Child with Rapid Growth and Precocious Sexual Maturation

A 6-year-old boy was admitted to the medical center with a 4-year history of rapid somatic growth and a 6-month history of pubic hair growth. The patient was the full-term product of a normal vaginal delivery following an uncomplicated first gestation in a 34-year-old healthy female. Birth weight was 8 lb 9 oz (3.9 kg) and length 21.5 in. (54.6 cm). There were no neonatal problems. The mother ceased breastfeeding the infant at 10 days of life and changed to formula because he did not seem to...

Differential Diagnosis

The diagnosis of any stage or phase of syphilis can be complicated, especially in the setting of HIV. In primary syphilis, the hallmark symptom is a painless lesion usually on the external genital. The differential diagnosis would include other STDs such as genital herpes, chancroid, or lymphogranuloma venereum (LGV). Most of these diseases create a painful lesion or local lymphandenopathy. The lesions associated with secondary syphilis can be confused with other skin manifestations, such as...

Differential Diagnosis of Erythrocytosis and Thrombocytosis

Causes of erythrocytosis and thrombocytosis are reviewed in Tables 56.1 and 56.2. Congenital erythrocytosis is extremely rare. Various mutations that disable the negative regulatory domain of the erythropoietin (EPO) receptor have been identified in autosomal dominantly inherited familial erythrocytosis. Congenital erythrocytosis may also result Table 56.1 Classification of Erythrocytosis EPO receptor hypersensitivity Hypoxia sensor hypersensitivity Acquired Appropriate (chronic tissue hypoxia)...

Hot Flashes and Abdominal Pain

During a routine physical examination, a 45-year-old woman complained to her gynecologist of a 3-month history of transient burning sensations in her face and chest that would last for a few minutes, and then pass. She stated that she experienced these hot flashes between 7 and 8 times per day, and often they disrupted her sleep. She had no other physical complaints, and she denied any menstrual cycle irregularities. To determine whether she was menopausal, the physician ordered a serum...

Laboratory Diagnosis of Qualitative Platelet Disorders

Von Willebrand Screen Test

Laboratory analysis of patients with apparent bleeding problems utilizes initial testing of the cellular and fluid-phase components of hemostasis, followed by more specialized testing of the suspected problematic aspect (Fig. 64.2). A platelet count will identify patients with a quantitative platelet defect, although one must remember that some qualitative defects are associated with lower platelet counts as well (Table 64.1). The possibility of coagulation factor inhibitors and deficiencies...