List things that were taught repeatedly, but will never see

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yaah said:
CJD is often diagnosed by brain biopsy on the living.
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Often, really? Seems like a waste of resources unless there are other treatable forms of rapidly progressive dementia that you want to rule out.
 
That's what his doctor told me. When I was telling the doctor when I was explaining something he said "well that's what happens with patients with Creutzfeldt(sp?)-Jacob disease". That's also what his family told me on my first day there. I don't know which type he has if it's vCJD or the spontaneous type. I heard that vCJD is the type that's more rare and that's normally diagnosed by autopsy because the patient dies quickly and since he's been living for longer than the doctor thought he would it's most likely the spontaneous type.
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Ashers said:
Hehehe. Nice.


Anyone seen tularemia?
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If you do a rotation on one of the Cape Cod hospitals you'll see it. Apparently there are swarms of rabbits carrying tularemia there.
 
Doctor J said:
The Baghdad Boils, as I recall.

Another item that's been taught repeatedly but I will most likely never see... Encephalitis from Naegleria fowleri.

At least I hope I never see it. :cry:
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One of our profs visited a pond in New Hampshire with a large warning sign saying no swimming, Naegleria infestation. You can bet they didn't swim.
 
Encephalitis from Naegleria fowleri
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Apparently there were 6 cases last year, so it's not impossible. One of them was actually not that far away from me. Got the whole media panic "Is your child safe swimming? More at 11"

Charcot-Marie Tooth
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Saw it on a patient on surgery who had it listed under family history. Her legs were jacked up, definitely. I told the surgeon about it who promply stated "What the hell is Charcot Marie Tooth?"


Osler-Weber Rendu
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Never seen, but apparently there's a high concentration in Utah (Mormon founder effect I think).
 
Saw Pentalogy of Cantrell on OB/GYN rotation
Moyamoya on Peds as well

I think those are the rarest things I've seen so far.

I haven't seen a case of Raynaud's phenomenon yet.
 
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ranmyaku said:
I haven't seen a case of Raynaud's phenomenon yet.
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Really? A lot of my class has seen Raynaud's because I've got it, and any time I'm cold, my fingers change colors (my toes change colors/go numb first, but most people don't see that). I think I know about 15 people with Raynaud's but maybe since I go to school in WI (and family history -- my sister's got it too), and I didn't know I had it until I moved there. It made it so I didn't have to hold an ice packed heart during CABGs. =) It's also a ginormous reason why I want to go somewhere warm again for residency.

I saw one of my dad's patients when I was shadowing him with Charcot-Marie-Tooth. Never saw it in med school.

On neuro I saw some weird thing called Rasmussen's Syndrome. Never learned about it in class.

Edit: I think most cases of Raynaud's aren't diagnosed in a clinic by seeing them. The patient describes what happens, and then gets the diagnosis. It'd be really mean to put the patient's hand in ice water, which is one reason it's not that common to see. In the hospital, they try to keep most patients warm, so it's probably not that common to just see either.
 
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Ashers said:
Really? A lot of my class has seen Raynaud's because I've got it, and any time I'm cold, my fingers change colors (my toes change colors/go numb first, but most people don't see that). I think I know about 15 people with Raynaud's but maybe since I go to school in WI (and family history -- my sister's got it too), and I didn't know I had it until I moved there. It made it so I didn't have to hold an ice packed heart during CABGs. =) It's also a ginormous reason why I want to go somewhere warm again for residency.

I saw one of my dad's patients when I was shadowing him with Charcot-Marie-Tooth. Never saw it in med school.

On neuro I saw some weird thing called Rasmussen's Syndrome. Never learned about it in class.

Edit: I think most cases of Raynaud's aren't diagnosed in a clinic by seeing them. The patient describes what happens, and then gets the diagnosis. It'd be really mean to put the patient's hand in ice water, which is one reason it's not that common to see. In the hospital, they try to keep most patients warm, so it's probably not that common to just see either.
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Cool..😎
 
Sjögren's anyone?

I saw a male case last year.
 
Why would you expect to see it at a CF clinic? Kartagener's and CF have some similar symptoms, but completely different pathophys.
 
ZagDoc said:
Anyone ever seen Lesch-Nyhan Syndrome? The NIH doc that gave our lecture on metabolic disorders said he had seen several cases, but then again he's knee deep in the field and our school is the referral for all metabolic disorders for the whole state.

That one always stood out to me because of the self-mutilation behavioral aspect of it.



Saw diphtheria in the peds ER. Kid presented with the classic "grey" mucosa of the posterior pharnx and a nice swollen neck.
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I've seen one guy with Lesch-Nyhan. His hands were bound up with gauze and Mitts to prevent self mutliation. The cool thing about radiology is that we often see the radiologic manifestations of diseases I never thought I would see.
 
I've seen Osler-Weber-Rondo! The pt was on my medicine team...she multiple AVMs and heart failure.

Other weird stuff I've seen....3 cases of malaria, a patient w/ typhoid, 2 w/ hirschprungs, tuleremia, and patau's syndrome, all thanks to being at a school with a large children's hospital.
 
Blondbondgirl said:
situs freakin' inversus
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girl in our class with it... talked about it during orientation during 1st year, and how she was denied entrance into the army (if i remember correctly)
 
Just in general- like as a DD for right axis deviation in an EKG, or as a rare DD for "appendicitis-like symptoms" in a young person in the LLQ (as diverticulitis is unlikely).

Denied entrance to the army? 😕 wierd.

Anyway, I haven't seen it yet! 😉
 
Blondbondgirl said:
situs freakin' inversus
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Saw it on Ob/Gyn. I was taking a history from a woman in labor and I asked about prior surgeries. She points to her left side and says, "I had my gallbladder out a few years ago."
 
Blade28 said:
We see this in Peds Surg all the time - at least 1-2 inpatients every month, and at least a couple a week in clinic.
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My 6month old niece was just diagnosed with Hirschsprung's. It's pretty crazy because she had no symptoms until her 6th month. The docs said they have never seen a fecal impaction so large in an infant (it was the size of a baseball). Anyway, they are going to try to do a resection without a colostomy but does that really happen often? Apparently the ganglion did develop in some of the colon, but it just seems that doing a reattachment would be tough after her colon has been through such trama due to overstretching.

My question: How often is this seen outside of Down's Syndrome? My niece has not been diagnosed with downs but she is behind developmentally and the question has crossed my mind. Wouldn't the doctors have mentioned it if they thought it was a possibility?
 
JohnnieBlue said:
Saw it on Ob/Gyn. I was taking a history from a woman in labor and I asked about prior surgeries. She points to her left side and says, "I had my gallbladder out a few years ago."
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Seen it twice. One appy, and one newborn with a host of other issues.
 
I once saw a vague abdominal pain that did not get a pelvic, a CT, an ultrasound, every lab known to man and was sent home with instructions to return in 12 hours if the symptoms did not resolve.

Top that, biaches.
 
Panda Bear said:
I once saw a vague abdominal pain that did not get a pelvic, a CT, an ultrasound, every lab known to man and was sent home with instructions to return in 12 hours if the symptoms did not resolve.

Top that, biaches.
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no rectal or vaginal exam? I know an attending that would shart.
 
Good Yeast said:
Whipple disease.

There are like 1000 cases in the last 100 years. Most doctors don't ever see one in their careers.

Small Pox

Last confirmed case was in the 1970s.
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However, often, cases aren't reported after they're recognized. I have a quadcuspid aortic valve (it's very pretty on echo - just like a diamond), and I told my cardiologist about less than 200 diagnosed cases, and he said that no one reports it anymore, because it's straightforward and options haven't changed.

As for smallpox, there are still several poxes running around in central Africa, and look like variola (but are caused by another pox virus). Monkeypox and tanapox (named after the Tana river in Kenya), although they're all orthomyxoviridae, so others in the same family have the chance to do the same thing.
 
da me ka don said:
Grew up in Nigeria. My Brother even had it. He was born in the 90s. Well, I guess it's kinda stupid why people still have small pox and chicken pox. I got chicken pox😎
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Your brother that was born in the 1990s had a case of small pox? A disease that has not been seen since 1978? I am going to have to call BS on this one.
 
Blondbondgirl said:
situs freakin' inversus
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Twice. One of our cadavers in anatomy lab had it (surprise! cool to look at, but difficult for that team to learn correct anatomy) and then a patient on one of our ward teams also had it.
 
Wasn't in school, but had a friend die from Hantavirus (aka Sin nombre). Lungs filled with fluid and died in CCU. Too bad.
 
Ah, point taken.
 
African iron overload (secondary to large amounts of traditional beer brewed in steel drums)
 
I did see a scurvy a couple weeks ago in an alcoholic. Chief complaint was extensive ecchymosis in both legs. Bleeding gums, petechiae, everything but the eye patch.
 
yaah said:
I think that's present in close to 1% of the population. Not exactly rare.
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Or a lot more, if you listen to the Italians.

Still, I have yet to see anyone with the diagnosis.
 
There are a surprising number of patients with Osler-Weber Rendu here at Penn, although it tends to get referred to as HHT since we don't like those crazy named diseases anymore, apparently. 🙄

edit for celiac disease: what? dude walk into the GI clinic and you'll see like fifty people with CD. heck, i have two professors that have it.
 
IHeartNerds said:
There are a surprising number of patients with Osler-Weber Rendu here at Penn, although it tends to get referred to as HHT since we don't like those crazy named diseases anymore, apparently. 🙄

edit for celiac disease: what? dude walk into the GI clinic and you'll see like fifty people with CD. heck, i have two professors that have it.
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Thx..

1) I think the new claim maybe that the prevalence of Celiac Disease is more common then they thought..
[ dermatitis herpetiformis, blunted villi, crypt hyperplasia, lymphocyte infiltration, antigliaden & antiendomysial antibodies]

2) As far as Oslers disease I assume it has nothing to do with Osler himself (near turn of the century) being {President of U. of Penn} at one time??? [strong family hx, AV malformation, bleed, "scratch and bleed"]

😉
 
diosa428 said:
Twice. One of our cadavers in anatomy lab had it (surprise! cool to look at, but difficult for that team to learn correct anatomy) and then a patient on one of our ward teams also had it.
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ugh, I'd be pissed if they expected me to learn anatomy on a situs inversus.
 
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