Your summary of what you presented, feedback received, and changes planned:

For this rotation, I had PA Nikeisha Stephens. I had her before back in February and I very satisfy to see my improvement throughout this year.

I presented a 66 y/o female with PMH HTN, HLD, and history of EtOH abuse who came to the ED c/o RUQ abdominal pain x 4 days. Patient reports her symptoms worsened overnight, which awoke her from her sleep; she describes the pain as intermittent, sharp, 5/10, localized to the RUQ radiating to the RLQ, and without any provoking factors. Patient also reports nausea and two episodes of emesis, which appeared to be only the food she ate this morning. She took acetaminophen without alleviation. Her last bowel movement was this morning. Patient reports she was here in the ED four days ago for similar symptoms, an ultrasound of the abdomen showed fatty infiltration of the liver with cholelithiasis. Patient denies fever, chills, chest pain, vaginal discharge or urinary incontinence, recent antibiotic use, recent travel or other person around her with similar symptoms. No history of prior abdominal surgeries.

I stated the possible differential diagnosis just from the HPI. Then presented the pertinent physical exam and labs, where I was able to refine the differential diagnosis once more.

The assessment was a 66 y/o female with PMH HTN, HLD, and history of EtOH abuse presents to the ED c/o RUQ abdominal pain x 4 days. Vital signs are within the normal limits. At this time, patient is well-appearing, significant tenderness to palpation in the RUQ and RLQ, positive murphy’s sign. CT abd/pelvis showed gallbladder wall thickening and mild infiltration of fat in the RUQ. Finding are most consistent with acute cholecystitis.

The feedback I received were mainly from my HPI

• Some parts of my HPI are still too wordy, should consider more pertinent negatives such as back pain, dysuria, hematuria, hematemesis, recent URI symptoms (such as cough etc)

I would definitely focus more on the HPI since other sections of the H&P is good

Incorporate more pertinent positive and negative

I should write my ER H&P shorter since it should basically be a soap note.

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