A 48-year-old woman was admitted to the hospital with deep venous thrombosis of the right leg. She had a history of non-Hodgkin lymphoma, which was in remission. The patient had been a heavy smoker for many years.

For 2 years, a 55-year-old woman’s abdomen gradually enlarged; the pace of this growth had accelerated during the last 6 months. The patient, who had not seen a physician in 10 years, denied abdominal pain, nausea, vomiting, constipation, diarrhea, or any change in bowel habits. She had no shortness of breath or weakness. The patient reported no significant medical history, had no allergies, and took no medications.

A 44-year-old man presents with sharp, severe abdominal discomfortthat began suddenly while he was driving to your office for a routinephysical examination. The patient reports that several days earlier he hadlifted a refrigerator. He experienced intermittent umbilical discomfort for severaldays afterwards.

ABSTRACT: Age-related anatomic and physiologic alterations in the thyroid gland have a variety of clinically important effects. Hypothyroidism, which is common in older persons, raises cholesterol and triglyceride levels; hyperthyroidism may be masked by the severity of the cardiac problems it causes. In younger persons, depression may accompany hypothyroidism but not hyperthyroidism; however, in the elderly, it may be a feature of either condition. Papillary carcinoma-the most common type of thyroid cancer-is more aggressive in older persons. All these factors necessitate a cautious and deliberate approach to the management of thyroid disorders in elderly patients.

A 19-year-old athlete complains ofpain and swelling of the anteriorpretibial area of his right lower leg. Hehopes to win a football or track scholarshipto college and is concernedbecause his symptoms are impairinghis performance.

During a routine office visit, a 64-year-old woman who has had type 2 diabetesfor more than 10 years complains of increased pedal edema. The edema is minimalon awakening and worsens throughout the day.

Dispel patients’ unrealistic expectationsabout bloodwork by explaining whatthe test results will not show as well aswhat they will show.

A detailed drug history is essentialwhen treating patients with myastheniagravis-especially those whoreport a sudden increase in symptoms.

For finger lacerations, a latex examinationglove can serve as a substitutefor a tourniquet.

My patient is a 42-year-old woman who experienced a nonblanching, purpuricrash and edema of the lower legs after she started taking nifedipine (Figure).

In his article, “Anemia: A Strategy for the Workup”(CONSULTANT, June 2002, page 869), Dr James Berginmakes several references to a test that measures the“serum transferrin receptor level.”

How does amyloid in the pancreatic islets contribute tothe development and progression of type 2 diabetes?

For 1 month, a 25-year-old woman had experienced discomfort in and around the left eye and diplopia. She was in good health; she reported no weight loss, excessive nervousness, heat intolerance, decreased strength, changes in the texture of hair or skin, or altered bowel habits. There was no personal or family history of goiter or other thyroid disease.

For 3 days, a 30-year-old man had had bilateral flank pain that radiated to the lower abdomen; gross hematuria had accompanied the pain for 1 day.

Although acute low back pain usuallyresolves within 6 weeks-with or withouttreatment-the pain may signal asignificant neurologic or life-threateningdisease that warrants immediateintervention.

More than1.8 millioncardiaccatheterizationsandat least 600,000 percutaneoustransluminal coronaryangioplasty (PTCA)procedures are performedin the United States annually.1 The use of these diagnosticand interventionalmodalities continues togrow even as financial constraintsincrease. Yet formany patients with coronaryartery disease (CAD),medical therapy may be anappropriate option.

A 22-year-old Filipino man with fever, lethargy, weakness, and malaise of 5 days' duration was brought to the emergency department by his family. Two days earlier, oral penicillin had been prescribed for streptococcal pharyngitis. The patient was unable to walk because of profound weakness. Circular and linear ecchymotic lesions were noted on his back.

ABSTRACT: A thorough history and physical examination can establish the diagnosis of tension headache; further evaluation is generally unnecessary. In contrast, the workup of cervicogenic headache includes standard radiographs, 3-dimensional CT, MRI, and possibly electromyography; nerve blocks may also be used to confirm the diagnosis. Episodic tension headache can be treated effectively by trigger avoidance, behavioral modalities, and structured use of analgesics. Reserve opioids for patients with intractable headaches. Chronic tension headache is treated primarily by prophylactic measures, such as antidepressants and anticonvulsants, and behavioral and physical therapy. Treatment options for cervicogenic headache include analgesics; invasive procedures, such as trigger point injections, greater or lesser occipital nerve blocks, facet joint blocks, segmental nerve root blocks, and diskography; spinal manipulation; and behavioral approaches.

As the world of sport has embraced the participation of women and girls, the incidence of health problems that pertain specifically to premenopausal female athletes has increased significantly. One of these is the female athlete triad, which consists of 3 interrelated medical conditions associated with athletic training

A 72-year-old man is brought to the emergency department by his wife. Hecomplains of nausea, vomiting, and severe abdominal pain that makes it difficultfor him to walk. The pain began the previous afternoon and has worsened steadily.The patient denies trauma and recent foreign travel. His history includes an appendectomyperformed many years earlier but is otherwise noncontributory.