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.
For 20 years, a lesion has been slowly growing on the penis of a 51-year-old man. He has noted bleeding and a foul-smelling discharge from the mass. Recently, the patient experienced a 30-lb weight loss. He has had 5 sex partners in his lifetime but has been monogamous for the past year.
A 22-year-old woman presented to her primary care physician’s office with right lower quadrant and suprapubic abdominal pain. She stated that the pain had begun earlier that day; she had no symptoms on awakening that morning.
Bacterial meningitis and herpes simplex virus type 1 (HSV-1) encephalitis are both associated with significant morbidity and mortality. Thus, hospitalization and prompt initiation of therapy are essential.
For 3 weeks, a 28-year-old man has had a pruritic, bilateral axillary rash. He stopped using deodorant, but the condition has not improved.
After 6 weeks of coping with itchy lesions on her arms and legs, a 43-year-old woman seeks medical advice. The rash first erupted with the onset of cold weather.
Chronic fatigue syndrome (CFS) is a distinct disorder characterized by debilitating and often recurrent fatigue that lasts at least 6 months but more frequently lasts for longer periods. Patients with CFS experience overall physical, social, and mental impairments and may subsequently qualify for medical disability.
A 41-year-old woman presents to the emergency department with chest pain and dysphagia. Routine laboratory studies reveal profound neutropenia. She denies recent fever, chills, or weight loss.
The physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It's one way a physician attempts to determine the cause of a patient's complaint.
A 48-year-old man was admitted with a sore throat, subjective fever, and cough of 2 days’ duration. Two days before admission, he had dysphagia, began to drool, and felt like he was choking.
For 4 months, a 45-year-old man with a history of alcohol abuse had made multiple visits to the emergency department (ED) and a dermatology clinic for evaluation of a diffuse, scaly, and intensely pruritic rash. The rash, which was photosensitive, had started on his upper extremities and spread proximally to the trunk and lower extremities.
When counseling patients about why they should receive the influenza vaccine, I remind them that each year the disease kills 250,000 to 500,000 persons worldwide and more than 37,000 persons in the United States. This means that influenza kills more people per year than auto accidents.
Chronic kidney disease (CKD) has become a burgeoning epidemic. Patients with various stages of CKD initially seek care from their primary care physician; some of these patients sustain acute, reversible renal injuries as well.
A 54-year-old woman presents for an initial consultation. She has multiple chronic disorders, including type 2 diabetes mellitus and hypertension, for which she takes various medications-none of which are new.
How best to manage ulcerative colitis? Here: highlights from guidelines from the American College of Gastroenterology on assessment, treatment, indications for surgery, and cancer surveillance.
Yes, ACE inhibitors should be used with caution in patients with acute renal injury and high-grade renal vascular lesions, but these drugs are designed to help, not hurt kidneys. Now fast forward to another caveat: avoid or discontinue statins in patients who have elevated liver enzyme levels. Get ready for a therapeutic paradigm shift.
A tender, crusting eruption first arose on a 69-year-old man’s ear 10 days earlier; an antibiotic failed to clear the lesion.
A 37-year-old man presented to the emergency department with painful, burning, blistering skin lesions. The lesions started 3 days earlier on the face and spread to the trunk and extremities. Ten days before presentation, the patient had received a diagnosis of AIDS.
For several years, an asymptomatic mass had been growing on the neck of a 54-year-old-man. Physical examination revealed a firm, nontender mass located slightly left of midline at the level of the hyoid bone.
A previously healthy 55-year-old woman complained of fever, weakness, and generalized malaise for the past 3 to 4 weeks. She had been treated with ciprofloxacin, amoxicillin, and azithromycin for 21 days with no resolution of her symptoms. Five days before she was hospitalized, multiple nonspecific constitutional complaints developed.
Men who have undergone localprocedures in the genital or analarea (eg, abscess drainage) find itdifficult to get a bandage to adhereto the skin because of the pubichair.
The diagnosis of many serious infectious diseases relies heavily on clinical suspicion, particularly in the early stages of the illness. In this 3-part series, we provide useful clues to the triage and diagnosis of these diseases. Here we discuss staphylococcal toxic shock syndrome (TSS) and streptococcal TSS.
Ulcerative colitis affects about 500,000 persons in the United States and accounts for more than 30,000 hospitalizations and 1 million workdays lost each year. The exacerbations and remissions that characterize the clinical course of the disease can make its management particularly challenging. What is the optimal approach to treatment? And which agents are most effective for maintenance therapy?
The gold standard for diagnosis is joint aspiration and synovial fluid analysis; however, compensated polarized light microscopy is not available in most primary care practices. In part 2 of his 3-part podcast, Dr Lieberman discusses the diagnosis of gout in real-world practice.
Will you recognize these potentially life-threatening infections when you see them? Inside: clues to early diagnosis.
