SOAP Note:

Typhon Report:

Site Visit Summary:

The site visits were a great learning experience where I learned about different kinds of patients. I benefited greatly from the Drug cards that were presented in our site evaluations. Having to present my SOAP notes to part of my cohort and site evaluator was helpful because I received constructive criticism on how to improve my presentations.  After the site evaluation, I had the opportunity to sit down with my evaluator and go over the pertinent questions that must be asked when a patient presents with certain symptoms. For example, if an infant presents with excessive spitting-out food or vomiting, an abdominal examination must be done to aid in ruling out pyloric stenosis. My preceptor was great at eliciting students’ participation and thought processes on differentials. Within five weeks, I was able to learn a lot about the pediatric population but I know I still have more to learn.

Case and Journal Article Summary:

Case: A new patient referred by her retired physician presents to the office with her parents complaining of eye discomfort for the past two days. The patient is a 6-year Female with a past medical history of Juvenile Idiopathic Arthritis (JIA). The patient was diagnosed with JIA two years ago and has been following up with rheumatology. The parents state that the patient would complain that the lights in a room are too bright and that sometimes she complains of blurry vision. Upon physical examination, the patient is found to have a red left eye with excessive tearing. Given her medical history of JIA, the parents are given a STAT referral to ophthalmology.

Journal Article Chosen:  Clarke SL, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J. 2016 Apr 27;14(1):27. doi: 10.1186/s12969-016-0088-2. PMID: 27121190; PMCID: PMC4848803.

JIA is an idiopathic inflammatory rheumatic disorder that affects children sixteen and under. JIA is very common in the western world and has seven different subtypes. Within all seven subtypes, the most common extra-articular manifestation that can occur is Uveitis. In the case mentioned above the child is suspected to be developing uveitis. The Journal article that I chose described how JIA can lead to uveitis, and what treatment is effective in preventing and treating uveitis. The most common type of uveitis associated with JIA is chronic anterior uveitis. Oftentimes, chronic anterior uveitis is asymptomatic making it detrimental for JIA patients to follow up with ophthalmology. Uveitis is diagnosed with a dilated eye exam and a slit lamp exam. These exams allow the retina, optic nerve, and structures in front of the eyes to be easily visualized. The reason for uveal inflammation is still not clear however, it is thought that JIA associated with Uveitis (JIA-U) is due to a mixture of genetic and environmental factors. The first line treatment for JIA- U is topical glucocorticosteroids to decrease the inflammation of the eye and prevent the complications of uveitis such as glaucoma or cataracts. Other treatments that are used to treat JIA-U are cycloplegics, systemic steroids, and synthetic DMARDs. Synthetic DMARDs such as methotrexate are used as second-line therapy after failure of the first line. Although DMARDs are second-line therapy, they were found to lead to a longer relapse-free survival rate. 

In conclusion, prevention and management of JIA-U center around early detection and proper testing. With JIA-U being commonly asymptomatic, it can lead to greater complications if not caught early on. Complications such as cataracts, macular edema, and glaucoma can be prevented with proper follow-ups and effective treatment. Currently, the first line treatment for JIA-U is topical glucocorticoids with DMARDs being the second line. However, more research is showing the importance and benefits of using DMARDs to increase the relapse-free period of JIA-U. 

Rotation Reflection

I had the pleasure of experiencing my first rotation at Premier Pediatrics. Premier Pediatrics caters to the pediatric population and their families on Staten Island. Walking into the office for the first day, I did not know what to expect, and quickly felt awkward and out of place. It took the remainder of the first week for me to get comfortable in my role as a student rotating and learning. I had to learn that making mistakes is part of the learning process. This rotation showed me how important it is to constantly update the knowledge that I currently have through guidelines, treatments, and identifying diagnoses.

Having spent the didactic year hearing lung sounds through a sims man, I found it difficult to differentiate lung sounds on an actual patient. As I am a novice at lung sounds, it was hard to tell the difference between Rhonchi, crackles, and wheezes. However, I was able to overcome this difficulty with the aid of the competent staff at Premier pediatrics. The clinicians would allow me to perform a physical exam and inform them of my findings. Other times, the clinicians would call me over to listen to the different adventitious sounds in the lungs. I have significantly improved in identifying lung sounds but still have a long way to go to learn other parts of the physical exam. I am a firm believer that the best way to increase my competencies in physical exams is through practice. I plan to expose myself as much as possible and to perform as many physical exams as I can.

The most memorable family I met during my rotation was a four-week preterm infant who came in with his parents due to failure to thrive. The family stuck out to me because his parents were kind and were very concerned about their child. Watching the parents do everything they could during these five weeks to get their infant to gain weight was spectacular because the family never gave up hope. I could feel their eagerness for their child to get healthier. By the end of my rotation, I was delighted to see the child begin to gain weight and thrive. I pray that the family continues to thrive and succeed!

These past five weeks taught me that I enjoy patient interactions. Speaking to patients is different from studying textbooks or learning in a classroom. Watching patients’ expressions as they explain their symptoms confirms something everyone has told me already: “patients never read the textbooks”. Hearing patients express their concerns and being able to aid and treat them reminds me exactly why I want to be a PA. I am looking forward to my next rotation in Family Medicine.