A Hand-Carried Diagnosis -- A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise

doi:10.1056/NEJMcps062271

Volume 356:2407-2411		June 7, 2007		Number 23

A Hand-Carried Diagnosis — A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise

Clinton L. Greenstone, M.D., Sanjay Saint, M.D., M.P.H., and Richard H. Moseley, M.D.

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PubMed Citation

In this Journal feature, information about a real patient ispresented in stages (boldface type) to an expert clinician,who responds to the information, sharing his or her reasoningwith the reader (regular type). The authors' commentary follows.

A 34-year-old black woman presented to a walk-in clinic witha 3-day history of malaise. Her colleagues had noticed yellowingof her eyes over the past few days.

Scleral icterus, which is usually apparent when total serumbilirubin levels exceed 3 mg per deciliter (51 µmol perliter), is frequently first noticed not by the patient but byothers. It may result . . . [Full Text of this Article]

Commentary

Source Information

From the Veterans Affairs Ann Arbor Medical Center (C.L.G., S.S., R.H.M.) and the Department of Internal Medicine, University of Michigan Medical School (C.L.G., S.S., R.H.M.) — both in Ann Arbor.

Address reprint requests to Dr. Greenstone at the Veterans Affairs Ann Arbor Medical Center, Ambulatory Care Division (11A), 2215 Fuller Rd., Ann Arbor, MI 48105, or at clintong@umich.edu.