General AppearanceGeneral Appearance

You are going to be presented with clinical You are going to be presented with clinical photographs. Answers will be provided in photographs. Answers will be provided in the following slide.the following slide.

What are your observations?What are your observations?

• This is my son, the This is my son, the handsome devil.handsome devil.

• He’s a normal He’s a normal healthy male.healthy male.

Patient on the left is 20 years old. Patient on the left is 20 years old. What’s the diagnosis?What’s the diagnosis?

• Stunted growthStunted growth• Fanconi anemiaFanconi anemia

What are your observations?What are your observations?Diagnosis?Diagnosis?

• Tall & thinTall & thin• Long limbs & fingersLong limbs & fingers• Span > than heightSpan > than height• Marfan SyndromeMarfan Syndrome

Patient’s in physician’s waiting Patient’s in physician’s waiting room with no response to calls.room with no response to calls.

Diagnosis?Diagnosis?

• Slightly obeseSlightly obese• Sleeping in waiting Sleeping in waiting

roomroom• Sleep apnea Sleep apnea

syndromesyndrome

What are your observations?What are your observations?Diagnosis?Diagnosis?

• CachecticCachectic• Gibbus of spineGibbus of spine• TB of vertebraTB of vertebra

Describe the facies.Describe the facies.Diagnosis?Diagnosis?

• Leonine faciesLeonine facies• Diffusely enlarged lymph Diffusely enlarged lymph

nodesnodes• B cell lymphomaB cell lymphoma

Observe findings on patient’s face. Observe findings on patient’s face. Diagnostic considerations?Diagnostic considerations?

• Drooping of left eyelidDrooping of left eyelid• Horner’s syndromeHorner’s syndrome• Cancer left apexCancer left apex• Pancoast tumorPancoast tumor

Describe patient’s face. Describe patient’s face. Diagnosis?Diagnosis?

• Malar rashMalar rash• Butterfly rashButterfly rash• LupusLupus

Your observations?Your observations?

• Thin young maleThin young male• Surgical scar on rightSurgical scar on right• Past lobectomyPast lobectomy

Patient cannot lay head on pillow. Patient cannot lay head on pillow. Diagnosis?Diagnosis?

• Inability to lay head on Inability to lay head on pillowpillow

• Ankylosing spondylitisAnkylosing spondylitis

Your findings?Your findings?

• Upper body emaciationUpper body emaciation• Protruberant abdomenProtruberant abdomen• AscitesAscites• CirrhoticCirrhotic

Extensive CXR changes seen. Extensive CXR changes seen. Diagnosis?Diagnosis?

• Disparity between Disparity between CXR & clinical CXR & clinical appearanceappearance

• Extensive lung Extensive lung changes seenchanges seen

• Looks healthyLooks healthy• SarcoidosisSarcoidosis

Patient has a slow, thick voice. Patient has a slow, thick voice. Diagnosis?Diagnosis?

• MyxedemaMyxedema• Coarse dry hairCoarse dry hair• Other not evident Other not evident

featuresfeatures• Loss of hair outer eye Loss of hair outer eye

browbrow• Coarse skinCoarse skin

Patient appears nervous and jittery. Patient appears nervous and jittery. Diagnosis?Diagnosis?

• Wide eyed stairWide eyed stair• Potentiation of Potentiation of

sympathetic activitysympathetic activity• ThyrotoxicosisThyrotoxicosis

Fowl smelling specimen.Fowl smelling specimen.Diagnosis?Diagnosis?

• Three layered sputumThree layered sputum• Fowl smellingFowl smelling• Top foamTop foam• Middle liquidMiddle liquid• Bottom sedimentBottom sediment• BronchiectasisBronchiectasis

What are your observations?What are your observations?Diagnosis?Diagnosis?

• On 2 liters of nasal On 2 liters of nasal oxygenoxygen

• Low flow & low FIO2Low flow & low FIO2• Patient with COPDPatient with COPD