Journal of General Internal Medicine

, Volume 33, Issue 11, pp 2010–2014 | Cite as

Putting Schemas to the Test: An Exercise in Clinical Reasoning

  • Daniel J. Minter
  • Reza Manesh
  • Patricia Cornett
  • Rabih M. Geha
Clinical Practice: Exercises in Clinical Reasoning

A 70-year-old previously healthy man presented to the emergency department with 6 weeks of fatigue, fevers, and chills. He had abdominal fullness, early satiety, and 20-pound weight loss over the preceding 8 months. He did not have headache, night sweats, cough, dyspnea, diarrhea, dysuria, or rash. His family noticed yellowing of his skin and eyes over the previous week. He had immigrated from Vietnam to the USA 30 years prior. He lived in Northern California and had traveled to Minnesota 1 month earlier. He previously worked as a landscaper and had been retired for 10 years. He denied tobacco, alcohol, or recreational drug use.

Early satiety usually represents pathology within the stomach, which may be from external compression (e.g., splenomegaly), impaired motility (e.g., gastroparesis), or more commonly, intraluminal disease (e.g., peptic ulcer disease). Yellowing of the skin usually implies hyperbilirubinemia. Elevations in indirect bilirubin result from hemolysis, impaired...


clinical reasoning medical education 


Compliance with Ethical Standards

Conflict of Interest

Dr. Minter, Dr. Cornett, and Dr. Geha do not have any disclosures.

Dr. Manesh is supported by the Jeremiah A. Barondess Fellowship in the Clinical Transaction of the New York Academy of Medicine, in collaboration with the Accreditation Council for Graduate Medical Education (ACGME).


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Daniel J. Minter
    • 1
  • Reza Manesh
    • 2
  • Patricia Cornett
    • 3
  • Rabih M. Geha
    • 1
    • 4
  1. 1.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Division of Hematology/OncologyUniversity of CaliforniaSan FranciscoUSA
  4. 4.San Francisco VA HospitalSan FranciscoUSA

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