Where has the key gone?

 "key feature"、"pivot point"の語が出現するCPSを集めてみた。

• A fundamental characteristic of expert diagnostic reasoning is the recognition of a key clinical finding, or "pivot point." "The Drenched Doctor"
• The pivotal step in identifying this condition as the cause of high-output heart failure in this patient was auscultation over a surgical scar. "A Missed Connection"
• A key feature of this case was the presence of concurrent arterial and venous thromboemboli, which can be attributed to only a small number of unifying diagnoses.
   "Painful Purple Toes"
• Anticipating a normal skin examination, examiners may have overlooked the lentigines or may have underappreciated the labial involvement as a key feature distinguishing the Peutz–Jeghers lentigines from ordinary freckles. "The Leading Diagnosis"
• A key feature when evaluating a patient with cough is symptom duration. "What's the Connection?"

"pivot point"であることを示す重要な表現が、"narrow the DDx"である。

• Although the differential diagnosis for lower-extremity edema is broad, two features of this presentation help to narrow it: the acute onset and the asymmetric distribution.  "Out of the Blue"
• The polyarticular, migratory nature of the joint pain in this patient helps to narrow the possibilities. "A Patient with Migrating Polyarthralgias"
• The urinalysis narrows the differential diagnosis; the absence of cellular casts decreases the likelihood of membranoproliferative disease. "A Complex Cause of Pleuritic Chest Pain"
• The finding of suppurative granulomas is helpful in narrowing the differential diagnosis. "Skin Deep"
• The combination of hypoxemia and normal breath sounds helps to narrow the differential diagnosis. "Breathless"
• This additional information narrows the differential diagnosis to causes of thyrotoxicosis associated with a low uptake of radioactive iodine. "A Hidden Solution"
• Additional details, such as the presence of blood in the stool, would be useful to narrow the differential diagnosis. "Thinking Inside the Box"
• The cutaneous findings help to narrow the differential diagnosis. "A Rash Hypothesis"
• The physical examination in this case is helpful in narrowing the differential diagnosis. "Under Pressure"
• A critical first step in narrowing the diagnostic possibilities is to determine whether this patient's hemostatic disorder is hereditary or acquired. "A Bloody Mystery"
• This differential diagnosis was narrowed after laboratory testing revealed marked peripheral-blood eosinophilia. "The Writing on the Wall"
• Earlier recognition of secretory diarrhea in our patient would have focused attention on a narrower list of potential causes, allowing the needle to be found in the haystack of possibilities. "Needle in a Haystack"
• Biochemical tests and MRI may narrow the diagnosis, but a definitive determination of the cause of a presumed infiltrative process generally requires endomyocardial biopsy. "Fool's Gold"
• Consideration of unusual exposures, treatments, or procedures may provide clues to narrow down an otherwise extensive differential diagnosis.  "An Unintended Consequence"
• The duration of cough at the time of presentation is a useful first step toward narrowing the differential diagnosis. "Nothing to Cough At"
• The rash on the palms of the patient's hands narrowed the broad differential diagnosis of intrahepatic cholestatic disorders and pointed to syphilis. "A Hand-Carried Diagnosis"
• The pattern of lung involvement (i.e. lobar, interstitial, or alveolar) can also help narrow down the possible causes. "Into the Woods"
• Although data from the physical examination often help narrow the differential diagnosis, in this case the finding of pulmonary hypertension necessitates expanding the diagnostic possibilities. "A Perfect Storm"