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Consultant Vol 43 No 6

Consider a concentrated solution
(10 mg/mL) of doxepin for patients
with fibromyalgia who experience
side effects with other tricyclics at
even 10-mg doses.

A 69-year-old man with an acute severe headache and nausea was brought to the emergency department. The patient was neurologically intact; an intracerebral hemorrhage was suspected.

A 67-year-old woman, who had hypertension and chronic obstructive pulmonary disease, presented to the emergency department with mild abdominal discomfort and shortness of breath.

A previously asymptomatic, large
black plaque on a 65-year-old man’s
scalp recently began to bleed. The lesion
had grown considerably since it
first appeared as

Bullae had recently appeared on the dorsa of the hands and fingers of a 46-year-old man. His medical history was significant for alcoholism, discoid lupus erythematosus (DLE), and hepatitis C. Systemic lupus erythematosus (SLE) was ruled out; the patient’s symptoms did not meet the American Rheumatism Association criteria for SLE.

For 5 years, a 54-year-old woman had been bothered by an intermittent dermatitis on her left hand and wrist. The rash had remained constant during the past year. The patient, a hairdresser, usually wears gloves when she works. Moderate erythema and flaking were noted on her hands.

A 45-year-old woman presented with a slowly enlarging, mildly tender lesion
on the left sole. The large indurated plaque was studded with multiple firm
papules and nodules that involved the instep and extended onto the medial
aspect of the foot. There was no regional adenopathy.

A 1-cm, tan-brown lesion had developed years earlier at the posterior helix of a
61-year-old man’s right ear. Central ulceration and crusting were noted on the
papule. The patient sought medical evaluation when the lesion became nodular
and began to flake.

A 43-year-old woman was admitted to the hospital with
left flank pain. The physical examination revealed a left abdominal
mass. Laboratory test results identified normochromic-
normocytic anemia (hematocrit, 33%; hemoglobin,
10.8 g/dL; and mean corpuscular volume, 88 fL) and
microscopic hematuria (10 red blood cells per high-power

A 38-year-old man presented with a fleshy lesion beneath the tip of his penis. He had discovered it about 18 months before the initial evaluation. A second similar lesion resembling a “cauliflower” had appeared several weeks after the first. Both lesions had grown and had begun to bleed during intercourse.

This 2-day-old infant was noted by Robert P. Blereau, MD, of Morgan City, La, to have duplication of the fifth toe with webbing between the two toes to the distal interphalangeal joint. There was a family history of polydactyly on the paternal side and syndactyly on the maternal side.

A 74-year-old man had vague abdominal pain, jaundice, pruritus, gray stools, and dark urine. A painless, palpable mass in his right upper quadrant was found at examination.

An 85-year-old man presented with intermittent abdominal pain of several years’ duration. Two years earlier, he underwent a laparoscopic cholecystectomy that was converted to an open procedure.

A 65-year-old woman presents with a 1-cm raised, light brown, circular, nodular
lesion on the top of her head, which has progressively enlarged during the last
6 months. The growth was removed by shave excision; electrodesiccation and
curettage were performed on the base. Pathologic evaluation determined the
lesion was a basal cell carcinoma.

A 40-year-old man presented with a 5-year history of progressively increasing bilateral leg swelling that was neither painful nor pruritic. There was no history of dyspnea, jaundice, or groin surgery. The patient reported multiple previous episodes of superimposed cellulitis, which were treated with antibiotics. There was no family history of similar illness.


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