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Consultant Vol 43 No 2

Perspiration in areas of skin redundancy—
such as under pendulous breasts
and in the groin—can predispose
patients to irritant or candidal intertrigo.

A nondrug remedy for menstrual discomfort
is to apply a heating pad to
the lower abdomen when symptoms

For patients with a persistent cough
who cannot take codeine, a combination
of benzonatate (1 or 2 100-mg
capsules tid prn), along with dextromethorphan
and guaifenesin (2 or
3 tsp tid prn), can be effective.

Write billing codes next to the diagnoses
on the master problem section
of patients’ charts so that the codes
can be easily transferred to the fee

Drs Gary Quick, Theodore Ruff, and Pam Wilson’s “What’s Wrong With This
Picture?” case of a woman with splenic laceration resulting from an assault by a
male friend (CONSULTANT, May 2002, page 714) seems to have missed the
“elephant in the living room.”

You recently diagnosed migraine without aura in a patient who complains of headaches of moderate intensity. Is a migraine-specific prescription agent warranted?

Round, smooth, bald areas had recently developed on the neck and chin of a 32-year-old man. No other areas of the body were affected. The patient had a lifelong history of chronic anxiety.

A 34-year-old woman complains of headaches that interfere with work. Her first headache episode, approximately 6 years
earlier, was relatively mild. Initially, she experienced attacks only once every 3 to 4 months and managed them effectively
with over-the-counter (OTC) agents. However, in the last 6 months the attacks have become more frequent—they occur at
least twice a month—and are so severe that she misses work.

In a 65-year-old man with a family history of colorectal carcinoma, an initial screening coloscopic examination revealed 2 arteriovenous malformations. These delicate red lesions with a vascular network and irregular edges were found in the cecum.

I read with interest Michael Rothstein’s Practical Pointer,
“No More (Foot) Fungus Among Us” (CONSULTANT, August
2002, page 1185).

What are the appropriate laboratory tests for an infant whose mother has hepatitis
C virus (HCV) infection?

The family of a 50-year-old
alcoholic man brings him to your
office. They are concerned about
his health and note that they had not
seen him for several months before
he reappeared. The patient complains
of generalized weakness, fatigue, and
bleeding gums.

For 36 hours, a 75-year-old woman had experienced weakness of the right side of the face. She was unable to close the right eye and drooled from the right side of the mouth. There was no weakness, numbness, or tingling of the extremities.

A 59-year-old woman presented for a routine physical examination. She had no physical complaints and took no medications. During the physical examination, bilateral, flat, slightly elevated, yellowish cutaneous lesions were noted above and below the skin folds of the patient's eyelids.

A 54-year-old man is admitted to the hospital because of worsening lower extremity
swelling and knee and ankle pain and stiffness. These symptoms have
made walking very difficult for the past month.

A 32-year-old previously healthy
woman presents to the emergency
department with skin lesions, suprapubic
pain, and generalized myalgia of
1 week’s duration. Trimethoprim-sulfamethoxazole
for a presumed urinary
tract infection is prescribed, and the
patient is discharged. The symptoms
persist; she is hospitalized 2 days later.

Many patients who present to the emergency department
(ED) with severe headache request a narcotic to relieve the


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