Site Evaluator: Professor Michael Malavet

At my site visit I presented the following case:

JS is a 66 year old reliable Caucasian male, with a  history of HTN that presents with persistent L sided squeezing HA. It began while he was sitting on the couch and watching TV around 2 pm. He took 2 tabs of Tylenol but experienced no relief. The pain is progressively worse, 4/10 – 8/10. It is described as a constant and band-like pain. JS admits to a “left chest cramp” that was associated with the headache, that was rated a 5/10, but states that it resolved before her arrival to the hospital. Throughout the past week she has had palpitations with exertion. JS denies any visual changes, weakness, photophobia or tinnitus.  JS also denies diplopia, photophobia, lacrimation, or hearing difficulties (bilaterally). Patient also denies chest pain, shortness of breath, nausea, vomiting and diaphoresis. JS has not come in contact with anyone who is sick and has not traveled anywhere recently. Vital signs were all normal and PE was unremarkable. Plan was to give Tylenol prn for the recurrence of the headache, monitor on tele and serial cardiac enzymes give ASA 324 mg in the ED, ASA 81 for now, check TTE to evaluate for structural heart disease, Ischemic eval with cardiac CT vs. Stress tes, continue losartan/HCTZ, and give Lovenox SC for prophylactic measures for a DVT.

I also worked through the drug cards with Professor Malavet. He helped me see when he would use the medication in practice. He provided me with great advice and corrections on my history and physicals and helped me see more efficient ways to write them. I really appreciated his feedback and hope that I can use it to improve my future H&Ps.