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Nailing the Diagnosis!
Physical examination plays a crucial role in patient evaluation by confirming the hypotheses during history taking, suggesting new clues, and directing investigations. We describe how the recognition...
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Muehrcke’s Lines
A 29-year-old woman with no significant medical history developed anasarca over the course of approximately 2 weeks. On the basis of renal biopsy, a diagnosis of minimal change disease was made. Her...
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Ludwig’s Angina
A previously healthy 33-year-old man, with a history of type 1 diabetes mellitus, underwent left lower molar extraction. Two days later, he presented to the emergency department with swelling in the...
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Stop, You’re Making Me Blush
The physical examination is vital in assessing a patient’s presenting symptom, especially when the symptom is dermatologic in nature. However, if the dermatologic examination shows no abnormality on...
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Terry’s Nails: A Window to Systemic Diseases
Despite the enormous involvement of imaging tools in medicine, a focused physical examination still plays a pivotal role in all medical fields. During and after taking history, a detailed inspection...
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A Diagnosis at Hand: Pulmonary Arterial Hypertension
A classic physical examination finding pointed to underlying disease in a 43-year-old Hispanic woman. On presenting to the Emergency Department, she reported progressive shortness of breath, fatigue,...
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The Five-Minute Moment
In today’s hospital and clinic environment, the obstacles to bedside teaching for both faculty and trainees are considerable. As electronic health record systems become increasingly prevalent,...
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Will Physicians Stop Performing Physical Examinations?
In the 21st century, debate continues concerning the value of the physical examination.1, 2, 3, 4 That such a hallowed and respected ritual of clinical medicine should even be questioned is the result...
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The Intention-to-Treat Analysis Is Not Always the Conservative Approach
The randomized trial design can be thought of as a means to answer 2 types of general questions: 1) what is the effect of assigning a treatment?; or 2) what is the effect of receiving a treatment? In...
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Steroid-Refractory Autoimmune Hemolytic Anemia with Massive Splenomegaly
(A) Clinical course of our patient. (B) Computed tomography revealed massive splenomegaly and irregular low-density area within the spleen. (C) Bone marrow aspirate (×400). (D) Immunohistochemical...
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Not so Obvious: Acute Herpes Esophagitis
Esophagogastroduodenoscopy demonstrated white plaque lesions that extended from the gastroesophageal junction to the midesophagus. The gross examination immediately suggested infection with Candida...
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Sometimes the Eyes Say More Than the Mouth
Ocular fundus image of the left eye shows mild optic disc swelling, multifocal retinochoroidal exudates, retinal phlebitis, and mild vitreous opacity. A 48-year-old man with a history of human...
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Urschel’s Sign in Paget Schroetter Syndrome
Prominent superficial veins over the right upper arm and shoulder, reflective of Urschel’s sign. A 32-year-old man, employed as a deckhand, was referred for right upper extremity swelling and pain of 3...
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An Uncommon Cause of Low Back Pain
Axial computed tomography of the abdomen/pelvis following intravenous contrast showing no evidence of paraspinal muscle pathology but an incidental finding of left greater than right quadratus lumborum...
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Dizziness Symptom Type Prevalence and Overlap
The traditional approach to dizziness encourages providers to emphasize the type of dizziness. However, symptom types might substantially overlap in individual patients, thus limiting the clinical...
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Geographic Tongue
Dorsum of tongue showing erythematous patches with white borders (black arrows). A 45-year-old female patient presented to our clinic with a painless, erythematous lesion on her tongue. Medical history...
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Teaching Diagnostic Reasoning in the Digital Age: The Role of the Mentor
Each case has its lesson—a lesson that may be, but is not always, learnt, for clinical wisdom is not the equivalent of experience. A man who has seen 500 cases of pneumonia may not have the...
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‘Landolfi’s Sign’—Eyes Don’t See What the Mind Does Not Know!
Still frame of long-axis parasternal view on 2-dimensional color flow transthoracic echocardiogram showing severe aortic regurgitation. as depicted by arrow. The thick arrow at the bottom depicts the...
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Big Gain, No Pain: Tumoral Calcinosis
(A) Ultrasound imaging of the patient’s right shoulder, shown here in this panoramic view, revealed multiple, round, mass-type lesions with homogenous echoes (arrows) and irregularly scattered...
View ArticleNot so Obvious: Acute Herpes Esophagitis
The gross examination immediately suggested infection with Candida species, but biopsy results pointed to a different culprit. A 29-year-old woman sought care in the emergency department after...
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