Pediatric Site Evaluation Summary

During my first Pediatric rotation evaluation, I went prepared with one H&P and 5 pharm cards. I was first tested on my pharm cards and then presented the case. The case I presented was about a patient who came in with abdominal pain, fever, nausea, and vomiting x 2 days. I chose this case because it was not a diagnosis that was listed in my differentials and it gave me a chance to learn something new. This was an 18 y/o Caucasian F  who had been vaping x 1 year, with no other significant PMHx, she presented to the clinic with her mother with c/o abdominal pain, fever, and vomiting x 2 days. Urine pregnancy test was neg making ectopic less likely. Her vitals and labs were within normal limit except for a WBC count of 20,000. On physical exam patient is TTP in the right lower quadrant. Symptoms, findings from labs (leukocytosis), and physical exam warranted a work-up for appendicitis and torsion and so we sent her to the ED. Two days later I asked for the patient’s chart so I can F/U on her reports from the ED visit, and found that she was released the same day with a diagnosis of an atypical PNA (treated with Azithromycin). I was confused about this treatment and therefore went through the imaging results and found:

• CT scan which showed normal appendix, and patchy lung opacities.
• Chest X-ray showed bilateral extensive perihilar and interstitial opacities- report stated it may be due to vaping or may be an Atypical PNA.

The girl seemed to have developed an Atypical PNA, but we still needed to make sure there is no vaping injury present.

During her last visit to the clinic, we had not explored how much or what she vaped. We then called the patient and had her come back in to explore the situation further. The girl admitted to smoking an extensive amount going through more than 2 pods a day (the nicotine content is 0.7mL (or 59 mg/mL) per pod, which is approximately equivalent to one pack of cigarettes, or 200 puffs. She was counseled on the dangers of vaping, was told to complete her antibiotics, and was referred out to a pulmonologist for further evaluation.

From this case I learned that many patients who have vaping lung injuries can present with GI symptoms as well, so it is important to explore this further with a pulmonology consult. According to up to date up to 43 percent of patients may present with abdominal pain, other symptoms can include vomiting, diarrhea, and fever. Respiratory signs that are more common  include shortness of breath, cough, chest pain, pleuritic chest pain, and hemoptysis. After presenting my case Professor Melendez and I discussed the issues with vaping and how we as providers we need to stay up to date with new information as it becomes available to us.

For the second evaluation, I came prepared with my two H&P’s, 5 pharm cards, and journal article. Once again, I went over the pharm cards first, and then I presented my patient’s case and explained how the article helped me prepare my plan for the patient. I then presented a summary of the article I chose, and we spoke a little about the approach to a child with gastroesophageal reflux.

What I liked the most about my evaluations was it did not feel as if I was being evaluated, but rather as if I was having a discussion about the patients cases with another provider. Before this I felt I had to prepare more for the presentations, and this time it came more naturally. Professor Melendez stated he was very interested in the cases I chose, and that I did an excellent job presenting.

After presenting my cases we chatted a bit about my commute to Staten island for this rotation, and about the patient population that I encountered there. He asked me what I liked about the rotation and if I felt the cases I encountered were interesting. We engaged in some conversation about situations I found were handled somewhat different from how we have been taught. At this time he gave me  some very wise advice on how he would approach similar situations. I will remember his advice as I go on to my next rotation and appreciate his contribution to our education as developing PAs. I hope to become even more stronger an confident during my future presentations.

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