Throughout this rotation, I participated in both mid-term and final site evaluations. During these meetings, I presented two patient cases, ten drug cards, and a journal article related to one of my patient cases. These evaluations were conducted via Zoom with my classmates, who were also undertaking their pediatric rotations. My last rotation had an evaluation without other classmates. After having a break from site evaluations with my peers I appreciated having them with me even more. I recognized that their presence allowed me to learn from their experiences and patient cases.
In this rotation, we thoroughly discussed our drug cards. We were expected to know key details about each drug and be able to answer any questions. For example, we discussed Nystatin, used for conditions like diaper candidiasis and oral thrush. We noted that for thrush, Nystatin must be used as a suspension and properly swished to be effective. However, many young children cannot use it properly and require systemic treatment with fluconazole, which has a risk of hepatotoxicity. We also discussed Amoxicillin, emphasizing that for acute otitis media, a higher dose of 80-90 mg/kg is necessary due to resistance.
For my first patient case, I presented a 5-year-old female with strep pharyngitis superimposed on erythema infectiosum. We discussed the complications of strep, such as rheumatic fever and post-strep glomerulonephritis. The distinction was made regarding when these complications occur. Rheumatic fever will only happen if strep is not treated, whereas post-strep glomerulonephritis can develop whether the initial infection is treated or not. My second case involved a 10-year-old female with mycoplasma pneumonia, who had 9 days of fever and non-responsive pneumonia to Amoxicillin and Augmentin. This case was particularly educational as it highlighted how mycoplasma pneumonia is a common atypical pneumonia, yet the diagnosis didn’t immediately come to mind. We also reviewed the treatment of atypical pneumonias with macrolides, and I presented a journal article discussing macrolide-resistant and macrolide-susceptible mycoplasma pneumonias.
Additionally, I submitted an H&P on a 15-year-old female with unexplained bruises on her upper and lower extremities. Although I did not discuss this case during the meetings, I received feedback suggesting follow-up on the patient, considering the concern for leukemia as a potential diagnosis for spontaneous bruising. Unfortunately, the patient did not follow through with the recommended bloodwork, and our office’s attempts to contact her mother were unsuccessful. This situation led to a discussion about the limitations of healthcare professionals; we can guide patients and educate them about necessary tests and treatments, but ultimately, they must take the steps to maintain their health.
Overall, the two site evaluations during this rotation were highly educational. I enjoyed discussing both my cases and my classmates’ cases, gaining valuable insights into various diagnoses. The discussions on drug cards were particularly beneficial, and I found myself recalling many of the key points and quick pearls learned during these meetings.
