13. A Distinguishing Feature

  1. James C. Pile4,
  2. Thomas E. Baudendistel5 and
  3. Brian J. Harte6
  1. Sanjiv J. Shah1,2,
  2. Aubrey O. Ingraham5,
  3. Sandra Y. Chung2 and
  4. Richard J. Haber2,3

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch13

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Shah, S. J., Ingraham, A. O., Chung, S. Y. and Haber, R. J. (2013) A Distinguishing Feature, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch13

Editor Information

  1. 4

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 5

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 6

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Department of Medicine, University of Chicago, Chicago, Illinois, USA

  2. 2

    Department of Medicine, University of California, San Francisco, California, USA

  3. 3

    Department of Medicine, San Francisco General Hospital, San Francisco, California, USA

  4. 5

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

SEARCH

Keywords:

  • activated partial thromboplastin time (aPTT);
  • adrenal insufficiency;
  • antiphospholipid syndrome;
  • chronic liver disease;
  • hypercoagulability;
  • thrombosis

Summary

This chapter presents the case study of a patient with a history of chronic liver disease of unknown etiology. The case study illustrates the importance, as the key to diagnosis, of determining a “distinguishing feature” such as a prolonged activated partial thromboplastin time (aPTT) from among the multitude of abnormalities that could have led the diagnostic process astray. Whereas faulty use of trigger features may make physicians inappropriately consider uncommon diseases, a “distinguishing feature” limits the number of diagnostic possibilities and significantly changes—increases or decreases—the likelihood of there being a rare disease. By correctly using the distinguishing feature of an elevated aPTT in the context of the patient's diverse clinical features, the discussant was able to arrive at a single unifying diagnosis of antiphospholipid syndrome.