Apparently, today is one of two days during our preclinical years that we are taught by the dermatology department. In case you are somehow unfamiliar with the weird place that dermatology holds in the medical specialty hierarchy, the head of dermatology had this to say about training in that specialty: "Dermatology is very hard to get into, but your life is very easy after that." [everyone laughs], not at his message, but at his candor.
When you ask the average person what the most prestigious medical specialty is, you are likely to hear some impressive sounding area of medicine like neurosurgery. Dermatology is, in fact, the most competitive and highest paid specialty. Though poking at people's rashes and scraping away moles might not seem like the most desirable work, the lifestyle, hours, and pay have made it, far and away, the most hotly contested field to enter every year.
One of the weird flukes of this arrangement is that, though most would admit one doesn't need to be the top of one's class in med school to treat diseases of the skin, only the most intelligent and talented graduates become dermatologists. This trend was driven home again for me today in a small group session where my module was taught by the senior dermatology resident at our hospital. She was quite the imposing and intelligent instructor. Though only a few years older than us, she was easily an expert on today's topics and absentmindedly bossed around our normally high-and-mighty physician instructor.
TIL: Hemophiliacs are like summer squashes... Stick with me on this one. You know how each individual squash can look dramatically different in size, shape and color from one another regardless of the seed from which it grown? The way they can modify their appearance, even with the same DNA is through epigenetics. Epigenetics is the suppression or augmentation of genetic information through processes like methylation and X-inactivation. This is the same mechanism that diseases like hemophilia use to present with completely different symptoms and severity between directly related family members.
IT'S NEVER LUPUS (at least on House MD)! Ever wonder why lupus is always in the differential diagnosis for the patients on House, even though it almost comedically was never actually lupus causing the symptoms? The reason for this is that lupus has very broad, variable diagnostic criteria. It only requires 4 of the following 11 symptoms to diagnose lupus, often remembered by the mnemonic
DOPAMINE RASH:
Discoid rash
Oral ulcer
Photosensitivity
Arthritis
Malar rash
Immunologic criterias
Neurological symptoms-(lupus cerebritis)
Elevated ESR
Renal disease
ANA+ve
Serositis
Hematological abnormality
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