Monday, January 28, 2008


An old timer challenges you: "You and your new fangled fancy frumpy fMRI and other imaging machines. Back in my day, we did everything by physical examination alone." He pulls out an Atlas of Physical Diagnosis and flips to a random page.

Challenge: What's the likely title of the page? What does each image show?

All images shown under fair use.


Alex said...


tree said...


1. Spider angiomata
2. Palmar erythema
3. Terry's nails
4. Dupuytren's contracture

Craig said...

nice job!

The first image shows spider angiomata, vascular lesions consisting of a central arteriole surrounded by many smaller vessels seen on the trunk, face, and upper limbs. The body (central arteriole) can be seen pulsating when compressed with a glass slide. The second image shows palmar erythema, an exaggeration of the normal speckled mottling of the palm, especially on the thenar and hypothenar eminences. The third image shows “Terry’s nails” where the proximal 2/3 of the nail is white whereas the distal 1/3 is red; the other nails that could be seen in this disease are Muehrcke’s nails with paired horizontal white bands separated by normal color, indicative of hypoalbuminemia. The fourth image shows Dupuytren’s contracture with flexion deformities of the fingers from thickening and shortening of the palmar fascia.

All of these findings are seen in liver disease and cirrhosis (though many are not specific).

Sources: First image from University of Washington Dept. of Medicine website; second image from eMedicine, original citation from Walter Reed; third image from; fourth image from University of North Dakota School of Medicine website.