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Managing Drug Interactions That Can Reduce Levothyroxine EfficacyLevothyroxine is one of the most commonly prescribed medications for the treatment of persons with hypothyroidism and the suppression of thyroid neoplasms.1 Most persons with hypothyroidism require lifelong therapy with levothyroxine.
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Linear Gingival ErythemaBleeding gums for the past 2 days was the complaint of this 22-year-old woman. She is HIV-positive but has been clinically asymptomatic. Her CD4 lymphocyte count is 84/μL, and her viral load is 160,885 copies/mL. Despite maintaining good oral hygiene, she has a distinct fiery red band along the gingival margin.
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The Solitary Lung Nodule:ABSTRACT: When a solitary lung nodule is detected, the key question is whether the lesion is malignant. The initial evaluation includes a careful history taking focused on risk factors for malignancy, a thorough physical examination, comparison of current chest films with previous ones, and CT scanning. Radiologic signs that suggest malignancy include lesion size greater than 2 cm in diameter, spiculated margins, lack of calcification, and change in size. Video-assisted thoracoscopic surgery or thoracotomy is the next step for patients with a suspected malignant lesion. If the results of the initial evaluation are equivocal, positron emission tomography (PET) scanning is the preferred follow-up.
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Oncology Q&AIs prophylactic oophorectomy recommended for healthy postmenopausal women with a strong family history of cancer?
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6 Top Primary Care Items From Around the WebA look around the web at breaking news -- not all of it medical.
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Acute Protrusion of the ScapulaSeveral hours after he had installed ceramic tile, a 33-year-old man experienced muscle spasms and felt pressure in his right shoulder. He denied previous injury to the area.
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Blue Rubber Bleb Nevus SyndromeBRBNS is a rare GI disorder characterized by distinctive cutaneous and GI venous malformations that can lead to occult or massive GI bleeding.
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Malignant Melanoma in a Patient withMulti-organ Metastatic DiseaseThis truncal lesion was revealed when a 47-year-old man disrobed for examination after he had fallen on a sheet of ice and broken a rib. The patient-a truck driver and 30 pack-year cigarette smoker-had been aware of the enlarging lesion for about a year but had not sought medical attention because it was asymptomatic.
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Woman Who Has Felt Unwell for Many YearsA 41-year-old woman presents as a new patient, with complaintsof chest pain and palpitations that occur intermittentlyand are not associated with activity, meals, or position.She says these symptoms have been present forsome time, and she expresses frustration that her previousphysician was unable to find their cause or to amelioratethem.
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Clostridium difficile-Associated Diarrhea:For some time, diarrhea caused by Clostridium difficile has been a serious problem in hospitals. Recently, more virulent strains of this pathogen have started to show up in hospitals.
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Bronchoscopy Clinic: Emerging options for managing foreign-body aspirationEndobronchial foreign bodies can be life-threatening, but once they are detected, they can usually be removed, leading to prompt resolution of symptoms. Chest radiography and CT scanning can be helpful in some cases, but bronchoscopy is necessary for definitive diagnosis and treatment.
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ISCHEMIA: Initial Revascularization Did Not Reduce Adverse CV Outcomes in SIHDAHA Scientific Sessions 2019: In SIHD patients with moderate-severe ischemia, initial revascularization + OMT compared to OMT alone did not reduce the risk for adverse CV outcomes
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What Are These Lesions?These circular, erythematous lesions of varying sizes on a 45-year-old woman’s dorsal right hand and extensor surface of the right forearm are
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Takotsubo Cardiomyopathy in a Man With a Gunshot WoundA 48-year-old African American man with no significant medical history sustained a gunshot wound to the face and shoulder.
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Disseminated Intravascular Coagulation as an Unusual Presentation of Acute Retroviral SyndromeMultiple atypical presentations of acute retroviral syndromehave been reported in the literature, but rarely has acute retroviralsyndrome been associated with disseminated intravascularcoagulation (DIC). We detail a case of a 19-year-old manadmitted to the hospital with initially unexplained severe DICthat on workup was found to be secondary to acute retroviralsyndrome. [Infect Med. 2008;25:24-28]
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Rhabdomyolysis Secondary to Urinary Tract Infection With E coliRhabdomyolysis is linked to infection in up to 31% of cases. However, only 19 cases of rhabdomyolysis related to E coli infection have been reported.
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HIV-Positive Woman With DyspneaA 48-year-old African Americanwoman with HIV infection who hadbeen hospitalized several days earlierfor presumed Pneumocystis cariniipneumonia (PCP) is readmittedbecause of worsening dyspnea and atemperature of 38.8oC (102oF).She also complains of painful swellingand erythema on her right arm.Her symptoms have worseneddespite treatment with trimethoprimsulfamethoxazole.
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Chronic Kidney Disease in Primary Care: Essential Basics ReviewPrimary care plays an essential role in identifying CKD, monitoring and slowing disease progression, and providing timely referral, when indicated, to nephrology.
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Histoplasmosis mimicking metastatic carcinomaThe differential diagnosis forendobronchial lesions includesbut is not limited toneoplastic causes, benign tumors,infections, and foreignobjects. We report a case of anunusual cause of endobronchiallesions.
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A covert cause of hypoxemia: Intravascular pulmonary lymphomaWe describe a patient with intravascularpulmonary lymphomawho presented withprogressive dyspnea and hypoxemiawith normal chest radiographicfindings. After anunrevealing noninvasive evaluation,a high-grade B-cellintravascular lymphoma wasdiagnosed by bronchoscopywith transbronchial biopsy.Treatment with a modifiedCHOP regimen resulted in resolutionof the patient’s hypoxemiaand exercise limitation.Although intravascular pulmonarylymphoma rarely presentswith pulmonary symptoms,it should be consideredin the differential diagnosis ofpatients presenting with hypoxemiaand normal chest radiographicfindings.
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Man With Headache, Diplopia, Nausea, and VomitingA 68-year-old man presents to the emergency department with diplopia and headache of acute onset accompanied by nausea and vomiting.
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Papilledema in NeurosarcoidosisSix days ago, a 36-year-old man had noticed a dark spot in the field of vision of his left eye. Now the spot more closely resembled a line. He denied other changes in his vision and had not seen any floaters or flashing lights.
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Submacular HemorrhageOne morning, an 83-year-old woman woke up to find a gray-colored spot in the central vision of her right eye. The spot was constant, and she could not see through it. She had a history of dry age-related macular degeneration and cataract surgery in both eyes.
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Atypical Manifestation of BrucellosisA 49-year-old farmer was hospitalized because of a 3-week history of intermittent fever, fatigue, anorexia, generalized myalgias, and malodorous sweating. A nonpruritic, nonhemorrhagic, maculopapular rash recently had developed on his arms, legs, and trunk. The reddish lesions were less than 1 cm in diameter. There was no history of antibiotic or antipyretic drug therapy, and no abnormalities were found on physical examination.
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Woman With Headache, Diaphoresis, Abdominal SymptomsA 47-year-old woman complains ofepisodic headaches that began severalmonths earlier and are accompaniedby sweating, flushing, abdominal pain,and vomiting; these attacks have progressivelyworsened. She takes no medicationsand denies fever, chills, andnight sweats. The medical history isunrevealing.
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Sebaceous CystA painless swelling on the dorsum of the scalp had been present for many years in a 36-year-old man. An increase in the size of the lesion prompted the man to seek medical evaluation.
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Consultations & Comments: Monitoring Lentigo Maligna After ExcisionAre follow-up radiographs or laboratory studies needed when lentigo maligna has been completely excised and a biopsy has been performed?
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Clinical Observations on West Nile Virus InfectionsIn 2004, 391 cases of West Nile virus (WNV) infection werereported in Arizona. This represented an epidemic thatchallenged area clinicians. We treated 34 patients with WNVinfection and reviewed their medical records. They werehospitalized at 3 community hospitals during the epidemic.These patients represented 9% of all WNV infection casesreported in Arizona. Meningitis was diagnosed in 13 patients,encephalitis in 12, fever of unknown origin in 5, transversemyelitis in 3, and carditis in 1. Respiratory failure requiringmechanical ventilation developed in 6 patients. Five of thesickest patients were empirically treated with interferon alfa 2band ribavirin. The epidemic and associated clinical challengesprompted evaluation of the available diagnostic and treatmentstrategies to optimize care of very ill patients. The consensusamong clinicians was that they were poorly prepared todiagnose and treat WNV infection in hospitalized patients.All patients survived hospitalization, although 4 patientsdied after discharge because of factors attributable to WNVinfection. [Infect Med. 2008;25:430-434]
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Sexually Transmitted Diseases: Recognizing Telltale Skin Lesions Condyloma LatumTelltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
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Complications of Body ArtPrimary care providers are seeingan increasing number ofpatients who have snakes orbarbwire coiling around theirarms or gold rings danglingfrom their eyebrows and navels. Tattooingand body piercing are particularlypopular among adolescents andyoung adults-many of whom may notbe aware of the possible medical complicationsof these ancient practices.
