Sunday, April 22, 2012

Chasing Zebras

This week I became fascinated again with the basic sciences, this time through physics and chemistry. The department had a Wood's lamp easily accessible and I had a urine specimen readied for testing. A patient with dermatological manifestations of a diseased state presented and according to my research, this simple bedside test would demonstrate fluorescence if positive. Shown here is my wishful attempt at something out of the ordinary, which to my dismay was negative.

Trial by Experimentation

Sometimes going out on a limb to explore a part of the differential can be illuminating to the disease process. In this case, it was more educative. Should I have a patient in the future with similar symptoms, this test will more likely come to mind than having to research it. After discussing the out-of-the-ordinary, potential diagnosis with my attending, he encouraged my investigation rather than laugh me to scorn. They told me that medical students, even in their limited knowledge can actually have a significant contribution to the patient's care. Even though we may come up with a "zebra" or two, if we didn't consider them as part of the diagnosis perhaps nobody would.

For those not familiar with the term zebra, although they appear similar and may even audibly sound similar, it is more common to come across a horse than a zebra. In medicine we use this idea to relate to diseases wherein the common things are common. We look for the obvious and common problems while considering that there may be a zebra in front of us. If we don't look for the zebras, then we will effectively miss them and erroneously treat the "horse" disease states, thus leaving the patient inadequately treated.

This little exercise was a reminder to me of how many varied sciences are included in the art of medicine. The fact that many professionals with educated backgrounds come together adding their piece of the puzzle to bring understanding to the whole picture. Whether a bioscientist, chemist, physicist, or technologist it is a team effort in creating the best outcome for a patient. On this particular day, I got to venture a little off the beaten path and was enlightened by my exploration.

Question of the Week
A 57 year old homeless male presents after a night of alcoholic binge drinking complaining of new blisters forming on his forearms. You notice that his skin appears tanned and consider the diagnosis of Porphyria Cutanea Tarda. The uroporphyrins in his urine sample appear to fluoresce under the Wood's lamp. What other finding would you expect to see in this patient?

A. Hypertrichosis
B. Melena
C. Telangectasias
D. Nail pitting
E. Cotton-wool spots

Answer & Explanation

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