CASE STUDIES

You can get some CME credits visiting medsitecme, which is a part of emedicine. All the case studies are FREE, but not all of them give you CME credits. Anyways, we all like freebies, right?

Some more information about medsitecme:

MedsiteCME provides free online CME that is engaging, trusted, convenient, and fun. Presented as case studies in a variety of clinical topics, content is developed to utilize the interactivity of the Internet while catering to the needs of busy clinicians. The effect is a powerful learning experience that is realistic and rewarding.

 

Respiratory Failure in a Middle-Aged Smoker

A 46-year-old man presents to the emergency department (ED) with shortness of breath on mild exertion, a nonproductive cough, and chest pain that worsens when he takes deep breaths. The symptoms have been progressively worsening for 10 days. He denies the production of blood when he coughs, and he has not had any weight loss, nausea, vomiting, or lightheadedness. He has no pain in his joints and no rash. He does not recall any recent viral infection, and he also denies any exposure to fumes, vapors, or excessive dust; however, the patient does admit to smoking about a pack of cigarettes per day.

 

What Does This Man Do for a Living?

A 48-year-old man with no significant past medical history presents to the emergency department (ED) with a 3- to 4-month history of slowly progressive difficulty with active, but not passive, extension of the ring and little fingers of his right hand. He denies any tingling, numbness, or skin changes in his hands or his forearms. There is no neck pain, and a thorough neurologic review of symptoms, including motor weakness, decrease in proprioception, and 2-point discrimination, is negative.On physical examination, the patient appears well with normal vital signs. His temperature is 98.6°F (37°C); pulse, 86 bpm; respiratory rate, 18 breaths/min; and blood pressure, 135/85 mm Hg. The patient’s oxygen saturation is 98% while breathing ambient air. The appearance of the patient’s hands is shown in Image 1. The palmar surfaces are noted to be normal, without any skin changes (including rashes or discrete lesions). He has no pain or tenderness in the neck, with a full range of motion. Passive range of motion of the wrist and fingers is normal, with no evidence of increased resistance to movement. Active flexion of the fingers is normal, but all extension of the ring and little fingers of the right hand is absent. The left hand has a normal range of motion, including extension and flexion, of all fingers.

The examining physician (please note, this was not the author) was also able to guess the patient’s occupation. Which anatomic structure is affected, and where is it most vulnerable?

ANSWER

 

Choking with Eating

An 83-year-old man with a history of chronic obstructive pulmonary disease, congestive heart failure, and hypertension presents with a 6-week history of choking while eating. He reports difficulty swallowing both solids and liquids. The patient mentions that he has a chronic productive cough, but he is unsure if it contributes to his difficulty with swallowing. He denies having experienced any fever, chills, sore throat, pleuritic chest pain, or acute worsening of his baseline dyspnea.

On physical examination, the patient appears well and in no general distress. His blood pressure is noted as 135/89 mm Hg, with a heart rate of 65 beats/min. His oral temperature is 98.6°F and his oxygen saturation while breathing room air is 94% (baseline, given his pulmonary condition). He has normal breath sounds, his cardiac examination is normal, and he has normal bowel sounds in the setting of a soft, nontender abdomen.

A barium swallow study is performed (see Images 1-2) on suspicion of an esophageal pathology for his condition.

What is the diagnosis?

For the diagnosis from emedicine case study here…

Some healthy eating tips here…

 

eMedicine image case 94-Swelling and Pain in the Back and Hip of a 35-Year-Old Man

That will be a new category providing links to some interesting cases. We will start with eMedicine image case 94.