werner@aecom.UUCP (Craig Werner) (11/02/86)
<<>>
.pa
Medical Puzzle #1
Subject: Oh my God !!!!!!
Newsgroups: net.med
Distribution: na
At a benefit here, a comedian had to digress from his act to tell us
the following true story.
One day he noticed something that felt like a little ball between his
legs, in his groin area. ("No, an extra one" he added.) At first he thought
it was kind of neat, but over the weekend it kept growing. Monday morning,
he looked at it in the mirror and all he could say was "Oh, my Gooddddddd."
He showed it to his roommate, and the roommate just turned sick and said, "Oh
my Goodddddddd."
He decided to go see a doctor. He had to wait in the waiting room
for an hour or so, and he's thinking, "I'm going to die." Finally, he gets
to see the doctor, and the doctor examines him, takes a look at the, by this
time, hugh growth, and says "Hhhmmmph" ("I hate when doctor's go Hmmmph", he
said.) Then the doctor gets called away. Meanwhile, he's sitting there
thinking, "Well that's it, it's cancer for sure. How many weeks have I got
to live, Doc." He's sitting in the exam room, watching his life go by.
Finally, the doctor comes back, and says "I want you to be seen by
a Surgeon. He's next door and will be here in a few minutes." [Repeat last
paragraph.] Eventually, the Surgeon comes in, takes a look at the growth,
taps it, feels it, and then says, "Could you please take your socks off."
At this point, everyone but the First year medical students break out
laughing.
I'll tell you next week. In the meantime, let me leave you with two
thoughts. One, if you don't know the answer, I'd think twice about taking
your medical treatment into your own hands. And two, in one retrospective
study, this particular "Cancer" accounted for over 1/2 of all "Cancer Cures"
claimed by a nonconventional therapist (Laetrile and the like.)
If however, you know what it is, I bet you're laughing as hard as we
were. (Well maybe not as hard - he did have a very good delivery.)
.pa
Medical Puzzle #2
History of present illness: Two weeks ago the patient had a bout of
severe epigastric (that's directly underneath the belly button) pain and
nausea that lasted a little more than 12 hours and then went away. However,
two days after that he felt a little tired, and has had a continuous headache
ever since, and sweating and chills (and presumably fever) at night. However,
he feels fairly good, albeit fatigued, and his physical exam reveals
nothing remarkable, and routine tests are normal.
Contained in the above is a Classic symptom of a disease. It should be
all that's needed. I'll get back in a week (or so, OK, last time it took me
longer, I got sidetracked.) with what it is, whether it is serious or not,
.pa
Medical Puzzle #3
The following is an actual case that someone asked me to diagnose over
the phone. It was actually the mother of a friend, and the person had a real
doctor's appointment the next day, so I made a guess. Have a try ...
For the last week or two, the woman (age 45-50 or so) felt bloated
after meals - it was much worse after eating fried foods (so she had to give
up cooking in a wok). Not only that, but in the last week, about an hour
after eating, she developed sharp colicky pains in her right shoulder, and
felt sick and nauseous.
That's all I got. As it turned out, the obvious diagnosis is the
correct one (verified the next day), so the above information is all you need.
Answer, as usual, in a week (more or less).
.pa
Medical Puzzle #4
[This week's puzzle is a tricky one suggested by John Wurzelmann. It
is very tricky, but I am presenting it as a puzzle on two levels, only the
second of which requires Medical knowledge.]
A patient comes into the Emergency Room extremely jaundiced -- that's
very yellow due to Liver failure. There are also other signs of liver failure.
Since people's skin color varies, to determine the extent of jaundice,
you examine the whites of the patients eyes. One eye is almost orange. The
other is totally normal-looking, showing no signs of jaundice. In addition,
the non-jaundiced eye is not responsive to light.
Now the eyes shouldn't be different like that, so that requires an
explanation, and then and only then, can the liver failure be explained.
The latter, incidentally, requires a bit of medical knowledge that even I
didn't have when John suggested this problem to me.
.pa
Medical Puzzle #5
[A little easier than the last one]
A young woman comes into the clinic with (obviously) a health complaint.
You first introduce yourself, then begin the interview.
You ask what's wrong, and she says that her stomach hurts.
You ask her to describe the pain further, and you find that it
is worse before she eats breakfast.
You ask how long this has been going on, and she says it started to
bother her a few weeks ago, no, maybe a little more than a month, but that it
has gotten worse recently.
You ask two more questions, the first of which is suggestive but
non-specific, the second of which suggests the obvious diagnosis?
What is the informative question, and why do you ask? (Well, you ask
because you suspect the cause, but need to confirm it with the patient. That's
not the angle I'm looking for to have answered.)
.pa
Medical Puzzle #6
[If I included the whole history, it would make this too easy, so I'm leaving
out several detail, that, while not essential, are highly suggestive.]
A 27-old Hispanic female from the South Bronx is referred to clinic
with a 2-week history of dry cough, fever, shortness of breath, and weight
loss. On physical exam, she has a temperature of 102. An examination of her
head reveals oral thrush (an infection of the mouth by the yeast Candida).
Because of her extreme difficulty breathing, she is admitted to the
hospital. An admission chest X-ray reveals is diffusely cloudy on both sides,
suggesting interstitial pneumonia. Routine blood test shows mild anemia (low
hematocrit) and a White Blood Cell count in the low normal range.
What is the suspect diagnosis?
.pa
Medical Puzzle #7
You are a doctor at a military hospital (one way of paying yor way
through Medical school.)
A young recruit, previously healthy, comes into clinic after being
ordered to see you by his drill Sergeant.
As he sits head upright and straight as an arrow, he tells you his
symptoms, which are: "I feel real tired, Sir. I've got the worst headache
I've ever had in my life, and my eyes hurt in the sun." He also has a
temperature of 102.
After discussing the case with your attending physician (and Senior
officer), you discover that you have no choice but to immediately admit this
person to the hospital for diagnostic tests.
1. What is the suspected diagnosis and why has it been written into
MilRegs (Military Regulations)?
2. What obvious symptom isn't the patient telling you about (Read
carefully!)
3. What's the test to do in the hospital?
.pa
Medical Puzzle #8
<>
Another patient comes into the hospital heavily jaundiced. (And, the
whites of BOTH eyes are deeply orange.) He had been seen in clinic for
another (and for this puzzle, unimportant) illness two weeks earlier and had
been prescribed tetracycline based on a history of Penicillin allergy.
Other than that, he had been previously healthy.
To confirm the initially obvious diagnosis, a liver biopsy is done,
and much to the suprise of the residents, it does not reveal membrane bound
fat accumulation typical of idiosyncratic Tetracycline toxicity, but rather
large quantities of iron in almost all the liver cells.
The blood count is normal, as is the hematacrit, so there is no
sign of hemolytic anemia, or increased Red Blood Cell destruction.
1. What was overlooked, and what needs to be done to remedy the
situation?
2. What is your best guess as to the cause of the liver failure?
.pa
Medical Puzzle #9
<<<<>>>>>
A up-and-coming liability lawyer is in your office complaining of
alternating constipation and diarrhea, with occasional tenesmus (painful
non-productive bowel movements -- more colorfully described as dry heaves
of the Rectum), occasionally passing just mucus, or just a pencil thin
small stool. There is no gross blood as far as he can tell. He denies any
indigestion at any point, although occasionally says he has some lower
abdominal discomfort associated with the episodes of diarrhea and tenesmus.
His father died at the age of 57 from cancer of the colon, although
the patient denies any concern that this might be cancer -- repeatedly --
without prompting.
1. What does the patient almost certainly have?
2. What could the patient have, but almost certainly doesn't, but you
had better make sure in light of his profession?
.pa
Medical Puzzle #10
<<<>>>
This is a real quicky. It's neat. It's quick. I like it.
A 52-yr old housewife comes in with two complaints. Over the past few
months, she had dropped 7 dishes, and had to switch to washing dishes with
her left hand, at which point the china breakage stopped. She also said that
she had trouble holding a pencil while writing, and dropped it repeatedly.
She also has another symptom, but hasn't noticed it. Additionally,
there are findings you can elicit on physical exam. To tell you which would
give away the answer.
What is the most likely diagnosis?
--
Craig Werner (MD/PhD '91)
!philabs!aecom!werner
(1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
"Beware of Yuppies bearing Uzis."