This site evaluation with Professor Rachwalski was conducted in person at NYPQ. In total we had to present 3 H&P’s and 1 article and also show the 10 pharm cards.

For my first site evaluation, I presented Ms. JL who was a 36-year-old female patient with PMHx of metastatic colon cancer, rectal stricture, large bowel obstruction and recurrent small bowel obstruction who presented with crampy abdominal pain and multiple episodes of bilious emesis x1 day. Upon admission, CT of the abdomen was consistent with recurrent small bowel obstruction. Patient underwent ileostomy reversal, laparoscopic lysis of adhesions and reduction of internal hernia with no complications and was placed on soft PO diet, was able to pass gas, had positive bowel movements, able to ambulate and had pain at the incisional area which was well controlled with lidocaine patches and Tylenol. She was eventually discharged as she improved dramatically and was advised to check up with her PCP.

For my second H&P, I presented Ms. AM who was a 17-year-old female with pmhx of perforated appendicitis and ovarian cyst. Two days ago, she underwent laparoscopic appendectomy for perforated appendicitis and was doing well, however today she is re-admitted for worsening right lower abdominal pain and vomiting. CT of the abdomen suggested abscess formation in right lower quadrant adjacent to the surgical clips. Pt is hemodynamically stable. She was placed on Oxycodone/Paracetamol for the pain and CT guided pelvic abscess drainage was done the same day. Patient was discharged the following day as she improved and reported little to no pain.

For my third H&P, I presented Mr. PP who was a 87-year-old male with a PMHx of HTN/HLD, pancreatitis, BPH, DM type 2 and mild dementia. He presented with abdominal pain that started that same morning of admission. This was his second episode of gallstone pancreatitis as 2 months ago he was admitted for gallstone pancreatitis but did not have his gallbladder removed at the time. Physical exam showed distended abdomen with epigastric tenderness to palpation. Imaging shows gallbladder stones and pancreatic inflammation. Pt was hemodynamically stable and has a Ranson’s criteria of 2 (age and AST).

For my first H&P, Professor Rachwalski overall liked it and said that it was an interesting case, however he wanted my HPI to be focused only on the day of admission and not give him a detailed story on the patient day by day. He suggested to make this change for my other 2 H&P’s and to keep my HPI short and simple. Taking this into consideration, I made sure my other 2 H&Ps had nice and short HPI’s and anything extra I had to add on this patient I just included it in the end. I also made a few changed with my lab values presentation. Instead of just including every single lab value in the H&P, I started to include only the pertinent ones related to the patient and the possible condition he/she had.

I selected 1 article to present to Professor Rachwalski which was titled “ Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis”. This was done in 2017 and it included a total population size of 3460 patients. It’s main focus was to compare imaging modalities for chronic pancreatitis (Endoscopic ultrasound, ERCP, MRCP and CT). This article concluded that MRCP and CT had comparable diagnostic accuracy for chronic pancreatitis and the choice between the two should be made based on invasiveness, local availability, and costs. It more of a clinical preference.

For my 10 pharm cards, I tried to select all drugs that I saw during my Surgery rotation such as Propofol, Keppra, Diazepam, Toradol, Morphine and some opioid medications.

Overall this was a great experience and I received very helpful tips and comments from my site-evaluator.

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