Clinical women

One woman died after 1 week, with multiorgan failure despite intravenous dimercaptosuccinic acid chelation. The other gradually recovered from severe neuropsychiatric symptoms over several months. She had been chelated for several weeks with oral dimercaptosuccinic acid, which apparently improved her clinical condition. ... 

The variant was found In a 22 year old woman with chronic hemolytic anemia characterized by a persistent retlculocytosls, development of gallstones requiring cholecystectomy, frequent episodes of jaundice, dark urine, and falling PCV value. Her mother, maternal grandfather, and sister have a similar clinical picture In all patients red cell enzymes are elevated with a retlculocytosls of about 10%, and 2,3-DPG levels are normal ... 

JT, a 55-year-old African-American woman, comes to your clinic with a recent diagnosis of hypertension. She is 5 5"... 

A 25-year-old Caucasian woman presents to the university student clinic with complaints of intermittent crampy abdominal pain and four to five loose stools per day. She describes some visible mucus and blood in the stool and states that these symptoms have been present for 6 to 8 weeks. She also has intermittent lower back pain, fatigue, fever, and a 10-lb (4.5 kg) weight loss. The back pain started about the same time as her gastrointestinal symptoms. She denies any sick contacts and has not eaten any take-out or restaurant food over the last 2 months. She takes nonprescription naproxen as needed for aches and pains. She has been using more naproxen recently because of the back pain. She also takes an oral contraceptive pill once daily. She consumes alcohol socially and currently smokes 1/2 to 1 pack of cigarettes per day. 

VS blood pressure 128/62 mm Hg supine, pulse 77 beats per minute, respiratory rate 15/minutes, temperature 37°C (98.6°F) Gen Poorly-groomed, thin woman looks stated age Neuro Folstein Mini Mental Status Exam score 16/30 disoriented to month, date, and day of week, clinic name and floor poor registration with impaired attention and shortterm memory recalled 0 out of 3 items good language skills but problems with commands CT Scan Mild to moderate generalized cerebral atrophy... 

AB is a 60-year-old woman presenting to the clinic with a chief complaint of fatigue and weakness. She has noticed a gradual increase in symptoms over the past year but attributed this to "old age." Recently, she has required more frequent rest breaks than before. On further questioning, she complained of intermittent nausea leading to decreased appetite and a 10 lb (4.55 kg) weight loss over the past year. She also reported darkening of a recent scar. 

EB, a 48-year-old woman, presents to a new primary care clinic. EB s chief complaints are chronic pain of the knee and "pins and needles" and "numbness" in both hands. Over the past few years, she feels that her body has been changing. EB reports increased urinary frequency, excessive sweating, worsening headaches, an increase of two shoe sizes, and facial hair that she shaves once a week. She says that her hands have enlarged to the point that "my wedding band won t fit anymore."... 

RC, a 22-year-old woman, presents to your clinic requesting information on contraception. You begin to take a history and determine that the patient is currently sexually active and is not using any method of birth control. Her past medical history is significant only for acne, and she takes no medications except occasional ibuprofen for menstrual cramps. On further questioning, you discover that she has a positive family history for hypertension and coronary artery disease. As you begin to discuss various contraceptive options with the patient, it is clear that she has a preference for an oral contraceptive agent. 

Amenorrhea traditionally is described as either primary or secondary in nature. Primary amenorrhea is the absence of menses by age 16 in the presence of normal secondary sexual development or the absence of menses by age 14 in the absence of normal secondary sexual development. Secondary amenorrhea is the absence of menses for three cycles or 6 months in a previously menstruating woman. However, in clinical practice, there is a significant amount of overlap. The initial evaluation of amenorrhea is often the same regardless of age of onset, except in unusual clinical situations.1... 

BW, a 50-year-old woman with a history of osteoarthritis and hypothyroidism, presents to the clinic complaining of hot flashes, vaginal dryness, and insomnia. She states that she experiences approximately two hot flashes per day and is awakened from sleep at least three to four times a week in a "pool of sweat" requiring her to change her clothes and bed linens. Her symptoms began about 3 months ago, and over that time, they have worsened to the point where they have become very bothersome. On questioning, she states her last menstrual period was 1 year ago. 

A 50-year old woman with hypertension and diabetes comes into your clinic seeking advice about which incontinence pads work best. After questioning her, you determine that she has multiple issues of low volume urine loss daily, which is a significant change (increase) from 1 year ago. All episodes occur at times of physical activity. She s a single mother of three grown children, all delivered vaginally. Her last menstrual period was 11 months ago. 

A 62-year-old obese woman presents to your clinic complaining of deep, aching pain in her right knee. The pain is provoked by walking and subsides with rest. She also notes that her knee is difficult to bend for 1 0 minutes after rising in the morning. The symptoms have worsened over the last several years. Your interview also reveals that she injured her knee several years ago getting out of a car. 

A 28-year-old woman with no significant past medical history presents to your clinic with complaints of sneezing, rhinorrhea, and nasal congestion persisting for the previous 3 weeks. On further questioning, she reports that the symptoms began this spring and worsen when she is outdoors. 

A 73-year-old woman presents to your clinic complaining of difficulty breathing and shortness of breath. Her physical examination reveals that she is alert and oriented x 3, has decreased breath sounds on the left side compared with the right, and has rales in the left lower lobe. Her temperature is 37.4°C, respiratory rate is 20 breaths per minute, and blood pressure is 110/76 mm Hg. 

The 73-year-old woman presents again to your clinic complaining of difficulty breathing and shortness of breath. Her daughter also states that she is easily confused and that this is not normal for her. 

A 35-year-old woman presents to your clinic complaining of "burning and soreness in my mouth" along with a metallic taste and "this funny white stuff." On initial examination, she has white patches on her tongue, gums, and buccal mucosa. These patches are easily removed, revealing erythematous tissue underneath. 

This is the woman s first visit to your clinic, therefore no medical history is available in her chart. 

A 36-year-old woman who has been in good health presents to your clinic complaining of constipation and abdominal pain. She explains to you that she has been feeling stressed lately because her 40-year-old sister is undergoing chemotherapy for breast cancer, and they just lost there mother to ovarian cancer a few years ago. 

JM is a 32-year-old woman who was recently diagnosed with stage IIIB Hodgkin s disease. She comes to the clinic to receive her first dose of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy. She currently does not have a central access device therefore, she will receive her chemotherapy via peripheral vein. 

A 35-year-old woman with a history of hypertension presents to your clinic complaining of low energy and irritability. She reports not following any specific diet because they have all failed in the past. She does admit to eating out frequently. This patient does not exercise because her job and her kids are too demanding. Patient does smoke a half pack of cigarettes per day and consumes low-calorie, caffeinated and alcoholic drinks most days. Her BMI is 32 kg/m2, and her waist circumference is 38 in (97 cm). 

Jackie is a 46-year-old woman who weighed 180 pounds and was only five feet, four inches tall. She read about rimonabant, a drug that was being investigated in clinical trials for weight loss. Jackie was able to participate in a clinical trial and took this drug for one year. She lost 30 pounds during that time. 

It is remarkable that most of the data collected from the available SERMs are unanimous in reproducing an estrogen agonistic profile in venous thrombogenesis. The vast clinical experience acquired with tamoxifen confirms an augmented risk for both deep venous thrombosis and pulmonary embolism. This increase, however, did not presuppose increased mortality in the overview of randomized trials of adjuvant tamoxifen for early breast cancer, where the one extra death per 5000 woman-years of tamoxifen attributed to pulmonary embolus was not statistically significant (Early Breast Cancer Trialists Collaborative Group 1998). 

Absolute risks can better reflect the clinical importance of the protective effect. In the placebo group the incidence was 5.3 cases per 1000 woman-years, while in the treated group only 1.9 cases per 1000 woman-year were diagnosed. If we only take into account invasive cancers, the figures would be 4.7 and 1.3, respectively, meaning a relative risk of 0.28 or a decrease of 72% (Cauley et al. 2001). 

Clinical evidence indicates that the use of tamoxifen increases survival up to 10 years in women with breast cancer. Tamoxifen also seems to diminish the incidence of breast cancer in healthy women with a high risk of suffering from the tumor. Its use as a therapy in breast cancer should be accompanied by careful periodic vigilance of the endometrium. In healthy women, a careful evaluation of the risk/benefit for each and every woman should be imposed. 

A thorough clinical evaluation with a systematic anamnesis and physical examination including body weight, height, waist/hip ratio, and blood pressure should precede any lab tests or instrumental examinations. In the process of detecting the weak points of a given woman, the application of specific risk scores can be of interest. 

The possibility of cerebrovascular action of PCP was raised by the development of focal seizures and hemiparesis in a 6-year-old boy who had ingested what was presumed to be PCP (18). Hypertensive encephalopathy with a blood pressure of260/160 occurred in an 18-year-old woman who used PCP (43). These clinical findings are compatible with in vitro studies indicating that cerebral artery spasms can be produced by PCP as well as by LSD and mescaline (4). Whether such cerebrovascular actions are pertinent to the mental effects of these drugs is questionable. 

---