A Couple Zebras.

"We look for horses not zebras." "Common things occur commonly." yeah yeah, we've heard it before. But, my friends, sometimes zebras do happen. Even in Family Med.

1. Mastoiditis: YAYYYY, how many test questions have we seen about this?! My exam master is obsessed with this question I swear. Well, I finally saw it. This poor lady presented to the ER with ear pain that felt like "I was being stabbed in the ear with a hot poker." Whoever saw her in the ER, looked in her ear, said it was red, told her she had TMJ and sent her home with pain meds.... Boo. Fast forward 24 hours and we see her. Her ear was not "red" it was flaming on fire with smoke rolling out of it. Yes, I'm dramatic but you get it. I have never seen an ear look like this. Holy cow. She was exquisitely tender in the mastoid process and in terrible pain. Doc was pretty certain she had progressed from otitis media to mastoiditis. Tx: Augmentin 875mg BID X 10 days.

2. Colon CA: Okay, this doesn't sound like a zebra, but when it shows up at an urgent care visit as epigastric pain it seems pretty unlikely. This lady was in her 50s and presented with epigastric pain x 4ish days which was getting worse. No N/V/D. No weight loss. No melena. But I just didn't feel right about it. Had a "feeling" something was wrong. She was in real pain and you could tell she wasn't being dramatic. Tried to tell me it was from a bad Arby's sandwhich because her husband had one too and he didn't feel well. But that had been days ago and she had no GI upset symptoms, just pain. Also, brother died of pancreatic CA in his 50s. So, we didn't know exactly what to do, but ordered stool culture work/up just in case she did have some type of infectious thing from bad food (knew it was unlikely but just needed to do something) and a CBC to see if she had signs of an infection. Her hemoglobin was 6.7. She was then directed to the ER who did a complete work up, gave her a blood transfusion, and the tumor was found on CT. She was admitted for surgery during the same stay. What a whirlwind for that patient...come to urgent care with stomach ache, end up at hospital getting a biopsy and scheduled for bowel resection. :( I keep thinking of her and hope she is recovering well.