Test your bedside diagnostic skills with this free clinical case question.
A 54-year-old woman presents with attacks of pain, burning, and redness of her hands and feet. Attacks appear suddenly, last for a half-hour to an hour and are quite disabling.
They occur every 2-3 days, are not related to activity, and have been occurring for about two weeks. Interestingly, these symptoms are prevented by a single aspirin tablet once a day.
The patient’s prior health has been good except for the detection of mild hypertension about 3 months ago for which she is receiving hydrochlorothiazide.
She takes no other medications, does no smoke and takes a glass of wine once or twice a week.
Physical examination reveals a pleasant woman of stated age.
- Temperature is 98.40F.
- Blood Pressure is 150/80 mm Hg.
- Pulse is 78 and regular.
- Respirations are 16/minute.
She has a ruddy complexion. There are no skin lesions. The heart and lungs reveal no abnormalities.
On abdominal examination, the tip of the spleen is palpable. The remainder of the examination is normal.
Just as the examination was over, the patient said, “I’m having another attack. May I lie down?’’ She was obviously uncomfortable.
She showed her hands to her physician. They were warm and revealed intense erythema. The same changes were noted on her feet.
She indicated that the hands and feet were quite painful. She added that she had forgotten to take her daily aspirin this morning.
Based on the diagnostic value of careful examination …
The findings from the patient’s history and physical examination suggest:
Acute Intermittent Porphyria
Systemic Lupus Erythematosus
See the Answer:
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About The Bedside Diagnostics Blog Series:
Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most physicians will spend the bulk of their professional time with patients in an office setting.
Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. These Bedside Diagnostic Challenges reinforces the value of these clinical skills and tests users on their knowledge of them.
Bedside Diagnostic Challenge questions are issued periodically every month as a free benefit of Med-Challenger.
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About the Author:
Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He has served the University of Rochester School of Medicine as Chief Resident in Medicine and as Professor, Department of Medicine. He has served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine. Dr. Griner is board certified in internal medicine.