What are Grand Rounds?
In the late 19th century, Sir William Osler, the father of modern medicine, one of the founders of Johns Hopkins Medical School, and John Hopkins’ first professor of medicine, introduced an innovative physician-to-physician teaching forum to disseminate cutting-edge medical knowledge at the bedside. This became known as grand rounds.
During grand rounds a patient’s problem is presented to medical students, residents, interns, attending physician and other staff. The goal is to teach by using the patient’s presenting problem as a vehicle to learn patient management at the bedside.
Paediatric Patient Presents with Mother Following Bike Accident
Rebekah is a friendly, six-year-old girl, who presents to the emergency department at Northwestern Memorial Hospital in Chicago with her mother. The mother describes how Rebekah fell off her bike the week before and had many grazed areas, including one on her chin. All the areas had healed well except for the one on her chin, which was still weeping and appeared to be getting larger. The mother also expressed a concern about a similar patch Rebekah had since developed on her finger.
All areas of concern were assessed and appeared satisfactory except for the facial one and the one on her finger. The areas were red and inflamed and contained many small, fluid filled vesicles. One small patch on her chin had formed a honey-colored crusted area but the majority of the lesions were blistered or weeping. Social history reveals that Rebekah attends school, and that several of her classmates have had similar lesions on their hands and mouth. Rebekah said that she felt fine, although her mother reported that she was more lethargic than usual. She was afebrile and appeared clinically well.
What’s the Diagnosis?
What is the most likely diagnosis, how would you treat it, and should the patient be excluded from school?
UHSA students, if you know the answer, please contact Dr Mangum via email for extra-credit on an upcoming quiz or examination.
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