At my first site evaluator meeting I presented the following case:

AS is a reliable 33 year-old African American female, G1P0010, with LMP of 04/18/21 (cycle day 1), with past medical history of dysmenorrhea and chronic pelvic pain, recently diagnosed with fibroid uterus, and left adnexal cyst, presents to the emergency room complaining of left lower abdominal pain. Patient states that the pain began at 9:00 pm on 04/18/21, as she was standing up from the toilet. The pain was characterized as sharp, 10/10 radiating to her upper abdomen. It was associated with one episode of vomiting after arriving to the emergency room. Patient states that the pain is aggravated by movements and that the pain “reminds her of when she had food poisoning” four years ago. The pain has improved with Tylenol and Toradol given at 10:35 pm on 4/18/21 in the ED.  Patient states that for many years she has dysmenorrhea on cycle day 1 and 2, which usually improves with naproxen. Today her pain is more severe than her usual dysmenorrhea. Tonight she ate chicken and rice from a take-out Greek restaurant. Patient admits to having “ovary pain” for the last 6 months, every other day or every few days, lasting for 10-20 minutes, and it resolves spontaneously. She did not seek medical attention until 3 weeks ago, when she was told she had fibroids and left ovarian cyst after a sonogram. MRI on 4/9 showed 5 cm left adnexal hemorrhagic cyst, and multiple fibroids. She has an appointment with her private GYN on 4/29 to discuss surgical management via laparoscopy. Patient denies fever, chills, dizziness, palpitations, SOB, or chest pain. At the present moment the patient denies nausea, vomiting, diarrhea or constipation. Patient also denies recent travel or contact with anyone who is sick. Her abdomen was nondistended, she had positive bowel sounds, soft, tenderness in LLQ, no rebound tenderness, guarding or rigidity. Additionally she had a normal perineum. Speculum exam shows small amount of blood in the vaginal vault; normal appearing cervix. Bimanual exam shows cervical os closed; uterus 8 week sized, retroverted firm, mobile, non-tender; left adnexal tenderness, approximately 4 cm mass. Right adnexal non-tender, no mass present. Bedside sono: Uterus 8×4.5 cm, 4 x 5 cm intramural fibroid in the anterior uterine wall, and 2 cm subserosal fibroid in the fundus. Left ovary enlarged, 4.5 x 3 cm, heterogeneous appearance, no obvious cyst seen, right ovary not well visualized. Small amount of free fluid in the pelvis suggestive of a ruptured ovarian cyst. The patient was to be educated on pain management and follow up with her personal GYN.

I appreciated that in this site evaluation Professor Melendez worked through my H&P asking me relevant questions and helping guide me on how to work up a similar patient. His questions were thought provoking and allowed me to really see if I truly understood the material.

Professor Melendez even educated me on what to look out for in future cases. He pointed out things that I would have overlooked and I really appreciated his comments and suggestions on my presentations!