By David Ellenberg
Faculty Peer Reviewed
Mr. A is a 91 year old male with a history of hypertension and two myocardial infarctions. He presented with shortness of breath and worsening lower extremity swelling and was subsequently admitted to the medicine floor for a CHF exacerbation. While on the floor, he also complained of painful pressure ulcers on his lower buttocks. He was diuresed and given oxygen by nasal cannula during his 48-hour hospital stay, and his ulcers were…
By Demetrios Tzimas, MD
New York City. Bellevue Hospital Center. July 17, 2009. 1:53 pm. Intern Year. Long Call.
“Go down to the ER. There’s a guy with chest pain for the past three days, EKG shows some non-specific changes, vitals stable. First set of labs negative. CXR clear. They gave him a full-dose aspirin. This sounds like a rule out chest pain, and since it’s Friday, he’ll go to medicine and not the chest pain unit. I’d go…
Commentary by Judith Brenner MD, Associate Editor, Clinical Correlations
Faculty Peer Reviewed
For an internist, discovering a patient with clubbing is so rewarding since it appeals to the core of our profession, a profession which can often be very similar to that of a detective. The physical finding of clubbing was first described by the ancient Greeks, who recognized it to be a clue to much more.
When a clinician discovers clubbing of the fingers, he must consider that hypoxemia may…
Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program
The most recent installment in JAMA’s Rational Clinical Exam Series seeks to determine the accuracy of the history, physical exam, radiology and laboratory in making the diagnosis of osteomyelitis in diabetics. This is relevant given its frequency of occurrence and its cost and since the gold standard for diagnosis, namely a bone biopsy and culture, is less than optimal for a variety of reasons.
Less than 10% of the…
Commentary by Kristin Remus MD, PGY-3, and Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program
The purpose of the physical diagnosis series is to review the origins, pathophysiology and actual techniques of common physical diagnoses. Our hopes are to renew interest in an area of medicine that is occasionally overlooked due to the current use of laboratory values and imaging tests frequently used to make a diagnosis.
Goiter
In the industrialized world, enlarged thyroid, or “goiter”, occurs in 10%…
Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program
Diabetic neuropathy is one of the most commonly encountered complications of diabetes mellitus. It is seen in up to 20% of diabetics. Patients typically present with neuropathic pain in a “glove and stocking” distribution with the earliest signs in the feet. Night time complaints of “my feet are on fire” are common. Relying on a patient’s complaint of “pain” or “numbness” is inadequate in the diagnosis of peripheral neuropathy since…
Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program
A 66 year old woman with a history of dyslipidemia and remote tobacco use presents with a sudden onset of pain located in her posterior left thigh radiating down her left leg below the knee. The pain began during the course of an upper respiratory illness with a cough. The pain is burning in quality and is bothersome day and night. NSAIDs have been taken and relieve the pain temporarily.…
Welcome to our inaugural Bedside Rounds a new regular feature of Clinical Correlations. Here you will learn not only practical physical diagnosis pearls, but also the historical context in which these findings were discovered.
Commentary By: Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program
When you take a deep breath in, what happens? Because of an increase in the negative intrathoracic pressure, blood is sucked into the right side of the heart. Temporarily, a filled right…
