Two drops of mercury...

[Paul D]

Common things present uncommonly more often than uncommon things.

Unless you are studying for boards. Then it is ignore horse, consider zebra, rule out unicorn.

Maybe for path, but in cardiology it's usually atherosclerotic vascular disease, valvular disease or AFib. Don't get me wrong, I do think about zebras and unicorns. Think. In this day and age, I try to get a good history and go over available tests before I start burning through their copays and deductible. The weirdest/rarest cases that I've diagnosed was Whipple's disease with endocarditis in a 84 year old man (only 30 cases per year) and a guy who had both Hantavirus and a endocarditis from a bug that is indigenous only to Tahiti. He told me he cleaned out debris under his New Mexico cabin (including droppings) and he flew shortly after that to Tahiti for vacation. He returned to AZ after he started to have severe cough, fever and dyspnea. He died quickly after diagnosis unfortunately.

[Dr_Thanatos]

Maybe for path, but in cardiology it's usually atherosclerotic vascular disease, valvular disease or AFib. Don't get me wrong, I do think about zebras and unicorns. Think. In this day and age, I try to get a good history and go over available tests before I start burning through their copays and deductible. The weirdest/rarest cases that I've diagnosed was Whipple's disease with endocarditis in a 84 year old man (only 30 cases per year) and a guy who had both Hantavirus and a endocarditis from a bug that is indigenous only to Tahiti. He told me he cleaned out debris under his New Mexico cabin (including droppings) and he flew shortly after that to Tahiti for vacation. He returned to AZ after he started to have severe cough, fever and dyspnea. He died quickly after diagnosis unfortunately.

Cool case.

Pathology is a little bit weird with respect to it's board exam. We have a two day written test, one day for anatomic pathology (surgical pathology, cytology, renal pathology, neuropathology, Electron microscopy, Maybe one forensics question), one day for clinical pathology (Blood banking, hematology, microbiology, molecular, lab management, clinical chemistry, etc). The ABP's attitude is that you should know every possible detail about every possible disease and so there is no way they are going to show a common case. Hence, ignore horse, consider zebras and rule out unicorns. But that's only for boards. It really gets ridiculous. The reason pathologists are a running joke about know everything, is because it's on our test.

The rest of the career is spend on common things. Shockingly, in forensics, I also spend 50+% of my time on atherosclerotic cardiovascular disease, hypertensive heart disease, a good spattering of diabetes, chronic alcohol abuse and pulmonary thromboemboli. The other half of cases are drug overdoses, suicides, car wrecks and homicides. The fun cases are the zebras.

[Nephrology]

My most memorable zebra was catching pyoderma gangrenosum as a MS2. It was all downhill from there.

Speaking of zebras, I will probably never forgive the NBME for making me learn all those inborn errors of metabolism.