Summary of evaluation

Present materials: two H&Ps, ten pharm cards and one article

In site evaluation, I present a patient with ectopic pregnancy. The patient is a 30 years old female, G2P0010, with no reported past medical history presents with cramping, intermittent left lower quadrant abdominal pain since this morning with a severity 9/10, not radiating, associated with mild vaginal spotting and nausea. LMP Sep 2019. Physical exam notable for mild left lower quadrant tenderness. UA, CBC, BMP negative, pregnancy test positive, and ultrasound shows no viable intrauterine gestation and complex structure adjacent to the left ovary. This case allows me to explore GYN examination skills, and review all labs that are required. For this case, the patent is hemodynamically stable, and she will need methotrexate 89mg IM and then follow up with the clinic to test for beta HCG levels until undatable. I also find an article that compares ultrasound-guided local methotrexate (MTX) vs. systemic methotrexate in ectopic pregnancy regarding the beta HCG clearance duration. The results show that systemic MTX has a much shorter duration.

For the second case, I write up for cholelithiasis presentation. The patient is a 30 years old male with no past medical history complaint of a sharp and intermittent right upper quadrant and epigastric abdominal pain for 1 month. Pain has no radiation, gets worse after meals and associated with nausea and diarrhea. Physical examination is remarkable for mild tenderness over the right upper quadrant and epigastric area. Labs are negative, and ultrasound of the abdomen shows cholelithiasis.

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