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The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Peripheral edema occurs for a number of reasons, most commonly because of a cardiovascular etiology. Anasarca may be caused by hepatic and renal failure, as well as by nephrotic syndrome. Lymphedema can occur after surgery, injury and other causes. Myxedema is a manifestation of hypothyroidism.
Diseases of the Hair
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Rodney Sinclair, Wei-Liang Koh
Clinical presentation: For congenital localized hypertrichosis, this can be an isolated finding with a discrete circumscribed patch of increased terminal hairs, or associated with a congenital melanocytic nevus, Becker’s nevus, or underlying spinal dysraphism (faun tail sign at lumbosacral region). For congenital generalized hypertrichosis, patients rarely can present with increased body hair from birth, either lanugo hair (congenital hypertrichosis lanuginosa) or terminal hair (congenital hypertrichosis terminalis). This can be an isolated finding or associated with other congenital syndromes (e.g., Hurler syndrome, Cornelia de Lange syndrome). For acquired localized hyper-trichosis, this can be a feature in porphyria cutanea tarda. This can also occur in pretibial myxedema plaques, usually associated with Graves’s disease. Topical medications, for example, minoxidil, bimatoprost, and potent topical steroids, can induce hair growth. Repetitive rubbing/scratching and application of plaster cast can also result in localized hypertrichosis. For acquired generalized hypertrichosis, this condition can be associated with underlying malignancies (“malignant down,” reported rarely in gastrointestinal, lung, breast cancers), hypothyroidism, eating disorders (e.g., anorexia nervosa, bulimia), dermatomyositis, dystrophic epidermolysis bullosa, and certain drugs (e.g., minoxidil, phenytoin, cyclosporine).
Thyroid emergencies: Myxedema coma and thyroid storm
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Dushyanthy Arasaratnam, Nadia Barghouthi, Jessica Perini, Robert Weingold
The primary objectives in treatment of myxedema in pregnancy are restoration of normal thyroid hormone levels, correction of any underlying electrolyte abnormalities, and identification and treatment of underlying conditions.
Is auditory brainstem response a prognostic factor in patients with sudden sensorineural hearing loss?
Published in Acta Oto-Laryngologica, 2019
Hye-Jeong Heo, Chul-Hee Choi, Sung Hwa Hong, Sihyung Kang, Myung Gu Kim, Young-Soo Chang
It is known that clinical manifestations, such as mental status, bradycardia, hypothermia, poor short-term memory, peripheral neuropathy, entrapment neuropathy, and myxedema coma, are associated with clinical hypothyroidism. The frequency and severity of peripheral nerve dysfunction in hypothyroidism depends on the severity and duration of the thyroid hormone deficiency [17]. The strength-duration properties of the peripheral nerves could be improved following hormone replacement therapy in hypothyroid patients, which suggests a strong association between nerve dysfunction and thyroid hormone levels [18]. However, the exact pathophysiological changes following thyroid hormone levels are not fully elucidated. One proposed pathophysiology of nerve dysfunction in hypothyroidism suggests that a hormonal imbalance can affect segmental demyelination of Schwann cells. In addition, other researchers suggest that lower thyroid hormone levels lead to a decrease in cell energy production, compromising microcirculation and consequently the metabolism and oxygenation of the involved organ [11]. Thyroid hormones are also known to control protein synthesis and myelin production in the central auditory pathway. In addition, T4 also acts as a neurotransmitter in the central nervous system. Thus, it can be speculated that lower thyroid hormone levels can affect the cochlea, the central auditory pathway, and the retrocochlear region [6].
Clinical guide to eosinophilic fasciitis: straddling dermatology and rheumatology
Published in Expert Review of Clinical Immunology, 2022
EF is distinguished from systemic sclerosis by the absence in EF of three typical findings in systemic sclerosis – sclerodactyly, Raynaud’s phenomenon, and nailfold capillary changes, as well presence of anticentromere, anti- topoisomerase I, and anti-RNA polymerase III antibodies. In distinction, the face, hands, and feet are spared in EF [1,3]. Morphea profunda holds clinical and histological similarities with plaque-like EF [3,5]. While isomorphic morphea occurs in areas of skin friction (not so EF), the symmetrical morphea variant is distributed on the trunk and extremities alike EF and may be confused with EF. Moreover, EF and morphea may overlap. The toxic oil syndrome, caused by ingestion of adulterated rapeseed oil 1981 in Spain, was characterized by morphea-like skin lesions affecting the face, trunk, and extremities, along with myopathy, peripheral neuropathy, and arthralgia [8]. The eosinophilia–myalgia syndrome, which had epidemic proportions in 1989 was caused by ingestion of the dietary supplement L-5-hydroxytryptophan, unfortunately contaminated. Patients complained of severe myalgias. Morphea-like lesions were conspicuous. Visceral involvement was occasionally present. Blood eosinophilia was a frequent attribute [9]. Nephrogenic systemic fibrosis is a progressive multiorgan fibrosing condition developing 2 to 75 days after exposure to gadolinium-based contrast agents used for magnetic resonance imaging. Patients with advanced renal insufficiency are at higher risk. Prominent findings on physical examination are indurated papules and plaques, on the extremities, buttocks, and trunk, sparing the face [10]. Other fibrosing disorders, easily distinguished on physical examination from EF, are myxedema, scleredema, and palmar fasciitis. Pretibial myxedema is a cutaneous manifestation of Graves’ disease presenting as yellowish-brown papules, nodules and plaques on both shins; it may be refractory to control of underlying thyroid disease. Scleredema of Buschke is characterized by stiffness and hardening of the subcutaneous tissues on the upper back and posterior surface of the neck. Palmar fasciitis is a paraneoplastic syndrome manifesting as a painful swelling of the hands, caused by inflammation and sclerosis of the palmar fascia, tendon sheaths, small joints of the fingers, and flexion contractures.