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    Hints for Suggesting New Zebras[Top]
After eagerly poring through Zebra Cards countless times, readers will, I hope, gain an appreciation of what makes a good card (and what does not). To minimize the amount of frustration and nonproductive effort, however, some general principles are listed below:
  1. A rare disease does not a Zebra Card make. We seek little known, but striking manifestations of any disorder, be it rare or common. Thus, Mollaret meningitis is a rare condition, but it has no symptom or sign sufficiently striking to set it off from other chronic meningitides. The manifestation must be reasonably obscure; every medical student knows that "sterile pyuria" occurs in renal tuberculosis, even though renal tuberculosis is nowadays rare.

  2. Manifestations with long differentials should, in general, be avoided. Thus, nephrotic syndrome after an insect sting is unsuitable because listing "nephrotic syndrome" as the observation calls an extremely long differential to mind. This can sometimes be circumvented by mentioning a specific population in the zebra, for example, "nephrotic syndrome in a neophyte beekeeper" (ugh!). When many of the items in the differential have occurred only at the case report level of frequency, an approach similar to card EA-006 (calcified pinna) may be adopted.

  3. It is imperative that each zebra be referenced as completely as possible.

  4. No pediatrics, please (all those congenital syndromes!), unless untreated or undiagnosed patients have been reported to live past adolescence. As mentioned elsewhere, neurology is a zebra-rich environment, so submissions in this category will be judged more stringently.


Finally: It was stated at the Outset, that this system would not be here, and at once perfected. You cannot but plainly see that I have kept my word. But I now leave my [classification] System standing thus unfinished, even as the great Cathedral of Cologne was left, with the crane still standing upon the top of the uncompleted tower. For small erections may be finished by their first architects; grand ones, true ones, ever leave the copestone to posterity. God keep me from ever completing anything. This whole book is a draught -- nay, but the draught of a draught. Oh Time, Strength, Cash, and Patience!

Herman Melville, Moby-Dick [1851]

    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:32 PDT on July 4, 2000.[Top]

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