Site Evaluator: Gary Maida, PA-C

At my second site evaluation for my Family Medicine rotation, I presented the following case:

• MC is a reliable, African American 47 year old female with no significant past medical history presents to the office complaining of right upper arm swelling x 1 day. She reports that she first noticed the swelling the previous night while washing herself. She admits that during the previous day she was moving around floorboards and other heavy objects in her basement. She denies any pain, redness in the skin overlaying the swelling, limitations in strength or range of motion, recent injections to the arm, evidence of any insect bites, heat, cold, fever, chills, nausea, vomiting, diarrhea, or any other symptoms. She did not try anything to alleviate the swelling and nothing makes it worse. On physical exam, there is a noticeable bulging mass in the region along her right bicep. No cyanosis, erythema, or visible lesions or rash are noted. MC has full range of motion in her arm without any pain with active or passive movement. All special tests assessing the rotator cuff muscles are negative. Her brachial and radial pulses are 2+ bilaterally and strength is 5/5 bilaterally in the upper extremities. She denies tenderness to palpation. Her right upper arm is slightly warmer to the touch than the left, but not significantly so. Differential diagnoses included biceps tendon rupture, biceps tendonitis, allergic response, effusion, and venous insufficiency. MC is referred for an ultrasound and Doppler of her right upper extremity to rule out biceps tendon rupture and any venous abnormalities in the right upper extremity and she was instructed not to return to work until after the results are assessed. Results of the imaging were available the following day and showed no significant findings apart from skin thickening in the affected area. She was prescribed a medrol dose pack in an attempt to alleviate any potential inflammatory process and was instructed to return to the office in 2 weeks for further evaluation.

I appreciated the group setting of the site evaluation because I got to listen to my fellow students’ cases from their Pediatrics rotations and practice differential diagnosis formation in that context. I also enjoyed being able to work with their pharmacology cards and consider medications that I was not typically exposed to in my Family Medicine rotation.

Professor Maida was able to provide much appreciated insight into the practical uses and cautions of the medications we chose for our pharmacology cards and provide a different, seasoned perspective into the cases we all presented.