During the first clinical site visit, I presented 1 focused H&P and five drug cards. I discussed a patient who presented with abnormal uterine bleeding who was scheduled for a total vaginal hysterectomy. My site evaluator and I discussed her case fully and also several causes and treatment options for abnormal uterine bleeding. He provided good constructive feedback on how I could elaborate on the patient’s story and how to document a more detailed preoperative note. During the second site visit, I presented another focused H&P, five drug cards, and an article. I discussed a patient who came to the …

The article is titled Delayed versus immediate pushing in the second stage of labor in women with neuraxial analgesia: a systemative review and meta-analysis of randomized controlled trials.  This article was a systematic review and meta-analysis of RCTs that included 5,445 women. 2,754 of these women were randomized to the delayed pushing group and 2,691 to the immediate pushing group. These women were evaluated on the effect of delayed versus immediate pushing in the second stage of labor. The primary outcome was the mode of delivery, which included spontaneous vaginal delivery, operative vaginal delivery, and cesarean delivery. They found that …

Overall this rotation was a great learning experience. Each week I was scheduled to a different service in OB/GYN which exposed me to a variety of diagnoses and procedures. For example, during week 1 I was in labor and delivery, week 2 was GYN, and week 3 and 4 was clinic. In labor and delivery, I triaged patients, conducted pelvic exams, learned how to read transabdominal and transvaginal sonograms, experienced fetal non-stress tests, and assisted in vaginal deliveries and cesarean sections. This week was challenging as I learned how to effectively conduct a thorough OB history and physical, but felt …

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AMtyphon

During the first clinical site visit, I presented four SOAP notes and five drug cards. I discussed patients who had eyelid erythema and swelling, a pruritic rash, a sore throat and body aches, and dysuria. My site evaluator and I discussed differential diagnoses and various assessments and plans. He provided good constructive feedback on how I could elaborate on the patient’s story and how to document a more detailed physical exam. During the second site visit, I presented four more SOAP notes, five drug cards, and an article. I discussed patients who presented with mouth pain, abdominal pain, a hand …

Article Summary: Antibiotics for acute pyelonephritis in children This article is a meta-analysis that evaluates the benefits and harms of antibiotics used to treat children with acute pyelonephritis. Researchers evaluated different antibiotics, dosing regimens, duration, and different routes of administration.  Randomized and quasi-randomised control trials of children aged 0-18 years with proven UTI and acute pyelonephritis were selected for the study. 27 studies of 4,452 children were included, and the settings were inpatient and outpatient.  Interventions included short duration (3-4 days) versus long duration (7-14 days) IV therapy, different dosing regimens of aminoglycosides (daily versus 8 hourly), and 3rd generation …

SOAP 1 RC – 27 y/o male  Chief complaint – laceration to left hand Subjective RC is a 27 y/o male presenting with laceration to his left hand. Patient admits to cutting his knuckle over the third digit with a piece of tile at work less than six hours ago. He states he applied pressure immediately and bleeding stopped after 30 minutes of direct pressure. His wound was cleaned with soap and water thoroughly, and states he was not going to seek treatment until he noticed he could see his bone. Patient states his last Tetanus was within 5 years. …

My ambulatory medicine rotation was at Statcare Urgent Care. Overall, this was a great rotation and I learned a lot being in a small clinic with one provider. Each day, the doctor or PA would allow me to triage, take medical histories and conduct physical exams on all patients. Afterwards, I would discuss the exam findings with the doctor or PA and create a plan. My prior rotations were in hospital settings, so I found it challenging presenting patients in a primary care setting during my first few shifts. Although this location saw many urgent cases, the majority of patients …

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