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.