Pulm: Interesting patients

After morning report (7:30 a.m.!), everyone went to clinic. I had nothing to do (Dr. JS hadn't shown up yet) when Danny came over and said that Dr. V, the ID doc, had an interesting case for med students to see. So I went to the room and Dr. V asked the patient to hold out his hands. Both palms were covered with a diffuse rash that the patient said was non-painful, and Dr. V said, "He also has them on the soles of his feet." Well, if that wasn't a huge giveaway of what this patient had I don't know what it was. When I left the room, Danny asked me what I thought it was, and I said, "Secondary syphilis." "Really?" he asked; he hadn't seen secondary syphilis before, whereas I saw a case of it at JPS. When Dr. V came out of the room, we discussed potential differentials, including erythema multiforme. "What's a common cause of erythema multiforme?" he asked, and we said drug reactions. "Which drug is most common?" was the next question. Danny didn't know, but I remembered it was Bactrim, which the patient was taking b/c he had advanced HIV. But...the localized rash to the palms and soles was very characteristic of secondary syphilis. The patient, however, had a negative RPR. "Why is that?" asked Dr. V. I thought the answer was obvious; he had HIV so his immune system never had antibodies against the syphilis. At any rate it was good learning experience and teaching case.

I had some pretty interesting patients in the clinic today. One man (his wife was the patient, who had an elevated left hemidiaphragm after her phrenic nerve was injured during open heart surgery; both were in their late 80s/early 90s) was wearing an interesting yet beautiful pair of boots, and someone asked him what they were made of. "Ostrich," he said proudly. Another patient asked if he could get his sleep study done before next month because after that, "I'm gonna go kill me a bear." Dr. JS asked where he was going to go shoot a bear, and he said, "Montana." I asked if he was planning to eat the bear or skin it when he was done with it, and he said if he got a bear he was going to have it made into a rug. =( I'm glad I'm not a bear in Montana.

Lisa and I went to the gym this evening and did an aerobics class. See, we are working out! =P