November 22nd 2024
Your daily dose of the clinical news you may have missed.
Woman With Recent Respiratory Tract Infection and Anemia
April 1st 2009A 50-year-old woman presents to the emergency department with severe dizziness, weakness, and dyspnea of 1 week’s duration. Ten days earlier, an upper respiratory tract infection (URTI) was diagnosed; over-the-counter cough syrup and acetaminophen were prescribed. However, the patient’s condition has steadily deteriorated since then. In addition, her urine has darkened over the past few days.
Bilateral Leg Ulcers in a Cachectic Man
March 2nd 2009A 51-year-old man is admitted to the hospital with painful ulcers on both lower extremities, severe anemia, and a 45-kg (100-lb) weight loss over the past year. Pain from the ulcers prevents him from walking. The ulcers developed about 5 years earlier, as a result of his wearing high boots for work; they began as small sores and grew over time.
Renal Artery Stenosis: When Is Revascularization Warranted?
February 2nd 2009Q:My patient is a 66-year-old man with long-standing hypertension and atherosclerotic heart disease. During a recent coronary arteriogram, the cardiologist performed renal artery screening, which revealed a left renal artery stenosis. Renal artery angioplasty and stenting were recommended. Is this appropriate?
Woman With Severe Headache and Left-Sided Weakness
December 2nd 2008A 47-year-old Hispanic woman with severe headaches of 1 month’s duration presents to the emergency department (ED). The pain encompasses the entire head, is constant and crushing (10 on a scale of 1 to 10), and has progressively worsened.
Nonalcoholic Fatty Liver Disease: Update on Evaluation and Treatment
November 2nd 2008Nonalcoholic steatohepatitis (NASH) was first reported by Ludwig and associates in a series of patients who had no significant history of alcohol intake but whose liver histology resembled that of alcoholic liver disease.
A Woman With Markedly Asymmetrical Breasts
November 2nd 2008A 77-year-old woman with Alzheimer dementia admitted to a behavioral hospital because of intractable agitation. Denies prior breast problems. Subsequently, her daughters state that she had a diagnostic breast biopsy 5 years earlier; diagnosis confirmed by review of pathology report. Patient has adamantly and consistently refused further investigation or treatment of breasts.
Tonic-Clonic Seizure in a Man With HIV Infection
November 1st 2008A 36-year-old man presents to the emergency department (ED) after a single tonic-clonic seizure. He has a history of numerous male sexual contacts. HIV infection was diagnosed 5 months earlier. At that time his CD4+ cell count was 66/μL and his HIV RNA level was 20,000 copies/mL.
Breast-Size Paired Bumps on the Back of an Old Man
October 2nd 2008A 93-year-old man with known Alzheimer dementia has his admission physical examination on transfer to a geropsychiatric hospital unit due to behavioral difficulties. A language barrier and his stoicism minimize communication, but his devoted wife translates and recounts that he is not in any physical discomfort. Has sometimes needed oxygen treatment in the past.
Drug Interactions That Decrease Levothyroxine Efficacy
October 2nd 2008Levothyroxine is one of the most commonly prescribed medications for the treatment of hypothyroidism as well as the suppression of thyroid neoplasms.1 Most patients with hypothyroidism require lifelong therapy with levothyroxine; therefore, the likelihood of drug interactions is high.
Non-HDL Cholesterol: When-and How-to Treat
September 2nd 2008Over the past 4 decades, our understanding of the role of elevated cholesterol in cardiovascular disease (CVD) has undergone radical change. During that time, we have moved from a belief that cholesterol does not matter and that atherosclerosis is an irreversible process to a strong conviction that treating elevated cholesterol, especially elevated low-density lipoprotein cholesterol (LDL-C), can slow and perhaps halt the progression of atherosclerosis. But it has been a slow process for several reasons. In the 1960s, the Framingham investigators demonstrated that elevated serum cholesterol is a risk factor for CVD.1
Serratia marcescens Pneumonia in an HIV-Infected Patient
August 2nd 2008For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.
Woman With Fever, Hoarseness, and a Half-Swollen Face
July 1st 2008A 55-year-old woman seen because of new lump under right side of her jaw; present for 24 hours. Associated neck discomfort causing dysphagia, and also a raspy turn to the voice; both much worse in last 12 hours. No dyspnea. No sore throat.
A Risk-Based Approach to the Care of Survivors of Childhood Cancer: 3 Case Studies
May 2nd 2008Survivors of childhood cancer frequently present to primary care practitioners for a routine physical examination or for urgent care. Knowledge of the patient's cancer history and of the specifics of the treatment are essential to providing proper care and addressing his or her unique risks.
Screening for Vascular Disease in a Former Smoker
May 2nd 2008As part of his preparation for retirement, a 66-year-old executive undergoes a complete physical examination. He is in good health and has no symptoms to report. Along with other age-appropriate screening studies, you discuss testing for vascular disease with him.
Chronic Pain Syndromes: How to Break the Cycle, Part 1
April 2nd 2008Pain is a significant public health concern. In a prevalence study conducted in Australia, 17% of men and 20% of women reported chronic daily pain. A US study found that 13% of the total workforce had lost productive time during a 2-week period because of a pain condition. Headache, back pain, and arthritis pain headed the list of causes.
Treatment of Sleep Apnea: To Cut May Not Always Be To Cure
March 2nd 2008How effective is upper airway surgery in treating obstructive sleep apnea? The fallout from the growing obesity epidemic includes obstructive sleep apnea (OSA) syndrome. Although OSA may be considered a "specialty disease" (managed by pulmonologists, sleep specialists, otolaryngologists, and bariatric surgeons), the primary care physician bears the brunt of providing ongoing care.
Systolic Hypertension: A Guide to Optimal Therapy
March 2nd 2008Systolic hypertension is an independent risk factor for coronary artery disease, stroke, and end-stage renal disease. Nonpharmacological interventions for systolic hypertension include limitation of dietary sodium and alcohol intake along with weight reduction and aerobic exercise.