At my first site evaluation with Professor Lopez I presented the following case:

CM is a 67 y/o male with PMH of HTN, T2DM, acute pancreatitis, alcohol abuse  who presents to the ED with a 3 day history of worsening epigastric pain. The pain is characterized by the patient as constant and sharp and rated an 8/10. He states that the pain radiates to his back. Patient states that the pain began as an achy pain and has slowly progressed to a sharp pain. Patient reports that on the first day he took alka-seltzer to try to relieve the pain, which provided moderate relief. On the second day, the patient states that he developed nausea and non-bloody bilious vomiting.  The patient states that the vomiting could fill two full cups.  Patient again took alka seltzer, with no improvement of the symptoms. Patient has not taken any other medication for symptom relief. Patient states that it is worse at night while he is lying down in bed. Patient states that a few years prior he was treated at Lenox Hill for similar symptoms. Patient has struggled with alcoholism and states that Lenox hill discharged him and he was instructed to reduce his alcohol intake. Patient states that he used to drink one bottle of rum a week. Patient reports that he currently drinks two bottles of rum per month. Patient admits to loss of appetite due to the nausea. Patient denies chest pain, shortness of breath, fever or chills. Patient also denies diarrhea, constipation, dystrophy, weakness, numbness, parenthesis, headache, syncope, recent travel, sick contacts or previous abdominal surgeries.   

Physical Exam: Bowel sounds are normal in all four quadrants. Abdomen is soft. Abdominal tenderness diffusely. Guarding noted. There is no right or left CVA tenderness. Positive Murphy’s sign. NO ecchymosis noted on the skin. Patient is actively vomiting upon evaluation.

WBC – 19.72

HGB – 18.6

HCT- 54.3 

Total Bilirubin- 1.9 

AlkPhos -169

ALT – 398

AST- 343

Lactate- 3.9

Troponin – <0.010

FS- 203

Professor Lopez was a great site evaluator. She worked through many of the procedures that I was able to perform and we discussed in details about how and why surgeons took certain approaches. She also helped me classify antibiotics and gave me better ways to recognize which ones were used for which procedures, infections, and bacteria.

Professor Lopez asked many questions throughout the presentation to help guide me in a broader way of thinking. She helped expand my scope of knowledge. I believe that her experience and her didactic course truly gave me a great foundation for my rotation.