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…
Posts Tagged ‘primary care/hospitalist/clinical practice’
Polycystic Ovary Syndrome
Posted by Carla Rothaus • 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 Carla Rothaus • 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 Carla Rothaus • 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…
Body-Mass Index in Adolescents
Posted by Carla Rothaus • 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 Carla Rothaus • 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 Carla Rothaus • 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 Carla Rothaus • 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 Carla Rothaus • 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…
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