During the past few years, several vaccines have been added to the adult immunization schedule. The human papillomavirus (HPV) vaccine is recommended for girls and women aged 11 to 26 years (minimum age, 9 years) to prevent cervical cancer, precancerous or dysplastic lesions, and genital lesions caused by HPV types 6, 11, 16, and 18.
The family of a 49-year-old Chinese man brings him to the hospital after he becomes confused and disoriented. For about a week, the patient has had cough, cold symptoms, dizziness, and occasional vomiting.
High morbidity and mortality are associated with non-food-borne Vibrio infections, particularly those caused by Vibrio vulnificus (Figure), a species that is endemic to the Gulf Coast of the United States
The numerous symptom domains of fibromyalgia syndrome (FMS) include pain, fatigue, sleep disturbance, mood disturbance, function impairment, irritable bowel syndrome, tension and migraine headache, and cognitive dysfunction. Its pathophysiology is rooted in neural dysregulation in the spinal cord and brain.
A 27-year-old primigravida is seen 3 weeks before expected date of confinement, with a 1-week history of vulvovaginal pain and a yellowish white discharge.
A Photo Quiz to Hone Dermatologic Skills
Survivors of childhood cancer frequently present to primary care practitioners for a routine physical examination or for urgent care. Knowledge of the patient's cancer history and of the specifics of the treatment are essential to providing proper care and addressing his or her unique risks.
The emergence of antimicrobial resistance has increasingly impeded the management of a number of clinically important infections.
A 54-year-old woman presents with an asymptomatic rash of sudden onset on both malar cheeks that developed 1 day earlier. She denies any facial trauma.
A 28-year-old woman presents with milky discharge in both breasts and throbbing occipital headaches of 4 months' duration. The headaches begin gradually, do not radiate, and have no apparent triggers or relieving factors.
Tinea is caused by dermatophytes that can infect the stratum corneum epidermidis, hair, and nails. Dermatophytosis is a common infection worldwide, and about 20% of the US population is infected.1 Although numerous fungi can cause tinea, Trichophyton, Microsporum, and Epidermophyton are the genera that cause most cases of tinea.2 Classified by the part of the anatomy that is infected, tinea is referred to as tinea pedis, tinea manuum, tinea cruris, tinea corporis, tinea capitis, tinea faciei, tinea barbae, and tinea unguium.
Black discoloration appeared on the fingernails of a 51-year-old white man who had sustained burns on 15% of his body in a house fire 2 months earlier. The discoloration is a typical side effect of silver nitrate, which was applied to his skin and fingernails during the month he was hospitalized. This topical broad-spectrum bacteriostatic agent is used to reduce the risk of infection and mortality in burn patients.
For 2 months, a 30-year-old man with a history of cocaine abuse had had a painful gingival mass and difficulty in eating. Examination revealed a large, fungating mass in the anterior oropharynx that extended posteriorly up to the retromolar region. Posterior cervical lymph nodes were enlarged bilaterally, with no other peripheral lymphadenopathy.
A 36-year-old man presented with a 2-week history of pain, swelling, and redness of the right elbow. He also had decreased range of motion during elbow flexion. There was no associated fever or recent illness.
A young woman recently came to my office for contraception management and a Papanicolaou test; she complained of mild dyspareunia. I sent a vaginal sample for culture to rule out gonorrhea and chlamydial infection.
A previously healthy 21-year-old man presented with high fever, cough, and pleuritic chest pain. His illness began 6 days earlier with a sore throat that was followed by worsening dyspnea.
My patient is a 45-year-old otherwise healthy, asymptomatic woman from Iran in whom a hydatid cyst (Echinococcus granulosus) was incidentally discovered. The immunologically confirmed cyst is located in the left lobe of the liver, and it pushes slightly on the pancreas; its dimensions are 13 3 2.5 cm.
An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.
A 71-year-old man complains of left elbow pain that increases with movement and has worsened over the past 12 hours. He has also had a cough with sputum production for the past several days.
I work for the Child Protection Team at a local university. Recently, I saw a 9-year-old girl who had been taken to the local emergency department (ED) with sudden left-sided abdominal pain.
Parents of young children know that colds are extremely common, especially from fall until spring. Colds account for a large number of pediatric office visits and telephone calls-particularly during "cold season."
A 53-year-old man, who had initially presented with an upper respiratory tract infection, was found to have a stage IV follicular low-grade lymphoma with malignant cells that were positive for CD19, CD20, CD10, surface kappa, and CD45 and negative for CD5. A grade 1 tumor (follicular center cell lymphoma/follicular small cleaved) was suspected. Enlarged lymph nodes (2.5 to 4.0 cm) were found in the mediastinum, azygoesophageal recess, and periaortic region as well as in the porta hepatis, peripancreatic, mesenteric, and celiac regions.
For 3 years, my 30-year-old patient has had outbreaks of small, vesicular, frequently pruritic lesions on the neck and upper trunk.
A 22-year-old woman has had chronic nausea, emesis with green vomitus, and diarrhea for the past 10 months. The diarrhea is frequent (about 3 to 8 times daily) and does not resolve with starvation.
For 2 weeks, a 49-year-old woman has had mild, intermittent epistaxis with left-sided facial pain, swelling, and otalgia; the severity of the bleeding has increased during the past 24 hours. She also has congestion of the left naris of 1 month's duration.
