Textbook Diagnosis

It's in the books. There is something fascinating when you actually get to see a "textbook" case in the clinic. Before medical school, I would have thought disease states followed some text written description or at least would present as we are taught. They don't and that is what makes medicine a "practice". Diseases don't do a whole lot of reading in their spare time.

Learning from the Patient

Earlier this month, a young child was brought to the clinic with decreased appetite and oral sores that the mother had noticed for a couple days. My initial exam suggested this was more than oral ulcers. Thinking back to the diseases with oral lesions I was excited to look for more skin changes on other parts of the child's body. One small vesicle on the palm and one on the foot confirmed my suspicion of hand, foot, mouth disease (HFMD). It was exciting to see what the books had described, albeit a mild case. On follow-up examination days later, I reached for the child's hands to see what changes could be seen, there were none. Mimicking my examination, the child's sibling did a self-exam and quickly realized he too was affected. Once a family supporter and now a patient, the sibling actually had a worse case of HFMD that would have gone undiagnosed if he wasn't present.

In a sense, the diagnosis was rewarding knowing that somewhere in my mind was stored the details to help my patient. With the vast amounts of knowledge we are expected to retain and the impossibility of doing so, I am willing to celebrate the small successes. Seeing textbook cases helps confirm my understanding of the many documented pathologies we are expected to understand. Written details are reinforced by touching, seeing and hearing the real thing in person. At least I am making progress in the right direction...and washing my hands a lot more frequently.

Question of the Week

A parent brings in their 4 year old child with what appears to be hand, foot and mouth disease. You know this is commonly associated with the Coxsackie A virus and want the parents to be aware of possible complications that may arise including which of the following?

A. Encephalitis
B. Renal Failure
C. Cardiac arrhythmias
D. Myalgias
E. Vision impairment

Answer & Explanations