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31 Dementia and therefore, serial examinations and multimodal prognostication approaches are advised. For example, the absence of the cortical responses of the somatosensory evoked potentials has been shown to be a strong indicator of poor outcome following hy...

33 Sleep Disorders avoid making a diagnosis of “frontal lobe syndrome” in a patient with no evidence of frontal cortex disease, it is advisable to use the diag­ nostic term frontal network syndrome, with the understanding that the responsible lesions can lie a...

34 Disorders of the Eye ■ ■FURTHER READING Aquino G et al: Towards the neurobiology of insomnia: A systematic review of neuroimaging studies. Sleep Med Rev 73:101878, 2024. Cash RE et al: Association between sleep duration and ideal cardio­ vascular health amo...

35 Disorders of Smell and Taste Exaggerated gaze-evoked nystagmus can be induced by drugs (seda­ tives, anticonvulsants, alcohol); muscle paresis; myasthenia gravis; demyelinating disease; and cerebellopontine angle, brainstem, and cerebellar lesions. VESTIBUL...

36 Disorders of Hearing disturbance. Patients should be warned not to overcompensate for their taste loss by adding excessive amounts of sugar or salt. Smoking cessation and the discontinuance of oral tobacco use are essential in the management of any patient ...

38 Oral Manifestations of Disease Noninfectious causes of laryngitis include vocal trauma (e.g., due to yelling, screaming, or loud singing), inhalation injuries, allergies, gas­ troesophageal reflux disease (laryngopharyngeal reflux), asthma, and pollution. I...

39 Dyspnea malodor. Periodontal disease, caries, acute forms of gingivitis, poorly fitting dentures, oral abscess, and tongue coating are common causes. Treatment includes correcting poor hygiene, treating infection, and tongue brushing. Hyposalivation can pro...

40 Cough Bruce D. Levy Cough Cough performs an essential protective function for human airways and lungs. Without an effective cough reflex, we are at risk for retained airway secretions and aspirated material predisposing to infection, atel­ ectasis, and resp...

41 Hemoptysis undergo chest CT. Diseases causing cough that may be missed on chest x-ray include tumors, early interstitial lung disease, bronchiec­ tasis, and atypical mycobacterial pulmonary infection. On the other hand, patients with chronic cough who have ...

42 Hypoxia and Cyanosis ■ ■DIAGNOSTIC STUDIES Laboratory studies for initial evaluation should include a complete blood count, coagulation studies, basic metabolic panel, and urinalysis (to evaluate for pulmonary-renal disease). The absence of anemia in lifeth...

43 Edema Cyanosis can be caused by small quantities of circulating methe­ moglobin (Hb Fe3+) and by even smaller quantities of sulfhemoglobin (Chap. 103); both of these hemoglobin derivatives impair oxygen delivery to the tissues. Although they are uncommon ca...

45 Palpitations Joseph Loscalzo Palpitations Palpitations are extremely common among patients who present to their internists and can best be defined as a “thumping,” “pounding,” or “fluttering” sensation in the chest. This sensation can be either inter­ mitte...

46 Exercise Intolerance Joseph Loscalzo Palpitations Palpitations are extremely common among patients who present to their internists and can best be defined as a “thumping,” “pounding,” or “fluttering” sensation in the chest. This sensation can be either inte...

47 Dysphagia ■ ■FURTHER READING Bunsawat K et al: Exercise intolerance in heart failure with preserved ejection fraction: Causes, consequences and the journey toward a cure. Exp Physiol 109:502, 2023. Edwards JA et al: Characteristics and treatment of exercise...

48 Nausea, Vomiting, and Indigestion tongue atrophy, in addition to evidence of generalized neuromuscular disease, should be elicited. The neck should be examined for thyro­ megaly or lymphadenopathy. A careful inspection of the mouth and pharynx should disclo...

49 Diarrhea and Constipation advocated and should be discontinued if no benefit is observed. H2 antagonists also improve symptoms in functional dyspepsia, but a guideline advocated PPIs over H2 antagonists as first-line therapy. Antacids are useful for short-t...

50 Unintentional Weight Loss Defecography (a dynamic barium enema including lateral views obtained during barium expulsion or a magnetic resonance defeco­ gram) measures changes in rectoanal angle, degree of pelvic floor relax­ ation and perineal descent, as w...

51 Gastrointestinal Bleeding of UWL and is often more pronounced in men. More intense forms of mental illness such as paranoid disorders may lead to delusions about food and cause weight loss. Alcoholism can be a significant source of weight loss and malnutrit...