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Adult and Adolescent Immunizations: When to Recommend the New VaccinesVaccination rates in adults are lower than those in children, but the consequences of lack of immunization in adults are just as significant. Barriers to adult immunization include patients’ lack of knowledge or misconceptions about vaccines and health care providers’ failure to recommend vaccination.1
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Thyrotoxic Periodic ParalysisAttacks of muscle weakness associated with this condition can range in severity from mild deficit to complete paralysis. Episodes may alternate with periods of normal muscle function.
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Effort-Related Upper Extremity ThrombosisDuring the first quarter of a football game, a 17-year-old athlete noticed that his right (dominant) arm was swollen and heavy. Two days earlier, he had fired a shotgun right-handed multiple times while hunting.
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Effort-Related Upper Extremity ThrombosisDuring the first quarter of a football game, a 17-year-old athlete noticed that his right (dominant) arm was swollen and heavy. Two days earlier, he had fired a shotgun right-handed multiple times while hunting.
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HIV-Associated LymphomaFor 2 months, a 30-year-old man with a history of cocaine abuse had had a painful gingival mass and difficulty in eating. Examination revealed a large, fungating mass in the anterior oropharynx that extended posteriorly up to the retromolar region. Posterior cervical lymph nodes were enlarged bilaterally, with no other peripheral lymphadenopathy.
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An Unusual Cause of Pleural EffusionA 36-year-old man presents with a 10-day history of progressive dyspnea anddiscomfort on the left side of his chest.Three weeks earlier, he was dischargedfrom the hospital after a 2-week stayfor acute pancreatitis. He has a historyof long-term alcohol abuse and recurrentpancreatitis.
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A 45-year-old man with intralobar bronchopulmonary sequestrationBronchopulmonary sequestrationis a rare congenitallung malformation characterizedby an abnormal segmentof bronchopulmonary tissuesupplied by an anomaloussystemic artery. The diagnosismay be easily missed in adults,since many are asymptomatic;moreover, symptoms, whenpresent, often overlap withthose of other pulmonaryprocesses. Surgical resectionprovides definitive managementand is usually reservedfor patients with symptoms.We present a case of intralobarbronchopulmonary sequestrationthat presented duringadulthood.
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Thanks for the MemoriesEach time I see a patient, I note on the chart personal events in his or her life--such as "going on a cruise" or "attending grandson's graduation"--in addition to the clinical findings.
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Respiratory infections in diabetes: Reviewing the risks and challengesABSTRACT: Although the organisms that cause community-acquiredpneumonia are similar in diabetic and nondiabetic patients,those who have diabetes mellitus (DM) may have moresevere disease and a poorer prognosis. Elevated blood glucoselevels are associated with worse outcomes in patients withpneumonia, and the mortality risk may be as high as 30% in patientswith uncontrolled DM. Thus, appropriate treatment-and possibly prevention-of bacterial pneumonia should includeaggressive efforts directed at glycemic control. Other respiratoryinfections, such as influenza, tuberculosis, and fungalpneumonia, also are associated with greater morbidity in patientswith DM. Diabetic patients with tuberculosis are morelikely to present with bilateral lung involvement and pleural effusions.(J Respir Dis. 2008;29(7):285-293)
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Effort-Related Upper Extremity ThrombosisDuring the first quarter of a football game, a 17-year-old athlete noticed that his right (dominant) arm was swollen and heavy. Two days earlier, he had fired a shotgun right-handed multiple times while hunting.
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Bronchial Carcinoid TumorA 59-year-old man presented with a cough and 2 episodes of pneumonia during the past 4 months. He had a 45-pack-year history of smoking cigarettes.
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Eye on Ocular Disorders: Isolated Abducent Nerve PalsyA 65-year-old woman presented withdouble vision of 2 days’ duration.The diplopia mainly occurred whenshe looked toward her right. She deniednausea, vomiting, vision loss,headache, change in mental status,facial pain, weakness in the extremities,and sinus infection. She had nohistory of head trauma or systemicmalignancy.
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Case In Point: A boy with shortness of breath, cough, and myalgiasAn 8-year-old boy presented with a 6-week history of shortness of breath, cough, and myalgias, but no fever. His pediatrician had made the diagnosis of bronchiolitis, and the patient was treated with azithromycin and albuterol via a metered-dose inhaler. Because the patient did not improve, he was given a 10-day course of amoxicillin, followed by a course of clarithromycin after a chest radiograph revealed bilateral infiltrates, suggesting atypical pneumonia.
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Headache as a Rare Presenting Symptom of Löfgren SyndromeLöfgren syndrome is a form of acute sarcoidosis characterized by a triad of symptoms: hilar adenopathy, erythema nodosum, and arthralgias.
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Amyotrophic Lateral SclerosisIn its classic form, ALS affects motor neurons at 2 or more levels supplying multiple regions of the body.
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Purple Urine Bag SyndromeThe purple-stained urine bags and tubing of 2 elderly patients are shown here. Neither patient received urine-discoloring medications.
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Photo Quiz: Mysterious Spheres on a Chest RadiographIn plombage therapy for pulmonary TB, polymerized methyl methacrylate, or Lucite, balls were inserted into the chest to collapse the lung and to maintain adequate thoracic expansion.
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LithophagiaLatest:
Friday Feedback: Can Fitness Trackers Step Up Weight Loss?A new study suggests trackers don't help, but medical experts weighed in with a full spectrum of opinions.
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Hand Deformities and Heart Problems: A Case ReportPatients who present with congenital hand deformities in association with cardiac disorders require a detailed evaluation.
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Lymphoepithelial Cysts in a Patient With HIV: Is HAART the Answer?Lymphoepithelial cysts of the parotid gland may be diagnostic of HIV infection; they are typically bilateral, benign, and associated with lymphadenopathy.
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How best to diagnose and control asthma in the elderlyAbstract: A number of factors can complicate the diagnosis of asthma in elderly patients. For example, the elderly are more likely to have diseases such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) that--like asthma--can cause cough, dyspnea, and wheezing. Spirometry can help distinguish asthma from COPD, and chest radiography and measurement of brain natriuretic peptide levels can help identify CHF. Important considerations in the management of asthma include drug side effects, drug interactions, and difficulty in using metered-dose inhalers. When discussing the goals of therapy with the patient, remember that quality-of-life issues, such as the ability to live independently and to participate in leisure activities, can be stronger motivators than objective measures of pulmonary function. (J Respir Dis. 2006;27(6):238-247)
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Adult and Adolescent Immunizations: When to Recommend the New VaccinesVaccination rates in adults are lower than those in children, but the consequences of lack of immunization in adults are just as significant. Barriers to adult immunization include patients’ lack of knowledge or misconceptions about vaccines and health care providers’ failure to recommend vaccination.1
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Scrub Typhus: Two Cases Presenting as Abdominal PainScrub typhus, which is caused by Orientia tsutsugamushi, has various systemic manifestations, including GI symptoms. We describe one patient with scrub typhus who presented with symptoms that suggested acute appendicitis and another who presented with symptoms of acute cholecystitis.
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Middle-Aged Man with Polyuria and Penile Swelling and PainFor 2 weeks, a previously healthy 40-year-old man has had excessive thirst and increased frequency of urination. He awakens at least 5 times every night to urinate. He reports no nausea, vomiting, change in bowel habits, chest pain, or dyspnea.
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Two Cases of Rhythm DisturbanceFor 2 days, a 49-year-old man with hypertension and hypercholesterolemiahas experienced light-headedness and fatigue.Based on the presenting ECG, what is the most likely cause of hissymptoms?A. Accelerated junctional rhythm.B. First-degree atrioventricular (AV) block.C. Mobitz type I (Wenckebach) second-degree AV block.D. Mobitz type II second-degree AV block.E. Third-degree AV block (complete heart block).
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Paget's Disease of BoneA serum alkaline phosphatase (ALP) level three times higher than normal, found on routine laboratory examination, prompted further evaluation of a 57-year-old man. At admission, his temperature was 36.8°C (98.2°F), blood pressure was 120/85 mm Hg, pulse rate was 90 beats per minute, and respiration rate was 19 breaths per minute. The physical examination was unrevealing, and the patient's personal and family medical histories were unremarkable.
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Boerhaave SyndromeAn 85-year-old white woman was brought to the emergency department (ED) with acute, severe left posterolateral chest wall pain of several hours' duration. The nonradiating pain was accompanied by shortness of breath. She denied palpitations, diaphoresis, syncope, or dizziness.
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White Tongue Lesions: Candida, Contact Stomatitis, Oral Lichen Planus?Contact stomatitis can occur as a result of cinnamon exposure. The condition can easily be managed by withdrawal of the antigen. A short course of systemic corticosteroid can produce dramatic improvement if symptoms are severe.
