This site evaluation with Professor Sadat was conducted via webcam and not in person due to the pandemic situation. During our evaluation there was no technical difficulties and everything ran nice and smooth.

In total we had to present 2 H&P’s, one per site evaluation. For my first site evaluation I presented Mr. GS who was a 58-year-old male patient with a chief complaint of mass on his inner thigh. He first noted the mass while taking a shower and reported no pain. Patient stated the mass felt warm and soft and when lifted heavy stuff it become larger and gave him an uncomfortable feeling. On physical exam, hernia was noted over the left inguinal canal, with no pain on palpation and scrotum swelling noted as well. My top DDX was Indirect hernia because patient presents with a mass at the inguinal canal which increases when lifting up objects which increases the abdominal pressure. Given that he also presented with scrotal swelling too indicated that this is most likely indirect hernia. I don’t think the hernia is incarcerated or strangulated as he is asymptomatic with no pain or N/V. For my plan of this patient, I ordered labs such as CBC, CMP, groin/testicular ultrasound and referred patient to GU for the scrotum swelling and GI for bulging hernia and possibly for surgical repair of the hernia. For my second site evaluation I presented Ms. JK who was a 50-year-old woman and had a chief complaint of severe headaches for the last 4 days. She stated that during her lunch break 4 days ago was the first time she got these headaches. She rated them as 7/10 and describes them as sharp, especially on her right side of her head with no radiation and last about 10 mins and is not constant pain. She also complained of jaw soreness and stiffness while chewing (especially when chewing gum or eating bread for a longer time). On exam, patient reported pain when the right side of her head was being palpated. Patient had visual acuity of 20/40 on both eyes and the rest of the physical exam was benign. My top DDX in this case was Temporal Arteritis because patient presents with unilateral headache, unilateral scalp tenderness during palpation and jaw pain when chewing all of which point to temporal arteritis. Temporal arteritis is most commonly seen in females who are over 50 years old, and our patient falls right into that category as well. On exam we also noted some visual changes which further point to temporal arteritis. For this patient I ordered labs (CBC, CMP, CT and ESR/CRP) and if results were still indecisive, I also ordered a temporal biopsy doe definite diagnosis of temporal arteritis. Referred her to ophthalmologist for her decreased visual acuity and observe for possible blindness. If this was in fact temporal arteritis I suggested her to start on high dose methylprednisolone 60 mg/day. I received some great feedback from Professor Sadat especially for my second H&P he suggested that my plan and assessment needed a little bit more work and to be more expanded upon. He did like the suggestion of giving my patient methylprednisolone however he suggested to add more possible treatment and explain better the reason why behind it which I failed to do. Another suggestion that Professor Sadat made was to add more DDX on my H&P’s, at least 5. For my second H&P, my second DDX was “head trauma” which did not really make sense to be placed as my second DDX as patient did not have any recent trauma to the head. Overall, Professor Sadat gave some really important tips and suggestions which I will implement on my future H&P’s.

The article I selected to present to my site-evaluator was a Randomized Controlled Trial which was published in 2018 and the title of it was “Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout”. I decided to do this article because it very relevant to the patient we saw at our family medicine rotation. We had a lot of patients with cardiovascular risks who had gout and were taking Allopurinol. I also selected this article because it had a great population size of 6,190 pts and it did a great exploring the effectiveness of both Febuxostat and Allopurinol in these patients.

For my 10 pharm cards, I tried to select all drugs that I saw during my Family medicine rotation such as sumatriptan for headaches, SSRI for depression, HTN medications and Diabetes medication such as Metformin and glipizide.

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

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