Site Evaluator: Gary Maida, PA-C

At my first site evaluation I presented the following case:

IM is a 16-year-old white female who presents to the clinic due to an inability to defecate and a burning sensation upon urination. IM states that for the last day she has had these symptoms, with the addition of mid and lower back pain and general pain across her entire abdomen. She characterizes the pain as beginning as dull but upon palpation describes the pain as sharp. Pain does not radiate anywhere else. This morning IM woke up with a temperature of 102.6 F orally. IM took Motrin at 1:30 PM today and the fever has resolved. Patient also took stool softener, Miralax, Ducolax and a suppository, but they did not help relieve the symptoms. Touching the area makes the pain feel worse. Patient admits to a normal appetite and no change in diet. Patient has never experienced these symptoms before and her LMP was 02/03/21. IM denies blood in the stool, cough, and conjunctivitis. She also denies nausea, vomiting, and denies being sexually active. IM denies any recent travel or any contact with anyone who is ill. On the physical exam IM appeared to be in mild distress. Patient is observed crouching over in pain. She was not able to walk without bending over and was unable to jump without significant pain.  IM was positive for Rovsing’s, Obturator sign and McBurney’s. The differential diagnosis was appendicitis and a possible UTI. She was sent directly to the emergency room for imaging and also prescribed Cefdinir 300 1 tab BID x 10 days for the possibility of a UTI.

I appreciated this site evaluation because Professor Maida would question me on my pharmacology cards and then we would discuss the various indications and contraindications and other drug classes that could be used to treat those conditions.

Professor Maida provided me with practical advice on how to diagnose and treat patients. I appreciated his feedback on my case presentation and believe that it helped me prepare for my second site evaluation.