Methodical Diagnoses – Vitamin C

Baylor Med’s first year medical students begin their first real day of med school tomorrow morning. In light of this milestone, I wanted to share something which I initially took for granted as a student but find myself constantly using as a resident.

Vitamin C.

It’s a mnemonic used for synthesizing a differential diagnosis.

  • Vascular
  • Infectious
  • Traumatic
  • Autoimmune
  • Metabolic
  • Idiopathic/Iatrogenic
  • Neoplastic
  • Congenital

In my opinion, this is the single greatest list you’ll learn as a medical student. Basic sciences will start to build the jargon and diagnoses which will ultimately be filed into each of the aforementioned headings. For example, while learning the nuances of human embryology and genetics, you’ll learn the countless ways things can go wrong. Chromosomal nondisjunction leading to Down’s Syndrome, the VACTERL association of defects, clinodactyly, spina bifida, etc – all of these could present with symptoms as older children/adults which can be traced to congenital etiologies.

This approach will come in even more handy as a clinical student. Let’s say a 40 year old woman presents with diarrhea and abdominal pain lasting several weeks. Could this be due to some sort of mesenteric vessel ischemia (vascular), bacterial/viral/parasitic agent (infectious), a condition like primary biliary cirrhosis or autoimmune hepatitis (autoimmune), an acquired lactase deficiency or alcohol pancreatitis (metabolic), or a malignancy involving the bowel (neoplastic)? As students get farther in their training, they’ll be able to assign priority to certain diagnoses over others based on the patient’s presentation, clinical history, and physical exam. It’s just a matter of being disciplined enough to go through the whole spectrum.

I’d strongly advise incoming med students to keep VITAMIN-C in the back of their minds as they build a knowledge base for their careers. It’ll serve you (and your patients) well. 🙂

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