discussion

Summary: A 62-year-old man presents to your office for a routine checkup. He reports having occasional bloody stools and you discover guaiac-positive stools. He is a bit pale, but hemodynamically stable at the moment. You decide that further evaluation ofthis bleeding is necessary, but most ofit can be carried out on an outpatient basis with close follow-up.

Discussion

Summary: A 56-year-old white man with well-controlled hypertension is found to have elevated cholesterol on a screening blood test as part of a physical examina­ tion. He has no known history of coronary artery disease or of any coronary artery disease risk equivalent.

Discussion

A 28-year-old woman presents with a several-year history of crampy abdominal pain and constipation alternating with diarrhea. She denies any fever, weight loss, heartburn, or bloody stools. Her past medical history and family his­ tory are otherwise unremarkable. The physical examination, including abdominal and pelvic examination, are grossly within normal limit.

Discussion

A 33-year-old woman presents with a complaint of headaches. She has had headaches since she was a teenager, but they have become more debilitating recently. The episodes occur once or twice each month and last for up to 2 days. The pain begins in the right temple or at the back of the right eye and spreads to the entire scalp over a few hours. She describes the pain as a sharp, throbbing sensation that gradually worsens and is associated with severe nausea. Several factors aggravate the pain, including loud noises and movement. She has taken several over-the counter medications for the pain, but the only thing that works is going to sleep in a quiet, darkened room. A thorough history reveals that her mother suffers from migraine headaches. Her vital signs, general physical examination, and a thorough neurologic examination are all within normal limits.

Discussion

A 50-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. The CBC results indicate hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition. Discuss the following: