During my first site evaluation for my Ambulatory Medicine rotation, I presented a patient that I saw in the clinic that was diagnosed with scabies. While I thought it was interesting to see my first patient with scabies, I thought it was even more interesting that he had recently completed the prophylactic treatment because his roommate had been diagnosed with scabies. The patient presented with relatively typical symptoms such as itching worse at night and linear burrows. Interestingly, the rash was only present on the right lower side of his body and he did not have any rash between the creases of his fingers. During the site evaluation, we discussed the prophylactic treatment options and the way to properly use permethrin. We also evaluated the use of ivermectin and whether it has a role in the treatment of scabies as an oral medication. I also prepared five drug cards for this Site Eval. I chose to include medications that I had either seen prescribed to treat patients in the clinic or had discussed with providers throughout the rotation.

At my second site evaluation meeting, I prepared two patients to present. The first patient that I presented was seen in the Urgent Care for an allergic reaction to a bee sting. The patient stated that he currently works as a beekeeper and often gets stung. He reported that he never had an anaphylactic reaction to bee stings, however he develops an allergic reaction typically consisting of edema and pain. He stated that he applied supportive measures at home, but his symptoms were not improving. In the office, we treated him with Benadryl and a steroid injection. He was also prescribed an oral steroid to take for the next 4 days. I also found an interesting journal article that evaluated the benefits of using heat rather than ice to alleviate pain, swelling and itch from bug bites and stings. The article found that applying localized heat did show to improve symptoms. I also prepared a second patient presentation regarding a young female that presented with complaints consistent with URI. Lastly, I prepared an additional five drug cards to discuss during the site eval.