How to Manage Somatic Symptom Disorder in Medical Settings

Introduction Somatic Symptom Disorder (previously known, roughly, as somatization disorder) is a maladaptive and counterproductive focus on physical symptoms or sensations, real or imagined. Patients with somatization disorders are really (and sometimes really, really!) suffering, it’s just that they have non-physical states and comorbidities that are making their symptoms worse. These include psychological determinants (e.g., anxiety, depression), social determinants (e.g., social isolation),… Read More »

The Clinical Significance of the Various Descriptions of Vomitus

Undigested food → esophageal issue (e.g., pharyngeal pouch or achalasia). Note: this is not really vomiting, but regurgitation, which is much less forceful and does not come from the stomach (and therefore not associated with nausea!) Non-bilious, with partially digested food → Gastric outlet obstruction (e.g., from peptic ulcer disease or malignancy, or from pyloric stenosis) Gastroparesis Bilious (green) →… Read More »

Physical Examination of Muscles in Systemic Disease

How to examine patients and report findings in patients with suspected muscle diseases: Abnormal movements Fasciculation → peripheral nerve injury Tremor Resting → Parkinsonism (with bradykinesia and rigidity) Intention → cerebellar issue → look for additional signs of cerebellar problems (e.g., ataxia) Myoclonus (involuntary purposeless jerks of limbs) → toxic metabolic issues (e.g., hypoxia, uremia, serotonin syndrome, opioid… Read More »

The 25 Best Medical Books of All Time

Here is the Medical Media Review’s as-of-year-2015 list of the best medical books of all time: Dr. Gerald de Lacey, The Chest X-Ray: A Survival Guide by  (2008, reviewed here). Igbaseimokumo, Usiakimi, MD, Brain CT Scans in Clinical Practice (2009, reviewed here) Herring, William, MD, Learning Radiology, Recognizing the Basics, 3e (2015, previous edit reviewed here) Kurtz, Ira, MD, Acid Base Case Studies (2004, reviewed here) Desai, Samir P., MD, Clinician’s Guide to… Read More »

Central vs. Peripheral Vertigo Simplified

The first and most important step in evaluating a patient with vertigo is to attempt to distinguish vertigo of central origin from vertigo of peripheral origin because the management of central vertigo (brain imaging, hospital admission) is very different from the management of peripheral vertigo (symptomatic treatment, outpatient referral). Differences Between Central and Peripheral Vertigo Peripheral Vertigo Central Vertigo Percentage… Read More »

Stroke & TIA Mimics

Here are the important stroke and TIA mimics: Systemic and metabolic insults: especially hypoglycemia, but also a very wide variety of other systemic insults such as infections (urinary tract infections, pneumonia) and toxins, all of which can cause re-expression of symptoms of old strokes. Peripheral neuropathies such as idiopathic seventh cranial nerve (Bell’s) palsy, peripheral vestibulopathy, and even… Read More »

Headache: The Ominous Causes

Introduction Most headaches are benign and do not require a specific workup. Here are the ominous ones that require a specific workup and management. From the Patient History Sudden, severe, and maximal at onset, especially in an older patient without a prior history of headaches → subarachnoid hemorrhage → get a head CT without contrast → CT angiogram or cerebral angiogram. Systemic… Read More »