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Cocaine and amphetamine intoxication continue to be common causes of emergency department and hospital admissions.

Intoxication with street drugs: Cocaine and amphetamines

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.

Clinical Topics

White Knuckles

As the number of aging adults expands and rates of cognitive decline rise, primary care clinicians will remain the first point of contact for detection and early management—so how prepared do they feel for this role? A new survey of US primary care clinicians conducted by

 offers a snapshot of current attitudes, practices, and knowledge related to cognitive assessment in the clinical setting and familiarity with standard-of-care medications. 

While a majority report conducting annual screenings for mild cognitive impairment, barriers such as limited time, uncertainty about guidelines, and a lack of confidence in interpreting results persist. The survey also highlights variation in tool selection and notable gaps in clinicians’ self-reported familiarity with distinguishing early cognitive decline from normal aging. These findings shed light on the opportunities—and ongoing challenges—of integrating cognitive health for older adults into routine primary care.

The slides above provide visual highlights of the results. For open-ended responses regarding challenges to conducting cognitive screening voiced by survey respondents, see

5 Challenges Physicians Face With Cognitive Screening in Practice. 

The survey of primary care clinicians found that a majority do conduct screening for MCI, but that time is an issue, guidelines are few, and low levels of confidence persist.  

Physician Survey Results: Primary Care Knowledge of Screening for Cognitive Decline

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

10 Essential Vaccination Updates for Primary Care: Winter 2024-2025

From ACIP updates on age eligibility and research on vaccine efficacy to US adults' attitudes toward recommended shots, these 10 at-a-glance news briefs are must-reads for PCPs.    

Toolkits

10 Essential Vaccine Updates for Primary Care


This intensely itchy, blistering rash on the forearms and upper chest of a 13-year-old girl occurred after a day at the beach. The girl had polymorphic light eruption (PMLE), the most common abnormal reaction to UV light.

A. PMLE classically presents as a papular or papulovesicular eruption on the arms and anterior chest

B. The reaction usually begins 12 to 24 hours after an initial exposure to light of a suddenly increased intensity

C. Some parts of the body are severely involved while similarly exposed areas are paradoxically spared

D. The rash resolves after 7 to 10 days, often leaving whitish scarring

What are the characteristics of this blistering rash caused by exposure to UV light? 

Intensely Pruritic Rash After Sun Exposure in a Tween Girl 

A 5-year-old boy with a history of atopic dermatitis since 6 weeks of age, presents with a rash around his mouth that has been present for approximately 1 year. The patient’s mother reports that desonide topical cream was applied to the affected area for about 5 days, which initially resulted in improvement, however the rash returned after this medication was discontinued. The rash also recently improved after the patient took amoxicillin for an infection. She also notes that the patient has been licking his lips more frequently.

On examination there is an erythematous papulopustular eruption restricted to the perioral region, with sparing of the vermillion border. Mild hyperpigmentation is noted on the patient’s neck. There is no active involvement of other areas of the body.

The eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential? 

Rash Around the Mouth of a 5-year-old Child

Richard W. Carlson, MD, PhD

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