During my two site visits, I presented two H&Ps and one journal article. Writing H&P in an Urgent Care setting is slightly different than the H&P we learned how to write in class. It is more focused and has a legislative component to it. For example, for my post MVA patient with a mild trapezius contusion including NEXUS criteria as a reason why I deferred imaging was something that would have been a good point to make in case if I have unintentionally omitted anything that could have prompted imaging at that point. I thought of NEXUS criteria when I …

Health Policy Analysis Childhood Obesity and Other Harms of Sugary Beverage Consumption by Children and Adolescents               One out of four American children age 2-19 is or is going to be overweight or obese at some time in their life1. The prevalence of obesity rose dramatically in the last few decades of the 20th century and beginning of the 21st century2. The high prevalence of overweight and obesity has serious health consequences3. Being overweight or obese for the affected individuals is not just about the weight – it comes with a risk of serious comorbidities such as cardiovascular disease, endocrine, …

     Clinical Correlation was one of my favorite courses of the didactic year as it encourages critical thinking and application of knowledge we gained in the course so far.      When the course just started, it was very frustrating because it made me exercise a muscle that’s never been used before. My first presentation took 4.5 hrs to prepare and I was very nervous. As we progressed, things started coming along more naturally and became less time consuming. Formulating a differential diagnosis became easier. However, sometimes even the most common diagnoses still sometimes slip away.       I still have to …

What differences do you note between the two H&Ps? Since I felt more comfortable in the Spring semester, it was easier to elicit pertinent positives and negatives before going through the ROS and to make connections. However, my initial DDx was very narrow and I have to admit patient’s actual problem was not on it during the interview. 2. In what ways has your history-taking improved? Are you eliciting all the important information? I learned to ask why certain things were happening instead of just documenting facts as it is a good way to elicit additional information . It is …

C.Shamrock Clinical Question: Pt is a 55 YOF with Graves Disease.  She is looking for a natural supplement to help decrease the size of her thyroid and nodules as well as help with Ophthalmopathy. She found an article saying Selenium may help normalize her thyroid function. She is asking her PA if this is true and if she should try it and if there’s any associated side effects. PICO Question: Do Selenium Supplements help improve symptoms of autoimmune hyperthyroidism PICO elements P      Adult females I       Selenium Supplements C      No Selenium Supplements O      Thyroid Volume and Thyroid …

HPI R.V Chief Complaint: “Unable to breath*5 hrs Mr.V is a 82 y.o. male with a PMH of ESRD on HD, well controlled HTN and DM who missed his Dialysis for one day, presents to ED with c/o dyspnea*5 days. Mr.V’s dyspnea started this morning, about 5 hours ago and was accompanied by an intense non-productive cough that woke him up from sleep. Food seemed to make it worse but small sips of water made it better. Mr.R also has diarrhea*24 hrs which is mostly opaque water, denies dysphagia, abdominal pain, nausea or blood in stool. Pt admits to DOE …

Alice Lam & Christina Shamrock HPPA-514: Biomedical Ethics Case-Based Argument from 10/23/19 Patient is an 87-year-old female who has been in a rehabilitation center for the past 2 months for a right hip fracture after a slip and fall in her home. She has been living independently for the past 12 years with her dog. The PA caring for the patient motivates her by emphasizing the need to build her strength in order to care for her dog. The patient’s daughter plans to move her to an assisted living facility after rehab because she believes the patient is too frail …

HPI B.D. GETTING EVALUATED FOR MASTECTOMY Mrs. B.D. is a 63 y.o. female with a PMH of hypothyroidism and HTN presented to the PAT for evaluation for her upcoming left breast mastectomy. Patient states she does not have any pain. Her right breast ductal carcinoma was discovered in July 2018 during a routine mammogram following a right breast mastectomy and a left breast lumpectomy (with a nipple removal). Her hypothyroidism and HTN are well controlled with medication. Patient admits to fatigue, weakness and recent weight gain (10lbs). PMH: Past illnesses – denies, Present illnesses: left knee pain diagnosed as arthritis …

Christina Shamrock, PA-S, Fall 2019 HPDP CASE STUDY: JUANA NEGRON Immunizations List the immunizations this patient should have – assume that they have all had their childhood immunizations (including HPV vaccine where appropriate) Assume that you are seeing the patient in November For Juana, I will first of all recommend getting a flu shot since it’s November. Then I would give her the Tdap, run titers for MMR to see if she has immunity. I would speak to the patient about  Zoster vaccine (RZV, 2 doses). Since Juana is a smoker, she may need a Pneumococcal vaccination. If Juana is …

HPI A.J. NY Presbyterian 10/22/2019 Identifying data: Name: A.J. Sex: F              Race: Latina             Religion: Did not disclose               Age: 62 Nationality: US                                 Marital status: separated Time: 9:10am History source: self Referral source: self PCD: Dr. Kazi K Haider (718 ) 886 03 55 Reliability: reliable Transportation: ambulance  Chief complaint: “Couldn’t breath well, had water in my lungs” * 6 days     Ms. A.S. is a reliable 62 y/o  separated Latina female, with a significant part medical history of smoking, cardiovascular disease, Asthma,  diabetes, HTN, acute kidney injury , depression and anxious panic disorder presented to the ED with dyspnea and shortness …