My site evaluator for this rotation was Professor Sadat.

For my mid-rotation evaluation I presented an H&P on a 43 year old male with significant PMH of sleep apnea who presented with lower back and bilateral knee pain x 2 weeks. The patient works as a youth development specialist for ACS who had a work injury 2 weeks prior to presenting to the office. The patient was attempting to break up a fight between two male teenagers and ultimately this led to the patient falling and landing on his knees onto the marble floor. On physical exam, the patient’s lumbar range of motion was limited in flexion (80/90), left rotation (30/40), right rotation (30/40), left lateral flexion (20/25) and right lateral flexion (20/25). The patient was able to flex and extend both knees fully with pain noted at the patellar region of his right knee. Because the patient already obtained x-rays in the ED, the plan for him was to start physical therapy (2-3x a week) for strengthening, and consider an MRI if the patient’s symptoms worsen.

For my final evaluation I presented another H&P, this time of a 55 year old male with significant PMH of HTN and HLD, who presented complaining of pain to his right foot/fifth digit x 2 days. The patient works as a warehouse agent for WFS and reports that while setting down a skid, it fell onto his right foot crushing his toes, primarily his fifth digit. On physical exam, the patient had moderate edema at the talus and was tender to palpation at the fifth MTP joint. Patient had full range of motion of his right ankle and foot and was able to wiggle all his toes with slight pain. The plan for this patient was to obtain an x-ray of his right foot/fifth toe to eliminate suspicion of fracture. Additionally, his foot was wrapped in ACE and a hard sole shoe was given for support in addition to a referral for a podiatry consult.