A number of prediction models have been developed to identify patients with community-acquired pneumonia (CAP) who are at increased risk for severe illness. España and associates have developed a relatively simple model that can be used in the emergency department (ED), and they report that it compares favorably with other prediction models, such as those developed by the American Thoracic Society (ATS) and the British Thoracic Society (BTS).
Tinea corporis appears as an annular plaque with a rim of scaly erythema.
Tinea that occurs on the hands is referred to as tinea manuum.
To determine whether a midline neck swelling is caused by a thyroglossal cyst or by enlargement of the thyroid gland, ask the patient to open his or her mouth and move the tongue in and out.
Maceration or scale between isolated web spaces of the fingers suggests erosio interdigitalis blastomycetica (interdigital candidiasis). It most often occurs in the web space between the middle and ring fingers; sometimes the toes are affected. Erosio can spread and can be painful.
A fungal folliculitis (Majocchi granulomas) can occur if a superficial fungal infection is treated with topical corticosteroids. Fungal folliculitis is best treated with a short course of oral itraconazole or fluconazole.
Candidal infection can also occur at the lateral angles of the mouth; it causes erosions and breakdown of the skin. Angular cheilitis, or perleche, resembles the relationship between intertriginous candidiasis and intertrigo in that it is part infection and part inflammatory response to the impairment of epidermal integrity.
An easy way to make ice packs is to fill small zip-lock plastic bags with wet gauze and then freeze them.
When young children are afraid to have you look in their ears, try this trick: take the little ear speculum off the otoscope and place it on your finger, then make it "magically" disappear by passing your hand over it.
Is it necessary to prescribe lipid-lowering therapy for a patient with a mildly elevated total cholesterol level (240 mg/dL), a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL, and a high high-density lipoprotein (HDL) cholesterol level of 100 mg/dL?
For several months, a 60-year-old woman has had weakness, lower extremity edema, and dysphagia. She denies fever, chest discomfort, and rash.
This infection is usually caused by Candida albicans, whichis often present in body folds. Candidiasis is common in persons with diabetes and in obese persons. Other predisposing factors are the use of antibiotics, topical corticosteroids, or immunosuppressive drugs; poor nutrition; and immunosuppression.
Tinea pedis, or athlete's foot, is common in elderly persons. It manifests as maceration in the interdigital web folds and as scaly plaques on the plantar surfaces of the feet. A potassium hydroxide evaluation can establish the diagnosis. Tinea pedis is commonly associated with xerosis. It is best treated with a topical antifungal agent; treatment can be aided by a keratolytic such as lactic acid 12% cream.
Oral candidiasis, or thrush, is not uncommon in elderly persons. It can be related to poor dentition or immunosuppression, particularly as a result of oral corticosteroid use.
How safe is the use of high doses of niacin to foil urine drug screening tests?
Tinea corporis occurs most often on the torso of elderly persons. It commonly appears as an annular plaque with a rim of scaly erythema. Occasionally, tinea corporis manifests with polycyclic annuli or with nummular plaques, which mimic nummular dermatitis. The examination of a potassium hydroxide preparation can establish the diagnosis. Tinea corporis can be treated effectively with a topical antifungal agent.
The prevalence of onychomycosis increases with age; it is less than 1% in persons younger than 19 years and rises to about 18% in those who are 60 to 79 years. The infection is more common in men than in women. Among the predisposing factors are diabetes mellitus, psoriasis, a family history of onychomycosis, use of immunosuppressive drugs, and peripheral vascular disease.
A 73-year-old man presented with constant watering, irritation, and redness of the left eye. An outward turning of the left lower eyelid was noted. The palpebral conjunctiva exhibited hyperemia and thickening. Keratinization of the exposed conjunctiva indicated that this was a long-standing lower lid ectropion. Slit-lamp examination revealed superficial punctate keratopathy in the inferior one third of the cornea.
A 50-year-old man with end-stage renal disease secondary to long-standing hypertension had an elevated hematocrit and progressively increasing hemoglobin levels. For the past 7 years, he had been receiving hemodialysis 3 times a week. He denied headache, flushing, easy bruising, bleeding, nausea, vomiting, chest pain, dyspnea, and other symptoms. He was not receiving exogenous erythropoietin.
A 62-year-old woman is seen because of profuse vaginal bleeding that has led to anemia (hemoglobin, 4.5 g/dL). She has also noticed a lump in her navel.
