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USMLE Step 1 Classic Clues Classic clues seen in clinical case scenarios in USMLE Step 1 questions.

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Old 10-16-2009
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Arrow Teen with Liver Problem + Personality Changes

If the question stem describes a child with signs of chronic liver disease such as bleeding tendency, signs of liver cirrhosis, jaundice, elevated LFTs, ...etc.
Plus a noticeable change in behavior such as clumsiness or even some Parkinsonian symptoms.

Think Wilson's Disease immediately.

They may also show you this picture (click the thumbnail to enlarge)

Teen with Liver Problem + Personality Changes-kayser-fleischer_ring.jpg
This picture is copied from Wikimedia page

In addition to the Kayser Fleischer ring shown above,
The question may ask about the mode of inheritance (autosomal recessive) or treatment (Pencillamine or liver transplantation) or lab abnormalities (decreased ceruloplasmin and increased urinary copper) and the gold standard for the diagnosis is Liver Biopsy.
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Old 12-20-2013
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Correct Answer

Hi, Ceruloplasmin level is increased.
Impossible is impossible!
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Old 02-01-2014
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low ceruloplasmin level is not diagnostic for Wilson's disease in the absence of Kayser-Fleischer rings
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Biochemistry-, Clinical-Signs, Figures-, Gastrointestinal-Tract-, Pathology-, Syndromes-Acronyms

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Sign Of Liver Problem Images This thread Refback 05-19-2011 04:28 AM

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