Peds Evaluation Reflection: For my Pediatric Medicine rotation evaluation, I presented a pre-pubescent female patient with a unilateral breast mass. Presenting the H&P of a child was very different from that of an adult and I had a bit of trouble breaking all of the information down accordingly and including all necessary information for this H&P. The patient I presented had a fairly uncommon ailment, an inflamed and painful breast mass that turned out to be an abscess that required surgical drainage. When the child first presented, an eleven-year-old female, she had pain and swelling to her right breast for two days. Upon physical exam, her right breast had an indurated and palpable mass directly behind the areola and towards nine and ten o’clock laterally. The patient was first given Augmentin pharmacological therapy as the mass was determined to be mastitis versus an abscess. The patient was referred to a pediatric general surgeon on Staten Island for possible drainage of this 3 cm x 3 cm mass. I felt that this was a Patient worth writing an H&P for as it was a fairly unique presentation. I got to practice doing a write up for not only a pediatric patient but also for an uncommon infectious process. I feel that this helped me to round out my H&P writing skills and will help me to continue to broaden my abilities as I work towards becoming a physician assistant.
Peds Article Summary:
In this article, the occurrence of breast abscesses in two adolescent female patients is discussed. These abscesses were determined to be caused by a staph aureus infection, along with the patients having atopic dermatitis. Atopic dermatitis is determined to be a chronic inflammatory condition of the skin in children, leading to high rates of staph aureus colonization on the skin’s surface. If the skin barrier is compromised due to inflammation or excoriation, the risk of infection by staph aureus is possible. In this discussion of two adolescent females seen with breast abscesses, the same strains of staph aureus were found to be the cause of the abscesses as well as to be colonizing both the atopic dermatitis-affected areas as well as healthy skin tissue. With identical infections, one patient did have to have her abscess surgically drained while the other did not. This article, while small, does call attention to the possibility of pediatric patients with atopic dermatitis having a higher risk of staph aureus infection and abscess development due to higher rates of skin bacteria colonization. While the development of deep tissue infection such as abscess is rare for these patients with atopic dermatitis, it is still a complication that clinicians need to be aware of.
Peds Self Reflection: While on my Pediatric medicine rotation, I was exposed to medical care for not only children but for newborns as well. This was new for me as I have never seen how much has to go into a newborn well visit. The red reflex testing of the eyes in newborns was the most fascinating to me, congenital cataracts and retinoblastomas are screened for within a few days of birth. I found performing these newborn exams to be very difficult as I had several reservations about possibly being too rough with such small and fragile babies. I did learn quickly, though, that even babies as young as a few days old are fairly resilient and do just fine with being manipulated for a head-to-toe exam. I also found out just how difficult it can be to give vaccinations to a small child, and that they sometimes possess a strength that’s comically disproportionate to their size and age. At first, I was quite nervous to give a vaccine to a screaming 18-month-old, but I soon rallied and did what had to be done. I also found that many parents are still apprehensive about giving vaccines to their children. At least three well visits were spent explaining the need for vaccines to parents and discrediting the hearsay about how vaccines can cause autism. Numerous parents insisted that they wanted to space out the vaccines for their children as they had heard tall tales from friends and Facebook. Also, COVID-19 still being the ever-lingering black cloud over medicine currently, really became a topic of fear and anxiety for parents visiting with their children. Many parents who were there for well-child visits prior to starting school had questions for each of the providers regarding how to approach school given the current social climate post-COVID. Many parents were reluctant to send their children back to school because of fear of the virus, while others couldn’t wait to get them out of the house. As I discussed in my prior reflection for my Family Medicine rotation, COVID-19 truly colored my experience in my rotation differently from how I first expected. I think that this experience will continue to help me to become an adaptable and more well-rounded clinician in the future. Unprecedented times will definitely make for extraordinary PAs.
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