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Consultant Vol 43 No 10

Two patients who presented for evaluation of unrelated maladies were noted to have true polydactyly. Both patients—a 32-year-old white man and a 35-year-old African American woman — had a duplicate left thumb. There were no other associated congenital abnormalities.

In the recently published Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure (JNC 7), a new category, called "prehypertension,"
was added in the classification of blood pressure (BP). What was the
rationale for this addition?

A 62-year-old obese woman with adult-onset type 1 diabetes mellitus had a 6-year history of bilateral leg edema. During the last year, the edema worsened and the skin on her legs thickened. She also had multiple, bilateral, painful, superficial ulcers that drained copiously.

Bald patches were noted on the head of a 40-year-old woman with longstanding mental illness. She claimed, “I have to pull out my hair, so my scalp won’t hurt.” The patient began pulling out her hair when she stopped taking her psychotropic medications 6 years earlier.

A 48-year-old woman complained of dull, aching abdominal pain and epigastric swelling. She had a 6- to 7-month history of painless swelling that intermittently decreased in size. The patient denied vomiting and nausea.

Intense pruritus centered around a sparse “rash” sent a 32-year-old Chinese man for medical evaluation. The patient’s medical and social histories were unremarkable.

The patient is a 56-year-old man who presents with daily headaches that occur
behind the right eye, right temple, and occasionally on the right side of the
forehead. He has never experienced this type of headache on the left side. He
describes the pain as “stabbing,” “throbbing,” and occasionally “burning.”
He rates the intensity of the pain a 7 on a 10-point visual analog scale on
which 10 is the most severe.

ABSTRACT: Fibromyalgia syndrome (FMS) is a common condition that causes chronic pain and disability. It should be diagnosed by its own clinical characteristics of widespread musculoskeletal pain and multiple tender points. American College of Rheumatology criteria guidelines are most helpful in diagnosing FMS. The major symptoms are pain, stiffness, fatigue, poor sleep, and those of other associated conditions, for example, irritable bowel syndrome, headaches, restless legs syndrome, chronic fatigue syndrome, and depression. The pathophysiology of FMS is thought to involve central sensitization and neuroendocrine aberrations, triggered or aggravated by genetic predisposition; trauma; psychosocial distress; sleep deprivation; and peripheral nociception.


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