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Consultant Vol 50 No 10

For a few weeks, a 36-year-old woman has had this pruritic labial rash.

A 43-year-old woman with chronic hip pain presents with an asymptomatic eruption on the hip of several months' duration. She has been using a heating pad at night for pain relief because NSAIDs have not been effective.

How to determine whether opioids are appropriate, what to do about breakthrough pain, and how frequently to monitor.

Many patients with a viral upper respiratory tract infection still expect an antibiotic prescription when they come to the office.

Measure your volume by season and day.

Remember that patients will Google you and nowadays rate you on one of the many rating sites.

To safely immobilize children for suturing of forehead lacerations, try the "Superman cape" technique.

I use ICE at each visit to help ensure that patients are satisfied with the care they receive.

Sixteen-year-old African American boy with progressive loss of vision in the left eye over 2 weeks. He also had pain around the left orbit with some radiation to the temple. His mother reported that one side of his face appeared to be more flushed when he exerted himself; he had not seen a physician for this problem. He had no seizures or hemiparesis and was cognitively intact.

Since continuing technological advancements are going to add to rising costs (dialysis, for example, with more “baby boomers” coming of Medicare age), one has to wonder what the something is that “has to give” in the future.

A 69-year-old man with stage II chronic kidney disease due to hypertension fell from his bicycle and presented to the emergency department (ED) with abrasions, ecchymoses, and a 3-cm laceration on his right leg. The patient was an avid cyclist. His wounds were cleaned and the laceration sutured. There were no fractures, and the patient was discharged home.

MRI scans of the kidneys of an 83-year-old woman with history of myelodysplastic syndrome are shown. Normal MRI scans are shown for comparison. The patient had intermittent episodes of dark-colored urine for years. Findings from repeated cystoscopies were normal.

What are the most significant health risks associated with tattoos?

A 48-year-old woman sought medical attention after an episode of gross hematuria associated with mild right-sided loin discomfort. She did not have urinary frequency, urgency, or dysuria. Her history included 3 urinary tract infections; a Proteus species was cultured on each occasion. The family history was unremarkable. Other than mild loin tenderness, physical findings were normal.

A step-by-step review of various wound closure techniques, illustrated with a wealth of instructive clinical photographs.

This year's influenza season is approaching fast. Although the World Health Organization officially declared an end to the 2009 H1N1 influenza pandemic in August, the H1N1 virus is still circulating and is likely to continue to cause serious disease in infants, young children, pregnant women, and other high-risk groups.

A 69-year-old man presents with a cough of 3 months' duration. He has taken a variety of over-the-counter suppressants and received a course of antibiotics, without resolution. The cough is not position-related; it produces a small amount of sputum and recently flecks of blood as well.

I enjoyed Dr D. Brady Pregerson's Practical Pointer, "Heat Therapy 'On the Go'".

My patient is a woman in her late 30s who has several episodes a month of confluent facial erythema that is very warm to the touch and highly pruritic.

A recent issue of the Wall Street Journal contained a stark statement about the contemporary management of hypertension. "Our current prescribing methods are very primitive," said Dr Michael Alderman, coauthor of a study recently published in the American Journal of Hypertension.


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