Hunting for the Cause: How Far to Go

A 71-year-old man consulted his doctor because he had had stiffness and swelling of his hands and feet, especially in the morning, for the previous six weeks.Swelling of the hands and feet suggests arthritis or an edematous state, perhaps due to a low serum albumin level and a decrease in oncotic pressure. Swelling that is more pronounced in the morning is consistent with generalized edema, such as would occur with the nephrotic syndrome, cirrhosis, or constrictive pericarditis.He had noticed an 8-lb (3.6 kg) weight gain and weakness of his legs, which he attributed to the . . .