Primary hyperparathyroidism, which accounts for most hyperparathyroidism cases, results from excessive release of PTH and manifests as hypercalcemia.  Patients with hypercalcemia who have normal renal function and no malignancy must be suspected of having primary hyperparathyroidism and must be subsequently tested for elevated PTH levels. Hyperparathyroidism is often incidentally discovered during routine laboratory testing when [...]

A subarachnoid hemorrhage presents as: Sudden Severe Headache (occasionally there we be a sentinal headache at the initiation of the bleed) Nausea and/or vomiting Symptoms of meningeal irritation (ie: neck stiffness, low back pain, bilateral leg pain): These are seen in more than 75% of cases of subarachnoid hemorrhage Photophobia and visual changes Loss of [...]

Achalasia is a disorder of the esophagus that is characterized by: Episodic spasms that can mimic cardiac pain due to disorganized peristalsis.  There is elevated lower esophageal sphincter (LES) pressure. There is dysfunctional LES relaxation. The symptoms show difficulty swallowing solids and liquids with associated regurgutation while supine or asleep. The symptoms develop insidiously over [...]

History The classic clinical presentation of Boerhaave syndrome usually consists of repeated episodes of retching and vomiting, typically in a middle-aged man with recent excessive dietary and alcohol intake. These repeated episodes of retching and vomiting are followed by a sudden onset of severe chest pain in the lower thorax and the upper abdomen. The [...]

Infection Source Clinical Features Alaria americana Undercooked frog legs Disseminated fatal thoracic, gastrointestinal, retroperitoneal, and CNS manifestations; intraocular infections Echinostomiasis (16 species) Freshwater fish, aquatic plants, clams, snails, mollusks, contact with aquatic birds May be asymptomatic; mild abdominal pain, bloating, dyspepsia, diarrhea, eosinophilia Fibricola species Tadpoles Abdominal pain, diarrhea, fever, eosinophilia Fasciolopsis species Water chestnut, [...]

Acoustic neuromas are intracranial, extra-axial tumors that arise from the Schwann cell sheath investing either the vestibular or cochlear nerve.  Acoustic tumors, like other space-occupying lesions, produce symptoms by any of 4 recognizable mechanisms: (1) compression or distortion of the spinal fluid spaces, (2) displacement of the brain stem, (3) compression of vessels producing ischemia [...]

Malignant external otitis is an infection that affects the external auditory canal and temporal bone. The causative organism is usually Pseudomonas aeruginosa, and the disease commonly manifests in elderly patients with diabetes. The infection begins as an external otitis that progresses into an osteomyelitis of the temporal bone. Spread of the disease outside the external [...]

Glaucoma is a disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye. The nerve damage involves loss of retinal ganglion cells in a characteristic pattern. There are many different sub-types of glaucoma but [...]

Painless loss of monocular vision is the usual presenting symptom of retinal artery occlusion. Ocular stroke commonly is caused by embolism of the retinal artery. Retinal artery occlusion represents an ophthalmologic emergency, and delay in treatment may result in permanent loss of vision. Immediate intervention improves chances of visual recovery, but, even then, prognosis is [...]

Features of Basal Cell Carcinoma and Lesions of Similar Appearance Lesion Location Surface Color Outline Other features Basal cell carcinoma Most common on face, but can occur anywhere Raised, pearly, firm Normal skin color Round at first, irregular later May ulcerate Superficial basal cell carcinoma Any location Roughened Skin-colored or pink Round or irregular Resembles [...]

Features of Squamous Cell Carcinoma and Lesions of Similar Appearance   Lesion Location Surface Color Outline Other features Squamous cell carcinoma Areas exposed to sunlight, radiation or arsenicals Rough, irregular, sometimes scaly, sometimes has visible vessels, sometimes warty or with fleshy masses Skin-colored at first, sometimes reddened later Vague New lesions may appear near old [...]

A foodborne illness is any illness associated with or resulting from ingestion of food. This definition, as in most texts, is intentionally broad to accommodate the diverse methods and agents responsible for foodborne illness. These agents include microorganisms, marine organisms, and fungi, along with their associated toxins, and various chemical contaminants. The organism/agent and the [...]

Adult Still’s disease is a rare illness marked by high fevers, rash, and joint pain. It may lead to chronic arthritis. It is more commonly called adult-onset Still’s disease (AOSD). Fewer than 1 out of 100,000 people develop adult Still’s disease each year. It affects women more often than men. Still’s disease that occurs in [...]

Antiphospholipid antibody syndrome , also known as lupus anticoagulant syndrome, or Hugh syndrome  is characterized by the presence of anti-phospholipid antibodies, which are frequently linked to pregnancy losses in the pre-embryonic (<6 wk), embryonic (6-9 wk), and fetal (≥10 wk gestation) time periods. 10-20% of women with early losses are positive for the anti-phospholipid antibodies, [...]

Polymyalgia rheumatica (PMR) is a clinical syndrome characterized by severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle.  It causes severe pain in the proximal muscle groups; however, no evidence of disease is present at muscle biopsy. Muscle strength and electromyographic findings are normal.  It is closely linked to giant cell arteritis [...]

Limited systemic sclerosis/scleroderma is well described by the CREST syndrome (Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasias). Diffuse systemic sclerosis/scleroderma is rapidly progressing and affects a large area of the skin and one or more internal organs, frequently the kidneys, esophagus, heart and lungs. Typical scleroderma is classically defined as symmetrical skin thickening, with about [...]

Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia (a heightened and painful response to pressure).  Other symptoms include severe fatigue, insomnia, and joint problems. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia frequently co-exists with psychiatric conditions such as depression [...]

Similar to polymyositis in muscle presentation (ie weakness of proximal muscles, minimal if any pain). Some cases of dermatomyositis actually “overlap” other autoimmune diseases such as: Sjögren’s syndrome, lupus, scleroderma, or vasculitis. Because of the link between dermatomyositis and autoimmune disease, run an ANA test. Skin findings occur in dermatomyositis but not polymyositis and are generally [...]

Patients present with proximal muscle weakness usually in the legs/thighs.  They have difficulty arising from a chair or bed, and cannot kneel or squat. Invariably the presentation is with WEAKNESS, not pain (pain should suggest PMR). Polymyositis, like dermatomyositis, strikes females with greater frequency than males. (Remember: Inclusion Body Myositis effects men more !!) 1.) [...]

A common inflammatory myositis occurring in men (usually) over 50. The disease is characterized by distal muscle weakness, most prominently demonstrated in the hand (wimpy hand shake). Prominent weakness can occur elsewhere, but look for dysphagia as a co-symptom. Drug exposure is the cause, with special attention to cocaine, alcohol, statins, steroids, and colchicine. Labs [...]

Water-soluble vitamins and their characteristics. Common food sources Major functions Deficiency symptoms Overconsumption symptoms Stability in foods Vitamin C (ascorbic acid) Citrus fruits, broccoli, strawberries, melon, green pepper, tomatoes, dark green vegetables, potatoes. Formation of collagen (a component of tissues), helps hold them together; wound healing; maintaining blood vessels, bones, teeth; absorption of iron, calcium, [...]

Fat Soluble Vitamin Facts Vitamin Source Physiological Functions Deficiency Overconsumption A (retinol) (provitamin A, such as beta carotene) Vitamin A: liver, vitamin A fortified milk and dairy products, butter, whole milk, cheese, egg yolk. Provitamin A: carrots, leafy green vegetables, sweet potatoes, pumpkins, winter squash, apricots, cantaloupe. Helps to form skin and mucous membranes and [...]