April 15, 2008

  • Hmm...that's weird

    So first and foremost, allow me to congratulate waterfallphilosophies, who despite reading my plethora of ob/gyn posts, decided to go ahead and have a baby anyway. He is adorable, and you should go here to see him, and I am going to harass both of them mercilessly when i go to california in the summer.

    Next, some really interesting pathology today in peds clinic. Perhaps the most interesting thing to me was that most of the pathology I saw was as a result of incidental findings

    Example 1: Cute little baby Rodolfo has been constipated for a couple days along with a fever, and mom brought him in to make sure he was alright. Fairly standard case of acute viral gastroenteritis, aka tummy bug. So I start doing a full physical because 1)hey, why not and 2) I am supposed to do a full physical in this type of setting.

    While sifting through his curly hair to check fontanelles, i look down and lo and behold, he has a hemangioma on his head
    The image “http://www.sickkids.ca/craniofacial/images/conditions/hemangioma1b.jpg” cannot be displayed, because it contains errors.

    Of course the pic above is not him , as his was more centrally located and not quite as large. This is a strawberry hemangioma (thanks, google image search!) and should give you a rough idea of the color and size. It is a benign tumor and he had had it since birth, but hey, its still good to know  about. As Dr Zaret says, the eyes can't see what the mind doesnt know.

    Example 2: Pixie like toddler girl sarai was here for a follow up appointment for a mild case of bronchiolitis. No new diagnoses needed to be made, she was basically here to confirm that her illness was resolving which it was. But after taking a fairly simple history, i decided to do a focused physical and just check the heart and lungs since she had no other symptoms in other organ systems.When lifting up her shirt to listen to her lungs, i noticed two moderately sized black/blue spots on her back. Which instantly screams "abuse!"...

    Example of Mongolian Spot

    If you dont know about mongolian spots, that is. These are basically birthmarks, or "stork bites" that represent a concentration of melanocytes and is totally benign. But had i just listened through the shirt, i would never have seen them. You cant see what you dont look for. Maybe there IS something to that complete physical exam thing the attendings keep harping on about ;-P

    Example 3: The attending leans out the doorway and yells, "hey students come here" in a heavy indian accent. I walk in the doorway and he asks me, "look at this baby...normal or abnormal?" I respond abnormal. "Why?" he follows up. And I dont quite know, but the baby doesnt look right. Not the classic features of downs, and a fairly chubby baby, but on first glance, something was simply not quite right. Then the attending lifts the baby up, and the baby cant support the weight of his own head as it lolls back like a rag doll. This is NOT a normal finding. He puts the baby down and NOW i notice the baby has its fists tightly balled up and they have been so since i entered the room, highly unusal. The baby was clearly hypotonic. But once the attending demonstrated ankle clonus, the diagnoses narrowed significantly. "Cerebral Palsy" he said. "Is that what he's here for?" I ask, amazed to have seen the condition diagnosed firsthand. "Oh no, we knew that already, he is here for a cold."

    The physical exam is like a game of hide and seek, or detective work. You have to do each part the same and do it every time, because you never know what you might find, even incidentally.

    And now for something completely different:
    THANK
    YOU FOR CONVERTING TO THE DARK SIDE. DRIVE THROUGH AND PICK UP YOUR
    COMPLIMENTARY COOKIES-N'-EVIL-OVERLORD-LIST GIFT BASKET AT THE WINDOW!

    REMEMBER TO CLEAR YOUR SCHEDULE FOR THE "IT'S A VILLIANOUS WORLD"
    CONFERENCE NEXT MONTH. TOPICS INCLUDE: "SHOULD SUPERVILLIANS GO
    GREEN?", "EVIL OVERLORDS FOR THE NEXT GENERATION: HOW TO EDUCATE ONE'S
    OFFSPRING IN THE WAYS OF DARKNESS WITHOUT PUSHING TOO HARD(AND
    PREVENTING INCONVENIENT AND EMBARRASSING 'SUDDEN, INEVITABLE
    BETRAYALS')" AND "MAD SCIENTIST PARENTS: WHEN THE EXPERIMENT GOES
    WRONG. HOW DO YOU COPE WHEN YOUR KID'S IS MORE OF A FREAK THAN USUAL?".

    BYE!

    Posted by elven pirate lady over on LJ. Reposted here because I find the idea of supervillian business conferences funny.

Comments (4)

  • Nice post.

  • Hey thanks for the congratulations!  It may be me who will harrass you this summer with endless questions on raising a baby, etc.  Either that or I'll see you in the roda!!

    My baby has mongolian spots on his butt too, hahaha.  Do they go away? 

  • As always, the pictures really drive the point home. I think that's the idiomatic expression. Man, the things you see everyday. What's with the baby in the last picture?
    I was reviewing my blog and you have changed profile pics. quite a bit. Hahahaha.

  • More parents should Mongolian spots on their kids' behinds.

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