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.

Case #5

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-12