{"id":9565,"date":"2020-02-25T12:21:51","date_gmt":"2020-02-25T17:21:51","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9565"},"modified":"2020-02-25T15:55:55","modified_gmt":"2020-02-25T20:55:55","slug":"first-week-on-service-with-one-a-day-id-learning-units","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/first-week-on-service-with-one-a-day-id-learning-units\/2020\/02\/25\/","title":{"rendered":"First Week on Service, with One-a-Day ID Learning Units"},"content":{"rendered":"

\"\"<\/a>There is almost always something<\/em> to be learned from every new patient.<\/p>\n

It might be buried somewhere in the history, or the physical, or the lab tests, or the micro, or the imaging — but the odds are excellent that, with enough rumination, you’ll find it.<\/p>\n

I can’t remember now who taught me this important fact, or even if it was ever explicitly stated to me. Quite possibly it was just implied — or personified in action — by some really smart, impressive clinical mentor. Someone skilled in finding that nugget of learning in every case.<\/p>\n

It might have been my legendary residency program director<\/a>; or the World’s Greatest Chief Medical Resident<\/a> (I’m still missing her, sadly); or the brilliant Chief of ID during my fellowship<\/a>; or the most intuitive ID clinician on the planet<\/a>.<\/p>\n

(FYI, that last guy remains an invaluable resource on tough cases.)<\/p>\n

Regardless, these ID Learning Units are out there. And here are seven — one-a-day — from my first week on the inpatient ID consult service:<\/p>\n

1. Cystic neutrophilic granulomatous mastitis. You’ll have an “a-ha” moment the first time you see this strange and challenging entity.<\/p>\n

\n

Day #1: Cystic neutrophilic granulomatous mastitis (CNGM) is a chronic inflammatory process, associated with corynebacterium spp. (Causal?) Optimal management remains unclear–generally involves combination of abx and corticosteroids. @Yijia_89 https:\/\/t.co\/RjeerNHSb6<\/a><\/p>\n

— Paul Sax (@PaulSaxMD) February 19, 2020<\/a><\/p><\/blockquote>\n