Posts Tagged ‘primary care/hospitalist/clinical practice’

A Bruising Loss

Posted by • July 7th, 2016

Whereas inherited clotting-factor deficiencies are typically clinically evident from birth, the sudden appearance of a bleeding diathesis in a previously healthy adult is suggestive of an acquired factor inhibitor. Although inhibitors to most of the major clotting factors have been described, factor VIII inhibitors are the most common; however, factor VIII inhibitors are still rare,… Read More…

Polycystic Ovary Syndrome

Posted by • July 7th, 2016

The polycystic ovary syndrome is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. The polycystic ovary syndrome increases the risk of infertility, endometrial cancer, abnormal glucose metabolism, and dyslipidemia. Strategies such as lifestyle modification, hair removal, and combined oral contraceptive therapy and other pharmacotherapies are reviewed. A new Clinical Practice summarizes. Figure 1. Basic Pathophysiology of Hyperandrogenemia… Read More…

Axial Spondyloarthritis

Posted by • July 1st, 2016

The classic clinical description of ankylosing spondylitis was made in the late 1800s and was refined by the addition of radiographic descriptions during the 1930s. Pathological investigation revealed the importance of enthesitis (inflammation at sites of ligamentous attachment to bone) and synovitis. The identification in 1973 of a very strong association with human leukocyte antigen… Read More…

A Man with Cloudy Vision

Posted by • July 1st, 2016

Syphilis can cause uveitis and retinitis. The uveitis can be anterior, posterior, or both (panuveitis) and can occur with or without a hypopyon (usually without). A 50-year-old man with psoriatic arthritis and HIV infection presented with cloudy vision, decreased hearing, and gait instability. Two months earlier, the patient had begun taking antiretroviral medications. A diagnostic test result was… Read More…

A Man with a Pruritic Rash

Posted by • June 24th, 2016

Although human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus, it seems to induce a precancerous state that can lead to adult T-cell leukemia–lymphoma (a subtype of cutaneous T-cell lymphoma), instead of being directly carcinogenic. HTLV-1 is associated with a long latency period, and most affected patients are exposed to the virus early in life…. Read More…

Body-Mass Index in Adolescents

Posted by • June 24th, 2016

Overweight and obesity in adolescents have increased substantially in recent decades and affect a third of the adolescent population in some developed countries. Twig et al. assessed the risk of fatal cardiovascular events in adulthood according to the body-mass index range during adolescence, using a national database of 2.3 million Israeli adolescents in whom height… Read More…

A Woman with a Pleural Effusion

Posted by • June 16th, 2016

A 52-year-old woman presented with a unilateral pleural effusion. Several weeks later, uterine bleeding, pelvic fullness, and bloating developed. Magnetic resonance imaging revealed a large pelvic mass. Diagnostic procedures were performed. A new Case Record of the Massachusetts General Hospital summarizes. Clinical Pearl • What is the most common benign solid ovarian tumor? Although only 4% of all ovarian masses… Read More…

Upper Gastrointestinal Bleeding

Posted by • June 16th, 2016

Peptic ulcers, which are primarily due to Helicobacter pylori infection or the use of nonsteroidal antiinflammatory drugs (NSAIDs), occur in the stomach or duodenum and are the most frequent cause of upper gastrointestinal bleeding. Most patients who are hospitalized with upper gastrointestinal bleeding should undergo endoscopy within 24 hours, after appropriate resuscitation and transfusion to… Read More…

A Woman with Dyspnea

Posted by • June 10th, 2016

Bronchiolitis is a disease of the small airways, which are defined as airways less than 2 mm in diameter and without cartilage. The bronchioles are especially vulnerable to infectious or inhalational insults because of their narrow diameter. A 60-year-old woman was seen in a pulmonary clinic because of increasing dyspnea. Chest imaging revealed bronchiectasis and mild,… Read More…

The Hidden Lesion

Posted by • June 3rd, 2016

The repeated occurrences of clots involving the veins in the proximal left leg raise suspicion for the May–Thurner syndrome (compression of the left iliac vein by the overlying right iliac artery). A 24-year-old woman presented to the ED with pain in the left leg. She had been training for a 5-km race when, 2 days before presentation,… Read More…