Question
32yo man, who is otherwise healthy with no PMH, presents to your clinic with a 2-month history of polyuria, nocturia, and polydipsia. Both of his parents have DMII and told him he needed “to get his sugar checked”. He denies any weight changes or vision disturbances. Vitals in clinic are BP-112/72 mmHg, HR-108, RR-12, O2-100%, and temp-98.9o. Initial screening labs are below.
Tanner Stages
Other Known Aliases – sexual maturity rating
Definition – scale of physical development in children, adolescents, and adults based on primary and secondary sex characteristics
Clinical Significance – every patient will progress through each of the five stages during development, but due to innate individual variability, the rate and timing of each of the stages is highly variable. There are both a male and female scale and evaluates breast and testicular size, genitals, and pubic hair distribution.
History – Named after James Mourilyan Tanner (1920-2010), a British pediatric endocrinologist who received his medical doctorate from the University of Pennsylvania in 1944, as well as a fellowship in endocrinology from Johns Hopkins as a result of a Rockefeller exchange grant program. A supurb hurdler and athlete prior to WWII, he likely would have competed in the in 1940 Olympics. Following his training stateside, he would return to England to oversee a national study on the effects of malnutrition on children. While documenting and analyzing the data, he noticed a trend of secondary physical characteristics as children and adolescents developing into adulthood. This led to a 20-year longitudinal study on human development and the publication of his eponymous staging system in 1962 in his classic textbook “Growth at Adolescence”.
References
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Question
This one is a quick one this week. When evaluating a patient with testicular pain (either acute or chronic), what are the specific physical examination techniques you can perform and what conditions do they help rule in/out?
Answer
Sertoli Cells
Other Known Aliases – none
Definition – sustentacular cell of the convoluted seminiferous tubule of the testes
Clinical Significance – these cells are activated by FSH to produce and mature sperm during spermatogenesis
History – Named after Enrico Sertoli (1842-1910), who was an Italian physiologist and histologist and received his medical doctorate from the University of Pavia in 1865. His love and passion for histology was groomed while training under Eusebio Oehl, who was an early pioneer in microscopic anatomy and histopathology. He would go on to become professor of anatomy and physiology at the Royal School of veterinary medicine in Milan and it was here that he founded the laboratory of experimental physiology. In 1865, during his tenure in Milan, he published the paper describing his eponymous cell.
References
Question
This one is a quick one this week. When evaluating a patient with testicular pain (either acute or chronic), what are the specific physical examination techniques you can perform and what conditions do they help rule in/out?
Fournier’s Gangrene
Other Known Aliases – none
Definition – necrotizing fasciitis of the external genitalia and/or perineum
Clinical Significance – this infection commonly affects older men and is associated with diabetes mellitus or a compromised immune system. Other risk factors include trauma or surgery to the perineal area, alcoholism, and childbirth. Pain, erythema, crepitus, and fever are common findings and treatment is aggressive surgical debridement and antibiotics to cover anaerobic and facultative pathogens.
History – Named after Jean Alfred Fournier (1832-1914), who was a French dermatologist and venereologist, and received his medical doctorate in 1860 while studying in Paris. He would begin his career as an understudy of Philippe Ricord at the Hôpital du Midi and would later become médecine des hôpitaux at the famed Hôtel-Dieu de Paris. It was in 1883 when he presented a case series of patients with gangrene of perineum and for which this eponym is attributed, although it was first described and published in 1764 by Baurienne. He is best known for his work with congenital syphilis (for which he has two additional eponyms) and advancing the study of venereal diseases and their connection to degenerative diseases.
References
Question
49yo woman, with a history of hypertension and GERD, presents to your clinic with a six month history of bilateral shoulder weakness that she first noticed when putting on sweaters and jackets and carrying in groceries. She denies any history of pain, repetitive trauma, or weakness in the hands. On physical examination, she has 3.5/5 strength in shoulder abduction and flexion, as well as the below rash. She reports the rash has been present for about the same time, but doesn’t really bother her.
Answer
Kienböck Disease
Other Known Aliases – none
Definition – avascular necrosis of the lunate
Clinical Significance – most often results from trauma with biomechanical and vascular abnormalities that lead to progressive bone death. Patients will report wrist pain with decreased range of motion and grip strength. MRI is best for early diagnosis and treatment depends on the stage of disease using the Lichtman Classification system.
History – Named after Robert Kienböck (1871-1953), who was an Austrian radiologist and received his medical doctorate from the University of Vienna in 1895. He would explore the new and blossoming field of radiology before becoming the head of the radiological department at Vienna General Hospital before becoming professor of radiology in 1926. He was a pioneer in the use of x-rays for medical diagnosis and would co-found the Vienna Radiology Society in 1923. He would publish his eponymous condition in 1910 in his treatise Über traumatische Malazie des Mondbeins und ihre Folgezustände (Traumatic malacia of the lunate and its consequences).
References
***LISTEN TO THE PODCAST HERE***
2019 updated guidelines from American College of Rheumatology and American Arthritis Foundation
