Graves diseaseExophthalmos, lid retraction, diffuse enlargement of the thyroid gland, and hand tremor are typical findings in Graves disease.
Porcelain Gallbladder<div id="article-content-body"><p>During an evaluation to detect metastatic disease in a 75-year-old woman with recently diagnosed cecal cancer, a CT scan of the abdomen and pelvis revealed an incidental finding of a heavily calcified gallbladder (arrow). No metastases were found. The patient had no symptoms related to gallbladder disease. </p></div>
peritonsillar abscess<div id="article-content-body"> <p>A 17-year-old boy has had severe pharyngitis, fever, and dysphagia for the past 2 days. Although he took an NSAID and tried gargling with hydrogen peroxide, he obtained no relief.</p> </div>
Thyrotoxic Periodic Paralysis<div id="article-content-body"><p>A 17-year-old adolescent experienced an episode of generalized paralysis of acute onset after physical exertion and consumption of a high-carbohydrate meal. Despite a good appetite, the patient had lost between 2 and 3 lb during the past month. He complained of heat intolerance and palpitations and reported losing his temper easily.</p></div>
Hemolytic Uremic Syndrome<div id="article-content-body"> <p>For 24 hours, a 62-year-old woman had had severe weakness, abdominal pain, and watery diarrhea that had become bloody in the past 12 hours. She had no significant medical history. The patient was confused and dehydrated. Tenderness was noted in the right lower quadrant.</p> </div>
Waterborne Infection<p>A 79-year-old man presents to the emergency department with a painful lesion on his right forearm. Three days earlier, he had scratched his arm while removing crabs from a trap. Initially, the scratch had bled slightly, and he had self-treated with an over-the-counter antibiotic ointment and an adhesive bandage.</p>
Hyperthyroid HyperpigmentationHyperpigmentation is seen on the cheeks and eyelids of a 36-year-old woman. She became hyperthyroid at age 19 years, with accompanying exophthalmos and hyperpigmentation, following the birth of her first child.
Chest Pain and Dyspnea<div id="article-content-body"> <p>A 48-year-old woman with a history of hypertension and mild asthma has been transferred to the medical service because of an abnormal postoperative ECG. She had been admitted 2 weeks earlier to the gynecology-oncology service for local recurrence of a previously resected uterine sarcoma and underwent laparotomy for debulking of the pelvic mass and resection of the rectosigmoid colon.</p> </div>
Erythema Nodosum<div id="article-content-body"><p>A mildly painful, nonpruritic rash on the forearms and legs prompted a 42-year-old man to go to the emergency department (ED). The patient noted the rash when he awoke that morning. He had had joint pain and fever for the past 7 days and generalized malaise with chills that began about 3 days earlier.</p></div>
Actinic Cheilitis, Juvenile Xanthogranuloma, staphylococcal infection<div id="article-content-body"><strong>Case 1:</strong> This crusted eroded area on the lower lip of a 67-year-old man has been present for several months. Which of the following statements are true?</div>
stuffAn Elderly Man With Recent Atrial Fibrillation,
Rashes<div><strong></strong>A 78-year-old man presents with an asymptomatic acute eruption on both legs that extends from the ankles to just above the knees. Individual macules range from 4 to 10 mm in diameter and from light brown to red. Almost all of the lesions have multiple, tiny, discrete red puncta.</div>
Cellulitis With Felon<div id="article-content-body"><p>For 3 days, a 47-year-old woman had a painful red swelling on her finger. The patient—a cellist—had tried to lance the lesion at home, but it progressively worsened and was now “throbbing.” She denied fever and nail biting. The patient was in moderate distress; temperature was 36.8°C (98.3°F); blood pressure, 123/80 mm Hg; and heart rate, 62 beats per minute. She had no thrush, murmur, lymphangitis, or lymphadenitis. The entire distal portion of the fifth finger of her left hand was swollen.</p></div>
Pretibial Myxedema<div id="article-content-body"> <p>Swelling of the lower legs brought this 57-year-old woman to a family practice clinic. She had a history of hyperthyroidism with weight loss, tachycardia, and anxiety. This condition was confirmed with blood tests and radioactive iodine uptake testing.</p> </div>
Macrolide-Drug Interactions<div id="article-content-body"> <p>Macrolides are commonly used to treat a variety of infections. Erythromycin has long been recognized as having numerous highly important drug interactions.<sup>1</sup> Although clarithromycin generally has somewhat less of an effect on the clearance of other drugs, it also has several clinically relevant interactions.<sup>1-3</sup></p> </div>
COPDDrugs on the horizon include the phosphodiesterase-4 inhibitors, 2 of which—cilomilast and roflumilast—are in phase 3 clinical trials.
Gastric Banding<div id="article-content-body"> <p>Given the rapid rise in the prevalence of obesity—which now stands at 27% of the adult US population<sup>1</sup>—there is an urgent need for the development of safe and effective treatments.</p> </div>