My Internal Medicine site evaluations were held on-site at NYPQ. For the first evaluation, I prepared a H&P and 5 pharmacology cards. The second evaluation was the big one! I brought in another H&P, 5 more pharmacology cards, and one journal article. The site-evaluator challenged me for a H&P presentation without the use of papers (aka “crutches”). It was good to practice presenting from the pertinent knowledge in our minds, to train ourselves to do the same in real life. The H&P I presented was about a woman I went to evaluate as part of the stroke team. She was a woman in her 60s with multiple cardiovascular risk factors and a history of two strokes, who had come in for dizziness. It was an interesting case, because the more we interviewed the patient, the more stroke got lower on our differential, and BPPV got higher. It showed the importance of asking pertinent questions to reach the correct diagnosis. It was also a good case because I was able to practice using the NIH Stroke Scale.

After the H&P presentation, I was asked about the journal article I found. The idea behind the paper was that since BPPV is caused by the presence of calcium stones in the semicircular canals of the ear, and vitamin D is associated with the absorption of calcium; it investigated whether levels of vitamin D could be associated with the occurrence and recurrence of BPPV episodes. It was interesting because the article discovered that low vitamin D levels were more associated with the recurrence of BPPV, and not associated with patients who experienced a single episode of BPPV. Following this journal article, I was quizzed on the pharmacology cards I prepared for the meetings.

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