SECOND EDITION CASE FILES ® Family Medicine Eugene C. Toy, MD The John S. Dunn, Senior Academic Chair and Program Director The Methodist Hospital Obstetrics and Gynecology Residency Program Houston, Texas Vice Chair of Academic Affairs Department of Obstetrics and Gynecology The Methodist Hospital–Houston Associate Clinical Professor and Clerkship Director Department of Obstetrics and Gynecology University of Texas Medical School at Houston Houston, Texas Donald Briscoe, MD Director, Family Medicine Residency Program and Chair, Department of Family Medicine The Methodist Hospital—Houston Medical Director Houston Community Health Centers, Inc. Houston, Texas Bruce Britton, MD Clinical Associate Professor and Family Medicine Clerkship Director Department of Family and Community Medicine Eastern Virginia Medical School Portsmouth, Virginia Bal Reddy, MD Director of Predoctoral Education Assistant Professor Department of Family Medicine University of Texas Medical School at Houston Houston, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2010 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-160024-8 MHID: 0-07-160024-8 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-160023-1, MHID: 0-07-160023-X. 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Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or sim- ilar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. DEDICATION To my wonderful partners at the CHRISTUS Southwest Community Health Clinic including our leaders Sister Rosanne Popp, MD and Tyrone Springs, DDS; the excellent nurse practitioners Bernie, Cornell, Carlisa, and Kathy; and my phenomenal sonographer Patty—you and your associates are the everyday heroes providing medical care to the underserved each day. — ECT To Cal, Casey, and Heather. — DB To the students, residents, faculty and patients of EVMS: the best teachers I could ever have. And to May and Sean: for their infinite patience and love. — BB To my loving parents, whose sincerity, sacrifice, and hard work have made my efforts possible. — BR This page intentionally left blank CONTENTS Contributors / vii Preface / ix Acknowledgments / xi Introduction / xiii Section I How to Approach Clinical Problems . . . . . . . . . . . . . . . . . . . . .1 Part 1. Approach to the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Part 2. Approach to Clinical Problem Solving . . . . . . . . . . . . . . . . . . . . . . .6 Part 3. Approach to Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Section II Clinical Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Fifty-Five Case Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Section III Listing of Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .577 Listing by Case Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .579 Listing by Disorder (Alphabetical) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .580 Index / 583 This page intentionally left blank CONTRIBUTORS Matthew V. Backens, MD Chief Resident Portsmouth Family Medicine Residency Program Eastern Virginia Medical School Norfolk, Virginia Jaundice Menstrual Cycle Irregularity Adverse Drug Reactions and Interactions Acute Low Back Pains Patrick C. Beeman, 2d Lt, USAF Medical Student University of Toledo College of Medicine Toledo, Ohio Arthritis Contraception Family Violence Menstrual Cycle Irregularity Doan T. Do, MD Resident Family Medicine Residency Program The Methodist Hospital—Houston Houston, Texas Adult Male Health Maintenance Dyspnea (Chronic Obstructive Pulmonary Disease) Allergic Disorders Tobacco Use Medical Ethics Health Maintenance in Adult Female Skin Lesions Thyroid Disorders Labor and Delivery Molly K. Dudley Medical Student University of Texas Medical School at San Antonio San Antonio, Texas Anemia Dyspnea (Chronic Obstructive Pulmonary Disease) vii viii CONTRIBUTORS Attiyah T. Ismaeli-Campbell, MD Resident Portsmouth Family Medicine Residency Program Eastern Virginia Medical School Norfolk, Virginia Acute Causes of Wheezing Other than Asthma in Children Dyspepsia and Peptic Ulcer Disease Breast Diseases Diabetes Mellitus Lauren Laroche Medical Student University of Texas Medical School at Houston Houston, Texas Pneumonia Cerebrovascular disease Carey J. Lindemann, MD Resident Family Medicine Residency Program The Methodist Hospital—Houston Houston, Texas Joint Pain Prenatal Care Well-Child Care Geriatric Anemia Acute Diarrhea Musculoskeletal Injuries Hematuria Calcium Disorders Tiffani M. Sealock, MD Faculty Physician Family Medicine Residency Program The Methodist Hospital—Houston Houston, Texas Developmental Disorders Stephen E. Vandenhoff, MD Resident Department of Family Medicine Eastern Virginia Medical School Portsmouth, Virginia Palpitations Cerebrovascular Accident/Transient Ischemic Attack HIV and AIDS Fever and Rash PREFACE We appreciate all the kind remarks and suggestions from the many medical students over the past 3 years. Your positive reception has been an incredible encouragement, especially in light of the short life of the Case Files series. In this second edition of Case Files: Family Medicine, the basic format of the book has been retained. Improvements were made in updating many of the chapters. New cases include back pain, movement disorders and developmental disor- ders. We reviewed the clinical scenarios with the intent of improving them; however, their “real-life” presentations patterned after actual clinical experi- ence were accurate and instructive. The multiple-choice questions have been carefully reviewed and rewritten to ensure that they comply with the National Board and USMLE format. Through this second edition, we hope that the reader will continue to enjoy learning diagnosis and management through the simulated clinical cases. It certainly is a privilege to be teachers for so many students, and it is with humility that we present this edition. ix