Site Evaluation: Said Mohamed

The first case I presented was a 29-year-old male who had come to the ER complaining of a migraine headache that started that morning. I chose this case because it was a great example for me in why having a wide differential diagnosis list is important. The patient’s complaints of having a gradual onset of a pulsating and throbbing headache, generalized weakness, nausea, sensitivity to sound and light, and seeing “floaters” were all consistent with symptoms of a migraine, and he had even stated that this most recent migraine was like all his previous ones. However, the PA assigned to the case was concerned about the patient’s oral temperature reading 99.1°F because of the possible concern for meningitis. The PA ordered a rectal temperature to be done and we did a complete neuro exam. The rectal temperature read 99.3°F and the physical exam was negative for nuchal rigidity and Brudzinski/Kernig signs. The patient was alert, awake, and oriented, with a Glasgow score of 15. No motor or sensory abnormalities. Professor Mohamed agreed with my assessment that the patient’s history and physical exam was most consistent with a migraine headache and that there was low concern for meningitis at this time, and he agreed with my plan, only suggesting that Toradol may have been better for pain control than Tylenol if there was no concern for head bleed. 

The second case I chose to present was a patient who sustained a finger laceration after a glass window fell on him. I chose this case because I got to assist in performing the nerve block and then got to suture the wound. Upon physical exam, the wound was swollen with no signs of infection, and the patient was neurovascularly intact and had full range of motion in the finger. A hand x ray was taken to rule out any fractures or foreign bodies, all of which were negative. 1% lidocaine was used for the nerve block, the wound was irrigated with IL of sterile water and cleaned with betadine, and then I closed it with simple uninterrupted sutures of 5.0 Ethilon, total of 9 sutures. Professor Mohamed complimented me on my HPI, assessment and plan, and return precautions. He gave me some constructive feedback on what should be included in the exam and in the chart with patients with hand injuries, specifically mentioning to include the ability to flex/extend all digits at the MCP/PIP/DIP against resistance with individual isolation. This case also prompted some discussion on various types of wound closure and proper wound care. 

The third case that I submitted but didn’t present was a Group A Streptococcus case I saw in my second week of rotations. I chose this case because my preceptor and I had discussed many possible differentials diagnosis, especially since he was complaining of sore throat and postauricular pain. The preceptor helped me refine my HPI and develop my pertinent negatives and positives.