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Five months of frequent abdominal pain;
A painful swollen foot
CASE 1: A 36-year-old white woman presents in the emergency department with dull, intermittent abdominal pain of 5 months' duration.
CASE 2: A 59-year-old African American woman is seen for the first time in a medical clinic for chronic swelling of her left ankle and foot. The patient first noticed painful swelling of the left ankle about 2 years ago when she was seen in an emergency department (ED) and given a diagnosis of ankle sprain.
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CASE & COMMENT: Bone pain and a worrisome family history
Case A 51-year-old African American man describes a sudden onset of sharp, nonradiating pain in the proximal portion of his right arm that began after heavy lifting at work 3 days earlier. The pain worsens with use of the arm and improves with rest. The patient denies any chronic conditions, takes no medications, has had no surgeries, and had not seen a physician in the previous 3 years. Both the patient's maternal grandmother and maternal aunt died of breast cancer, and his father died of prostate cancer. Social history is significant for a 38 pack-year history of cigarette smoking and weekly consumption of 40 oz of beer. Findings on the review of systems are negative.
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CASE & COMMENT: Is this ruptured kidney tumor malignant?
A 77-year-old woman presents with acute, severe left flank pain accompanied by lower abdominal cramps. She denies trauma, hematuria, history of stones, or symptoms of urinary tract infection. Hemoglobin is 7 g/dL, and a stat CT scan demonstrates left kidney rupture and retroperitoneal hemorrhage with the lower pole renal parenchymal fragments and extravasated contrast material within the mass lesion (see the CT image
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Updates in colon, cervical, breast, and prostate cancer screening
Although minor differences among organizations still exist, major guidelines for colon, cervical, and breast screening and for testing for early prostate cancer screening are quite similar. Even so, a large subset of the general population either continues to go unscreened or is screened inconsistently. For example, few men and women (fewer than 30%) reported the recent use of any colorectal screening test in 2000.
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