Site Evaluator: Gary Maida, PA-C

For my site evaluation, I presented two cases, ten drug cards, and an article relevant to my case. My first case was a 5-year-old boy who came in with a sore throat, subjective fever, and was fully vaccinated, I performed a full-on physical exam on the patient and noticed the patient had exudates on his throat, which prompted me to get a strep test to rule out Step-A. Professor Maida noted I did a great job in performing the physical, and narrowing down my differential diagnosis to bacterial vs viral. Professor Maida did note I should be more familiar with the course of antibiotics to treat if the culture comes back positive.

Professor Maida gave feedback on my H&P  that when it came to pediatric patients don’t use templates for a physical exam, because you would not check a pediatric patient for DVT, and template H&P is not applicable to pediatric patients.

The case study I presented was about a 6-year-old female following up for anemia. The patient physical exam is unremarkable but has been anemic since she was 4 years old. The patient has a healthy diet but drinks milk several times a day which is leading to her anemic status, and my attending encouraged me to research this phenomenon, and I learned that consumption of too much milk can lead to anemia, because milk doesn’t contain vitamin C, and vitamin C is needed to absorb iron, and there a mechanism in play that is not well understood that diminishes the capacity of vitamin C when drinking too much milk. As I presented this cause professor Maida pointed out the importance of listening to the patient history because no amount of lab work or exam will lead you to know the patient’s cause of anemia has to do with milk consumption.

My biggest takeaway from the site evaluation is that I need to familiarize myself with antibiotics, and their side effects. Professor Maida did encourage me to focus more on the story the patient is telling as that can reveal a lot more about the patient’s condition than lab reports.