Tag Archives: Physical exam
Prominent superficial veins over the right upper arm and shoulder, reflective of Urschel's sign.

Urschel’s Sign in Paget Schroetter Syndrome

A 32-year-old man, employed as a deckhand, was referred for right upper extremity swelling and pain of 3 months’ duration. Physical examination revealed swelling of the right upper extremity and prominent superficial veins over the right upper arm and shoulder (Urschel’s sign; Figure). Blood work including thrombophilia screen was unremarkable. Right upper extremity venous duplex ultrasonography […]

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Ocular fundus image of the left eye shows mild optic disc swelling, multifocal retinochoroidal exudates, retinal phlebitis, and mild vitreous opacity.

Sometimes the Eyes Say More Than the Mouth

A 48-year-old man with a history of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS)-associated cryptococcal meningitis was referred to our hospital with blurred vision in his left eye for several months. He was diagnosed with bilateral chronic posterior uveitis (Figure). After ruling out secondary uveitis, such as sarcoidosis, Behçet disease, Vogt-Koyanagi-Harada disease, […]

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Esophagogastroduodenoscopy demonstrated white plaque lesions that extended from the gastroesophageal junction to the midesophagus.

Not 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 experiencing sharp epigastric pain over 2 days. She was initially seen at an urgent care center and empirically treated for gastritis with omeprazole. However, her pain progressively worsened and […]

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(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 staining findings of the spleen (×400). LD and LDH = lactate dehydrogenase; RCC = red cell concentrate; R-CHOP = rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone; T-Bil = total bilirubin.

Steroid-Refractory Autoimmune Hemolytic Anemia with Massive Splenomegaly

To the Editor: A 63-year-old woman was admitted in January 2012 with a 1-month history of general fatigue and jaundice. Physical examination revealed a pale conjunctiva, icteric sclera, and splenomegaly with no evidence of systemic lymphadenopathy. Laboratory findings revealed normocytic anemia (49 g/L) with increased reticulocyte count, decreased haptoglobin level, normal white cell count without […]

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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 public health, we are normally concerned with the first question—the effect of assigning a treatment. If we […]

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Dr. Joseph S. Alpert

Will Physicians Stop Performing Physical Exams? (video)

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 of the remarkable advances during the last 50 years in imaging technology and laboratory medicine. When I was a student and resident in the late 1960s […]

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