WILTIMS #390-4: Family Med catch-up Part 3

Ugh. It had been five years since I'd last been home for Thanksgiving, and now I remember why. A four day weekend is really short to fly round-trip clear across the country. A combined 27 hours of travel later, I had a great time but I need a vacation from my vacation.

Upon my return (about three hours after my red-eye flight's arrival), I was rewarded with a full day of didactics and a mock clinical exam. The latter consisted of a 15 minute session apologizing to a mock patient for the seizure you caused by your mock ineptitude, followed by writing a fake prescription, followed by a 15 minute visit for the world's most confusing case of dizziness, followed by 10 minutes to write a post-visit note. I did so well... up until the note. Apparently all these blogs have not, in fact, made me fast at typing.

LastMondayIL: Sometimes the diseases we've studied most can manifest underwhelmingly in actual patients. Last Monday we had a woman with Turner syndrome (only having one X chromosome (and no Y either (insert jokes about being male here))) come in. While refreshing my memory of the many, many possible effects of this genetic disease, I realized that the majority of them are A) pathologic and B) internal. The only outward signs when these patients are healthy are short stature, broad chest, webbed neck, and slightly rotated ears. And not all of these even have to be present.

I guess that's part of the trick of medicine though; you have to be able to spot a condition by a few seemingly benign signs, and know to connect them with the dangerous occult complications that might be brewing unseen.

LastTuesdayIL: Enthesopathy is pain at the insertion site of a tendon on a bone.

LastWednesdayIL: ...that I should always speak up about my concerns in the clinical setting. We had a patient that had pretty severe stomach pain. My preceptor was not super concerned and was about to send the patient home on medication for simple gastritis. After we left the room, I flagged her down and asked what she thought about a more severe part of my differential diagnosis: peritonitis. We quickly went over the fors and againsts for that diagnosis and decided to go back and take another look at the patient.

After our continued pokes and prods, the doctor still didn't think we should send him straight to the ER, but agreed that if the pain didn't get better or got worse by morning that he should just head straight to the hospital. Today we found out that he did head to the hospital with probable pancreatitis (diagnosed from labs we drew while he was at our clinic). I knew something serious was going on!

YesterdayIL: Don't ask a parent if their sick toddler is eating well; ask if they are drinking. Parents always have some anxiety about their child's eating habits, but every kid drinks, even when mildly sick. If the kid won't drink, something serious is going on.

TIL (yay! all caught up!): ...how to irrigate cerumen (earwax) out of an ear. Essentially, you squirt lukewarm water in the ear until the earwax either comes out on its own or loosens enough to be removed by hand with a stick (a sterile plastic stick with a tiny loop at the end, not a small tree branch we found on the sidewalk). The old fashioned way is to add a tip to a small syringe, but they also make fancy machines (as seen on the right) that can hold more water and dispense it at a constant, safe pressure.