October 31st 2024
ACG 2024: New study results indicate GLP-1 RAs have a potentially protective role to play in combating EO-CRC, the incidence of which is notably rising worldwide.
October 10th 2024
Can You Identify These Puzzling Conditions?
December 31st 2006A 51-year-old man presents with aseverely infected leg and 1- to 2-cmlesions on all of his extremities andtrunk; the bases of the lesions aredepressed, atrophic, and scarred.According to the patient, the lesionstypically appear as tender nodulesor pustules, which spontaneouslyburst, drain purulent material, andeventually heal as pictured.
Man With Severe Dyspnea, Fever, and Cough
December 31st 2006A46-year-old white man is hospitalized with increasing dyspnea of 3weeks’ duration. He has a history of stable chronic obstructive pulmonarydisease secondary to heavy smoking (2 packs of cigarettes a day for 27years, discontinued 6 years previously) and uses inhaled bronchodilators.
A Photo Quiz to Hone Dermatologic Skills
December 31st 2006A 38-year-old overweight woman presents with an asymptomatic rash ofat least 2 months’ duration that had not responded to a combinationcorticosteroid/antifungal agent. She has mild hypertension and type 2 diabetesmellitus that is being managed with diet and exercise. She is otherwisehealthy.
Gestational Diabetes: Worth Testing For? Worth Treating?
December 31st 2006Is there evidence that treating elevated fasting glucose levels or impairedglucose tolerance, from early in pregnancy until term, improves outcomes(ie, fewer cesarean deliveries, fewer macrosomic babies, fewer patients in whompreeclampsia develops, fewer mothers who subsequently require insulin)?
Abdominal Aortic Aneurysm and Dissection of the Left Internal Carotid Artery
December 31st 2006A 75-year-old man with coronaryartery disease presents to the emergencydepartment with abdominalpain and light-headedness. The painbegan as a dull ache 4 days earlierand recently became considerablyworse. The patient denies recenttrauma, fever, nausea, vomiting, and diarrhea.
Older Smoker With Worsening Dyspnea on Exertion
December 31st 2006A 75-year-old man with a 120-pack-year smoking history has dyspnea on exertion(eg, when he walks more than 3 blocks or climbs 1 flight of stairs) butnot when he is at rest or asleep. His symptoms have progressively worsenedover the past 3 to 4 years and have been accompanied by a 20-lb weight loss.
Older Woman With Nonhealing Foot Ulcer
December 31st 2006A 67-year-old woman has had an ulcer on her left heel for at least several weeks.She applied a homemade dressing and cut her shoes to try to relieve pressureon the ulcer; however, in the past week, areas around the ulcer have becomepainful. These areas, as well as the dorsum of the foot, are red and swollen.
Weight Loss in an Elderly Colon Cancer Survivor
December 31st 2006A 72-year-old man complains that he has been losing weightfor the last 2 months. Colon cancer was diagnosed 2 yearsearlier, and the lesion was resected; he did not receive anyadditional therapy at that time. Except for hypertension,which is well controlled with propranolol, the remainder ofthe medical history is unremarkable.
Elderly Man With Fatigue and Backache
December 31st 2006A70-year-old African American man, who is a retiredelectrician, presents with increasing fatigue anddull back pain of 4 months’ duration. Although he usuallywalks about 2 miles a day, he now becomes exhaustedafter half a block. He reports exertional dyspnea but noparoxysmal nocturnal dyspnea or orthopnea. Recently, henoticed ankle edema.
Progressive Dysphagia and Weight Loss in an African American Woman
December 31st 2006Over the past 6 months, a 76-year-old African American woman has had increasingdifficulty in swallowing solid food and has lost 40 lb. She can now tolerateonly liquids and foods with a pudding-like consistency. Ingestion of moresolid food produces the sensation that it is “sticking in her chest,” and shesubsequently regurgitates it undigested. She denies heartburn, reflux, nausea,hematemesis, abdominal pain, and melena.
Worsening Back Pain in an Injection Drug User
December 31st 2006For several weeks, a 29-year-old woman has had worsening left lower backpain that is aggravated by sitting and walking. The pain is most severe aboveher left buttock; it radiates into the buttock and very slightly into the leg. Overthe-counter analgesics have been ineffective. Assuming a supine position providessome relief, but the pain still occasionally awakens her at night. She deniesweakness, other neurologic symptoms, and any symptoms of bowel orbladder dysfunction.
Young Woman With Cardiac Complications of Anorexia Nervosa
December 31st 2006A 23-year-old woman has had 2 episodesof syncope during the past month.Her mother witnessed 1 episode inwhich the patient collapsed and lostconsciousness for a few minutes. Sheexperienced tonic-clonic seizure activitybut no subsequent confusion.
Radiating Midsternal Pain in a Middle-aged Woman
December 31st 2006A 45-year-old woman is admitted for evaluation of intermittentmidsternal chest pain that began 48 hours earlier.The pain is intense and radiates down both arms to theelbows; it has been accompanied by several episodes ofnausea and diaphoresis. She denies classic angina pectorisbut reports that she has experienced episodes of chestdiscomfort that is similar to her current pain-but muchless severe and without radiation-for about 3 months.She has no history of dyspnea on exertion, orthopnea, orparoxysmal nocturnal dyspnea.
Update on Clot Prevention in Patients With Antiphospholipid Antibody Syndrome
December 31st 2006In her response to a reader’s question about clot prevention in a patient with systemiclupus erythematosus (SLE) and anticardiolipin antibody syndrome,Dr Bonnie Bermas recommends warfarin (CONSULTANT, September 15, 2003,page 1329).
Young Man With Acute Right Lower Quadrant Pain
December 31st 2006A 21-year-old man presents to the emergency department with abdominal painof 6 hours’ duration. When the pain began, it was diffuse and periumbilical; now,it is worse and localized to the right lower quadrant. It has been accompanied byanorexia but not by diarrhea or emesis. Lying down, consuming liquids, andshowering have not provided relief.
A Photo Quiz to Hone Dermatologic Skills
December 31st 2006A 38-year-old woman presents with a pruritic, tender rash on the trunk and extremitiesthat has not changed over the past few days. She has taken fluvastatinand sertraline for 1 year and a popular, over-the-counter weight-loss product for1 or 2 weeks. The patient denies using any other medications. She has had norecent illnesses.
Woman Who Has Felt Unwell for Many Years
December 31st 2006A 41-year-old woman presents as a new patient, with complaintsof chest pain and palpitations that occur intermittentlyand are not associated with activity, meals, or position.She says these symptoms have been present forsome time, and she expresses frustration that her previousphysician was unable to find their cause or to amelioratethem.
Temporal Arteritis in a 60-Year-Old Man
December 31st 2006A 60-year-old man has had anterior neck discomfort for the pastseveral weeks. He also has right-sided cephalalgia and occasional jaw discomfortwhile eating but no dysphagia or odynophagia. The cephalalgia, which hasbeen present for the past week, is moderately severe and is associated withblurred vision.
Middle-aged Man With Worsening Foot Pain
December 31st 2006For about 3 to 4 months, a 53-year-old man has had gradually worsening footdiscomfort. He describes the discomfort as a burning sensation accompaniedby numbness and tingling. Initially, these symptoms were present only in hisfeet, but for several weeks they have involved both ankles as well. Althoughthe discomfort is always present, it is occasionally aggravated by the bed coversor by heavy woollen socks. The patient has no skin lesions, motor symptoms,or other abnormalities of his legs or feet.
Middle-aged Woman With Abdominal Pain, Jaundice, and Anorexia
December 31st 2006For 3 weeks, a 52-year-old woman has had right-sided, intermittent, dullabdominal pain and jaundice; these symptoms have worsened in the past fewdays. The pain radiates to the back, worsens with movement, is somewhatrelieved in certain positions, and is unrelated to eating or defecation. Duringthe past 3 weeks, she has also noticed darkening of her urine, a profound decreasein appetite, and an increase in fatigue; she has lost considerable weightbut is unsure of the exact amount. She has had no nausea, vomiting, or melenaor other change in her bowel movements.
Near-Syncope in an Elderly Woman
December 31st 2006An 84-year-old woman with hypertension and type 2 diabetes mellitus isbrought to the emergency department (ED) after an episode of nearsyncope.When emergency medical service personnel initially assessed her,blood pressure was 96/60 mm Hg and heart rate was “slow”; however, shehad no symptoms.
Older Man With Exertional Dyspnea and Leg Swelling
December 31st 2006A 74-year-old man with a history ofatrial fibrillation presents to hisprimary care physician with dyspneaof 4 days’ duration. The dyspnea developedwhile he was walking as partof his recovery from back surgery forspinal stenosis 1 month earlier. Hebecame progressively short of breathand was unable to carry out his exerciseprogram.