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Consultant Vol 50 No 9

A 32-year-old woman presents for evaluation of itching in the pubic area.

For 9 months, a 39-year-old woman has had a pruritic rash on the posterior portion of one thigh. She had consulted another physician, who prescribed a medication that she does not recall, but there was no improvement.

Superficial corticosteroid injections are highly effective for the treatment of lateral epicondylitis and de Quervain tenosynovitis.

Instruct patients with chronic obstructive pulmonary disease and asthma to discard their rescue albuterol inhalers 2 to 3 months after opening.

When a patient complains of a “sore that won’t heal” or mentions that a lesion “constantly bleeds and scabs,” heed the advice of Osler.

I have started asking my female patients to bring their own bathrobes for well-woman examinations.

Lidocaine-epinephrine-tetracaine (LET) and tetracaine-epinephrine (Adrenalin)-cocaine (TAC) can be particularly helpful when you need to suture facial lacerations in children.

Quality health measures monitored by insurers include body mass index (BMI), smoking status, and pain.

A 16-year-old boy with asymptomatic, hyperpigmented, hairy lesion on his left upper back. The pigmentation, first noted 5 years earlier, had progressively spread across his torso. The coarse and dark hair confined to the hyperpigmented area had appeared at age 13 years. Medical history uneventful. Review of systems showed no abnormalities. No family history of similar skin lesions.

For the past year, a 52-year-old man had dysphagia, which he described as a “knot stuck in the throat” and an associated 25-lb weight loss. He denied fever, chills, headache, abdominal pain, and diarrhea. The patient had been living in the Dominican Republic until about 1 year earlier, when he moved to the United States. He had a 30 pack-year smoking history; he also had hypertension, asthma, and coronary artery disease (none of which were pharmacologically treated). He denied alcohol and illicit drug use.

A51-year-old man who was an active injection drug user was admitted to the ICU with septic shock and severe respiratory distress. Notable findings were fever, multiple opacities on a chest radiograph, and an elevated white blood cell count.

This 40-year-old man presented with fever and a generalized, painful, nonpruritic rash of 2 days’ duration. The rash first appeared on his face then spread to his hands, buttocks, and lower extremities. Two weeks earlier, he had an episode of severe rhinitis followed by high fevers, chills, muscle aches, and ankle pain.

Dr Rosen invites you to match the clinical characteristics in the checklist with the disorders pictured in the photos. This month’s challenge: 2 leg lesions.

Right Ventricular involvement in acute inferior MI is an independent predictor of major complications and in-hospital death, as this case demonstrates. While in-hospital prognosis after left ventricular infarction is directly related to the postinfarct LV ejection fraction, involvement of the right ventricle drastically alters that linear relationship.

How effective is antimalarial therapy in patients with lupus?

Inside: a photo guide to the various manifestations of stasis dermatitis, irritant contact dermatitis, and allergic contact dermatitis—including diagnostic clues and treatment options.

A previously healthy 19-year-old woman presents with a sore throat that has become progressively more painful over the course of 1 week. She also has left-sided neck swelling, light-headedness, and intermittent headaches. She denies recent sexual activity.

Dr Schneider addresses myths and misunderstandings about the long-term use of opioids to treat noncancer pain.

In many instances, our patients receive invasive and aggressive subspecialty care at or near the end of life. Such care can become burdensome and painful without a favorable outcome.


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