Asthma

To detect wheezing during forcedexpiration in patients with dyspnea,asthma, or reactive airway disease,ask the patient to take a big breathand exhale as if he or she were blowingout the candles on a birthdaycake.

A 12-year-old boy with a history of atopy complained of pruritus and severe dryness of the hands. Over-the-counter moisturizers failed to resolve the condition. The patient did not wash his hands frequently and had no hobbies that exposed him to environmental irritants or allergens.

Three strategies have commonly been used for episodic migraine. In step care across attacks, the least expensive medications are tried for several episodes. If these fail, treatment is "stepped up" to specific agents.

For 2 months, a 31-year-old woman had had dyspnea anddull, continuous retrosternal pain. She was admitted to thehospital, and a helical CT scan of the thorax identified asaddle pulmonary embolism. An ultrasonogram revealeddeep venous thrombosis (DVT) in the left leg. Intravenousheparin was given; the patient was discharged,and warfarin was prescribed.