Heart Failure

Cardiovascular Clinical Consult

Adult Immunization

Hepatic Disease 

Behcet’s Disease

Rare Disorders

Pediatric Immunization

Implementing The Topcon Ocular Telehealth Platform

Weight Management

Screening

Monkeypox

Guidelines

Men's Health

Panic Disorder  

Anxiety

Eating Disorders

Depression

Substance-related Disorders

ADHD

Psychiatry 

Seasonal Allergies

Allergy

Nutrition 

Pregnancy and Birth

Women's Health

Atrial Fibrillation

Cholesterol Disorders

Cardiovascular Disease

Hypertension

Cardiology

Substance Use

Child/Adolescent

Pediatrics

Kidney Disease

Genetics

Medical Cannabis

Complimentary & Alternative Medicine

Skin Diseases

Dermatology

Thyroid Disorders 

Diabetes

Diabetes Type 2

Insulin

Endocrinology 

Oral Medicine 

Otorhinolaryngologic Diseases

Fibromyalgia

Pain

Irritable Bowel Syndrome 

Inflammatory Bowel Disease

Gastrointestinal Disorders

Geriatrics

Coronavirus

Hepatitis C

Cold, Cough, and Flu

Bacterial Conjunctivitis

Immunization

Influenza

HIV AIDS

Sexually Transmitted Diseases

Infection

Osteoporosis

Imaging 

Musculoskeletal Disorders  

Obesity

Rheumatoid Arthritis

Arthritis

Gout

Rheumatology

Technology

Colorectal Cancer

Kidney Cancer

Lung Cancer

Melanoma

Skin cancer

Prostate Cancer

Breast Cancer

Cervical Cancer

Cancer

Nephrology

Anemia

Dementia

Epilepsy

Cerebrovascular Diseases

Headache and Migraine

Parkinson Disease

Alzheimer disease

Stroke

Mental Health

Headache

Migraine

Nervous System Diseases

Sleep Disorders

Neurology

Asthma

Cystic Fibrosis

COPD

Pneumonia

Respiratory Diseases

Pulmonology

News

All News

Office Procedures

Practice Management

Media

Around the Practice

Between the Lines

ConsultantLive

Expert Interviews

Institutional Insights

Medical World News

Podcasts

Primary View

Provider Toolkits

Readout360

Conferences

Conference Coverage

Conference Listing

Resources

Image IQ

Interactive Posters

Polls

Publications

Quizzes

Subscribe

CE/CME

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Information

Patient Care Online

Facebook

LinkedIn

Clinical Focus

Allergy & Immunology

Endocrinology

Gastroenterology

Infectious Disease

Men’s Health

Pain Management

Psychiatry

Women’s Health

Business Focus

Billing and Collections

Career Planning

Coding and Documentation

Concierge Medicine

Cybersecurity

EHRs

Investing

Patient Relations

Personal Finance

Remote Patient Monitoring

Staffing

Telehealth

Value-based Care

Spotlight

Unmet Needs in Managing MDD

Interpreting Thyroid Function Tests

Using Thyroid Lab Tests

Testing & Screening to Optimize Men's Health

1rem

Authors

A 72-year-old woman with acute abdominal pain and vomiting was brought to the hospital. The patient had no significant medical history and was taking no medications.

Cullen Sign in Pancreatitis

A 64-year-old woman with a history of basal cell carcinoma presents to the dermatologist for skin cancer surveillance. She is incidentally noted to have bruising on her upper eyelids (above). On questioning, she reports experiencing recurrent intermittent eyelid bruising for several years. She denies a history of trauma to her face, pain, or other associated symptoms.

Her medical history is significant for hyperlipidemia, hepatitis C (diagnosed >30 years earlier), osteoporosis, celiac disease, and idiopathic proteinuria for several years. Her surgical history includes appendectomy and carpal tunnel repair.

Pertinent family history includes her mother dying of multiple myeloma and her father of complications of diabetes.

Review of systems is significant for vague symptoms of gastrointestinal discomfort. On more directed questioning, she reports the eyelid purpura is temporally related to the Valsalva maneuver/ strained bowel movements. Her medications include atorvastatin, risedronate sodium, a daily multivitamin, calcium, vitamin D, and aspirin.

Her examination reveals no bruising elsewhere and no findings of interest on skin or mucous membranes.

B. Allergic contact dermatitis, purpuric type

Eyelid bruising was observed on a 64-year-old woman during routine skin cancer follow-up. She denied trauma or pain. What does this look like to you? 

Image IQ: Recurrent Eyelid Purpura 

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Clinical Topics

Hard Purple Nodules: Your Dx?

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

White Knuckles

A panel of experts on type 1 diabetes (T1D) describe the prevalence and burden of the disease, highlighting the emotional and socio-economic burden extending beyond medical expenses.

Navigating T1D: Mitigating Burden and Monitoring Disease Progression

The following is a summary of the video transcript and has been edited for length and clarity. 

Jennifer D. Goldman, PharmD, RPh, CDCES, BC-ADM: 

Dr Burton, would you talk about the prevalence of type 1 diabetes and also about the myth around who is at risk for the disease?



 What's interesting is that we are definitely seeing increased rates of type 1 diabetes diagnoses. And there are a number of different causes including COVID-19 and other viruses. But while most people tend to think of type 1 diabetes as a disease diagnosed in children, over the past few years we’ve seen that the majority of new cases are in adults over the age of 20 years. And that’s the myth, that it's always kids and that's what we need to watch. It's so important that we consider adults and young adults, adults when we think about diabetes and screening.

How does family history affect the risk of type 1 diabetes?

 A family history of type 1 diabetes increases a first-degree relative’s risk for the condition by 15-fold, so this is something that we need to speak to our patients about. We don’t take care of all of the children in a family or the adults; we may treat one person in a family of 5. We need to make the person we treat or the caregiver aware of the family risk and that there is screening available.

What about the socioeconomic and emotional burdens of type 1 diabetes?

: Both burdens are huge. Financially, there are the direct costs of supplies, insulin, continuous glucose monitoring (CGM) supplies, pump supplies, doctor's visits including other specialists, therapists. There are potential hospitalizations. The emotional aspect is sometimes even bigger. For a kid, there are the social implications; you're a little bit different than your peers, things might look a little bit different for you at school or at parties or at sports. You might have to pay attention to things that nobody else has to pay attention to, carb counting, blood sugar monitoring. And then the strain on families is pretty incredible. We see a lot of difficulties in marriages. Maybe one parent takes the burden of caring for the affected child and resentment builds. All around the impact of type 1 diabetes on a family can be huge.

Goldman: Are you doing referrals to other specialists?

I think it's always important to refer to a therapist or a counselor. If there are support group options, that's helpful. I think sometimes people just want to be with people like them. And for kids it's great because there's so many diabetes camp options where they can go and they could feel like everything is normal. So just getting around others that are in the same boat is super helpful.

This afebrile baby presents with a target-shaped, centripetal rash. He has been taking amoxicillin for 5 days for an ear infection.

1-Year-Old With "Bullseye" Rash

This teen’s fingers become cold and white intermittently during the winter months since she moved to the northeast from the Caribbean. She has had violaceous papules, petechiae, and healing ulcerations on the distal digits of both hands and feet for about a month as well as intermittent shortness of breath.

A. Raynaud phenomenon, primary or secondary

This teen has had violaceous papules, petechiae, and healing ulcerations on the distal digits of both hands and feet for about a month this winter as well as intermittent shortness of breath since she moved to the northeast from the Caribbean. What's in your differential?

Cold, White Fingers

F. Apostolou, MD

Articles

Latest Updated Articles