Autoimmunity Seminar, PBL, and Subacute Session

Today was another crazy day. Next year we will be having two clinical days every week instead of just one. I had been thinking that I would like to do my two clinical days back-to-back on Tuesdays and Wednesdays, but now I'm not so sure. I am pretty exhausted from two straight days of clinic. Most of the upperclassmen either scheduled their clinical days on Monday-Wednesday or Tuesday-Thursday. I don't really want to have anything that I have to do on Thursday if I can help it, and I'd rather not start out the week on Monday with a crazy day either. Besides, my clinic day this year was Tuesday, and I don't know how my clinic preceptor would feel about changing it to Monday. I could ask, but it may not even be an option. Probably as long as I have my Thursdays off, Tuesday-Wednesday would be doable. The problem is that I don't know which day my next MS class is going to be scheduled for in the fall yet.

Our seminar this morning was on autoimmunity and tolerance, which is an interesting topic. There is a type of immune cell called a T cell that attacks foreign cells, as I've already explained previously. These T cells have to be "taught" not to attack your own cells though, and how this is done is a pretty hot area of research in immunology. If this doesn't happen, or if there is some kind of accidental recognition of self-tissues as being foreign, then an autoimmune disease like type I diabetes or rheumatoid arthritis can result. One of the most interesting things we learned is that there is some evidence that pieces of certain viral proteins called peptides can mimic self peptides. The T cells then get "confused" and attack body cells that express those peptides as well as cells that are infected with the virus. I read a paper about this that was linking viral peptides with type I diabetes. I don't think that this will ultimately be the cause of all or even most autoimmunity, but it's a really interesting phenomenon anyway because of how it affects our understanding of immune system regulation.

My learning objective for this week's PBL case is on the complement system and how it's related to autoimmune diseases like lupus. We went over the complement system a few weeks ago when we were studying the nonspecific immune response, but all of these concepts are still very important for the adaptive immune response because the adaptive immune response makes use of the components of the nonspecific immune system.

I had lunch with a friend and then I had to go to the subacute facility for another observed history and physical (H & P). We were supposed to conduct a full exam on a patient who was not ambulatory, again while being observed and evaluated. I had a patient whose surgical wound had become infected. He was a very pleasant guy and fun to talk with, but it wasn't very easy to keep the interview on track because he was wanting to tell me stories about things he had done when he was younger. It was hard to stop him not only because I didn't want to be rude, but also because his stories were actually really interesting. So I kept trying to steer him back toward health stories: his own health, his parents' health, and so on. I didn't even come close to finishing the entire H & P, but my observer passed me anyway based on what I had done and invited me to come shadow him. I am going to take him up on that this summer.