This site evaluation was with Professor Mohamed and it was via Zoom. This was the second time I had a site evaluation with Professor Mohamed so I was a bit familiar how he conducted his site evaluations. I had no technical difficulties and everything ran smooth.

In total we had to do 3 comprehensive H&P’s, 10 pharm cards, and one article. For my first site evaluation I presented Ms. TB who was a 72-year-old female with PMHx of cervical cancer, HTN/HLD, hypothyroidism, urinary incontinence and osteoporosis and presented with LLQ abdominal pain, vomiting and constipation x 1day. Physical exam showed slight abdomen distention with periumbilical and LLQ tenderness on palpation and hypoactive bowel sounds in the left and right lower quadrants. CT of the abdomen shows dilated small bowel loop and transition zone suggesting partial small bowel obstruction. Pt was hemodynamically stable. For this patient we decided to start her on IV fluids and NPO to rest the bowel. Later an NG tube was placed for bowel decompression and general surgery consult for possible surgical intervention. She was eventually admitted to surgery.

For my second site evaluation I presented Ms. TD who was a 29-year-old female patient G1P1001 LMP 10/27/2020 and PMHx of UTI complaints of vulvar pruritus, vulvar erythema and dysuria that’s been going on for 5 days. Physical exam noted thick and white discharge lateral to the vaginal canal and cervical os as well as erythema around the vulvar region. Pt was eventually diagnosed with Candidiasis. For her we decided to order b-HCG which was negative. UA and urine culture was also ordered for further assessment since patient also presents with dysuria and we wanted to rule our pyelonephritis. Pt was started on terconazole vaginal cream 0.8% which helps treat vaginal yeast infection, vaginal burning, and itching and advised to take ibuprofen 200mg for pain. Pt was eventually discharged the same day.

For my first H&P, Professor Mohamed liked the case and the presentation. We discussed the danger of small bowel obstructions and how it can perforate and quicky lead to severe infection and death. One suggestion that he made was to call for surgery consult as soon as its highly suspected that the patient might have a SBO and not wait for imaging to confirm it, especially if they are symptomatic. For my second H&P, he also agreed to do a UA and urine culture to rule out any other possible infections in the urine but suggested to maybe start patient on Diflucan PO since she had some erythema in her inner thighs as well, which PO Diflucan would cover it better than the cream.

The article I selected to present to Professor Mohamed was titled “Use of water-soluble contrast medium (gastrografin) does not decrease the need for operative intervention nor the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction?” This article was published in 2017 and it was a RCT. The main object of this study was to determine if water-soluble contrast medium Gastrografin was able to decrease the need for operative intervention or the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction. In conclusion, there was no significant difference between Gastrografin and normal saline and the study strongly suggested that Gastrografin administration was of no benefit in patients with ASBO.

For my 10 pharm cards, I tried to select all drugs that I saw during my EM rotation such as Diazepam, Toradol, Motrin, Morphine, Nitroglycerine, Albuterol, Prednisone, Ipratropium, Metoprolol and Plavix.

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

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