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Consultant Vol 50 No 7

An itchy facial rash of 1 week's duration prompts a 72-year-old woman to see her primary care provider. She reports that redness and scaling had developed on her cheek, and that vitamin E oil she applied to the area seems to have made it worse.

An obese 60-year-old woman presents with a chronic malodorous, itchy rash in her groin.

Here: a "how to" on Gomco circumcision, the method most commonly used in the US.

Many people have difficulty with completing the section of our office’s patient information sheet that asks for a complete list of their current medications.

Provide a better seal than regular plastic wrap or plastic bags

It can sometimes be difficult to detect the fine tremors of the hands and fingers of a patient with hyperthyroidism.

Prevent disruptive movements when administering a digital block.

Clinicians sometimes give patients a choice of medication or lifestyle changes to control blood pressure (BP) or cholesterol levels.

Children with lacerations that require suturing are typically afraid and uncooperative. The pain of a local lidocaine injection will increase their fear and lack of cooperation.

Overcrowded emergency departments (EDs) reflect a system-wide patient flow problem. Although there are multiple reasons for bottlenecks in flow, the inability to transfer patients to inpatient beds is a major factor.

Apreviously healthy 47-year-old woman presents with an ascending, nonpruritic rash of 3 days’ duration on her legs. She reports that the rash began on her ankles following a day of gardening. She does not recall any recent insect bites and denies chest pain, dyspnea, abdominal pain, fever, arthralgia, arthritis, cough, and hemoptysis. She has never had a similar rash before. The patient’s only medication is an oral antihistamine for seasonal allergies. She has no known drug allergies.

For about 2 weeks, a 61-year-old woman with diet-controlled diabetes and hypertension had fatigue and generalized weakness. For the past 3 months, she had had poorly localized back pain and bilateral flank pain. She denied dysuria, fever, decreased urinary output, or weight loss.

Intensely pruritic lesions of acute onset are evident on the legs of a 24-year-old woman who had no history of similar episodes. She was in excellent health and took no medications. She had spent the previous evening seated outdoors at a restaurant.

The patient has a history of hospital admissions for complications of alcoholism, including pancreatitis and trauma from falls. What's your diagnosis?

According to the Sgarbossa criteria, the patient had an acute MI: ECG revealed a greater than 1-mm ST-segment depression in lead V2 and about 5-mm discordant ST-segment elevation in leads II, III, and aVF.

Which antibiotics are most likely to cause a clinically significant drug interaction in elderly patients who are receiving warfarin?

A 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.

Selective serotonin reuptake inhibitors and other second-generation antidepressants have become common therapeutic options for the management of depression. Although these agents are effective and generally well tolerated, they frequently cause sexual adverse effects that can impact patients’ quality of life, thus ultimately leading to nonadherence to therapy in many cases.

In the December 14, 2009, issue of The New Yorker magazine, Atul Gawande observed, “Cost is the specter haunting health care reform.” The idea (or better, mantra?) of cost as central to health care’s reform is not new but is surely a topic that demands this generation’s consideration. Most of the economic debate has been general, looking at national “bottom lines” rather than focusing on the “dollars and cents” of individual diseases. Let’s take a sobering look at rising costs in the context of specific diseases, beginning with psoriasis.


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