Putting Schemas to the Test: An Exercise 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...
KEY WORDSclinical 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).
- 5.Sedgewick R, Flajolet P. An introduction to the analysis of algorithms. 2017 [cited 2018 June 26]; Available from: http://aofa.cs.princeton.edu/home/.