This site evaluation was with Surgical PA Andrea. The first site evaluation happened in person at NYPQ but the second one was via Zoom as the number of COVID cases were on the rise at NYPQ so our site evaluator decided it was safer if we did it remotely. I had no technical difficulties and everything ran smoothly.

We had the option to do 3 comprehensive H&P’s or 8 focused SOAP notes and for this rotation I decided to do 3 comprehensive H&P’s, 10 pharm cards, and one article. For my first site evaluation I presented Mr. LS who was a 26-year-old male with PMHx of asthma and came in with complains of periumbilical abdominal pain and N/V that started the night before. He just recently came from California and was not sure if he was exposed to COVID-19. Physical examination showed periumbilical tenderness on palpation and positive McBurney’s point tenderness however his labs values were benign. Pt was hemodynamically stable at that time. COVID test was negative, and his lab report showed elevated WBC and neutrophil. CT of the abdomen showed inflammation and wall thickening, fat stranding and acute appendicitis was confirmed. Pt was treated symptomatically and general surgery was consulted for appendectomy.

For my second site evaluation I presented Mr. VE who was a 68-year-old male with PMHx of dialysis (ESRD), HTN/HLD, CAD, gout, diverticulitis, and umbilical hernia and started to complain of chest pain and dizziness after going for his dialysis. He became tachycardic and O2 saturation was at 90% on room air with a normal physical exam. His troponin levels were trending upwards and there was ST elevation leads V1-V4. Pt was suspected of anterior myocardial infraction most likely due to dialysis and cath lab was called to get ready for PCI. In the meantime, pt was given aspirin to chew on and nitroglycerin (0.4mg) and was also placed on nasal canula since his O2 saturation on room air is at 90%.

For my first H&P, PA Andrea liked the case and the presentation but suggested for the next case to pick someone with more comorbidities since I was in my IM rotation and most patients there are elderly pts with more comorbidities. This is why for my second H&P I decided to present Mr. VE who had significantly more comorbidities and made the case a bit more interesting.

The article I selected to preswrnt to PA Andrea was titled “Increased Risk of Pancreatic Cancer Related to Gallstones and Cholecystectomy: A Systematic Review and Meta-Analysis. Pancreas”. This article was related to my third H&P presentation as it was about acute gallbladder stone pancreatitis. This article was published in 2016 and it was a Systematic Review and Meta-Analysis and its main focus was to investigate if there was a relationship between chronic gallstones and/ or cholecystectomy in increased risk of pancreatic carcinogenesis and pancreatic cancer. In conclusion, the current meta-analysis strongly supports that individuals with a history of gallstones and cholecystectomy are at a significantly increased risk of pancreatic cancer.

For my 10 pharm cards, I tried to select drugs that I saw during my rotation such as Metoprolol, Methotrexate, Metformin, Warfarin, Oxybutynin, and a few more commonly used in IM.

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

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