This site evaluation with Professor Maida was conducted via webcam. In total we had to present 2 H&P’s one per site evaluation, 2 articles (one per site evaluation) and also 10 pharm cards in total.
For my first site evaluation, I presented Ms. TR who was an 8-year-old female patient with a PMH of juvenile myoclonic epilepsy was brought in by EMS due to seizing that morning. Seizure lasted about 4-5 minutes and stopped on its own. Mother denied change in skin color during seizure episode, foaming from mouth, urinary incontinence, jerky movement, or stiffness of the limbs. After 3 hours in the ED, patient experienced another episode of seizure as she was trying to fall sleep which lasted 1 minute and 30 seconds with tonic-clonic activity and postictal period of 5 minutes and 1 mg of Ativan was given. 4 hours after that, a third episode of seizure occurred which lasted about 45 seconds to 1 minute and this time 2 mg of Ativan was given and 500mg IV of Keppra. Physical exam was benign. We continued to monitor patient and her vital signs. We also contacted her neurologist, Dr. P and he recommended for her to be admitted at the closest hospital for video EEG and medication adjustment. Patient was admitted at Cohens children hospital. For my second H&P, I presented Mr. JR who was a 12-year-old male patient with a PMHx of otitis media and came in due to complains of sore throat that started 3 days ago and fever x 1 day ago. Upon physical exam, patient had B/L swelling and erythema of the tonsils with no exudates and uvula midline, posterior and anterior cervical lymphadenopathy B/L and fever of 100.6. Labs showed rapid strep test which was negative, positive Monospot test and Peripheral smear- atypical lymphocytosis. An abdomen U/S was ordered to evaluate for potential splenomegaly and/or hepatomegaly and patient was placed on ibuprofen and continue supportive care. For my first H&P, Professor Maida overall liked it and said it was an interesting case. He did suggest adding a bit more information on what the patient’s neurologist said on the phone and be a bit more specific on that aspect. For the second H&P, considering that this patient was seen in the ED, professor Maida suggested that a focused H&P would be appropriate here but a full H&P was also not wrong.
I selected 2 different articles for this site evaluation. The first one was titled “Topiramate monotherapy for juvenile myoclonic epilepsy” which concluded that there was not sufficient evidence to support that topiramate is more effective than valproate for the treatment of people with JME. For the second article, I selected the article “Antiviral agents for infectious mononucleosis” which concluded that when it comes to treating infectious mononucleosis, antiviral treatment is not effective.
For my 10 pharm cards, I tried to select all drugs that I saw during my Peds rotation such as Prozac, Methylphenidate, Keppra, methotrexate and metformin.
Overall this was a great experience and I received very helpful tips and comments from my site-evaluator.
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