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Is There a Medical Explanation?A 13-year-old girl of African American descent is brought to the pediatrician’s office becauseof a lesion on her neck. The girl’s mother had telephoned the office before the visit, statingthat the lesion resembled a blister at first, but now looked like a burn.
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Prolapsed ColostomyA 43-year-old woman was hospitalized with a 3-day history of fever and back pain. She was malnourished and seropositive for HIV infection. Results of blood and sputum cultures were negative. A community-acquired pneumonia was diagnosed. Chest film findings and the clinical presentation were inconsistent with Pneumocystis carinii pneumonia.
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An Intriguing DiagnosisA 16-year-old Somali girl presents witha 3-day history of bilateral arm swellingand painful vesicular eruptions; hersymptoms are worsening. She reportsthat 5 days earlier, she and her friendshad used henna and black hair dyeto “tattoo” their skin. The others havenot experienced similar signs or symptoms.This patient has used henna(which is dark red) since childhoodfor decorative purposes. However, outliningan intricate design with hairdye is new for her.
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Podcast: Incretins for Type 2 Diabetes Mellitus (Part 2)In his second podcast, Dr Louis Kuritzky discusses the classes of incretin-based therapies now available for patients with type 2 diabetes mellitus.
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Elephantiasis Verrucosa NostrumA 62-year-old obese woman with adult-onset type 1 diabetes mellitus had a 6-year history of bilateral leg edema. During the last year, the edema worsened and the skin on her legs thickened. She also had multiple, bilateral, painful, superficial ulcers that drained copiously.
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Maltoma in a 72-year-old ManA 72-year-old man presented after several months of dyspepsia and 1 day of hematemesis. He was not taking NSAIDs.
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Basal Cell Carcinoma on Face of a 54-Year-Old Farm WorkerWhen this lesion was seen on the face of a 54-year-old farm worker, cutaneous melanoma was the immediate concern. Accordingly, a full-thickness excisional biopsy was performed. (Curettage and shave biopsy are contraindicated for a suspected melanoma.)
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Malpositioned Nasogastric TubeA 67-year-old woman, who had hypertension and chronic obstructive pulmonary disease, presented to the emergency department with mild abdominal discomfort and shortness of breath.
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Use the Earlobe for Pulse OximetryWhen using pulse oximetry to evaluate patients with Buerger disease, Raynaud phenomenon, a history of heavy smoking, or other conditions that cause vasoconstriction of the fingers, place the probe on the earlobe. In such patients, this gives a more accurate measurement of arterial hemoglobin saturation than does a digital placement.
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Older Man With Fever and Tender RashFor 1 week, a 77-year-old man had a fever and a tender, nonpruritic rash on both palms (Figure 1) and on the anterior aspect of both knees (Figure 2). Two weeks earlier, he had hives, which ameliorated after a 10-day course of cetirizine and a tapering course of prednisone. He also had headaches almost daily for the previous 6 to 8 weeks.
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Q&A: What Strategies Help Prevent Acute COPD Exacerbations?What are the most effective ways to reduce the incidence of acute exacerbations of chronic obstructive pulmonary disease?
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Cavitary Lung Cancer With MetastasesA 60-year-old woman with a 3-month history of cough, chest pain, and shortness of breath was brought to the emergency department. The patient denied any history of fever, chills, or rigors; she complained of mild hemoptysis for 1 week and a 9-kg (20-lb) weight loss during the last few months. The patient had smoked cigarettes for 40 years.
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OnychogryphosisThis patient, a woman, presented with onychogryphosis, a severe nail change seen on the toes, especially the great toe. Thickening and hardening of the nail substance with a curved growth pattern produces this abnormal clawlike configuration.
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Bochdalek HerniaA 48-year-old woman with hypertension, HIV infection, anemia, and chronic kidney disease presented with generalized body weakness and diarrhea of several months’ duration.
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Pituitary Macroadenoma in a 77-Year-Old ManDuring a workup for dementia, a 77-year-old man was found to have a pituitary macroadenoma (21 x 17 x 25 mm) with suprasellar extension on a coronal-section MRI scan. The patient had hypertension and mild erectile dysfunction. He denied headaches, nausea, vision problems, weight changes, weakness, and polyuria. His medications included nifedipine, hydrochlorothiazide, and aspirin.
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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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Sulfonylurea-Induced Hypoglycemia: The Case Against GlyburideSince it came onto the market in 1983, glyburide has been one of the most popular sulfonylureas. The American Diabetes Association (ADA) recommends the use of these agents as part of a stepwise approach to treating type 2 diabetes mellitus.
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Smallpox Vaccination: The Risks for Patients With Atopic DermatitisBecause of recent threats of bioterrorism, smallpox vaccination was reinstated in the United States earlier this year. Since January 2003, more than 35,000 civilian and public health care workers in 54 jurisdictions have been vaccinated.
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Woman With Purpura FulminansThe patient is severely ill. Temperature is 39°C (102.2°F). Shortly after admission, she requires intubation with ventilatory support. Hypotension, acrocyanosis, and an ecchymotic rash consistent with purpura fulminans (A) rapidly develop.
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Suture GranulomaAn 80-year-old woman presented with recurrent abdominal pain for 1 month, constipation, and vomiting. She had no diarrhea, rectal bleeding, or weight loss.
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Sudden Headache in a Woman With HypertensionA 37-year-old woman presents to the emergency departmentwith a diffuse, sharp, pounding headache,which started 2 hours earlier. She rates her discomfort as4 on a scale of 1 to 10. Neck muscle soreness is also present,but the pain does not radiate.
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Syncope: Causes and TreatmentBecause the causes of syncope are numerous and the diagnostic tests have low yield, this disorder is often difficult to evaluate. Here we describe a practical approach to the workup that can help you rapidly identify serious underlying pathology. We also discuss treatment of the most common causes of syncope.
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Renal Cell Carcinoma Metastases to the LungA 2-month history of cough sent a 62-year-old woman for medical evaluation. The patient denied fever, chills, and rigors but reported seeing streaks of blood in her sputum during the past month. The patient had undergone a right nephrectomy 4 years earlier for renal cell carcinoma.
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Case In Point: A patient with persistent left superior vena cavaThe authors describe a patient whose persistent left superior vena cava was first suspected because of difficulty in placing a right internal jugular venous catheter.
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Creeping EruptionThe foot of a 10-year-old boy demonstrates the unique wandering cutaneous lesions of creeping eruption, or cutaneous larva migrans. This disorder is caused by skin penetration of hookworm larvae. It is seen in the southeastern United States and tropical and subtropical regions throughout the world.
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Woman With Abdominal Pain and ObstipationA 63-year-old woman presents to the emergency department with a 3-day history of abdominal pain, nausea, and obstipation. The pain is located in the left lower quadrant and is sharp, constant, and nonradiating.
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CollagenomasDuring a skin cancer screening, a 45-year-old male soldier was noted to have bilateral subcutaneous nodules on the dorsa of his feet. The patient reported that the nodules had remained unchanged since they first appeared in his early 20s and were asymptomatic. He had no other lesions.
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Creeping EruptionThe foot of a 10-year-old boy demonstrates the unique wandering cutaneous lesions of creeping eruption, or cutaneous larva migrans. This disorder is caused by skin penetration of hookworm larvae. It is seen in the southeastern United States and tropical and subtropical regions throughout the world.
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Aortic Valve AbscessA 75-year-old woman with a bioprosthetic aortic valve, who had undergone surgical repair of an aortic root aneurysm 9 months earlier was hospitalized with fever, headache, and altered mental status of 1-day's duration.
