ABSTRACT
We report the case of a morbidly obese 65-year-old female who presented with repeated hypotensive episodes following dialysis. She was misdiagnosed as suffering from asthma, and eventually was found to have severe aortic stenosis. Obesity has become a common and formidable obstacle to gathering important diagnostic information in patients. Modern diagnostic lab tests and imaging modalities such as transthoracic echocardiography (TTE) can provide spurious data in the morbidly obese population, which can ultimately lead to misdiagnosis. In this clinical vignette, we discuss the relationship between the basic pathophysiologic mechanisms underlying aortic stenosis and patient clinical presentation. We also review the relevant literature and discuss the impact of obesity on the diagnosis of this condition.
Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Obesity, Morbid/complications , Respiratory Sounds/etiology , Aged , Aortic Valve Stenosis/complications , Asthma/diagnosis , Diagnosis, Differential , Dyspnea/etiology , Female , Humans , Hypotension/etiology , Renal Dialysis/adverse effects , UltrasonographyABSTRACT
PURPOSE: The purpose was to evaluate the use of Web-based library resources by third-year medical students. SETTING/PARTICIPANTS/RESOURCES: Third-year medical students (147) in a twelve-week multidisciplinary primary care rotation in community and ambulatory settings. METHODOLOGY: Individual user surveys and log file analysis of Website were used. RESULTS/OUTCOMES: Twenty resource topics were compiled into a Website to provide students with access to electronic library resources from any community-based clerkship location. These resource topics, covering subjects such as hypertension and back pain, linked to curriculum training problems, full-text journal articles, MEDLINE searches, electronic book chapters, and relevant Websites. More than half of the students (69%) accessed the Website on a daily or weekly basis. Over 80% thought the Website was a valuable addition to their clerkship. DISCUSSION/CONCLUSION: Web-based information resources can provide curriculum support to students for whom access to the library is difficult and time consuming.