During the mid-point evaluation, I presented one H&P, a related article and eight of my pharmacology cards.  The article I selected to present was on a patient I’d followed in the NICU, with suspected Prader-Willi Syndrome.  During my week with the neonatal team, I was responsible for presenting on this patient each day throughout the week so I thought it was appropriate that I continued this conversation with my site evaluator, Professor Maida. While presenting my case, I was sure to review the patient’s birth history and report her weight, complications and post natal course to ensure I provided information that was helpful and pertinent to the discussion.  I reported the respective pertinent positives and negatives from the physical exam especially given the cluster of symptoms often associated with Prader-Willi Syndrome.  I also discussed labs and feeds for this child to highlight the other diagnostics that were done to ensure the care team was covering all basis in evaluating her condition and formulating a differential.  Prior to discussing our cases we reviewed eight of our ten drug cards.  I tried to use medications from the different sub-specialties I covered while in my pediatrics rotation. My classmates and I reviewed our own cards but also each others with Professor Maida and had some discussion as to why they were important and applicable in the pediatric population.

When we returned for our final site evaluation, the discussion continued about my patient I’d previously presented on at the midpoint and shared that the Prader-Willi tests were negative and reported that her feeding had improved (which I was happy to see).  At this evaluation, we reviewed our remaining two drug cards and were questioned on each others as well.  Once we’d reviewed the pharmacology cards, I presented another H&P on a patient that I’d seen in the NICU and had piqued my interest that I actually wound up using the research I’d done for a PICO search.  This patient had a Patent Ductus Arteriosus that remained open despite several rounds of Ibuprofen and eventually wound up having to go to Cornell (main campus) for surgical ligation.  The articles I found evaluated the means of treatment and I shared with Professor Maida that Ibuprofen is used just as effectively as Indomethacin in initial pharmacologic treatment of PDAs.  Historically, and in the classroom, we’re taught that Indomethacin was used but the research shows Ibuprofen has equal effectiveness with a lesser side effect profile, making it more optimal for treatment.  I thought this was important and relevant information to share with Professor Maida as our Pediatrics professor!  As I continue on my rotations, I will continue to sharpen my H&Ps and apply the knowledge I’m learning in the clinical setting to practice and bring relevant information and drug cards to my site evaluations.

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