Site Evaluation Presentation Summary

For my final site evaluation, I presented on a case of a 47 year old male who came into the ED c/o sudden, worsening right flank pain with episodes of gross hematuria with blood clots that was eventually admitted to the medicine floor. The flank pain and hematuria started 3-4 months ago but patient admits to not liking to visit doctors so this was the first time he sought treatment. In the ED, CT abdomen/pelvis revealed a complex cystic lesion within the right renal pelvis measuring 11.3 x 9.2 cm, thus we were concerned about malignancy.

As for the ROS and PE examinations, patient admitted to right flank pain that radiated to the right groin, generalized abdominal pain, and episodes of hematuria with occasional blood clots. Otherwise, he denied all other symptoms. On examination, I was able to palpate the mass (since it was large), thus fulfilling the classic triad of flank pain, hematuria, and flank mass. My team and I decided to follow up with more imaging.

During the mid-site evaluation, Prof. Herel really helped me with organizing my H&Ps for the final site evaluation. I was somewhat confused as to how to present what occurred to the patient in the ED versus what was happening on the internal medicine floor. He taught me that I should put all relevant vitals, labs, and imaging that occurred prior to admission into the HPI portion, which I took into consideration for my final site evaluation. Additionally, I did not include enough patient education in my mid-site evaluation so I was able to elaborate on that section more thoroughly afterwards. Prof. Herel also discussed the importance and indications for different types of imaging, which I thought was helpful since there are many tests that we are able to order but we should select the ones that are necessary and indicated for each patient.

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