Answer 1

The problem:
The problem here is chronic diarrhea associated with fine tremors and failure of all medical treatments given in the previous years as the patient described.

Discussion:
In a discussion with some internal medicine residents they concentrated on the infectious causes of chronic diarrhea like bilharziasis (the patient already had many years ago), worm infestations and HIV infection (which was not suggested clinically because of the absence other immunodeficiency symptoms during the past years). There was no explanation for tremors associated with diarrhea (despite being remarkable with repeated neurological consultations and treatments prescribed). This pattern of thinking represents the pattern applied during all those years of the patient's illness.

The big picture:
The problem really lies in looking at the big picture. Thinking of a common cause of diarrhea, hypertension and fine tremors will reveal the cause of illness. A common cause in this case is hyperthyroidism which was then confirmed by the labs.

The patient was given antithyroid drugs with dramatic relieve of symptoms after all those years of suffering