I had the opportunity to work in a dermatology clinic the other day. We saw a young patient presenting with scalp swelling. She had no hair loss but described a lot of scalp discomfort with occasional purulent discharge. On physical exam I saw something I had never seen before. Her entire scalp was boggy and tender. Notably she had a history as a child of a similar issue that doctors told them was due to mold. With no inkling as to a differential diagnosis I presented to my supervisor. I rested on first principles and simply described what I had seen. My supervisor was able to quickly identify the likelihood of this being a kerion, a fungal abscess. We prescribed the patient some oral antifungals and reassured her that this would most likely fully treat the condition. This experience taught me the value of solid fundamentals in physical exam skills and how to describe them. These allowed me to properly convey the salient information to my supervisor even though I didn't have a unifying diagnosis in mind at the time.
- MH
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