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Clinical Diagnostic Pearls.

Herbert L. Fred, MD
Arch Intern Med. 1973;131(3):471-472. doi:10.1001/archinte.1973.00320090161033.
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This is a collection of notes on a wide variety of subjects related primarily to Internal Medicine. Birnholz and Michelson organize the material into four sections: "Symptoms and Regional Physical Findings"; "Diseases"; "Laboratory Findings"; and "Drugs." They have managed to assemble into one place many "pearls" that otherwise would require gleaning from numerous sources. Particularly well presented are the segments concerning Fabry's disease, acne, Horner's syndrome, myasthenia, globulins, and the external ear. Other good features are the adequate index, small size, and reasonable price.

Now the shortcomings. Erroneous assertions are prevalent. Thus, "with clubbing of the toes but not of the hands, coarctation is suggested" (page 9); preretinal hemorrhage "in a comatose patient is diagnostic of subarachnoid hemorrhage" (page 22); in right-sided endocarditis involving the tricuspid valve "blood cultures are most often negative" (page 52); "a preferential loss of taste for meat is seen in most cases of gastric carci


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