History and Physicals:

Typhon Report:

Site Visit Summary:

The site visits were an opportunity to learn about emergency medicine and treatment for acute diagnose along with treatment. I gained meaningful insight by listening to my classmates speak about their experiences in emergency medicine and the conversations held with the site evaluator. The site evaluation ensured that I understood the correlation between Differential diagnosis and exams ordered and the treatment options available to the patient. For example, if a female patient presents with lower abdominal/pelvic pain, the differential diagnosis can include menstrual cramps or gastritis to serious conditions of Pelvic Inflammatory Disease (PID) or Ectopic pregnancy. The site evaluation also asked multiple questions that questioned and strengthened my knowledge of certain subjects. I enjoyed these sessions and look forward to future site evaluations.

Case and Journal Summary: 

Case: A 67 year old male with PMHx of uncontrolled NIDDM and HTN due to noncompliance to medications presents to the ED complaining of a painful itchy rash on his left side. The patient states that the rash started as a small bump 2 days ago and has progressively worsened and is spreading since then. The rash wraps around from his back and abdomen of this left side from T9 to T12 with closely grouped erythematous papules, some vesicles on a erythematous and edematous base that has begun to cross midline. Small vesicles and erythematous papules found in L1-L2 with no penile involvement. The patient is diagnosed with disseminated Herpes zoster and admitted for IV antivirals. 

Journal Article: Suaya JA, Chen SY, Li Q, Burstin SJ, Levin MJ. Incidence of herpes zoster and persistent post-zoster pain in adults with or without diabetes in the United States. Open Forum Infect Dis. 2014 Aug 2;1(2):ofu049. doi: 10.1093/ofid/ofu049. PMID: 25734121; PMCID: PMC4281784.

Journal Summary: 

Herpes Zoster Virus (HZV) also known as Shingles is a neurocutaneous manifestation of reactivated Varicella zoster virus (VZV). The occurrence of HZV is closely associated with a decline in cell-mediated immunity that naturally occurs with aging and in immunocompromised people. While diabetes has been associated with an increased incidence of certain viral infections like hepatitis B, the link between HZ and diabetes remains elusive. The article by Suaya et al. focused on what effect diabetes has on the incidence of HZV and persistent post-HZ pain. The researchers used three large administration claims databases founded in the USA for 5 years to answer this question: Is Diabetes Mellitus a risk factor for HZV and does it increase pst-HZ pain? Researchers used medical and pharmacy claims to find patients between the age of 18 to 65 years old with diabetes who had HZV and compared them to patients without diabetes who had HSV. They found that the incidence of HSV and persistent post-HZ pain increased in the Diabetes group regardless of age. They also found that young diabetic patients have similar HZV incidence rates compared to older patients without diabetes. Therefore, diabetes should be considered a risk factor for HZV.  The treatment for HZV is oral antivirals such as acyclovir. In cases of disseminated HZV, the patient should receive IV antivirals and be monitored to ensure a response to treatment. 

Rotation Reflection:

I had the opportunity to have my fifth rotation at Queens Hospital Center’s Emergency Department. Queens Hospital Center (QHC) serves a diverse community with forty percent being African Americans and Hispanics. My fifth rotation was different from the rest as it challenged my ability to properly diagnose and treat patients through my history taking and physical exam. I had the privilege of rotating through the QHC Fast Track department and their main Emergency Department (ED). 

I grew a new fondness for History taking and physical exams during my time in the ED. I was able to see and experience how proper history taking and physical exams can save a patient’s life and ensure that they receive treatment promptly. During my didactic year, I had trouble associating differential diagnoses with proper testing/imaging to rule in or out a diagnosis. My time at the ED has sharpened this skill and many others through discussions held with my preceptors and being able to see real results in front of me. I honed my clinical skills by performing laceration repairs, incisions, drainages, giving IM injections, and many more. The clinicians were focused on teaching students and taught me valuable skills that I will continue to use in my career. The clinicians and nurses were kind and showed interest in teaching me techniques and strengthening my knowledge base. 

During my rotation, I learned that the ED is a unique place where patients can receive acute treatment. I discovered the importance of clinician patience and effective communication. Patience is a necessity for clinicians as it will assist in better connecting with the patient and treating the patient properly. Effective communication is essential as the ED is a busy place and oftentimes the patient can be unsure as to why they are waiting. Simply informing them that they are waiting for imaging or bloodwork results puts the patients at ease. Explaining the patient’s diagnosis and treatment plan also requires effective communication and is not easy; the clinicians at QHC taught me how much of an acquired skill it is. I enjoyed my time at QHC and I am excited for what comes next: Long Term Care at Veterans Affairs (VA).