For my first site evaluation I presented 2 H&Ps along with my drug cards. My first H&P was a routine OB revisit for a 28 year old G2P1001 female who was 29w5d gestation. She presented with no complaints. In my plan for this visit I discussed which labs/testing the patient needed at this time. This included her TDAP vaccine, along with her 1hr GCT test since she had missed her 24w-28w appointment (which is this typical time this test is done), and a syphilis screening. Since asymptomatic bacteriuria is always treated in pregnant women, we also ordered a UA. The patient also had previous labs that were significant for not being immune to rubeola so we discussed that MMR is a live vaccine and is thus contraindicated in pregnancy so it would be offered to her postpartum. Also significant was her abnormal quantiferon which came back positive, so we scheduled her for a chest xray and referred her to pulm. Her OB history was significant for macrosomia so we also scheduled her for a EFW at 38 weeks. The patient had a previous c section with no records but she desired TOLAC. On exam her scar was noted to be vertical. During my site visit we discussed when a TOLAC can be done and what the possible risks of it are. My second H&P included a 23 year old G1P0010 female who was presenting for her annual exam but was also complaining of a breast lump. During my site visit we discussed different modalities of investigating breast lumps and which would be best considering age, family history and the characteristics of the lump.

For my final site visit I included an additional H&P and a journal article. My third H&P was a consult I did in the ED on a female complaining of vaginal bleeding. The patient had recently been evaluated at the clinic and was determined to have an IUP. In my differential I included different types of spontaneous abortions along with other possible causes of first trimester bleeding such as trauma / cervical irritation from sexual intercourse. Since heart tones were heard and her cervical os was closed, the pregnancy was still viable and precautions were given about threatened abortions. My journal article related to this H&P because it was an RCT comparing the use of progesterone to a placebo in women with early bleeding in pregnancy.

This site evaluation was helpful for me because it allowed me to use the knowledge that I had learned during my rotation to answer questions. For example, when we discussed the criteria for TOLAC, this was a conversation I had with a PA and I was able to recall this information to help answer questions during my site eval. I also enjoyed being able to present different cases (OB and GYN) and being able to broaden my knowledge on both.