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A modified Epley maneuver for the treatment of left posterior semicircular canal benign paroxysmal positional vertigo. The head is turned 45° toward the left (A); then the patient reclines back with the head still turned left (B), and this position is maintained for approximately 30 seconds. If nystagmus is observed, the patient turns the head 90° toward the right side (C) while maintaining neck extension. The head-hanging-right position is then maintained for approximately 30 seconds. Next, the patient is turned further toward the right, into a side-lying position, such that the head is turned in the same direction, 90° beyond its last position; the nose should then be pointing in a direction that is about halfway between parallel and perpendicular to the floor (not shown). After approximately 30 seconds, the patient sits up. For the treatment of the right posterior canal variant, this procedure is followed with the modification of exchanging the words right and left. Treatments of the horizontal and anterior canal variants are outside the scope of this review.

Dizziness

  Dizziness is common, as reflected by the cost of assessing dizziness in U.S. emergency rooms, which reportedly exceeds $4 billion per year.1, 2 For many patients, the pathophysiology of dizziness will not be fully demonstrable by diagnostic tests. However, a systematic clinical approach allows for the identification of common forms of dizziness. Recognizing common patterns of […]

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Point-of-Care Ultrasound for the Assessment of Digital Clubbing

  Digital clubbing, a resultant finding from the proliferation of connective tissue in the terminal portion of fingers or toes, has long been recognized as a sign for a number of underlying infectious, inflammatory, malignant, and vascular conditions.1 A profile angle >176° and a hyponychial angle >192° support the diagnosis of clubbing.1Quantification of these angles can […]

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A Case of Addison’s Disease Nearly Mistaken for Anorexia Nervosa

A 22-year-old woman presented to her primary care physician because of an unintentional weight loss of 30 pounds (Figure A) associated with nausea, vomiting, anorexia, and generalized abdominal pain. She also described symptoms of anxiety and low mood that coincided with the breakdown of a relationship. Although she did not report body image distortion or fear […]

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doctor in uniform using futuristic looking digital screens and keyboard

Sherlock Holmes and the Case of the Vanishing Examination

We live in a world steeped in technology where we all spend increasing amounts of time on our cell phones and computers and less time observing the world around us. These changes have also affected how we practice medicine. Many physicians today spend more time reviewing imaging studies and laboratory tests and less time taking […]

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Adult-Onset Still’s Disease: A Classic Presentation of a Rare Illness

Adult-onset Still’s disease is a rare inflammatory disorder of unclear etiology. Here, we highlight a classic presentation of this disorder. Case Description A 30-year-old woman presented with a 1-month history of daily fevers, myalgias, 7.5-kg unintentional weight loss, and a 2-week history of diffuse skin rash. Her medical history was notable for Hashimoto’s thyroiditis, and […]

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Magnetic resonance imaging brain scan with contrast. (A) Axial view showing (arrow) transverse and sigmoid sinus venous thrombosis. (B) Axial view showing (arrow) left ophthalmic vein thrombosis. (C) Sagittal view showing (arrow) left ophthalmic vein thrombosis. (D) Axial view showing (arrow) focal perichiasmatic enhancement of the left optic nerve.

Lesson Learned Through a Case of Pneumococcal Meningitis: Sometimes Doing Less Is More Harmful

Pneumococcal meningitis is commonly associated with intracranial complications. We present a case of pneumococcal meningitis leading to partial loss of vision in the left eye secondary to vascular complications. A 62-year-old African American female with a past medical history of breast cancer and hypothyroidism presented with complaints of altered mental status, neck pain, headache, and […]

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