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Consultant Vol 42 No 11

A 63-year-old woman seeks evaluation of a persistent, rough, red area on
the dorsum of her left index finger. The lesion has been present for several
months. The patient’s manicurist is convinced it is a wart.

To reduce discomfort when administering potassium in a peripheral line, mix in 2 mL of a 1% lidocaine solution. This may also work with other painful IV medications, but first check with the pharmacy for drug interactions.

Lend a stethoscope to hard-of-hearing patients who are not wearing a hearing aid. Speak directly into the stethoscope diaphragm, and the patient may hear well enough to communicate with you. Be sure to clean the stethoscope's ear tips before and after the patient uses it.

Instead of throwing away the label from an injectable medication, peel it off and tape it to the patient’s chart. The nursing staff will not have to write the drug information on the chart because the label contains the name, unit dose, and lot number.

This simple technique can quickly reduce leg edema. Instruct the patient to place a chair on a
bed as shown, lay a pillow on the back of the chair, then lie down with legs elevated on the pillowcovered
chair back. (Do not use in patients with congestive heart failure; volume overload and
pulmonary edema may result.)

A previously healthy elderly woman reports that she has had
unilateral facial pain and crusting skin lesions for several days. She decides to
seek medical care because of concomitant impaired visual acuity.

Incarcerated umbilical herniations occur through the umbilical canal that is bordered by the umbilical fascia posteriorly, the linea alba anteriorly, and the medial edges of the 2 rectus sheaths on each side.

A 62-year-old woman presented with a rash and intermittent pain of the right upper quadrant. The reticular, brown hyperpigmentation was also seen on her right flank and around the umbilicus. The patient reported that she often applied heating pads to these areas for pain relief.

A 64-year-old woman with a history of diabetes, hypertension, and lymphoma was admitted to the hospital with a dull headache, conjunctival congestion, and slight dyspnea. Her pulse rate was 96 beats per minute; blood pressure, 146/68 mm Hg; and respiration rate, 22 breaths per minute. She also had increased jugular venous distention; cardiovascular and chest examination findings were normal. Edema of both arms and dilated blood vessels on the anterior chest wall were noted.

A 72-year-old man sought medical evaluation
after he awoke and was unable
to open his right eyelid (A). He denied
pain, recent trauma, and diplopia. This
patient’s history included well-controlled
hypertension and hypercholesterolemia,
for which he was taking atorvastatin.
He did not have diabetes.

A 75-year-old woman complained of
“tired and heavy eyes” and being unable
to keep her eyelids open to read
at night.

Over the years, a 78-year-old man had
noticed a progressive drooping of the
right upper eyelid, which finally occluded
his right pupil and obstructed
his vision. Although the drooping
worsened as the day went on, the ptosis
was evident even when the patient
awoke in the morning. He denied any
ophthalmic or periocular surgery or
trauma. He was otherwise healthy and
had no other neurologic complaints.

A 72-year-old man is brought to the emergency department by his wife. He
complains of nausea, vomiting, and severe abdominal pain that makes it difficult
for him to walk. The pain began the previous afternoon and has worsened steadily.
The patient denies trauma and recent foreign travel. His history includes an appendectomy
performed many years earlier but is otherwise noncontributory.

For 2 days, a 68-year-old woman had watery, yellowish diarrhea with mucus and left lower quadrant pain. Her medical history included hypertension, diabetes mellitus, and congestive heart failure (CHF); she had left the hospital 5 days earlier following treatment of an exacerbation of CHF with intravenous furosemide and sodium and fluid restriction. The patient was taking furosemide, lisinopril, and glipizide; she denied any recent antibiotic therapy.

Anisocoria and partial eyelid ptosis were detected during the routine eye examination of a 66-year-old woman. These findings had not been present during an examination 2 years earlier. Because the patient had no symptoms, she could not recall when these signs began. Her general health was unremarkable; she had smoked 1 pack of cigarettes per day for 40 years

Can cyclooxygenase (COX)-2 inhibitors
be used to treat gout?

Drs Sonia Arunabh and K. Rauhilla’s case of a 62-year-old woman with Raynaud’s
phenomenon (CONSULTANT, September 15, 2001, page 1526) offers one of
the finest photographs of this condition that I have seen (Figure).

Several of my female patients have chronic itchy, burning

Persistent pain is common in older adults but tends to be underrecognized and undertreated. Up to 50% of community-dwelling older persons have significant painand up to 80% of nursing home residents have substantial pain that is undertreated.


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