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Consultant Vol 51 No 3

A 56-year-old man has had progressive, erythematous plaques across the forehead and temples for the past few weeks. He describes these areas as “a little itchy and a little tender.”

After 6 weeks of scratching a very itchy, worsening rash on his left leg, a 53-year-old man seeks medical evaluation. He has tried over-the-counter (OTC) topical remedies with no success.

Two skin carcinomas that are in close proximity can be removed in a single excision.

A 44-year-old man presents for a preemployment physical examination. He is healthy, and he currently takes no long-term medications. A detailed review of systems reveals no ischemic chest pain, dyspnea with exertion, orthopnea, or any other symptoms of either coronary artery disease (CAD) or heart failure.

A 53-year-old woman presented with sudden onset of left upper quadrant abdominal pain. She had a history of atrial fibrillation, hypertension, and congestive heart failure.

A 48-year-old woman was hospitalized for acute-onset abdominal pain. She had a history of adult-onset Still disease and severe osteoarthritis. She had been taking 650 mg of aspirin every 4 hours to relieve her arthritis pain and fevers.

This HIV-positive, 48-year-old man presented with new-onset acne-like, pruritic lesions on his face. These erythematous painful papules had developed 2 months before presentation. The patient was taking antiretrovirals and trimethoprim/sulfamethoxazole for the HIV infection.

Certain papulosquamous and bullous diseases are more common in older adults than in younger persons. For example, bullous pemphigoid typically affects those in the fifth through seventh decades of life. Grover disease, or transient acantholytic dyskeratosis, is most common in white men older than 65.

On December 18, 2005, Ariel Sharon, Prime Minister of Israel, experienced the sudden onset of aphasia. Despite being overweight, he had none of the traditional risk factors for cerebrovascular disease—hypertension, history of smoking, diabetes, or elevated cholesterol levels.

A 50-year-old man was brought to the emergency department (ED) after a witnessed syncopal event. He was awake but confused and unable to provide a history.

The treatment of chronic fatigue syndrome (CFS) is mainly supportive. The key to effective management is to establish a therapeutic alliance with patients and to convey a consistent message that their complaints are taken seriously. Although spontaneous recovery is rare, it does occur in some patients with CFS.


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