By Fred B. Thomas MD, FACP (auth.), Juan Bowen M.D., Ernest L. Mazzaferri M.D. (eds.)
Read with ambitions: first, to acquaint your self with the present wisdom of a topic and the stairs in which it's been reached; and secondly, and extra vital, learn to appreciate and learn your situations. William Osler, the scholar existence What follows is a suite of cases-or extra aptly, the tales of our sufferers and pals who've been visible on the Ohio nation college Hospitals the place our school have supplied their care and approximately whom this quantity is written. at the present time many worry that our sufferers are being moved from heart level whereas we're being distracted via the know-how of drugs. This quantity used to be written with sufferers in brain. the assumption is that the main exciting questions and the main lucrative solutions start and finish on the bedside. it is a tale of our sufferers, informed by means of professional clinicians and spiced with remark alongside the way in which. This quantity under no circumstances at tempts to be accomplished. as an alternative, it really is just like the perform of drugs, scattered, a little bit disjointed, whereas while intensely own and concentrated upon no matter what challenge the sufferer brings to us. The discussions aren't a lot approximately sickness entities as they're approximately sufferers with problem". the 2 are uniquely dif ferent. for example, while the health practitioner suspects hepatitis, no longer each that you can imagine reason will be actively investigated. as a substitute, checks and tactics are discriminate ly selected, part of drugs that remains extra paintings than science.
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Additional resources for Contemporary Internal Medicine: Clinical Case Studies
4 Hemorrhage can also occur in papillary thyroid carcinoma giving the impression of rapid growth and causing difficulty in interpreting FNAB cytology, thus making the differentiation between benign and malignant hemorrhagic lesions difficult. 4 However, this patient's thyroid ultrasonography and FNAB were not consistent with hemorrhage. Table 1 Differential Diagnosis of Nodular Goiter • Cyst pure cyst mixed cystic-solid (complex) • Thyroid adenoma autonomously hyperfunctioning "hot" nodule non- or hypofunctional • Colloid (adenomatoid) nodule • Thyroiditis acute subacute chronic silent • Graves' disease (rarely) • Infections granulomatous disease abscesses • Developmental abnormalities cystic hygroma dermoid teratoma unilateral lobe agenesis • Carcinoma metastatic to thyroid primary thyroid • Thyroid lymphoma Dyspnea and Rapidly Enlarging Goiter 25 Acute thyroid pyogenic infection can also cause rapid goiter development, but it is almost invariably associated with intense pain and tenderness, fever, extreme leukocytosis and sepsis,1 features not seen in the patient under discussion.
Ann Intern Med. 1986;104:355-7. Mazzaferri EL, de los Santos BT, Keyhani-Rofagha S. Solitay thyroid nodule. Diagnosis and management. Med Clin No Amer. 1988; (in press). Eriksson M, Ajmani SK, Mallette LE. Hyperthyroidism from thyroid metastases of pancreatic adenocarcinoma. JAMA. 19n:238:1276-8. McCabe DP, Farrar WB, Petkov TM, Finkelmeier W, O'Dwyer P, James A. Clinical and pathologic correlations in disease metastatic to the thyroid gland. Am J Surg. 1985;150:519-23. Aldinger KA, Samaan NA, Ibanez M, Hill CS.
The patient was active, working in her garden and doing volunteer hospital work. She denied smoking or alcohol use, and did not drink caffeine-containing beverages. Physical Examination. 2° F, the pulse was 104, and the respirations were 22. The blood pressure was 142/84 rom Hg. On examination the patient was a pleasant, alert, elderly woman who weighed 175 pounds and was 5 feet 5 inches tall. She was in no acute distress. Her skin was dry, with numerous seborrheic and senile keratoses, but was not coarse.
Contemporary Internal Medicine: Clinical Case Studies by Fred B. Thomas MD, FACP (auth.), Juan Bowen M.D., Ernest L. Mazzaferri M.D. (eds.)