Learn more about the Physical Exam and Differential Diagnosis
Right on top I would like to mention DxSaurus 2.0. For the amount of work that has been put into this app from the Palm to the Android. It is simply awesome. The second program, now extinct and pending is Zapmed by Dr. Mark Spohr, out in California. The others are top notch and available to all include Epocrates, Mobile MerckMedicus and WebMD for the iphone and android and last but not least, Callrec. For those into tech, take a look at Callwave. Dr. Andre Chen based out of Austin Texas came out with a killer...
I attended one about two days ago, or it may have been the afternoon conference. It was about an young lady presented with sudden onset confusion and a calcium of 16.( normal should be less than 12 or so). The differential diagnosis is not vast and I attempted to alert the resident to the importance of considering ALL diagnosis before treating, and trying to make him/them aware that 1. You can have more than one disease at the same time and 2. If the differential includes a disease that kills, in this case it did...
A 42-year-old man is hospitalized after an episode of syncope (passing out). The event occurred while he was sitting in a chair; he did not have any symptoms before the episode, and afterward, he was alert and had no incontinence. He had previously been well and exercises regularly without difficulty. He was diagnosed with idiopathic cardiomyopathy 6 months ago. Echocardiography at that time showed left ventricular enlargement and left ventricular ejection fraction of 30%; coronary angiography showed normal coronary...
A 28 year old female presents with complaints of trouble swallowing. She's noticed a lump in her neck and for the past two weeks she's had difficulty swallowing solids. She denies diarrhea constipation or feeling her heart racing. She denies any weight changes. She doesn't smoke she doesn't abuse wine or beer. Her past medical history is unremarkable she's only taking a multivitamin. which of the following is most likely causing her symptoms? 1- A pituitary tumor 2- A tumour in the abdomen secreting TRH 3- Weight...
A 70-year-old woman undergoes cardiac catheterization for recent symptoms of typical anginal chest pain and dyspnea on exertion. During and around the time of this procedure, she receives both unfractionated and low-molecular-weight heparin. Three-vessel coronary artery disease is confirmed, and she is scheduled for cardiac artery bypass graft (CABG) surgery 10 days after her initial cardiac catheterization. The presurgical complete blood count is normal, with a platelet count of 325,000/μL. After surgery, the platelet...
A 69-year-old man is brought to the emergency department because of a 3-week history of gnawing stomach pain that is slightly improved with meals and TUMS. He also reports feeling full even on an empty stomach, nausea without vomiting, and some weight loss over the past 4 weeks. There is no blood in the stools, fever, or chills. He has hypertension, is treated with a thiazide diuretic, and degenerative joint disease of both knees,for which he takes Naprosyn.On physical examination, temperature is normal, pulse rate...
A 45-year-old man is evaluated in the emergency department for chest pain. He never had chest pain before, but over the past few days he has experienced several episodes of chest tightness with exercise. He has a history of hypertension and tobacco use. He takes 1 aspirin daily. On examination, the patient's blood pressure is 140/80 mm Hg and the cardiovascular examination is normal. The initial electrocardiogram is normal. Troponin is elevated. The patient is treated with aspirin and intravenous β-blockers. During...
It's one thing to read the message from the surgeon general on the side of every pack, I used to back when I smoked three packs a day. Read it, think,"that was interesting", and light the cigarette in your mouth. It is another thing as a physician to repeatedly see patients, who are post-operative, post motor vehicle accident, post sickness, post anything be sicker for a longer period of time with soreness, malaise and poor healing. It has been in the studies but I think the general public has not yet quite gotten...
I love Clinical Medicine.
You see, "Medicine is a social science in its very bone and marrow." Mayo Clinic Proceedings October 2011 vol. 86 no. 10 930-932, and the physical exam is one of its blocks in promoting health,well-being, compliance and civic competence.
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