Sunday, January 28, 2007

Cupcakes and a good common sense differential

I recently made a batch of mini cupcakes for the Sunday school class that Leonard and I teach. I have been learning cake decorating and recently moved into the realm of cupcakes. On this day, with these cupcakes, I came pretty close to achieving perfection.

Leonardism: At school we have been learning POPEs, which stands for Problem Oriented Physical Exam. Our instructor will have us read a case presentation, we will discuss what we think could be causing the problems (the differential diagnosis), and then one of the students demonstrates the physical exam that would correspond with the differential. During a recent class, we received the following case presentation:

Raymond is a 32-year-old homeless man with a history of intravenous heroin use who was well until yesterday when he began feeling feverish and having chills. He notes accompanying fatigue and feels achy all over, especially in his knees and hips. He also complains of an aching sensation over the sternal area of his chest, and feels slightly short of breath when he exerts himself. He denies sharing needles and had a negative HIV test six months ago. Past medical histry includes alcohol abuse, a 30 pack year history of smoking and multiple abscesses at injection sites over the past 5 years.

At this point, everyone started to shout out the differential: Endocarditis, Myocarditis, Rheumatic Fever, Influenza, Sepsis, Pneumonia, Primary HIV infection. Our instructor wrote these on the board, and then said "Is there anything else?" No one could think of anything, but she continued probing, as though the answer was right in front of our faces. Finally, Leonard broke the silence. "Maybe he ate some bad garbage!" Yes Leonard, odds are, Raymond probably did eat some bad garbage.