My site evaluator for this rotation was Professor Mohamed.

For my mid-rotation evaluation I presented an H&P on a 51 year old female presenting with right lower quadrant abdominal pain x 2 days. The patient had no significant past medical history. The pain was sharp, constant, and radiated towards her right flank. The patient admitted to some pain on urination as well. Professor Mohamed provided informative critique with emphasis on expanding my differential diagnosis. Because there was CVA tenderness on physical examination in addition to the flank pain, nephrolithiasis and pyelonephritis should be included in the differentials. Additionally, instead of prescribing Nitrofurantoin (Macrobid), it would be ideal to prescribe an antibiotic with better kidney penetration (i.e. Ciprofloxacin, Keflex). 

For my final evaluation I presented another H&P, this time featuring a 39 year old male smoker with significant PMH of asthma who presented with subcutaneous lumps on his chest x1 week. The differential diagnosis included breast cancer, fibroadenoma, lipoma, and gynecomastia. With this case, Professor Mohamed said my differentials were much improved and that the plan I provided to further assess the patient was well thought out. For future rotations I will continue to be cognizant of all aspects of my patient’s presentation to ensure that I include an accurate range of differentials and an appropriate plan tailored to that.