My pediatric rotation was located at Queens Hospital Center. For the first 3 weeks, I saw patients in the pediatric emergency department. I was able see and treat many patients from ages 0-21, with a variety of medical and psychiatric conditions. Each day, I was scheduled with a different provider who allowed me to see patients on my own first, and then present the case to them before they conducted their own physical exam. The provider and I then discussed our assessments and plans and made changes to mine as needed. Some conditions I saw included pyloric stenosis, cluster headache, …

During my site evaluations, I presented 2 H&Ps, 10 drug cards and an article. One of the patients I presented was a 17 year old female presenting with left sided severe headache for a week. Upon evaluation, she had left ptosis with excessive tearing. Her extraocular movements were intact and the rest of her physical exam was normal. Her head CT and MRI was negative, and was diagnosed with cluster headache. After presenting this case, my site evaluator was impressed with my detailed plan and expressed how I could improve in developing a more detailed cranial nerve exam. My article …

Pediatrics

Cognitive and Motor Outcomes of Children With Prenatal Opioid Exposure A systematic review and meta-analysis that studied the association between prenatal opioid exposure (POE) on cognitive and motor development in children from age 6 months to 18 years  Out of the 26 studies included, 1,455 children with POE and 2,982 controls were included. Children were all from high income countries and regions, including the United States, Australia, Europe, and Israel. Children were born between 1970 and 2004. Illicit drugs ingested (polydrug use) included Heroin in 10 studies, methadone in 13 studies, and unspecified opioids ingestion in 3 studies. Cognitive and …

CC: “I have a bad headache” HPI 17 y/o female with no PMH presenting to the ED accompanied by her mother, with worsening headache on and off x8 days.  Patient states the headaches are left-sided, from front to back, rated a8/10, and does not radiate. She states the headaches begin when she wakes up in the morning and worsens in the afternoon. She has taken Advil and Tylenol which did not provide relief, although she did not specify the dosage of each medication.  The headaches have been occurring intermittently every other day, but got worse today around 11am while at …

LTCtyphon

CC: “I think I had a mini stroke” HPI: 77 y/o female with PMH of HTN, CAD s/p stents 2017, hypothyroid, anxiety, glaucoma, and mitral valve regurgitation presenting with dysarthria x3 days ago. Patient states 3 days ago as she was eating lunch with her family, she suddenly “couldn’t get the words out”. Patient states this lasted for about 15 minutes and she was able to walk and move all extremities during the episode. Patient admits to intermittent heart palpitations which are happening more frequently. Patient states she went to rest afterwards. She attributes her symptoms to exhaustion and pain …

My LTC rotation was located at St. Francis Hospital. Each morning, I would meet with my preceptor whose medicine service consisted of nearly 60 patients. He would assign me 4 to 5 patients daily, and I would conduct my own history and physical examinations, and create my assessment and plan. Since I had note writing ability on EPIC, I was able to type a full H&P, which was then reviewed by my preceptor and cosigned by him. This allowed me to gain great experience with EPIC and being comfortable writing notes as a future certified PA. The patients I saw …

Worsening Physical Function during Hospitalization is Associated with Poor Outcome in Patients with Acute Decompensated Heart Failure article Gait speed (GS) is a simple assessment of physical function and a predictor of cardiovascular events in the elderly population with heart failure. In this study, 445 patients diagnosed with congestive heart failure were chosen to undergo exercise during hospitalization. Physical examinations and a 10 meters walking test was conducted to evaluate gait speed at the beginning of training and before discharge. Patients were evaluated after discharge on poor outcomes, hospital readmissions, and mortality. At both time points, NT-proBNP and nutritional status …

During my site evaluations, I presented 3 H&Ps, 10 drug cards and an article. One of the patients I presented was a elderly female presenting with dysarthria and heart palpitations lasting 15 minutes 3 days prior to being evaluated in the emergency department. Upon evaluation, she was completely asymptomatic and showed no signs of stroke. Her head CT was negative, however, the head MRI was consistent with a posterior lobe ischemic stroke. This patient was also diagnosed with paroxysmal atrial fibrillation on evaluation, which I learned most likely caused her blood clot. After presenting this case, my site evaluator was …