January 20, 2013

Week 1: Tdap, PPDs, and STI screening/_Counseling Needed!

We had an awesome urology team from FL and NJ, some stellar RN students from UCSD and a wonderful cardiologist+sonographer team who were volunteering at the hospital with us this past week.

I was stationed mainly in the outpatient clinic which was more like a walk-in urgent care day, but there were a surprising number of patients who came in for med refills for hypertension or mild acute complaints.  There was also some urgent/emergent care, wound care and urology mixed in-between clinic sessions.  Many of the wounds that I helped some of the nurses with were from motorcycle accidents and we opined the lack of resources for routine Tdap prophylaxis after routine injuries.  Children are vaccinated nowadays, but some of the adults have developed mortal cases of tetanus.

Here are some of the cases that I was involved in during my first week.

Dilated Cardiomyopathy CHF with severe mitral regurgitation (mimicking as "asthma")
Active Pulmonary TB (pretty much all the PPDs I ordered for suspicion of TB were 20mm in size or greater)

Testicular mass - massive hydroceles due to chronic filiriasis
Lymphatic filiariasis (Elephantiasis) of the legs
Tetanus -- mild and severe manifestations (with neck stiffness and muscle spasms vs risus sardonicus and trismus/lockjaw)
Spinal compression fracture with cord compression due to Pott's disease with subsequent spasm and paralysis of the lower limbs

Tinea versicolor
Acne keloidalis nuchae
Full thickness circumferential burn injuries

H. Pylori (80-90% prevalence in Haiti, apparently!)

Severe anemia (Hgb drop from 7 to 4.7 in two days!) due to leiomyomata of the uterus (negative pregnancy test but had a 20 week size uterus!)
8x8cm Breast mass -- likely due to phyllodes tumor in adolescent, hopefully it turns out to be fibroadenoma

Penile reconstruction s/p explosive trauma (a bovie explosion during an elective circumcision)
Emergent secondary pseudophimosis due to a young boy slipping a metal washer around his glans (with acute swelling!)

Our evenings were filled with case presentations on some of the more interesting and pertinent primary care topics.
I didn't get to do much pediatrics, ED care or HIV/infectious disease, but I still have a few weeks to go!  There are still a few residual cases of cholera and I'm glad that my stools have held firm thus far.

And on that pleasant note, I'll be signing off!

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