A Guide to Your Intern Report Case Presentation
Your work is going to be divided into two postings, we will call them post A (posted on Monday) and post B (posted on Friday)
Post A
Essentially a case presentation
History and Physical
- standard format
36-year-old woman presents to the emergency department complaining of RLQ pain for 2 days and vaginal bleeding that began this morning. She also vomited once and complains of persistent nausea. Past medical history is significant for a history of PID and asthma. Her medications include celexa and albuterol prn. On exam, her BP is 135/75 mm Hg, HR 124, RR 18, Sat 97% on room air, and Temp 98 degrees. In general, she is in mild distress secondary to pain. HEENT, CV, Pulm, Abdom, etc, etc.
Laboratory Results
- pertinent lab results
Her labs results include a WBC 12, Hgb 7, Platelets 230, etc, etc
Diagnostic Studies
- if you can incude radiographs, ultrasounds, EKGs that would be very nice (not required), multi-media defintely augments the rpesentation
Bedside FAST exam reveals…free fluid in Morrison’s pouch
Questions
- 3 multiple choice questions
- no negative-based questions (avoid using “Except” and “Not” in the question stem) – this is no longer allowed for the boards
- questions should have 5 answer choices (a through e)
1. Which of the following is a risk factor for an ectopic pregnancy?
a. nulliparous female
b. history of candidiasis
c. bicornate uterus
d. tubal ligation
e. irregular menses
This is what your first post (Post A) is going to look like.
__________________________________________________________________
Your second post (Post B) includes a summarized discussion of your case and provides the answers to your questions (also in discussion format)
Discussion
- In a few paragraphs provide info about your case inluding background, clinical features, diagnostic studies, and ED managament.
- Your focus should be on the ED relevant aspects of the case.
- Don’t spend too much time talking about the epidemiology, rather focus on practical information (how the entitiy presents in the ED, what is required to make the diagnosis, and how to manage it)
- You will provide the correct answers to your 3 questions and include in this discussiona brief (can be a sentece) explanation why the incorrect answer choice is incorrect.
- If you find any journal articles that you think are a nice review of the topic, please include them to post (just save a copy as a PDF and I will post it in your article)
- If you find any images, EKGs, radiographs, ultrasound images, that yiu would like to insert, just save the file and I will embed it into your discussion (be careful to not violate copyright law)
Here is a brief example of the discussion for a question
Although conception in the setting of tubal ligation is rare, when conception does occur, there is a high rate of ectopic implantation. Diagnosis of ectopic pregnancy is often delayed in women with tubal ligations because they do not think they can get pregnant. The incidence of ectopic implantation in the setting of tubal ligation is… (a) Nulliparous women are not at increased risk for ectopic pregnancy, although, they are at risk for breast cancer later in life. (b) Candidiasis is not a risk fator for ectopic pregnancy. Up to 50 percent of women with ectopic pregnancies have had inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease). (c) A bicornate uterus does not lead to increased ectopic pregnancy rates, though, any defect in the fallopian tubes can increase ectopic risk. (e) Irregular menses may lead to greater difficulty in conceiving, but not in ectopic pregnancy.
At the end of the Discussion, please include 3 to 5 Clinical Pearls about your topic, which can come from your discussion
(For Example)
- ectopic pregnancy is considered a surgical emergency and requires prompt diagnosis and treatment
- Any fertile women with lower abdominal pain is considered to have an ectopic pregnancy until proven otherwise
- Prior ectopic pregnancy is a high-risk for recurrent ectopic pregnancy
Please contact Kerin if you have any questions regarding the format of the case presentations and discussions
Please remember that if it is not your week to present a case, you must answer the questions that are presented each week.
We require that you submit answers to 75% of all web cases for conference credit.
Thanks for your hard work,
Bob, Kerin, Scott, and Erik
