Many conditions can be identified at first glance. Some arc very obvious, such as gross obesity; others less so. such as the increased arterial ncck pulsation in aortic incompetence or the blue sclera of osteogenesis imperfecta (Fig. 2.1 A). Other examples of 'spot diagnoses' are shown in Figure 2.1B-D. Skills of making these observations can be tested on the general public! First impressions are often invaluable. For example, hypothyroidism may be identified on first sight but overlooked by somebody in regular contact with the patient who has failed to appreciate the insidious onset of the changes in voice and facial appearance.
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