American College of Physicians: Internal Medicine — Doctors for Adults ®


Crossed Words: To finger the culprit, follow the tips

From the February ACP Internist, copyright 2014 by the American College of Physicians

By Justin Vader, MD, ACP Resident/Fellow Member

Answers to clues are placed horizontally in rows to reveal an answer written vertically. Unlike the familiar acrostic puzzle format, the final answer can be in any column.

Horizontal clues

1) Common cause of benign bili bump

Find in the vertical columns: Not a handsome disorder. The puzzle grid is here.

Bonus clue, find in the vertical columns: Knuckle down for the answer

Answer: Buerger’s disease

The answer grid is here. Buerger’s disease (thromboangiitis obliterans) is a vascular disorder characterized by acral tissue loss on the hands. Acute inflammation and clotting of the arteries and veins of the hands and feet can cause critical limb ischemia and/or claudication, rest pain, and non-healing sores or ulcers in the hands and/or feet.

Photo by iStock.

Photo by iStock.

Buerger’s disease, which occurs almost exclusively in heavy smokers, is treatable only by stopping smoking and other tobacco use. Failure to do so can result in amputation. (Information from the University of California, Davis Vascular Center.)

Bonus answer: Gottron’s papules

Gottron papules are erythematous to slightly violaceous papules over the bony prominences of the hands and fingers associated with dermatomyositis. Gottron sign is macular erythema over the extensor surfaces, particularly the interphalangeal joints or elbows and knees. Dermatomyositis is an idiopathic inflammatory myopathy with a peak incidence in patients between 40 and 60 years of age. An increased association with malignancy has been noted with dermatomyositis. Initial therapy is with glucocorticoids. (Information adapted from MKSAP 16.)


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