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Consultant Vol 44 No 11

A 20-year-old woman presents with a 3-week history of a pruritic, progressively
enlarging erythematous lesion on one arm. She has a cat and recently
started horseback riding lessons. She is otherwise healthy and takes no

Practical Pointers: Discover Shortcuts Devised by Colleagues

To allay children's fears about immunizations or allergy shots, keep a pocket-sized, battery-operated radio in the office.

An 81-year-old woman presented with abdominal pain of 6 months’ duration, anorexia, and a 4.5-kg (10-lb) weight loss. Her history was otherwise unremarkable. She denied fever, chills, diarrhea, and vomiting. The pain was diffuse; no rebound or guarding was noted. The peripheral lymph nodes were not palpable.

When palatal petechiae are present along with exudative tonsillitis and cervical adenitis, and test and culture are positive, a Strep diagnosis is more secure.

An 83-year-old woman is brought by her daughter for evaluation because
of increasing confusion during the past few days. The patient
has early Alzheimer dementia, hypertension, and type 2 diabetes. She takes donepezil, 10 mg/d;
lisinopril, 5 mg/d; and glipizide, 5 mg bid. She is unable to bathe and dress herself as well as previously,
has been crying for no apparent reason, and has lost her appetite.

A symptomatic brown macules developed on the face of a 32-year-old woman 1 year ago. She had been taking oral contraceptives for the past 5 years. Her medical history was unremarkable, and the results of a physical examination were normal.


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