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Consultant Vol 42 No 2

A nonhealing ulcer recently developed
in a painful facial rash that had
worsened over several months. The
44-year-old patient is a heavy drinker
with a history of elevated liver function
levels. She has had numerous
unprotected sexual contacts over the

Advise patients to use moist heat to
treat spinal or extremity injuries during
the first 48 hours.

How can you readily determine
whether your patient with bronchitis
may benefit from an inhaled bronchodilator?

Several techniques can decrease the
discomfort of an endometrial aspiration.

In addition to standard therapy for
sinusitis, suggest that patients breathe
in steam from water that contains
eucalyptus leaves or oil.

The "Quick Take" on water fluoridation states that "fluoride
prevents caries primarily after tooth eruption" (CONSULTANT,
March 2001, page 472).

My patient is an 87-year-old woman who requires transfusion every 3 weeks
for chronic GI bleeding.

A 45-year-old man comes to see you for a routine physical.
He has no complaints and no significant medical history.
However, while questioning him you discover that he used
intravenous heroin until about 10 years ago-and sometimes
shared needles. He also drank 6 or more beers a day for about 20 years, a practice
he stopped at the same time that he quit using illicit drugs. He has multiple tattoos,
which were done at commercial parlors. He is married but has no children. His wife has
no history of hepatitis. Physical examination is unremarkable.

A 55-year-old woman had a 10-day history
of a nonproductive cough and a
painful rash on both palms for 5 days.
The eruption subsequently spread
over her entire body.

A 75-year-old woman had a 1-year history of an anal protrusion, bloodstained mucus discharge, and anal incontinence of flatus and loose stools.

Smallpox, which is caused by
infection with poxvirus variola,
may follow various
courses. An erythematous
eruption can precede the
appearance of tense, deep-seated
papules that rapidly transform into
vesicles. The lesions may be sparse
or so numerous that they become

A pruritic, erythematous rash developed in a 6-year-old
boy over 5 days. The rash erupted in crops; the lesions appeared
initially as rose-colored macules, progressed rapidly
to papules and vesicles, and finally crusted (A). The distribution
of the lesions—with the greatest concentration
on the trunk—is typical of chickenpox.

A middle-aged woman had had a
low-grade fever, sore throat, and malaise
for 1 week. Her physician prescribed
amoxicillin. Three days after
starting the medication, an asymptomatic
erythematous and petechial
eruption developed over the patient’s
entire body.

A39-year-old man is brought to the
emergency department (ED)
after his car struck a tree. He experienced
a transient loss of consciousness
with a 3-minute episode of retrograde
amnesia at the scene of the accident,
despite wearing a seat belt and
shoulder harness. He was disoriented
to date and place.

The last naturally occurring
case of smallpox was reported
in Somalia in October 1977.
Despite the eradication of
smallpox, the causative agent,
variola virus, remains in existence.1,2

A 43-year-old fireman comes to your office after a routine blood test revealed
that his serum alanine transferase (ALT) level was elevated to approximately
twice the normal value. The level was confirmed by repeated testing.

A 36-year-old man who had collapsed
and sustained a bruised right shoulder
was brought to the emergency department
with acute emesis, cephalgia,
blurred vision, aphasia, and right
hemiparesis. He was confused but able
to follow simple commands.

A 64-year-old man has experienced melena 4 or 5 times in the previous
24 hours. He has had no emesis but complains of moderate epigastric pain.
He has had similar-although milder-pain in recent weeks.

I wish to add ileus to the list of atypical presenting symptoms
of acute myocardial infarction (MI) in an article by
Drs William J. Brady, Jr, Andrew D. Perron, and Chris A.
Ghaemmaghami (CONSULTANT, July 2001, page 1153).

A 64-year-old woman complains
of neck fullness that has increased in
the last few months. She has occasional
dyspnea but denies fever, cough, and
hemoptysis. Hypertension is well-controlled
with propranolol.

Q:Should we be prescribing α-blockers to control hypertension in light
of the ALLHAT findings of adverse effects?

Although widely regarded as a rare
disorder, hereditary hemochromatosis
is the most common genetic disease in
Caucasians. In certain populations of
northern European descent, 1 of every
200 persons is homozygous for the
causative mutation.1

A generalized pruritic, vesicular eruption on an erythematous
base developed in a 34-year-old man. His palms and
soles were not involved

As many as 300,000 sportsrelated
concussions are
diagnosed each year in
the United States.1 This
figure underestimates
the true incidence, however, because
many concussive injuries are not
recognized by the injured persons,
trainers, or physicians. A recent
study found that 4 of 5 professional
football players with concussion
were unaware that they had suffered
this injury.2

Is soaking the feet in an aluminum salt solution an effective therapy for

A 49-year-old woman was admitted to
the hospital with a high fever of
abrupt onset, rigor, headache, myalgias,
and profound prostration. Her
temperature was 41ºC (105.8ºF);
blood pressure, 60/40 mm Hg; respiration
rate, 30 breaths per minute;
and pulse rate, 130 beats per minute.

What are the current recommendations for hormonal contraception (eg, oral
contraceptives, medroxyprogesterone injections) in patients with migraine?

A 30-year-old man presented with a few-day history of a
viral prodrome, including a low-grade fever, mild headache,
muscle and joint aches, and malaise, accompanied
by a vesiculopapular rash. The mildly pruritic eruption
began on the head and neck and progressed within 36
hours to the trunk and proximal extremities; the palms
and soles were spared.

Impetigo developed on the face of a 7-year-old boy who had chickenpox. The
patient was given a 10-day course of oral cephalexin and mupirocin ointment;
the infection resolved promptly.

A 40-year-old woman was concerned about an area of redness and tenderness on her left breast. Despite antibiotic therapy prescribed by another physician, the rash had progressed during the past month to erythema and nodules that involved the anterior chest and right breast.

Following a motor vehicle accident, a 28-year-old man was admitted to the hospital burn unit. He had sustained third-degree burns on his left h and left proximal forearm. Intravenous colloid solution was administered, and wound dressings were changed twice daily.

Unrelated abnormalities in the preauricular area were noted in a 50-year-old man who had presented with acute rhinosinusitis following an upper respiratory tract infection. The patient stated that he had had these deformities since birth.

An intensely itchy dermatosis developed on the back of a 30-year-old Saudi Arabian renal transplant patient. The patient had never before experienced a similar eruption. He was taking prednisone and azathioprine to prevent transplant organ rejection, as well as amoxicillin for an upper respiratory tract infection.

A 50-year-old woman had visited 4 health care providers seeking relief from low back pain. The patient likened the pain to an electric shock that started at the left side of the lower back and radiated to the front of the left leg. The area was also numb.


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