Ronald Rubin, MD

For several months, a 52-year-old woman has had burning discomfort in the region of her lower sternum and frequent acid/sour sensations in her throat; the symptoms are usually associated with burping after meals and recumbency.

A 48-year-old woman is evaluated for transfer to the ICU. She presented to the emergency department 48 hours ago with severe abdominal pain and emesis. The pain had started several days earlier and was located in the upper abdomen with some radiation to the back. No position--even the fetal position--provided relief. After admission, she was given intravenous fluids and analgesics; in the last several hours, her condition has deteriorated. She now complains of thirst and is somewhat agitated.

A 29-year-old man presents with a recent episode of light-headedness of sudden onset. Although he denies associated loss of consciousness, witnesses report that he was briefly unresponsive to verbal stimuli. He also denies chest pain, dyspnea, palpitations, and diaphoresis; he is currently asymptomatic.

A 62-year-old previously healthy man is admitted for right upper quadrant pain; a workup reveals acute cholecystitis as the cause. During evaluation for surgery, his creatinine level is found to be 6.0 mg/dL; 1 year earlier it was 1.0 mg/dL. A trial of fluids does not lower the creatinine level. Renal ultrasonography shows no obstruction but reveals increased kidney size (left, 11.4 3 4.4 3 5.0 cm; right, 10.1 3 4.6 3 4.5 cm) with increased diffuse echogenicity.

A 62-year-old previously healthy man is admitted for right upper quadrant pain; a workup reveals acute cholecystitis as the cause. During evaluation for surgery, his creatinine level is found to be 6.0 mg/dL; 1 year earlier it was 1.0 mg/dL.

A 64-year-old woman presents with persistent, progressively worsening chest pain and dyspnea of 1 month's duration. She also reports orthopnea, bilateral leg swelling, and weight gain. She denies any history of similar symptoms.

Breast Infection in a Woman With Diabetes

The patient feels well and denies any symptoms; specifically, he has no pruritus, fever, weakness, fatigue, GI symptoms, or cardiac symptoms.

A 16-year-old boy visiting his aunt and uncle at a cabin in the country was bitten by their cat earlier in the day. He tried to pick up the animal after it had been injured, and it bit him on the dorsum of the hand between the thumb and first finger.

A 57-year-old woman complains of burning and dryness in her left eye and altered sensation in her mouth when eating; these symptoms began the day before. A coworker who had noticed facial asymmetry recommended that she seek medical attention.

Five days ago, a 46-year-old woman experienced dull, aching retrosternal pain that radiated toward the left shoulder. The pain was accompanied by diaphoresis and did not abate; she was hospitalized.

An 81-year-old man is seen for follow-up of leukocytosis detected during a recent hospitalization for community-acquired pneumonia. The leukocytosis had not resolved by the time he was discharged.

A 55-year-old man complains of fatigue. Although he sleeps 8 hours every night, he has to push himself to perform his usual daily activities. He has also experienced loss of libido and episodic impotence, which he ascribes to the fatigue.

Congestive heart failure (CHF) was recently diagnosed in a 71-year-old woman whose ejection fraction was 30%. The following CHF regimen was prescribed: metoprolol, 25 mg/d; digoxin, 0.25 mg/d; hydrochlorothiazide, 50 mg/d; enalapril, 5 mg/d; and spironolactone, 25 mg/d. A low-salt diet was also recommended.