As part of his preparation for retirement, a 66-year-old executive undergoes a complete physical examination. He is in good health and has no symptoms to report. Along with other age-appropriate screening studies, you discuss testing for vascular disease with him.
Modern Medicine Cases
My patient is a man in his early 70s who complains of lack of strength. His testosterone level is low, and his B12 level is low-normal.
Two days before a 72-year-old woman is admitted to the cardiac care unit (CCU), she had substernal discomfort she described as "heartburn," accompanied by episodes of nausea and vomiting. She attributed her symptoms to GI upset.
A 65-year-old woman with a history of alcohol abuse, hospitalized because of acute pancreatitis, had had petechial hemorrhages on her legs for the past 3 months.
After a family argument, an 83-year-old woman experienced chest pain, a "racing heart," and a choking sensation and was brought to the emergency department. The chest pain lasted 10 to 15 minutes; was sharp, substernal, and nonradiating; and was associated with dyspnea and a bout of emesis.
I have a patient who has taken escitalopram for a number of years, and he complains of increased sweating, particularly during the summer. Are SSRIs associated with hyperhidrosis? Would it be worthwhile to switch to a different SSRI?
A neurologist prescribed a combination pill of dipyridamole and aspirin (2 tablets daily) for secondary stroke prevention in my patient, a 74-year-old woman. However, this patient also has increased cardiac risk.
For several years, a 71-year-old man has had a mildly pruritic rash on his legs that develops every winter and resolves when the weather becomes warmer. He is scheduled to undergo knee surgery, but the surgeon refuses to perform the operation until the rash has cleared.
An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.