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8 ICD-10 Areas for Pediatricians to WatchResearch shows that pediatricians are at higher risk than other physician groups for financial loss as they transition to ICD-10. Here, 8 areas you can focus on now.
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Crusty Scalp LesionAn 89-year-old woman is seen for an erosion on the frontal area of the scalp. History is positive for actinic keratosis. What's your Dx?
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Acute chest syndrome: Getting down to the basicsAbstract: Acute chest syndrome (ACS) is one of the most common causes of death and hospitalization among patients with a sickle hemoglobinopathy. The clinical presentation is characterized by the appearance of a new infiltrate on a chest radiograph, with 1 or more new symptoms, including fever, cough, chest pain, and dyspnea. Additional findings include leukocytosis, hypoxemia, and auscultatory signs of consolidation. The differential diagnosis includes pneumonia, pulmonary infarction, fat embolism syndrome, pulmonary edema, and bone infarction. Treatment of ACS involves supportive care, empiric antibiotic therapy, and red blood cell transfusion when indicated. The decision of whether to use simple or exchange transfusions depends on the severity of illness and the risk of acute respiratory failure. Currently, hydroxyurea is the only FDA-approved drug designated as a preventive therapy. (J Respir Dis. 2005;26(12):529-534)
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Middle-Aged Man With Wedge-Shaped Growths in Both EyesA 45-year-old man of Hispanic ancestry presents for evaluation of what he describes as a "growth in both eyes." This growth has been present for some time; however, it has recently become more prominent. The patient has had mild redness and irritation in both eyes, but he denies any change in vision.
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Headache Secondary to Epidural AbscessTwo weeks before admission, he had visited the emergency department (ED) because of the headache. Migraine was diagnosed and ibuprofen had been prescribed. The headache persisted despite NSAID therapy, and the patient returned to the ED 2 days later.
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Bronchoalveolar Carcinoma in a 58-Year-Old ManA 58-year-old man presents with exertionaldyspnea of 6 weeks’ duration, adry cough for 2 weeks, and decreasedappetite. He denies fever, chills, sputumproduction, hemoptysis, cigarette smoking,and significant weight loss. Thepatient, a retired electrician, was exposedto asbestos 20 years earlier.
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Reducing Cost-Related Medication Nonadherence in Patients With DiabetesIn the United States, it has been estimated that 7.8% of the total population has diabetes. In 2007, the direct medical expenditures for diabetes were about $116 billion and the total direct and indirect costs were $174 billion, according to the CDC.1
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Recognizing the impact of obstructive sleep apnea in patients with asthmaAbstract: The coexistence of asthma and obstructive sleep apnea (OSA) in a given patient presents a number of diagnostic and treatment challenges. Although the relationship between these 2 diseases is complex, it is clear that risk factors such as obesity, rhinosinusitis, and gastroesophageal reflux disease (GERD) can complicate both asthma and OSA. In the evaluation of a patient with poorly controlled asthma, it is important to consider the possibility of OSA. The most obvious clues are daytime sleepiness and snoring, but the definitive diagnosis is made by polysomnography. Management of OSA may include weight loss and continuous positive airway pressure (CPAP). Surgical intervention, such as uvulopalatopharyngoplasty, may be an option for patients who cannot tolerate CPAP. Management may include specific therapies directed at GERD or upper airway disease as well as modification of the patient's asthma regimen. (J Respir Dis. 2005;26(10):423-435)
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Legg-Calvé-Perthes Disease Presenting With Limp and Knee PainA 10-year-old boy presented with right hip pain and a limp. The patient was taking no medications and had no personal or family history of disease. He denied a history of trauma.
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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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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.
