Imagine: you are the single provider manning a rural clinic in Northern Tanzania along the shore of Lake Victoria. You are one of only a handful of physicians in the entire region and you have minimal access to diagnostics or therapeutics. Your clinic does not have any power. Your diagnostics include: urinalysis, urine pregnancy, CBC and rapid tests for HIV, syphilis, and malaria. You have 2 nurses, one of whom acts as a translator (from Swahili to English). You are armed primarily with your intellect, knowledge of local disease processes, and your keen sense of intuition.
32 yo M PMH HIV p/w LLE >RLE swelling & pain x 1 year. Recent HIV+ and recently started ARVs. CD4=40. Pt denies trauma. No history of DM or CHF. No fevers, chills, N/V, abd pain, diarrhea.
PE: 37CHR-86BP-124/82RR-12Read More