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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.
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SARS: Would You Be Ready?In November 2002, cases of an atypical pneumonia were reported in the Guangdong province of southern China. By the following June, outbreaks of the illness-known as severe acute respiratory syndrome (SARS)-had occurred in Germany, Ireland, the United States, Canada,Hong Kong,Singapore, and Vietnam.
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Ulcerative Colitis With PseudopolypsFor 6 weeks, a 29-year-old previously healthy man had between 10 and 15 episodes daily of small-volume bloody diarrhea with intermittent paraumbilical pain. Anorexia and the loss of 25 lb accompanied the diarrhea. The patient had no significant medical history, took no medications, had not traveled recently, and had no contact with sick persons. He denied fever, chills, nausea, vomiting, and all other symptoms.
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Varicella-Zoster Virus InfectionAre these tender, vesicular erythematous lesions symptomatic of HIV/AIDS? Of Ramsay Hunt syndrome? Of herpes simplex or varicella-zoster virus? What's your diagnosis?
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What caused an elevated diaphragm in this woman with cough and dyspnea?A 52-year-old woman presented to her primary care physician complaining of a nonproductive cough and dyspnea on exertion. These symptoms had a subacute onset over 4 weeks before her initial visit. She denied fever, sputum production, hemoptysis, chest pain, palpitations, abdominal pain, nausea, vomiting, and diarrhea. She did not have any known sick contacts.
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Enoxaparin DermatosisThis is a very distinct, rare, and remarkable hemorrhagic rash, first recognized in 2006, with 7 known cases reported in the literature.
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End-of-Life Discussions: The Art of Delivering Bad NewsAn 84-year-old woman with progressive stenosis of the cervical spinal canal, type 2 diabetes mellitus, hyperlipidemia, gastroesophageal reflux disease, hypertension, and stable angina presents to her primary care physician after an appointment with the orthopedist who is monitoring her chronic degenerative joint disease.
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Woman With Sudden Drop in Platelet CountOn her third day of hospitalization for acute gallstone pancreatitis, a 49-year-old woman's platelet count fell to 113,000/L from 216,000/L the previous day.
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Diagnostic Images, Treatment DecisionsApreviously healthy 22-year-oldHawaiian man presents to theemergency department (ED) of a hospitalin California with a 3-day historyof fever and chills. He has also had aprogressively worsening, persistent,dull aching pain in the right upperquadrant of the abdomen for the pastweek. The pain is localized-with noaggravating or relieving factors-andis not related to meals. The patienthas had no nausea, vomiting, loss ofappetite, jaundice, abdominal distension,cough, chest pain, dyspnea,weight loss, or lymphadenopathy.
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Bronchoscopy Clinic: A patient with "worsening asthma"A 45-year-old man was referred to our pulmonary clinic for progressive dyspnea and worsening asthma. His shortness of breath had been worsening over the past 2 years. He denied fever, weight loss, and other systemic complaints.
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Enoxaparin DermatosisThis is a very distinct, rare, and remarkable hemorrhagic rash, first recognized in 2006, with 7 known cases reported in the literature.
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Suspected UTI in Nursing Home Patients: When to TestIs it appropriate to routinely order urinalysis for patients in a nursing home (both with and without dementia) when they exhibit behavioral changes but show no signs or symptoms of urinary tract infection (UTI)?
