📍Tried and tested method
This approach of tackling clinical vignettes has worked superbly for me.
👣 Step - 1 = Read the last line which holds the question. This will guide you in what you need to look for in the vignette.
👣 Step -2 = Based on the question, start picking up important details from the case described. Often, the case itself gives you half of the answer. This is the beauty of clinical vignettes. If you pay attention half of the battle is already won.
👣 Step 3 = Read the options and start eliminating them. Finally, pick one best answer from the key points in the vignette.
Just try to solve few cases by this approach to get hold of it.
From the example, points picked in step 2 -
Smoking + weight loss + cushing's symptoms = hints towards paraneoplastic syndrome
🚫 1. Adenocarcinoma of lung = does not have cushing's as the paraneoplastic syndrome.
🚫 2. Lactotroph adenoma of the pitutary = will present with other symptoms related to prolactin and gonadotropins.
🚫 3. Pheochromocytoma = Although it is tumor of the adrenal but pheochromo involves the adrenal medulla. So, cushing's unlikely.
✅ 4. Small cell carcinoma = Praneoplastic ectopic ACTH production, which can lead to cushing's. The first line of the vignette also says dry mouth and polyuria which points towards another paraneoplastic syndrome associated with ADH levels.
🚫 5. Squamous cell carcinoma = the paraneoplastic syndrome does not commonly involve ACTH production. It is rather linked to increased calcium.
The more information the question provides, the easier it gets to reach to the answer.
🧐 Think of it this way, there is a pt in front of you and I just give you the symptoms to diagnose the disease.
🧐 On the other hand, there is a pt for whom I give you his presenting complains, past history, medical history, lab results and then ask you to give a dx.
📍Which one is easier?📍
👩⚕️ Just get the limiting belief out of your head. Clinical vignettes are fun to solve.
❗️Which one do you prefer, one liners or clinical vignettes?❗️
Question Source - Doctors in training