History & Physicals: Journal Article Summary: Ketamine for the acute treatment of severe suicidal ideation: double blind, randomized placebo-controlled trial Treating suicidal ideation in bipolar disorder poses a challenge since the traditional first line agents SSRIs and SNRIs can induce mania which is why their use is not recommended in this population. These medications also take several weeks to a month before the beneficial effects are observed which makes them ineffective during an acute suicidal crisis. The same delayed effect has been observed for mood stabilizers and antipsychotics such as lithium and clozapine in mood disorders. Psychotherapy also takes several …

History & Physicals: Journal Article Summary: Much controversy has circulated in the general public as to whether or not the Covid-19 vaccination is safe in pregnancy and data on infection rates and outcomes is lacking in this patient population being that pregnant women were excluded from pre-marketing clinical trials studying the vaccine. Although pregnant women are not at a higher risk of catching COVID-19 but they are at a higher risk of having a severe infection. Results showed that 77.4% of COVID-19 infections in pregnancy occurred in unvaccinated women, 11.5% in partially vaccinated women, and 11.1% in fully vaccinated women. …

History and Physicals: Journal Article Summary: There are currently different recommendations regarding when to place tympanostomy-tubes for children with recurrent acute otitis media. This study set out to determine the efficacy of  tympanostomy tube placement vs medical management in children with recurrent AOM defined as at least 3 episodes within 6 months or 4 episodes within 1 year. The primary outcome was measured by the number of episodes of AOM per child per year during a 2-year period. The population included children age 6 to 35 months of age. The rate of episodes of AOM per child per year was …

Mini-CAT Final                                                                                    Name: Sierra Teegarden Clinical Question: While on my Pediatric Rotation, an 18-month-old child presented to the Pediatric Emergency Room with her mother who stated her child has been congested with increased breathing difficulty for the past 3 days. Upon physical exam the patient was in no acute distress with stable vital signs, but auscultation of the lungs revealed diffuse wheezing. The child was diagnosed with bronchiolitis and prescribed albuterol nebulizer treatments along with supportive care. The mother asked if the albuterol would improve her child’s breathing and the Pediatrician advised that there is no consensus on whether or …

History and Physicals: Journal Article Summary: Green DM, Boston University School of Medicine & Boston Medical. Dept. of Neurology. Determination of Brain Death. NEJM. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMcp2025326. Accessed Feb 18, 2022. One of the patients presented, DG, was a 58 y/o F who underwent a massive ICH w/ Subfalcine herniation. Brain death protocol was ordered based on clinical picture. I sought out to find an article that discussed, in detail, the determination of brain death which accounts for 2-5% of in-hospital deaths in the U.S. per year. The determination is made clinically upon the demonstration of permanent …

History & Physicals: Journal Article Summary: HR is a 73 y/o male with metastatic castration resistant prostate cancer (mCRPC). He was initially treated with standard brachytherapy and external beam radiation therapy which led to remission for approximately 10 years before recurrence. Soon after the reoccurrence it was discovered that his cancer had metastasized to several soft tissue areas. At this point, he began treatment with Enzalutamide, which is known to prolong the overall survival for patients with mCRPC. I would like to evaluate if the survival can be prolonged if Enzalutamide is started before castration resistant prostate cancer has metastasized. …

The following paper is a personal reflection on my 1st and 3rd History & Physical that I have performed for Physical Diagnosis II: What differences do you note between the two H&Ps? The assessment and plan were incorporated this semester. My first H&P reflects my limited knowledge at that time of how to address this part of the note. It was missing some of the patient’s past medical problems and not all the parts listed in the assessment were included in the plan. In my last H&P, the assessment was a statement that listed all the patient’s past medical problems …

Addressing Cultural & Religious Diversity in MedicineGroup 5: Matt Lemieszewski, Irma Purisic, Jaspreet Sra, & Sierra Teegarden As the world we live in continues to diversify and the long-standing inequalities in the health status of people from culturally diverse upbringings become more evident, there has been a challenge issued to health care providers and their organizations as a whole to view cultural diversity as a priority in providing the highest level of patient care. The patients we treat come from an immense range of cultures and religions that each have different needs, health beliefs, and behaviors. Additionally, patients often have …

Sierra Teegarden Clinical Correlations Reflection Paper 3 Over the course of the semester, my differential diagnosis has become more focused and is listed in accordance with most life threatening and most likely. At the beginning of the semester, the differential had more “zebras” listed without much organization to it. My presentations have become more concise. In the beginning, I would try to include as much information as possible about the subject, but my presentations were too long and included a lot of “fluff” that distracted from the main take away of the topic. My methodology by the end of the …