William Yaakob, MD

December 31, 2006

For the past month, a 19-year-old woman has had abdominalpain, diarrhea, intermittent fever, and occasionalvomiting. She now seeks medical attention because earlierin the day she noticed a large amount of blood in herstool. She denies trauma, travel to a foreign country, andillicit drug use. She drinks alcohol occasionally but hasnot done so for the past 3 months.

December 31, 2006

A 64-year-old woman complainsof neck fullness that has increased inthe last few months. She has occasionaldyspnea but denies fever, cough, andhemoptysis. Hypertension is well-controlledwith propranolol.

December 31, 2006

A 76-year-old woman complains of gradually worsening back pain thatbegan 6 weeks earlier, after she fell off a ladder rung 3 feet from the ground(she landed on her feet). She is otherwise in good health and denies fever andloss of sensation or control in the lower extremities.

December 31, 2006

A 72-year-old man complains that he has been losing weightfor the last 2 months. Colon cancer was diagnosed 2 yearsearlier, and the lesion was resected; he did not receive anyadditional therapy at that time. Except for hypertension,which is well controlled with propranolol, the remainder ofthe medical history is unremarkable.

December 31, 2006

A 75-year-old woman complains of chest pain that radiates to her back betweenher shoulder blades. The pain began the morning of her presentationand has progressed throughout the day. She denies recent trauma, shortnessof breath, and fever. She has hypertension, which is treated with a &#946-blocker.Three years earlier, she fractured her right femur in a motor vehicle accident;the fracture was treated by open reduction and internal fixation.

December 31, 2006

A 62-year-old man has had nightsweats and worsening fever andcough for the last 4 days; 2 days agohe had an episode of hemoptysis. Hedenies trauma or travel to a foreigncountry but has a 30-pack-year smokinghistory. The medical history isotherwise noncontributory.

December 31, 2006

Mammography is auseful tool. However,it has limitations. Until recently,it had been viewedas the ultimate diagnostictest, capable of detecting allbreast cancers in their earliest,treatable stages. Thissimply is not true. Evenwhen performed by themost capable institutionsand radiologists, mammographyhas a sensitivity of80% to 85% for the detectionof breast cancer. This hasbeen established by numerousstudies.1,2

December 31, 2006

A 53-year-old man complains ofdyspnea and a cough that has progressivelyworsened over the pastweek. He denies recent trauma.

December 31, 2006

A 29-year-old woman is brought to the emergency department after a caraccident. She complains of head pain and has a contusion over the posterioraspect of the right temporal bone and right occipital bone; a small amount ofblood flows from the right external auditory canal. She has only a vague recollectionof the accident. Past medical history-although difficult to ascertain-seems noncontributory.

December 31, 2006

A 58-year-old man complains ofintermittent headaches that beganabout 2 months earlier and have recentlyincreased in severity. Theheadaches occur at various times ofthe day and improve slightly whenhe sits. He denies trauma, fever, photophobia,and other neurologicsymptoms. He has 1 alcoholic drinka day and has smoked 1 pack of cigarettesa day for the past 20 years.Medical history is noncontributory.