During my site evaluations for this rotation, I presented two cases that I found to be interesting and very relevant to my internal medicine rotation. For my first H&P, I discussed a 34 year old male with a past medical history of alcohol use disorder, history of alcoholic hepatitis, and hx of liver cirrhosis who presented to the emergency department for worsening diffuse swelling to his abdomen and lower extremities. Physical exam revealed abdominal distension with abdominal ultrasound showing cirrhosis and moderate volume ascites within both upper quadrants and large volume ascites. Vitals were notable for tachycardia and mild hypotension. Labs revealed elevated transaminase levels with low albumin. Patient was admitted for decompensated cirrhosis and the plan was to perform a diagnostic and therapeutic paracentesis with further evaluation from the hepatology team. I found this case to be very interesting as it highlighted the progression and complications of chronic liver disease, especially the effects of cirrhosis. I also learned the importance of recognizing early signs of decompensation and understanding the long term management strategies. 

For my final site evaluation, I discussed a 78 year old female with a past medical history of type 2 diabetes, hypertension, hx of endometrial cancer (dx 2013) and asthma presenting to the emergency department as a transfer from Queens Hospital with worsening shortness of breath, chest pain and lower extremity swelling and pain bilaterally. CTA revealed extensive bilateral PE involving the main, segmental, and subsegmental branches with CT evidence of R heart strain. Doppler of BL lower extremities showed no DVT. Physical exam was significant for tachypnea with mildly increased work of breathing. Management included starting Lovenox with monitoring lab values, respiratory status, and clinical symptoms. This case taught me the importance of timely intervention to reduce morbidity and mortality while also considering underlying risk factors of treatment, especially in elderly patients. 

Overall, I received valuable feedback on my case presentations. These experiences reinforced the importance of comprehensive patient care in internal medicine and how to manage multiple chronic conditions along with the acute clinical presentation.