Systemic lupus erythematosus (SLE) was diagnosed in an 18-year-old man who presented with polyarthritis, fever, hypoxia, fatigue, anemia, neutropenia, and abnormal urinary sediment. A renal biopsy showed diffuse mesangial proliferative glomerulonephritis (World Health Organization class II). Serologic tests were positive for fluorescent antinuclear antibody (FANA), SS-A, SS-B, anti-Sm and anti-dsDNA antibodies, and rheumatoid factor; a direct Coombs' test result was positive as well.
A 48-year-old woman was hospitalized following 10 days of rectal bleeding. One year earlier, she had undergone combined external-beam radiation and brachytherapy for stage IIIA carcinoma of the cervix. The patient was orthostatic and pale on admission, and her hemoglobin level was 6 g/dL. After receiving a transfusion of packed red cells, she underwent colonoscopy. Several telangiectases were seen in the rectum, the mucosa was friable, and blood oozed from one of the lesions.
A 32-year-old woman with insulin-dependent diabetes noted a painful erosion at the site of "the rose tattoo," which she had gotten 5 days before.
This 4-month-old infant has calcaneovalgus foot--a relatively common finding in newborns.
A 1-year-old girl was noted to have abrasions on the left cheek when she was picked up by her mother from a day-care center. The day-care provider reported that the girl had been bitten on the cheek by a 3-year-old boy during rough play. Her immunization status for tetanus was up-to-date.
A 20-year-old man sustained a 2- to 3-cm soft-tissue laceration in the middle of the chin when he fell, face forward, onto pavement.
Tai Chi (also known as T'ai Chi Chuan, Taijiquan) is a form of mind-body exercise that has its roots in ancient Chinese martial arts. Throughout Asia, it is often practiced for preventive health, especially among the elderly. In recent years, Tai Chi has become popular in the West among all age groups and has been studied as a therapy for various medical conditions.
Vitamin E has been evaluated for the treatment and prevention of several different chronic diseases in numerous clinical trials over the past 2 decades. However, only a limited number of studies have investigated the potential therapeutic or prophylactic effect of vitamin E on allergic rhinitis and respiratory infections. In contrast to trials on cardiovascular disease, which have failed to demonstrate a benefit from vitamin E supplementation,1,2 there is mounting evidence that this essential vitamin may be useful for prevention of the common cold and treatment of allergic rhinitis.
A 53-year-old man presented with a 3-day history of bilateral pain in the lower extremities. He also had a 3-month history of thickening and desquamation of skin, with associated itching, and a 5-lb (2.27-kg) weight loss. The skin changes initially appeared on the hands and subsequently became generalized.
A 60-year-old woman with a history of iron deficiency anemia was hospitalized because of an episode of melena. A colonoscopy performed a year earlier had shown left-sided diverticulosis but was otherwise unremarkable.
Pruritic, erythematous papules on a man's forearms; nonhealing, asymptomatic ulcers on another man's lip and neck--to what do you attribute these lesions?
A 30-year-old active-duty sergeant with no history of urinary tract disease presented to a combat support hospital with acute pain in the left lower abdominal quadrant. For 4 months, the pain had been mild and intermittent; it had worsened during the past 24 hours. Before deployment, microscopic hematuria had been detected and the soldier had been informed of the possibility of a urinary stone.
Urinary incontinence is common--especially among older adults--but underdiagnosed. Many persons with this disorder are reluctant to discuss it with their physicians; often, only direct questioning can uncover the problem.
57-year-old woman is hospitalized because of a 3-week history of persistent left-sided dull flank pain that worsens with movement and is associated with intermittent high fever.
Although proton pump inhibitors (PPIs) are highly effective, clinical failure in patients with gastroesophageal reflux disease (GERD) is seen regularly--not only in GI clinics but also in primary care offices. In fact, the prevalence of failure with PPIs has increased in proportion to the expanding indications for their use.
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.
We were taught in medical school to wait 3 minutes after a posture change to check orthostatic vital signs. Many patients with orthostatic hypotension experience symptoms immediately on standing.
Some patients are allergic to ester-type anesthetics, such as procaine.
To foster equal stimulation and drainage of both breasts, advise lactating mothers to alternate the breast they begin nursing with at each feeding.
How many bottles of nitroglycerin should your cardiac patients have?