History and Physical:
Typhon Report:
Site Visit Summary:
The site visits were an opportunity to learn about different Family Medicine sites and how they function. I gained meaningful insight by listening to my classmates speak about their experiences in family medicine and the conversations held with the site evaluator. The site evaluation ensured that I understood the correlation between the HPI and differential diagnosis. For example, if a male patient presents with urinary urgency and frequency, the differential diagnosis can include Urinary Tract Infection (UTI), epididymitis, or Sexually Transmitted Infections depending on age. The site evaluation also asked multiple questions that questioned and strengthened my knowledge of certain subjects. I enjoyed these sessions to the fullest and look forward to future site evaluations.
Case and Journal article:
Case: A 25 year old female who presents complaining of right knee pain that started 2 weeks ago but worsened significantly yesterday. The patient describes the pain as sharp pain that worsens when she bends her knee. The patient states that no medication was able to relieve her pain for a long period of time. On physical exam the patient has limited range of motion on the right knee with ⅘ strength. The patient’s knee is not deformed but red and slightly swollen. Patient was found to have an overuse injury and informed to rest, limit activity and take Tylenol and Motrin as needed.
Journal Article : Patel, D. R., & Villalobos, A. (2017). Evaluation and management of knee pain in young athletes: overuse injuries of the knee. Translational pediatrics, 6(3), 190–198. https://doi.org/10.21037/tp.2017.04.05
Summary:
The most common causes of knee pain in athletes are overuse injuries. The most common cause of overuse injuries is patellofemoral pain syndrome AKA idiopathic anterior knee pain. The article by Patel et al. focused on differentiating between seven etiologies of knee pain in athletes such as anterior knee pain syndrome, Osgood-Schlatter disease, and iliotibial band friction syndrome. Idiopathic anterior knee pain is vague localized anterior knee pain thought to be caused by multiple anatomical and biochemical factors. Patients present with pain in the knee with prolonged sittings, ascending or descending stairs, and repeated squatting. In physical exams, patients may have weakened quadriceps muscles compared to the other side, abnormal gait, and asymmetry of lower extremities. A patellofemoral compression test can be performed to elicit the pain of idiopathic anterior knee pain. Treatment is mainly supportive of rehabilitation exercises. While Patellofemoral pain syndrome affects the anterior knee, Osgood-Schlatter disease affects the tibial tuberosity. The disease is due to rapid growth and increased physical activity whose underlying pathophysiology is thought to be due to minor avulsions at the site and an inflammatory reaction. On examination, patients are found to have localized pain and tenderness at the tibial tuberosity and pain with resisted knee extension. Treatment for Osgood-Schlatter disease is also supportively focusing on decreased activity and rest. Iliotibial band (ITB) friction syndrome is an overuse injury that affects the tendon and is the most common cause of lateral knee pain in runners. In contrast with idiopathic anterior knee pain, ITB friction syndrome is only felt with activity with no pain at rest. The Ober and Noble test for the lack of flexibility and knee pain associated with ITB friction syndrome. Patel et al. article was very effective in differentiating between different causes of overuse injuries and how these syndromes/ diseases can be diagnosed and treated.
Rotation Reflection:
For my second rotation, I had the pleasure of going to South Shore Family Medicine Arverne in Far Rockaway. South Shore Family Medicine serves a predominant minority community consisting of African Americans. A typical day in the office is doing annual visits, medication refills, and work physicals with the occasional sick visits.
My family medicine rotation was different from my first rotation in pediatrics; while most pediatric patients came in for sick visits, hardly any came in during my family medicine stay. In my family medicine rotation, I had to learn how to manage different types of patients. For example, I had to learn how to speak and respect a non-compliant patient decision on hypertensive medication. The patient’s blood pressure was 170/110 during his annual visit. When the doctor informed him that he needed medication, the patient became very hostile and shouted at the doctor. Watching the doctor de-escalate the situation, respect the patient’s wishes, and inform him of the danger of their decision was phenomenal. The doctor did this with so much grace and tact that when the patient returned two weeks later for his laboratory results, not only was he more open to talking about his health, he even agreed to take the antihypertensive medication. This situation taught me the importance of patience and placing patients first.
During this five-week rotation, I learned the importance of communicating effectively with patients and how to treat chronic illnesses properly. I learned that effective communication is detrimental to the patient-clinician relationship and increases adherence to medication for patients. Multiple patients explained their health to the doctor comfortably because they knew he would provide the best care. Treating chronic illnesses is not easy and in this rotation, I learned how challenging it is. From patients not wanting to take certain medications to educate the patient on how to take the medication. I enjoyed my time at South Shore Family Medicine Arverne and look forward to starting my third rotation at Woodhull Hospital for Ob/Gyn.
