You Know Finals Are Near When...

1. You sleep through your alarm and in your haste to get out the door on time, you put your shirt on backwards and don't realize it until after lunch. (That was last Friday).
2. You sleep through your alarm again on Monday, even after sleeping in all weekend (perhaps because you are so used to getting up at 6 am that you don't ever sleep past 8 am even on weekends).
3. You have no milk so you have your granola cereal with water (Monday and Tuesday).
4. You eat all the buffalo stew you made and start in on the frozen dinners (Wednesday).
5. You forget/mis-remember a good friend's birthday (sorry!)
6. You don't understand your own cryptic notes. I looked at something I had scribbled in the margins during a case presentation-- LR6SO4-- and could not figure out what it referred to. It had once made perfect sense to me, so much so that I wondered why our ophthalmology professor had said it was the last thing her resident said to her before walking out the door to take his boards. I remember thinking it was so obvious that no one would ever need a mnemonic to remember it. After much searching, it stands for the extraocular muscle innervation. Cranial nerve VI (abducens nerve) innervates the lateral rectus and retractor bulbi. Cranial nerve IV (trochlear nerve) innervates the dorsal oblique (superior oblique). Cranial nerve III (oculomotor nerve) does everything else. And so LR6 stands for lateral rectus muscle cranial nerve VI, SO4 for superior (dorsal) oblique muscle cranial nerve IV. All this to help me try to remember on tomorrow's test that abnormal deviation in the position of the globe of the eye can look like ventrolateral strabismus (lesion involving oculomotor CN III), medial strabismus (lesion involving abducens CN VI) or rotation of the globe (trochlear CN IV), which can be difficult to see if the pupil is round because the deviation in the position of an elongated, ellipsoid pupil is the easiest way to assess whether the glove of the eye is rotated (otherwise one is forced to look at the position of the retinal blood vessels on the back of the eye, the fundus). All that just for the eyes! And cranial nerves are just a small part of a neurological exam, there is so much more to the nervous system and so much more to just a basic physical exam (especially when one considers species ranging from chickens to alpacas to cows)!