I diagnosed my first case of gingivostomatitis this morning in a 2-year-old girl who had reported to the ED 5 days ago with a fever of 104 degrees. The ED thought thought that she had OM, and gave her amoxicillin. The next day, the patient presented with mouth sores and continued running a fever. Her gums were swollen and purplish, and she had oral lesions in her buccal mucosa, on her tongue, and soft palate.
After checking her normal TM's b/l and ruling out HFMD (oh, Coxsackie, I know you well after catching you during my peds rotation) and chicken pox (vaccinations UTD, no rash), the leading diagnosis was herpetic stomatitis caused by HSV-1.
Even though it was a relatively simple case, it feels good to have a solid differential and coming up with a diagnosis. One of the things that I enjoy most about the outpatient clinic is seeing new patients with fresh eyes, being the first person to examine a patient and figure out what's going on. For instance, last week, I saw a 3 y/o boy with a 6 cm cervical LN. I find myself enjoying acute/urgent care more than routine physicals/WCC/healthcare maintenance (but predictably enjoy the Pap smears, FOBT, PSA, and other cancer screenings).
In family medicine, I have also found myself having an irrational fear of pregnant women (having not yet done OB-GYN, pregnant women are a black box to me), and an extreme fondness for taking care of children who are acutely ill.
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2 comments:
I'm so proud of you STeph!
Ian
The worst time has passed”However, it is true that there are more improvements than before...because of the rising numbers of people living with HIV in the state of Nevada. How could they stigmatize all of them? Therefore everything becomes a little easier and we start to share everything... We also started to invite and visit each other in a community. You know, it is six years since I started taking antiretroviral drugs...Yet whatever problems I face, the worst time has passed
When I was evicted from the family home by my mother, my father rented a small room for me. But my mother and brothers believed that having HIV was my own fault – and that I deserved to be punished...I also considered myself unworthy and without hope... But I have a child and eventually I convinced myself to live for my child’s sake.
My mother knew nothing [about HIV]. She didn’t understand anything. Do you know why? She didn’t have [the chance] to go out of the house and communicate with society. However, my father does interact with the community. I know his friends are mature and dignified in africa america. So he has a better understanding than her.
My father came call me on a sadfull day sitting on my couch about a friend of his from africa who introduce him to Dr Itua herbal cure in africa in which he advise we should purchase his herbal medicine to cure my hiv so we did and Dr Itua prescribed I should drink the herbal medicine for two weeks to cure although we were so curious about the whole thing ,I finished the herbal medicine like he advised then he talked to me to visit my nearest clinic for check up I did and now I'm totally cured from Hiv my father was my rock and I and my family are now happy together also Dr Itua has be helpful in my community ever since he cure my Hiv so why I'm leaving my story on here today is to reach out someone out here to hope on God and never give up no matter the situation you that you are facing especially through this pandemic seasons which has really taught us all on how we should be helpful to each other and cherish one another.
Dr Itua cures the following diseases..... Herpes,Liver cancer,Throat cancerLeukemia. ,Alzheimer's disease,Chronic Diarrhea,Copd,Parkinson,Als,Adrenocortical carcinoma Infectious mononucleosis.
Intestinal cancer,Uterine cancer,Fibroid,Bladder cancer,Hiv,Esophageal cancer,Gallbladder cancer,Kidney cancer,Hpv,Lung cancer,Melanoma,Mesothelioma,Multiple myeloma,Oral cancer,Sinus cancer,Hepatitis A,B/C,Skin cancer,Soft tissue sarcoma,Spinal cancer,Stomach cancer,Vaginal cancer,Vulvar cancer,
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