Frankenstein.

Did i miss some?

10 Tips To Be A Successful Doctor

New Law Allows Med School Grads to Work as 'Assistant Physicians'

1- Read more : Every day there are new medical studies , new diseases , new drugs … etc , if you want to be a successful doctor you should read more everyday.

2- Details : Pay attention to details , you may diagnose a case with only one hidden word or sign.

3- Money is not everything : You are a physician , It is not an ordinary job you are treating with humans.

4- Ambitious : Ambition has no limit and you should renew your ambition to renew your success.

5- Humility : Respect others , even if you are excellent people hate conceited physicians , also even if you are excellent young doctors may know what you dont know.

6- Responsibility : Be responsible in every action you make as we said before it is not an ordinary job.

7- Communication skills : If you have time you can take a communication skills course , you should deliver good and bad news or advises for patients in a right manner.

8- Time management : You should manage your time between your work and your family and yourself , you are not a machine , Enjoy your life.

9- Be Patient : Dont hurry up , If you are good doctor you will be famous and you will be successful.

10- Marketing : You should search about new ways of medical marketing so people can find you.

Ten Ways To Be A Good Medical Student

1. Be An Excellent Manager of Your Own Time
Medical school will overwhelm you. In the four years it will take you to get your MD, you will be presented with more information that you must master than you might have thought possible, even if you did attend a rigorous pre-med program. Accordingly, the first tip to being a good medical student is to develop time-management skills.

2. Be Friends With More Experienced Medical Students
Making connections early in your med school career with students who have been around longer than you can be invaluable. You can learn from their mistakes instead of making them on your own.

3. Be Respectful of Your Own Health
During this overwhelming time, you will be taxing your physical and mental resources to stay on top of your studies. While it’s important that you do well, of course, you must balance your quest for excellence with a commitment to maintaining your health.

4. Be Respectful of The Undertaking
Becoming a doctor is one of the most important things a person can do. Respect this undertaking, and understand that the other aspects of your life (anything non-med-school related) are going to have to take a back seat for a while. A long while.

5. Hit The Books Hard and Often
Get to love studying if you don’t already. There’s only one way to master the amount of information you need to when people’s lives are in your hands, and that’s to immerse yourself in it.

6.Play To Your Strengths, But Don’t Be Limited To Them
Medical school is like any other kind of school in some ways — it’s a learning experience. Do engage in learning opportunities that will showcase your strengths, but also look for ways to grow, to build on areas where you might not be as strong.

7. Choose Your Specialization ASAP
The earlier you can decide about which area of medicine you’d like to practice, the earlier you can become an expert in this area.
8. Find Mentors In Your Field Of Choice
Before you decide on a specialization, talk to the experienced students you know about what they think. Talk to doctors currently practicing in the field that appeals to you. Talk to your instructors. Make professional connections with people who are already doing the kinds of things you want to be doing after you’re out of school.

9. Write As Much As You Can
Med school may be too early to think about publishing your work, but if you are looking for prestige in your field, plan on publishing in the future. The best way to get publication worthy is to write what you can, perhaps by helping already publishing doctors prepare articles.

10. Take The Occasional Break
Good luck with this one!

Ten Ways To Be A Good Medical Student

1. Be An Excellent Manager of Your Own Time
Medical school will overwhelm you. In the four years it will take you to get your MD, you will be presented with more information that you must master than you might have thought possible, even if you did attend a rigorous pre-med program. Accordingly, the first tip to being a good medical student is to develop time-management skills.

2. Be Friends With More Experienced Medical Students
Making connections early in your med school career with students who have been around longer than you can be invaluable. You can learn from their mistakes instead of making them on your own.

3. Be Respectful of Your Own Health
During this overwhelming time, you will be taxing your physical and mental resources to stay on top of your studies. While it’s important that you do well, of course, you must balance your quest for excellence with a commitment to maintaining your health.

4. Be Respectful of The Undertaking
Becoming a doctor is one of the most important things a person can do. Respect this undertaking, and understand that the other aspects of your life (anything non-med-school related) are going to have to take a back seat for a while. A long while.

5. Hit The Books Hard and Often
Get to love studying if you don’t already. There’s only one way to master the amount of information you need to when people’s lives are in your hands, and that’s to immerse yourself in it.

6.Play To Your Strengths, But Don’t Be Limited To Them
Medical school is like any other kind of school in some ways — it’s a learning experience. Do engage in learning opportunities that will showcase your strengths, but also look for ways to grow, to build on areas where you might not be as strong.

7. Choose Your Specialization ASAP
The earlier you can decide about which area of medicine you’d like to practice, the earlier you can become an expert in this area.

8. Find Mentors In Your Field Of Choice
Before you decide on a specialization, talk to the experienced students you know about what they think. Talk to doctors currently practicing in the field that appeals to you. Talk to your instructors. Make professional connections with people who are already doing the kinds of things you want to be doing after you’re out of school.

9. Write As Much As You Can
Med school may be too early to think about publishing your work, but if you are looking for prestige in your field, plan on publishing in the future. The best way to get publication worthy is to write what you can, perhaps by helping already publishing doctors prepare articles.

10. Take The Occasional Break
Good luck with this one!

Love Syndrome

Aetiology : Unkown

Age of Onset : Teenage. Recent studies
have shown that it may affect people upto 25 years of age.

Risk Factors : The age itself is the major risk factor. Others include
(a) Co-education
(b) Cell Phones
(c) Movies
(d) Internet Of these the part played by the cell phones is note worthy.

Pathology
Multi Organ System Failure

Clinical Features

Symptoms
A) The most common presenting feature is
throbbing pain in the heart often described by the patient as sweet pain.
B) Loss of appetite.
C) Sleeplessness.
D) Day dreaming
E) Disinterest in any type of work. There is a danger of patient being transformed into a
poet.

Signs
A) Very much dilated pupil (In search of his sweet
heart).
B) Blushing of cheeks (mainly seen in girls).
C) On Auscultation:
The First Heart Sound is heard as LOVE instead of LUB.
D) Smiling to self.

Pathogenesis and Clinical Course
The Disease is Gradual in onset. The patient presents with vague symptoms like loss of appetite,
sleeplessness, etc., As time progress mutli organ system involvement occurs with
varied symptoms. The symptoms are aggravated at the sight of patients sweet
heart. The sight of patients love causes the contraction of the radial fibres of
the iris muscle leading to the dilation of the pupil. The eyes remain wide open
and cease to blink. The Zygomaticus major muscle automatically contarcts and the
patient smiles (Smile at Sight Phenomenon). As the patient approaches his sweet
heart, action potentials are generated at an irregular rate in the heart and the
normal rhythm of the heart is lost. Microscopic examination of the cardiac
muscle reveals the presence of abnormal pacemaker tissue at certain areas called
the ROMANTIC SPOTS that are responsible for the lost rhythm of the Heart. The
patient feels agitated, and a throbbing pain develops in the heart. The
characteristc feature of the pain that patient wants to feel it more and more.
In advanced stages, the brain is affected. If not treated properly, the patient
may go bad.

Treatment
Marriage Therapy holds promise of 100% cure rates. If is effective only after 22 years of age. If performed early,
it may lead to adverse reactions.

Preventive Measures
Several attempts have been made to prevent the disease. The WLO (World Love
Organization) expert committee has finally declared that the disease is
inevitable during the age group and its prevention is literally impossible. Any
attempts to interrupt the normal course of the disease may lead to more severe
from of disease. So interventional measures are highly contraindicated for this
disease.

How Much Do Doctors Really Make?

Taking into consideration the explosive growth of human population globally, having reached a staggering 7.5 billion last year, one profession we can’t ever get enough of are medical doctors. With third world countries contributing to a major chunk of the populations, doctors are needed more than ever to counter and eradicate prevalent diseases that underdeveloped or even well developed countries find themselves up against. Did you know that doctors are among the highest paid professionals in the United States of America? Software engineers, lawyers along with other professions considered prestigious have a pay scale below that of medical doctors.
Ailments and illnesses are and have always been a part of the human condition which is why doctors can never run out of job openings. This high demand is represented by the sky high salaries that doctors receive. Doctor’s salaries vary drastically according to their specialization and area of practice. A doctor can earn about $156,000 a year as a pediatrician to about $315,000 as a radiologist or orthopedic surgeon. Interestingly so, despite these numbers, only about 11% of doctors consider themselves rich. Surveys have revealed that about 51% of all physicians and 46% of primary care physicians think that they were compensated fairly.

The “Doctors are overpaid” argument
Many would argue that doctors are overpaid. This claim is widely contested. In England, the basic salary for a newly qualified doctor is £20,295. Additional pay over this is accounted for the overtime hours. The average nurse works for 37.5 hours per week and junior doctors work around 56 hours per week but this number can increase depending on the patient influx and overtime hours. If a nurse chooses to put in extra hours, they are rewarded accordingly. It’s also important not to forget the responsibility a doctor carries with him. When things go well, the healthcare team including staff and nurses are appreciated, but when things go wrong, doctors are to be blamed. Additionally, being a doctor isn’t all about attending to patients and working long hours. It means continual studying, research and staying updated on medical advances happening internationally.

Let’s take a look at the highest paid salaries amongst doctors
Orthopedics seems to be the most financially rewarding specialization with an average salary of $421,000 for patient care in 2014. Orthopedists seem to earn a lot more than other physicians when it comes to non-patient care activities too. These may include product sales and speaking engagements which can add another $29,000 a year. Cardiologists are the runner-ups with an average compensation of $376,000 for patient care only. Whereas, non patient care activities can earn them another $19,000 on average. Developed countries have a high incidence of cardiovascular diseases and obesity is another associated culprit responsible for the rising mortality rate of developed nations. The first world lifestyle of fast food coupled with a sedentary way of life seems to keep cardiology amongst the most needed heath care. Moreover, gastroenterologists are third on the list with an average compensation of $370,000 for patient care and another $14,000 in non-healthcare activities.

Cover picture by iofotoyayimages.com

The amazing anatomy of Dental Plexus

As you probably are already aware of, the trigeminal nerve is quite a vast one. It itself has three major branches which innervate a vast region of the head, including such internal parts as the sinuses and dura mater, and, of course, big part of the upper digestion earns credit to the trigeminal nerve – including the muscles involved in chewing and swallowing as well as the sense of your gums and teeth.

All of this is done via smaller branches which furthermore innervate their target structures. The dental plexus is one of those branches, which actually consist of two quite different parts (see the image below, precisely demonstrated by Anatomy Next).

Although they do innervate teeth, the superior branch comes from the maxillary nerve and the inferior branch originates from the mandibular nerve. The superior dental plexus arises from the infraorbital nerve in the infraorbital canal. This branch of nerves furthermore innervates superior molar, premolar, canine and incisor teeth together with gingiva surrounding them before the infraorbital nerve exits the canal via the infraorbital foramen and innervates the skin of the upper lip, cheek, nasal ala, lower eyelid and conjunctiva.

It is always worth remembering the close location of the maxillary sinus. Not only the nerves can be a common thing between the teeth and the maxillary sinus, but part of the dental infections can spread in the sinus as well.

The inferior dental plexus, however, arises from the mandibular branch of the trigeminal nerve as it travels through the mandibular canal on its way to become the mental nerve before giving a branch to the incisive teeth. It is worth noting though, that the gingiva is innerved via the inferior dental plexus just as it is with the upper dental plexus. The incisive branch, as the name suggests, innervates the incisors, and the inferior dental branches innervate the premolars and molars together with the canines.

Although the anatomy of teeth innervation might seem challenging to learn and remember, for me it is a piece of art. Such complex structures are amazing to explore and we really do hope that the illustrations and renders will make it easier for students out there as well. If you want to see the nerve in greater 3D detail, visit anatomynext.com!

 

Interesting facts about trigeminal nerve

Did you just feel that last warm gasp of summer air touch your face? Fair enough, whilst writing this it is still summer, but there is more to it than just motion of the air in the atmosphere. And this is where the fifth cranial nerve, or trigeminal nerve, comes in. It is a nerve responsible for such motor functions as chewing and biting and – you guessed it – the sensation in the face.

When talking about the trigeminal nerve, it is most important to remember both functional classification and anatomical division. For the sake of simplicity let’s start with the anatomy part. As the name “trigeminus” already suggests, the nerve itself is divided into three great branches – ophthalmic (or V1), maxillary (V2) and mandibular (V3), which leave the skull via different foramina – the superior orbital fissure, foramen rotundum and foramen ovale, respectively. Those branches converge on the trigeminal ganglion, from which a large sensory root and a smaller motor root travels to the brainstem, which it enters at the level of pons. This also quite precisely describes the proportion of function in the nerve, of which the most part is sensory that involves all three branches. When talking about interesting and unique things about the nerve, then the borders of the dermatomes of the branches are relatively sharp and have almost no overlap, comparing to other dermatomes of the body. This means that, when under local anesthesia or if a branch is infected, a very well-defined area will be affected. To explore the nerve in greater detail, we truly recommend you to visit anatomynext.com. The amazing detail really makes it stand out in the field and make anatomy learning and teaching a different experience.

When talking about the function, it is usually easier to learn the nerve step-by-step, starting from the very uppermost branch – the ophthalmic or V1. This branch transmits sensory information from the forehead, scalp, upper eyelids, parts of the eye such as conjunctiva and cornea, most of the nose (the exception are the nose wings, which are innerved by the maxillary branch), nose mucosa with the help of the maxillary branch and the frontal sinuses. Interestingly enough, the nerve innervates dura mater and meningeal vessels as well, although this is done in a teamwork of all three branches.

The maxillary nerve furthermore covers lower eyelids, nares and the upper lip, the cheek, upper teeth and gums, roof of the pharynx along with the palate and the sinuses that the ophthalmic branch did not cover – the maxillary, ethmoid and sphenoid ones.

The third branch, or the mandibular nerve transmits senses from the lower lip along with lower teeth and gums, the chin and the jaw and parts of the external ear. It is worth noting though that the angle of the jaw is not innerved by this branch, but by the C2-C3.

When summarizing the sensory part of trigeminal nerve, it is very useful to use sensory diagrams, which you can check out when learning anatomy with the help of Anatomy Next as well. As I already mentioned earlier, the borders are quite sharp and specific for each branch and this helps those of us who have a good visual memory, and all of the branches take part in meningeal innervation and divide the job of innervation of the sinuses between the ophthalmic nerve (for the frontal sinus) and the maxillary nerve (the ethmoid, maxillary and sphenoid).

The smaller, but not lesser part of the nerve has a motor function which involves four muscles of mastication (masseter, temporal and lateral and medial pterygoids) as well as four other muscles – tensor veli palatini, tensor timpani, mylohyoid and the anterior belly of the digastric. They are all controlled by the motor part of the mandibular branch and involved into the process of eating – biting, chewing and swallowing. The exception is the tensor tympani, which has a sound dampening function, including the sound of chewing.

As always, your feedback is welcome. What are your thoughts? Please share a comment below or contact us via email!