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

2. What are your observations?

3. This is my son, the handsome devil. This is my son, the handsome devil. He’s a normal healthy male. He’s a normal healthy male.

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

5. Stunted growth Stunted growth Fanconi anemia Fanconi anemia

6. What are your observations? Diagnosis?

7. Tall & thin Tall & thin Long limbs & fingers Long limbs & fingers Span > than height Span > than height Marfan Syndrome Marfan Syndrome

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

9. Slightly obese Slightly obese Sleeping in waiting room Sleeping in waiting room Sleep apnea syndrome Sleep apnea syndrome

10. What are your observations? Diagnosis?

11. Cachectic Cachectic Gibbus of spine Gibbus of spine TB of vertebra TB of vertebra

12. Describe the facies. Diagnosis?

13. Leonine facies Leonine facies Diffusely enlarged lymph nodes Diffusely enlarged lymph nodes B cell lymphoma B cell lymphoma

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

15. Drooping of left eyelid Drooping of left eyelid Horner’s syndrome Horner’s syndrome Cancer left apex Cancer left apex Pancoast tumor Pancoast tumor

16. Describe patient’s face. Diagnosis?

17. Malar rash Malar rash Butterfly rash Butterfly rash Lupus Lupus

18. Your observations?

19. Thin young male Thin young male Surgical scar on right Surgical scar on right Past lobectomy Past lobectomy

20. Patient cannot lay head on pillow. Diagnosis?

21. Inability to lay head on pillow Inability to lay head on pillow Ankylosing spondylitis Ankylosing spondylitis

22. Your findings?

23. Upper body emaciation Upper body emaciation Protruberant abdomen Protruberant abdomen Ascites Ascites Cirrhotic Cirrhotic

24. Extensive CXR changes seen. Diagnosis?

25. Disparity between CXR & clinical appearance Disparity between CXR & clinical appearance Extensive lung changes seen Extensive lung changes seen Looks healthy Looks healthy Sarcoidosis Sarcoidosis

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

27. Myxedema Myxedema Coarse dry hair Coarse dry hair Other not evident features Other not evident features Loss of hair outer eye brow Loss of hair outer eye brow Coarse skin Coarse skin

28. Patient appears nervous and jittery. Diagnosis?

29. Wide eyed stair Wide eyed stair Potentiation of sympathetic activity Potentiation of sympathetic activity Thyrotoxicosis Thyrotoxicosis

30. Fowl smelling specimen. Diagnosis?

31. Three layered sputum Three layered sputum Fowl smelling Fowl smelling Top foam Top foam Middle liquid Middle liquid Bottom sediment Bottom sediment Bronchiectasis Bronchiectasis

32. What are your observations? Diagnosis?

33. On 2 liters of nasal oxygen On 2 liters of nasal oxygen Low flow & low FIO2 Low flow & low FIO2 Patient with COPD Patient with COPD