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Consultant Vol 42 No 9

A slightly pruritic, red, scaly rash on an 8-year-old boy’s
hands has been progressively worsening since it appeared
4 months earlier. Nail pitting also was noted. There are no
other rashes on his body. The patient is active in sports;
denies any new exposure to soaps, clothing, or other contactants;
and spends time in the homes of his recently divorced

Patients with mycotic toenails who
are unable to take oral antifungal
agents may find relief with this old
remedy. Instruct them to fill a basting
pan with warm water, add 2 or 3 capfuls
of chlorine bleach, and soak both
feet in this solution for 10 to 15 minutes
twice a day for 2 weeks.

About 1 month ago, a 58-year-old man experienced malaise
and fatigue accompanied by mild diffuse swelling in his neck.
After 3 days, the malaise and fatigue began to abate. They resolved
after a week; however, minimal swelling on the left side
of the neck remains. The patient has no other symptoms.

A 28-year-old man presents to
the emergency department
with high fever; progressive, severe,
generalized, throbbing headache;
blurred vision; and increasing
confusion. These symptoms started
3 days earlier.

For several months, a 52-year-old woman had nausea, mild dysphagia with solid food, vague abdominal pain, and diarrhea. The patient denied hemoptysis, hematochezia, and melena. Lansoprazole and dicyclomine provided minimal relief of her symptoms.

Foot ulcerations and infections are the leading cause of hospitalization
among patients with diabetes; they occur in about
15% of these patients. Given the rapidly increasing incidence
of diabetes, physicians can expect to see a growing number
of diabetic foot problems. Here, a group of experts, many of
whom practice at the renowned Joslin-Beth Israel Deaconess
Foot Center in Boston, offer guidance on all aspects of diabetic
foot care. The topics covered range from proven preventive
strategies to cutting-edge wound care techniques that draw
on such new developments as growth factors and living skin
equivalents. A detailed review of the pathophysiology of the
diabetic foot is also included. The emphasis throughout is on
a multidisciplinary approach that incorporates the services
of diabetologists, podiatrists, orthopedic surgeons, orthotists,
diabetic nurse educators, and others. Numerous black-and-white
and color photographs, drawings, algorithms, and charts illustrate
the text.

A 65-year-old woman experienced dyspnea, dizziness, and left pleuritic pain several hours after falling down a flight of stairs. Shallow breathing and increased tenderness of the left thoracic wall were evident with palpation. Decreased breath sounds on the left and dullness on percussion were also noted.

The parents of a 3-year-old boy bring him to your office after he
complains of genital pain. The child is otherwise healthy; there is no known
history of trauma or difficult urination. The child has a low-grade fever and is
in mild discomfort.

Match each picture with the phrase below that best describes it. The organisms in these pictures might be microscopic
or macroscopic, and they can be recovered from skin lesions or clothing by the patient and/or clinician.

As skateboarders and scooter riders take to the streets this summer, the risk
of serious injuries related to these sports increases. Most of those injured are
children and adolescents. To help you protect your young patients this summer,
the American Academy of Pediatrics (AAP) has developed recommendations
for the safe use of skateboards and scooters.1

Long-term oxygen therapy (LTOT) improves both the length and quality
of life of hypoxemic patients with COPD. It is the only therapy that
clearly increases survival for selected patients with advanced stable COPD.

Foot ulcerations and infections are the leading cause of hospitalization among
patients with diabetes; they occur in about 15% of these patients.

The results of a preoperative serum protein electrophoresis (SPEP) test were
abnormal in a 72-year-old man who underwent a successful hernia repair
2 weeks earlier.

Two asymptomatic lesions that had been present for 1 year on the left upper chest of a 61-year-old man were excised. Pathologic examination revealed the raised, dark brown medial lesion to be an interdermal nevus; the lateral, light tan lesion with papules was a papillomatous interdermal nevus with primary macular amyloidosis.

A 72-year-old man slipped and fell backward in the bathroom, hitting his
head on the toilet seat; he suffered only minimal discomfort. The following
day, he presented with mild back pain and extensive bruising.

Dr Gregory Rutecki's interactive teaching case, “A Middle-Aged Man With
Polyuria: The Initial Visit” (CONSULTANT, March 2001, page 357), provided a
welcome opportunity for me to review the care I provide to my patients with type 2
diabetes, who comprise a very large percentage of my practice.

In their report of a young man who had dislocated his shoulder during a fight,
Drs Gary Quick and Gale Joslin described a well-known technique for reduction of
the dislocation (CONSULTANT, July 2001, page 1100y).

Although many patients with primary HSV-1 infection have no clinical
recurrences, the failure to seroconvert occurs very seldom—in
no more than 1% of patients.

ABSTRACT: When a solitary lung nodule is detected, the key question is whether the lesion is malignant. The initial evaluation includes a careful history taking focused on risk factors for malignancy, a thorough physical examination, comparison of current chest films with previous ones, and CT scanning. Radiologic signs that suggest malignancy include lesion size greater than 2 cm in diameter, spiculated margins, lack of calcification, and change in size. Video-assisted thoracoscopic surgery or thoracotomy is the next step for patients with a suspected malignant lesion. If the results of the initial evaluation are equivocal, positron emission tomography (PET) scanning is the preferred follow-up.

The differential diagnosis of intrascrotal pathology includes a myriad of benign and malignant entities. Timely detection is imperative to reduce the morbidity associated with many of these disease processes.

Prevention of and therapy for osteoporotic disorders in men have been virtually unexplored. Although osteoporosis in men is associated with significant morbidity and mortality, many clinical decisions must be based on extrapolation from data on osteoporosis in women.

Which treatment approaches are effective in a woman who has persistent or refractory vaginal trichomoniasis? Should the male sex partner of a patient who has recurrent vulvovaginal candidiasis be treated? Answers to these and other questions can be found in the recently updated CDC guidelines on managing sexually transmitted diseases


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