Note
that it does take some
experience in using the software to achieve some results. Such as
finding the closest symptom/sign/lab/etc. Even though there are over
8,000
predefined and many aliases, sometimes you still need to find the most
likely symptom/etc. that might have been used in the symptom/sign/labs.
pattern definition. Also the
software does not assume symptoms/signs/etc. are related to the one
specific condition unless so told. Also bear in mind the software is a
"diagnosis aid" for the professional physician and is intended to
assist, not compete, with the diagnostician. The database is also huge
and the mathematics forming the short lists depend on positions of
symptoms/signs/labs and other factors such as differential diagnosis
tables for each condition short listed, etc., and it is too complex a
task to
ensure such are perfectly defined. Also, in medicine there is sometimes
little standard in the exact and precise definition of
a symptom/sign/etc. thus what one person might refer to as a facial
hemangioma another might call a port-wine stain and another a tumour of
blood vessels and another a reddish facial rash. When in doubt, a feel
for the software is required to sometimes find the most appropriate
symptom/etc. to use in the inquiry. You can change or rename any of the
symptoms or improve the symptom/sign/lab. patterns.
Case 1
(February 2004; By Youn W. Park, MD, and Mark Matthews, MD)
A three-year-old boy is brought in by his mother for evaluation of a tongue deformity. The lingual frenulum is short and thickened and the tongue is notched at the tip. The mother wonders whether her son's speech problem is related to this condition.
5GL-Doctor Result
Emergency Medicine Diagnosis:
Ankyloglossia
(tongue-tie) is a tongue deformity in
which the lingual frenulum appears abnormally short and thick, and in
extreme cases, causes a fusion of the tongue to the anterior floor of
the mouth....
Case 2
Emergency Medicine Diagnosis:
The patient has sarcoidosis. Biopsy specimens from the
nasal turbinate mucosa and the external nasal lesion show noncaseating
granulomatous changes. This disease of unknown etiology commonly
affects young adults. In the United States, blacks are 10 times more
likely to be affected than Caucasians. Chest films will show bilateral
hilar lymphadenopathy or lung involvement in 90% of cases. Eye and skin
lesions are next in frequency....
Case 3
A four-month-old girl presents for evaluation of new-onset seizures. She has no known medical problems, nor any recent history of fever or other possible symptoms of illness, and is up to date with immunizations. She was born to a healthy mother who drank no alcohol and experienced no perinatal complications, and she has met all developmental milestones to date. Her family history is noncontributory. Physical exam reveals a sizable facial hemangioma. The neurologic exam is normal, as are her heart, abdomen, and oral mucosa. A CT scan of the head and X-rays of the skull are unremarkable.
(in this case note that a neural network pointed out a "common sense" observation in regards to the short list and in particular the Sturge-Weber syndrome. Producing the short lists using mathematical principles does not always result in some "down to Earth" results, thus various "neural networks" keep an eye on the short list and analyse these and at times inform of their view. P.S. The entry with a red background in the short list implies an emergency condition.)
Emergency Medicine Diagnosis: This patient has Sturge-Weber syndrome. She has the classic "port wine stain" (although it does look much like a hemangioma), which is usually located over the distribution of the first branch of the trigeminal nerve. She underwent an extensive workup for her seizures, which continued for many months. A repeat CT scan revealed intracranial calcifications...
Case 4
A 32-year-old female finds abnormal patches on her tongue during a self-examination prompted by mild discomfort. She is a nonsmoker and reports no other symptoms.
(Note: in this case, because an approriate symptom was not found, a "group symptom" was used in the inquiry in order to cover a wider range of tongue lesions or changes. The "group symptom" during analysis and replaced inquiry.)
Emergency Medicine Diagnosis: Migratory glossitis or erythema migraines...
Case 5
A 62-year-old man presents to the emergency room with pain and swelling in his left foot, which also has patches of discoloration that have been present for three months. The pain and swelling, however, have appeared only during the previous week. His medical history is significant for rheumatoid arthritis and hypertension, and his current medications include fosinopril and atenolol. He also started cephalexin therapy three days before this visit, as prescribed by his primary care physician. Physical examination reveals a slightly swollen and tender foot marked by purplish blotches and a nontender discoloured plaque on the sole.
(note: the "measure" is a "guide" and a 3 points difference in the measure value is not significant. The top entry is a summary, an overview, of skin lesions).
OR
Emergency Medicine Diagnosis: Kaposi sarcoma is a low-grade vascular tumour associated with human herpesvirus 8 infection. It is characterized by lesions that develop beneath the skin or in the mucous membranes.... After this patient's diagnosis of Kaposi sarcoma was established, he tested HIV-positive.
Case 6
A 5-year-old boy, in Bolivia, is evaluated during an international medical clinic in his rural village. He, like all his fellow villagers, has never seen a physician before. Since birth, he has been experiencing recurrent, lingering respiratory infections, sometimes featuring a productive cough with foul-smelling sputum. He and other family members have recently had scabies and are at risk for parasitic infections, which run rampant in this locale. Physical examination reveals no rash, with the exception of a punctate lesion near the sternal notch that exudes purulent material when expressed. The only other abnormalities are cervical adenopathy and a soft, subtle mass lateral to the patient's cricoid that is mobile and moves with swallowing. The boy's oropharynx, lungs, and nose are unremarkable.
(note: the entry Chest Infection is a summary/overview of causes of chest infections).
Emergency Medicine Diagnosis: This patient had a thyroglossal duct cyst and sinus. The limited resources of a goodwill clinic in a remote location precluded any testing, but with a punctate skin lesion a parasitic or worm infection was also likely, so he was treated with anthelmintics and broad-spectrum antibiotic. He was brought to a surgeon in La Paz who incised the fluctuant mass and discovered a sinus tract running from the sternal notch to the underside of the boy's tongue, which had been missed in the initial examination.
Case 7
A 34-year-old male with an extensive rash for three or four weeks. The dermatitis began as a solitary patch on his left upper arm, and several days later similar lesions appeared on his back and chest. He has no symptoms aside from occasional mild itching and is not taking any oral medications. Cutaneous examination reveals multiple, discrete, round-to-oval erythematous scaling patches on the extremities and trunk. The face, palms, and soles are not affected.
(note: the entry Viral Illness and Chest or Abdominal Rash are "summary/overview" entries, thus there are only three good candidates in this result, namely Hives, Chickenpox (usually affects children), and Pityriasis Rosea (usually affects young adults).)
Emergency Medicine Diagnosis: The patient has pityriasis rosea, a common, acute, self-limited papulosquamous skin disorder typified by round-to-ovid lesions encircled by a fine collarette of scale...and a Christmas-tree distribution on the back is classic. Also classic is the appearance of a so-called herald patch a few days before...
Case 2
(August 2002,
Youn W. Park,
MD, and M. Akram Dar, MD)
A 36-year-old African-American woman complains of having difficulty
breathing and nasal congestion, and exhibits lesions of the external
nose. A chest x-ray shows bilateral hilar masses. An anterior
rhinoscopic examination reveals swollen mucosal lesions as well.
5GL-Doctor
Result
Case 3
A four-month-old girl presents for evaluation of new-onset seizures. She has no known medical problems, nor any recent history of fever or other possible symptoms of illness, and is up to date with immunizations. She was born to a healthy mother who drank no alcohol and experienced no perinatal complications, and she has met all developmental milestones to date. Her family history is noncontributory. Physical exam reveals a sizable facial hemangioma. The neurologic exam is normal, as are her heart, abdomen, and oral mucosa. A CT scan of the head and X-rays of the skull are unremarkable.
5GL-Doctor Result
(in this case note that a neural network pointed out a "common sense" observation in regards to the short list and in particular the Sturge-Weber syndrome. Producing the short lists using mathematical principles does not always result in some "down to Earth" results, thus various "neural networks" keep an eye on the short list and analyse these and at times inform of their view. P.S. The entry with a red background in the short list implies an emergency condition.)
Emergency Medicine Diagnosis: This patient has Sturge-Weber syndrome. She has the classic "port wine stain" (although it does look much like a hemangioma), which is usually located over the distribution of the first branch of the trigeminal nerve. She underwent an extensive workup for her seizures, which continued for many months. A repeat CT scan revealed intracranial calcifications...
Case 4
A 32-year-old female finds abnormal patches on her tongue during a self-examination prompted by mild discomfort. She is a nonsmoker and reports no other symptoms.
5GL-Doctor Result
(Note: in this case, because an approriate symptom was not found, a "group symptom" was used in the inquiry in order to cover a wider range of tongue lesions or changes. The "group symptom" during analysis and replaced inquiry.)
Emergency Medicine Diagnosis: Migratory glossitis or erythema migraines...
Case 5
A 62-year-old man presents to the emergency room with pain and swelling in his left foot, which also has patches of discoloration that have been present for three months. The pain and swelling, however, have appeared only during the previous week. His medical history is significant for rheumatoid arthritis and hypertension, and his current medications include fosinopril and atenolol. He also started cephalexin therapy three days before this visit, as prescribed by his primary care physician. Physical examination reveals a slightly swollen and tender foot marked by purplish blotches and a nontender discoloured plaque on the sole.
5GL-Doctor Result
(note: the "measure" is a "guide" and a 3 points difference in the measure value is not significant. The top entry is a summary, an overview, of skin lesions).
OR
Emergency Medicine Diagnosis: Kaposi sarcoma is a low-grade vascular tumour associated with human herpesvirus 8 infection. It is characterized by lesions that develop beneath the skin or in the mucous membranes.... After this patient's diagnosis of Kaposi sarcoma was established, he tested HIV-positive.
Case 6
A 5-year-old boy, in Bolivia, is evaluated during an international medical clinic in his rural village. He, like all his fellow villagers, has never seen a physician before. Since birth, he has been experiencing recurrent, lingering respiratory infections, sometimes featuring a productive cough with foul-smelling sputum. He and other family members have recently had scabies and are at risk for parasitic infections, which run rampant in this locale. Physical examination reveals no rash, with the exception of a punctate lesion near the sternal notch that exudes purulent material when expressed. The only other abnormalities are cervical adenopathy and a soft, subtle mass lateral to the patient's cricoid that is mobile and moves with swallowing. The boy's oropharynx, lungs, and nose are unremarkable.
5GL-Doctor Result
(note: the entry Chest Infection is a summary/overview of causes of chest infections).
Emergency Medicine Diagnosis: This patient had a thyroglossal duct cyst and sinus. The limited resources of a goodwill clinic in a remote location precluded any testing, but with a punctate skin lesion a parasitic or worm infection was also likely, so he was treated with anthelmintics and broad-spectrum antibiotic. He was brought to a surgeon in La Paz who incised the fluctuant mass and discovered a sinus tract running from the sternal notch to the underside of the boy's tongue, which had been missed in the initial examination.
Case 7
A 34-year-old male with an extensive rash for three or four weeks. The dermatitis began as a solitary patch on his left upper arm, and several days later similar lesions appeared on his back and chest. He has no symptoms aside from occasional mild itching and is not taking any oral medications. Cutaneous examination reveals multiple, discrete, round-to-oval erythematous scaling patches on the extremities and trunk. The face, palms, and soles are not affected.
5GL-Doctor Result
(note: the entry Viral Illness and Chest or Abdominal Rash are "summary/overview" entries, thus there are only three good candidates in this result, namely Hives, Chickenpox (usually affects children), and Pityriasis Rosea (usually affects young adults).)
Emergency Medicine Diagnosis: The patient has pityriasis rosea, a common, acute, self-limited papulosquamous skin disorder typified by round-to-ovid lesions encircled by a fine collarette of scale...and a Christmas-tree distribution on the back is classic. Also classic is the appearance of a so-called herald patch a few days before...