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Man With Prosthetic Valve Who Needs GI SurgeryA 68-year-old man with a prosthetic mitral valve presents to the emergency department with acute abdominal pain, nausea, vomiting, and constipation. Surgical evaluation is performed; the results suggest a complete bowel obstruction. Urgent celiotomy is recommended.
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Cecal Volvulus at an Unusual AgeFor the past 2 hours, a 19-year-old man had lower abdominal pain accompanied by nausea and vomiting. He had no fever and no diarrhea. Direct tenderness was mainly in the right lower quadrant, radiating slightly to the left lower quadrant. There was no significant rebound tenderness. The patient refused rectal examination.
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Lower Quadrant Pain and Emesis in a Young BoyThe 9-year-old was admitted after 1 day of symptoms; he had no fever, diarrhea, constipation, dysuria, or rash. More details here. What's your diagnosis?
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A patient with Cushing syndrome and reduced lung volumesWe present a rare case ofCushing syndrome resultingfrom thymic carcinoid of thelung. Although Cushing syndromeis not usually associatedwith respiratory muscleweakness or restriction, ourpatient had reduced lung volumesand expiratory muscleweakness. His reduced lungvolumes could not be completelyexplained by respiratorymuscle weakness, parenchymallung disease, or obesity.Six months after removal ofthe carcinoid tumor, the patient'sgrowth hormone leveland the lung volumes improvedsignificantly, and hebecame asymptomatic.
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Metastatic Melanoma in an 83-year-old ManAn 83-year-old man with a history of hypertension and coronary artery disease presented with a 4-day history of mental status changes, slurred speech, and difficulty ambulating. He reported a lack of appetite and weakness of several days.
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Visual Hallucination: Charles Bonnet SyndromeCharles Bonnet syndrome is an uncommon condition causing visual hallucination in patients who do not have mental illness
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Inflammatory Breast CancerA 40-year-old woman was concerned about an area of redness and tenderness on her left breast. Despite antibiotic therapy prescribed by another physician, the rash had progressed during the past month to erythema and nodules that involved the anterior chest and right breast.
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Chylothorax After Debridement of Necrotizing FasciitisA 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.
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A case of progressive shortness of breath in a patient with emphysemaA 71-year-old man who had received a diagnosis of emphysema 12 years ago was referred by his primary care physician to the pulmonary clinic. His symptoms were well controlled until a few months ago, when he complained of mild shortness of breath on physical activity. However, the shortness of breath worsened and became a significant limiting factor. He also had a persistent dry cough.
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MAC Infection in a Man With Pectus ExcavatumFor 6 weeks, a 56-year-old man had worsening dyspnea on exertion and a cough productive of yellow sputum with scant hemoptysis. He reported subjective fever over the past month but no weight loss.
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Removing Fishhook From FingerA 3-year-old boy was at home with his cousin who was preparing for a fishing trip when a fishhook accidentally became lodged in the distal part of the child's right middle finger. There was mild erythema and swelling, with tenderness on palpation. No bleeding or discharge was noted. The patient had full range of motion, with normal sensation and capillary refill. Remaining examination findings were unremarkable. Radiographic views of the affected area confirmed the absence of bony infiltration.
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Disseminated CandidiasisA 72-year-old morbidly obese man who had diabetes mellitus was admitted to the hospital from a nursing home with a fever of 4 days' duration. A tracheostomy had been performed 3 months earlier for respiratory failure. The patient was being treated with corticosteroids for chronic obstructive pulmonary disease.
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Eczema Herpeticum in a 4-Year-Old GirlThis diagnosis is a relative dermatologic emergency; presumptive treatment with antivirals should at least be considered if any suspicion exists.
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Lisfranc Ligamental InjuryAfter a fall during a soccer match 2 weeks earlier, a 26-year-old woman had pain of the right midfoot, with moderate swelling. The pain was aggravated with a normal gait and alleviated with an antalgic gait, specifically with inversion of the right ankle such that most of the weight from heel-strike through toe-off transmitted forces from the lateral calcaneus through the fifth metatarsus to the fifth phalanx.
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Middle-aged Hiker With Facial ParalysisA 46-year-old man presents with right-sided facial paralysis. His symptoms beganthe previous evening when he had difficulty in closing his right eye; by morning,paralysis had developed. He also reports headache and mild photophobia.
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Elderly Man With Weakness, Poor Appetite, and Abdominal Cramping on DefecationAn 83-year-old man complains of weakness, easy fatigability, and poor appetitethat began 4 to 6 weeks ago. He becomes short of breath on his daily walksand has lost about 20 pounds over the last 3 months. He denies nocturia,paroxysmal nocturnal dyspnea, exertional chest pain, fever, cough, melena,and hematochezia. His only GI symptom is occasional crampy abdominal painwith bowel movements.
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A Young Woman With Sudden Loss of Vision in One EyeA 17-year-old sexually active young woman presented with sudden loss of vision in the left eye 2 weeks before presentation.
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Chilaiditi SyndromeDull, intermittent, midepigastric abdominal pain of 1 day's duration prompted a 73-year-old man to seek medical attention. He had no other symptoms.
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Swallowed Toothbrush in a Bulimic AdolescentA 16-year-old girl of normal weight for height (body mass index, 21) was evaluated for a 6-month history of binge-purge cycles and amenorrhea. She met the diagnostic criteria for bulimia nervosa and began treatment that involved a multidisciplinary team. During the second month of therapy, the patient presented to the emergency department after she accidentally swallowed a toothbrush while trying to induce vomiting with the brush’s handle.
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Case In Point: A man with renal failure, dyspnea, and an apparent lung massA 54-year-old man with chronic renal insufficiency presented with shortness of breath, nonproductive cough, and chest pain. The patient had hypertension, type 2 diabetes mellitus, and a 30-pack-year history of cigarette smoking. He denied alcohol or illicit drug use and prolonged exposure to asbestos, chemicals, or fumes.
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An Unusual Presentation of Septic HipEmphysematous cholecystitis is a rare condition that is the result of infection with Clostridium perfringens and other gas-producing organisms including Escherichia coli, Bacteroides fragilis, and Klebsiella species.
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Fracture After Fall in a Middle-Aged African American WomanA 58-year-old African American woman comes for a follow-up visit after sustaining a fracture of the right radius, which occurred when she tripped on loose carpeting and broke her fall with an outstretched hand.
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Hematemesis Secondary to a Bronchogenic CystA 24-year-old man with an unremarkable medical history presented to the emergency department with abdominal pain and hematemesis of 3 days' duration. His symptoms were postprandial, and each episode yielded up to half a cup of blood without clots. He denied using NSAIDs or alcohol. He had had an episode of hematemesis 2 years earlier that resolved spontaneously, for which he had not sought treatment. His vital signs were normal, and his physical examination was notable only for moderate epigastric tenderness without rebound or guarding.
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Infection of the Cutaneous Apocrine GlandsHidradenitis suppurativa is a chronic acneiform infection of the cutaneous apocrine glands.
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COX-2 Inhibitor–Induced RashA 63-year-old man was given oral celecoxib, 100 mg bid, for shoulder pain. Three days later, a pruritic rash appeared on his back, then spread to the chest, lower legs, and face. He stopped the celecoxib on his own and self-administered diphenhydramine for the pruritus. The rash and itch persisted, which prompted the patient to seek medical care. He had no respiratory symptoms.
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A Rash of Rough Spinous Patches on a Young GirlThe rash has been present for 2 years. Originally on the trunk and extremities it has now spread to her face and hands. She has been diagnosed as having and been unsuccessfully treated for nummular eczema and tinea corporis. What's your Dx?
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Fifth DiseaseThe parents of a 2-year-old sought treatment for a rash on their son's face. The child had had a low-grade fever for 3 days before the rash erupted. An intermittent lace-like rash was beginning to develop on the extremities. The patient was otherwise asymptomatic.
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Takotsubo Syndrome in an African American Woman With Typical PresentationAlso known as “broken-heart syndrome,” Takotsubo syndrome is a stress-induced cardiomyopathy.
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Might Obstructive Sleep Apnea Explain Your Patient’s Nightmares?Consider OSA in your the differential diagnosis in patients who present with nightmarers. Continuous positive airway pressure (CPAP) can provide effective treatment.
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Nonspecific symptoms are among the obstacles to diagnosis Pulmonary alveolar proteinosis: An easy-to-miss diagnosis key words: Alveolar proteinosis, Surfactant, Whole lung lavageabstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)
