QUIZ: How recgonise an icterus? *solved*

Tuesday, 10 November 2009 13:37

Hello, I found in my notes from internal medicine a riddle made by my internal medicine teacher. I point out that this patient will be particularly burdensome and there will be some interesting options for a couple of your attempts at the diagnosis ;-)

Case description:
40-years old male, yellow race comes to a general practitioner claims to have an icterus.

QUIZ questions: How to confirm or exclude an icterus WITHOUT ANY LABORATORY TESTS?

P.S. This question is mainly for beginners because the medicine veterans will already know how ;)

Comments

0 #1 patrycja 2009-11-10 20:11

The patient will have yellowish conjunctival membranes over the sclerae, mucous membranes and oral cavity.

0 #2 cat_anonim 2009-11-10 20:22

And at this point we have a problem, made up by our "wonderful" doctor

The patient refuses to open his eyes (don't ask me how he got there)
The patient refuses to show his tongue

0 #3 Radecki 2009-11-10 22:00

Maybe we could ask the patient to give us an urine sample and analyze it, but I'm guessing he's not too keen on doing this either :P

0 #4 Ewelina 2009-11-10 22:09

Is the stool sample out of the question as well ;-)?

0 #5 izolda17 2009-11-10 23:09

Yellowish integuments - but that's only with the Caucasian race

0 #6 cat_anonim 2009-11-10 23:33

izolda17... as you can see, it is stated that the patient is Asian ;-P

0 #7 Michał 2009-11-10 23:39

We can ask the patient if his skin itches :]

0 #8 Radecki 2009-11-10 23:58

We could ask the patient why does he think he has an icterus? :P

0 #9 al.capone 2009-11-11 00:13

-I understand that he is shy and doesn't want to show us his groin area.

-Let him bring a picture of himself from a time when he thought he didn't have an icterus

0 #10 cat_anonim 2009-11-11 09:56

Michał, you can ask, but the response is no.

Radecki, good idea, the patient tells you that he has a feeling ;-)

al.capone
- Yes, he is shy, he won't show you his groin.
- The picture idea is good, but the patient doesn't have one.

0 #11 oxycontin 2009-11-11 11:06

And what if we press our finger against his skin so it would get pale, if the patient has icterus it would show.

0 #12 cat_anonim 2009-11-11 11:23

The idea worth considering :-) but are you sure there will be no yellow integuments? The pigmentation applies to the skin, and even though we press the skin would remain yellow no matter what.

I'm waiting for further ideas ;-)

0 #13 oxycontin 2009-11-11 14:12

What about the fingernails?

0 #14 cat_anonim 2009-11-11 14:39

Also a good idea, could work, but smokers usually have yellowish fingernails :sad:

0 #15 bakelit 2009-11-11 16:16

But not every single one of them :-)

0 #16 cat_anonim 2009-11-11 16:26

Good remark :-)

We have a first clue.

Who'll give another one? :-)

Don't assume from the beginning that something cannot be done :-)

Do ask questions

0 #17 xray1815 2009-11-11 16:47

And what does the patient have in mind by saying icterus. We could make sure we're talking about the same thing...

0 #18 Ewelina 2009-11-11 17:05

It could be splenomegaly... but it's not present in all icterus types so there is no guarantee. Will he allow for a physical examination of the abdomen?

0 #19 cat_anonim 2009-11-11 17:59

xray1815 very good remark ;-) The patient will tell you that it's a condition that makes you yellowish ;-)

Ewelina, yes, he will allow for the examination. But as you've said before, it's not a certain symptom