Clinician Case Study

D.D is a 16 yr old male who was in his usually state of health until he developed right-sided abdominal pain approximately 5 days prior to arriving at the hospital. His pain progressively worsened and spread throughout his abdomen. He also had nausea non-bloody, non-bilious vomiting, some diarrhea, as well as fevers, when pain did not improve he presented to ER. He was admitted and diagnosed with sepsis and perforated appendicitis. He had a laparoscopic appendectomy and a central venous catheter was placed. Following surgery he was then transferred to the med-surg floor. His parents are both Spanish speaking and at the bedside.

An orthopedic doctor diagnosed an injured 25 year old male skier with torn right medial collateral (MCL) and anterior cruciate ligaments (ACL) with possible medial meniscal involvement. The superficial medial collateral ligament (MCL) originates at the medial epicondyle of the femur, inserts at the medial condyle of the tibial shaft and also attaches to the medial meniscus. (Marieb) The MCL stabilizes the knee by resisting medial rotation of the knee and protecting against genu valgum stresses, which stress the tibiofemoral joint in the medial direction. (Biel) The anterior cruciate ligament (ACL) originates from the anterior intercondylar area of the tibia and inserts on the medial side of the tibial lateral condyle. (Marieb) The ACL provides stability by preventing anterior translation of the tibia, preventing hyperextension of the tibiofemoral joint, reinforcing the medial collateral ligament and controlling the tibial rotation during femoral extensions from 0 to 30 degrees. (Brown Biomed) The medial meniscus functions to deepen the articular surfaces of the tibia, helps prevent medial to lateral movement of the femur on the tibia and provides shock absorption in the tibiofemoral joint. It attaches only at the outer margins and frequently suffers rips with knee injuries. (Marieb)

On Tuesday 06/27/2017, veteran Mr. Saenz walked very angrily in my office with his wife about 11:00 AM. I greeted them and offered to sit down; Mr. Saenz and Mrs. Saenz were very upset and asked me where they need to go as they have VA examination, they both said “nobody tells them anything; they have been sitting in waiting room”. They told me that the lady on the desk told them to come to me.

It is my privilege to take this opportunity to recommend Dr. Juan Pablo Ortega for a residency position in Internal Medicine. I have known Dr. Ortega for approximately 2 months during his observership in the Lymphoma/Myeloma Department at MD Anderson Cancer Center. During this time, I have seen firsthand the dedication that Dr. Ortega has. He is on the right track to be an outstanding internist who values the input of his peers. He has a clear vision for where he wants to be and dedicates much of his time and energy to his success. He was very open to discuss his goals of becoming an Internist and later pursuing a fellow either in nephrology or endocrinology.

At your request I have reviewed the Boards electronic case folder in the above-referenced matter, paying particular attention to the resumption of treatment in 2017.

What was the most impactful thing you learnt from your clinical placement? What did you find most challenging?

DOI: 06/06/2015. Patient is a 61-year-old female full time housekeeper at a hotel resort who sustained a work-related injury when she fell and broke her wrist when taking trash out. Per claim notes, she was initially diagnosed with right comminuted fracture radius and right wrist contusion. Submitted medical report is handwritten and most of the notes are illegible.

These behaviors, sedentary lifestyle and poor food choices, are further supported by both Patient A and B’s healthcare behavioral display in the hospital. Patient B would not allow the nursing staff or the phlebotomist to draw any blood specimen from him (to include finger stick for glucose checks) unless he has a can of a caffeinated-carbonated drink with all his meals to include breakfast. While Patient A admitted, “I stop eating when I get full,” with his family members bringing in fast-food bought sandwiches in addition to his hospital meal.

Evaluator met with Ms. Patty to discuss her medical condition. Ms. Patty stated that she was told that she had a “stroke on the brain.” Previously, she provided a doctor excuse requesting May 17, 2017 to May 24, 2017 off because she was ill. Ms. Patty was scheduled to return 05/25/2017. However, Ms. Patty stated that Dr. South stated that she still should not return to AbilityWorks until her doctor appointment, Wednesday, June 12, 2017 at 3:20 pm. Ms. Patty stated that she became dizzy at her significant other’s home in McAdams, MS. She continued to verbalize that she was lightheaded and she passed out in her significant other’s living room. She stated that her significant other’s grandfather heard the commotion and came over. Ms. Patty reported

There are many different departments and programs that are run by the state of Illinois that are potentially related to long-term care and thus should be involved in the integration effort. The first program is Long-term Ombudsman Program which is a resident-directed advocacy program that protects and improves the quality of the individual’s life in various long-term care settings.

Dialysis clinics like DaVita and Fresenius, being the two largest for-profit corporations are fighting against a proposed Senate Bill No.349 (SB 349, 2017) that would necessitate dialysis clinics in California to have a mandated minimum staffing requirement. Furthermore, SB 349 (2017), as authored by Senator Ricardo Lara, would also require that dialysis clinics to provide patients with forty-five (45) minute transition time, and frequent inspection be done yearly instead of every five to six years (SB 349, 2017). With this regulation in place, patients will be provided with a higher level of care. The mandated staffing ratios would also help promote patient safety. Furthermore, with greater than 66,000 dialysis patients in

After the date of loss on July 22, 2017, Ms. Sityar said she received a text message from the claimant on August 6, 2017. Within the text, Ms. Sinay said the claimant texted her and requested to make note that on the second day of her training on July 22, 2017, Dr. Sinay had adjusted her in a prone position with adjustment to her thoracic spine located at the TA8, T9 and T10 segments of her spine, as he proceeded to adjust her lumbar A3 segment of her spine. After being adjusted, according to the text she received, Ms. Shirer complained that the adjustment she received from Dr. Sinay was painful. She further stated in the text that Dr. Sinay failed to complete and intake inpatient history form from her prior to adjusting her.

Paul is a sixty-four-year-old Caucasian male. He was an exceptional athlete in high school and college where he participated in football, baseball, and track. Paul is socioeconomically middle-class which allows his wife to work part-time. He has been married for forty years, raised four children, and is now enjoying the ability to participate in raising his six grandchildren. Paul recently retired and spends his free time with leisure activities, but primarily he loves to bicycle long distances. He said that he took up bicycling about twenty-five years ago, because it was less stress on the joints than the running he used to do. He knew of the toll taken on his knees from the days of sports involving running, and he has history of

Mrs. J. arrives at the emergency department with her 6 year old son, PJ, who has a history of Cystic Fibrosis (CF). He is febrile (101.7° F orally), BP 98/66, HR 122, RR 32 with the use of accessory muscles. Mother states PJ has, for the last five days, exhibited signs and symptoms of upper respiratory infection, runny nose, low grade fever, cough, and fatigue. He has lost 2 pounds over the past 5 days due to anorexia though he has not had vomiting. He weighs 36 pounds and height is 3’2”. Today, PJ became more lethargic and his fever was difficult to control with pyretics.

Discuss the preclinical research and approvals (regulatory and other) that are required prior to commencing human clinical trials. What are the safety and other requirements that need to be satisfied?