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Falls and Delirium: Platypnea-Orthodeoxia Syndrome

An 85-year-old woman’s inability to remain standing was ultimately connected to an undiagnosed congenital defect. The patient was admitted to the geriatric unit of a university hospital for new frequent falls and subacute delirium, both of which began 1 month before presentation. Her medical history included ischemic stroke 10 years earlier, mild neurocognitive impairment, and […]

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‘Landolfi’s Sign’—Eyes Don’t See What the Mind Does Not Know!

To the Editor: A 60-year-old woman was admitted with progressively worsening dyspnea on exertion associated with intermittent lightheadedness and palpitations. On physical examination, a 3/6 diastolic decrescendo murmur was audible along the left sternal border. The murmur was most prominently heard in the left third intercostal space at end expiration with the patient in the […]

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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 understanding of the disease which comes with an intelligent study of a score of cases, so different are knowledge […]

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The Hyperlipidemia Effect: Pseudohyponatremia in Pancreatic Cancer

A patient’s newly discovered malignancy was evidently accompanied by a sodium deficit. The 48-year-old man presented to the Emergency Department for evaluation of abdominal pain and weight loss. He described gradual onset of severe, burning, epigastric pain with radiation to the back. In addition, he reported a 70-lb weight loss over 2 months, yellowing of […]

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Challenges in Ordering and Interpreting Pharmacogenomic Tests in Clinical Practice

More than 160 US Food and Drug Administration–approved medications have information in their labeling regarding genetic mutations known to be associated with efficacy or safety.1 Not surprisingly, pharmacogenomics is increasingly incorporated into clinical practice in an effort to optimize prescribing to improve treatment outcomes.2, 3, 4, 5 Clinical implementation of pharmacogenomics has been facilitated by efforts to standardize pharmacogenomic-related terminology and […]

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