A patient can’t swallow. These nails tell you why.

A patient can’t swallow. These nails tell you why.

A middle aged woman presents with difficulty swallowing. She has a history of  menometrorrhagia for 10 years, secondary to uterine fibroids. She endorses fatigue and shortness of breath. What’s the cause of her dysphagia and why? Answer: Esophageal webs in the setting of iron deficiency anemia. This is seen in Plummer-Vinson syndrome. This syndrome usually has: dysphagia

What Is The Specific Cause of This Patient’s Clubbing?

Figure 1. Obvious clubbing in patients toes. Note the relative severity in the toes compared to the hands. From (1) with permission. The causes of clubbing are a favourite bedside question on rounds. They can be divided into: Pulmonary (commonest – think neoplasm until proven otherwise). Bronchial carcinoma Mesothelioma Bronchiectasis Cystic fibrosis Interstitial fibrosis Cardiac

Tripe Palms

A patient’s hands may reveal much about them. Fingers, nails and palms can all tell their own stories of habits, occupations or disease. The right hand of a 71-year-old female is shown below. Deep tar staining of the thumb and pulps of the index and second finger are visible – a consequence of many years manipulating cigarettes

Do You Know How to Measure an Ankle Brachial Index?

The ankle brachial index (ABI) is a common and useful exam in the outpatient setting to detect peripheral arterial disease. ABI’s should be measured in all people over the age of 50 if they are a diabetic or a smoker. It should also be checked in patients over the age of 60. While many doctors

What’s the Cause of These Nail Findings?

A patient is transferred out of the intensive care unit after a 3-week course of sepsis. You are asked to identify and explain why his nails have these lesions. The patient has never noticed them before. Do you know what these are called and their cause? (Answer below) Scroll down for the answer This patient

Stanford 25: Approach to Tremor

Using a Google Glass, we filmed a patient with tremor who was admitted to Stanford Hospital. In this video, we aim to provide you an overview of the approach your patient with tremor. *|YOUTUBE:myQdK6BuBws|*

A patient presents with foot pain and these chronic findings?

A patient comes to you with these findings and new onset of left foot pain. What’s your likely diagnosis? This is a patient with chronic tophaceous gout likely presenting with an acute gout attack of the foot. The enlarged and often inflamed fingers (dactylitis) can be mistaken for psoriatic arthritis and ankylosing spondylitis. Additionally, the

This patient presents with chest pain. What’s the diagnosis?

This 32 yr old patient presents with chest pain. Based on the pictures, can you diagnose what the most likely cause is? The cause of chest pain is Aortic dissection. This is a patient with Marfan’s Syndrome. A majority of adults with Marfan’s syndrome have aortic dilation and if untreated can lead to aortic dissection.

A patient asks you… what is this?

A patient admitted into the hospital for another reason asks you why she has this between her fingers. She works as a cleaning lady. What’s the cause and therapy? If you guess a candidal infection, you’re right! This is a type of candidal intertrigo (intertrigo refers to inflammation where two skin surfaces rub together). This

Can you diagnose the cause of the patient’s lymphedema?

Lymphedema can have a number of causes. See if you can figure out this patient’s reason after we show you these clinical findings (scroll down for answer): Correct! We’re sure you got this right! Neurofibromatosis Type-1 (NF-1) can have a number of clinical exam findings. A hallmark of NF-1 are the tumors that can be