Patients who don’t speak Englishoften bring a translator to their firstvisit but not to subsequent ones.

This child fell from his bicycle 3 days ago and suffered mild head trauma.He lacerated his forehead and sustained some abrasions and bruises in thesurrounding scalp. His mother now seeks medical care because the child’seyelids have become so swollen that he can hardly open his eyes.

To more easily visualize a largerwoman’s cervix, use a regular orextra-large Graves speculum and askthe patient to relax her knees out tothe sides as much as possible.

Apreviously healthy 22-year-oldHawaiian man presents to theemergency department (ED) of a hospitalin California with a 3-day historyof fever and chills. He has also had aprogressively worsening, persistent,dull aching pain in the right upperquadrant of the abdomen for the pastweek. The pain is localized-with noaggravating or relieving factors-andis not related to meals. The patienthas had no nausea, vomiting, loss ofappetite, jaundice, abdominal distension,cough, chest pain, dyspnea,weight loss, or lymphadenopathy.

Is treatment recommended for high-normalblood pressure (BP)-say, 135/88 mm Hg-ina postmenopausal woman?

We chose to present this case to readersbecause the patient’s neurologicexamination was normal and her presentationthus appeared benign.

A 22-year-old man hashad a swollen tongue for the past2 days. The swelling is not associatedwith trauma, recent illness, or medicationuse. The patient denies dysphagia,drooling, and shortness ofbreath but does have some difficultyin speaking because of the swelling.

My patient occasionally has seminal “leakage” from the penis.

A 32-year-old man recently noticed a dark lesion behind his right knee. The patientdenies trauma and fever and has no other medical problems. Since he started workingfor the parks and recreation department of the state of Florida 18 months ago, hehas spent an increased amount of time outdoors.

After a professional football player died of heatstroke, national attention focusedon heat-related illnesses among athletes. However, many amateur and “weekend”athletes do not fully appreciate the stress that a hot environment places on theirbodies when they exercise. As the popularity of outdoor exercise and sports continuesto grow, the number of persons at risk for heat illnesses increases each year.This book-the first to focus exclusively on exertional heat illnesses-describes howto identify, treat, and prevent these disorders. Among the topics covered are thephysiology of heat stress; classification of heat illnesses; exertional heatstroke; heatexhaustion; exercise-associated collapse; heat syncope; exertional heat cramps; hyponatremia;minor heat illness, such as miliaria and sunburn; and predisposingfactors for exertional heat illnesses. Case reports appear throughout the text. Alsoincluded are reproducible checklists, charts, tables, algorithms, and photographs.

A 67-year-old man complainsof abdominal distention and bouts ofdiarrhea with intermittent constipation.These symptoms have beenpresent for weeks but recently havebecome more severe. The patienthas not seen blood in his stool. Hedenies fever, travel to a foreign country,and recent trauma. He has hypertension,which is well controlledwith calcium channel blockers.

When corticosteroids are no longer a viable option for management of Sjögrensyndrome in a particular patient and GI symptoms preclude NSAID use, whatother treatments can be tried?

For several weeks, a 68-year-old man has had painful blisterson his hands that crusted as they healed. The patienthas diabetes mellitus, hypertension, and chronic renalfailure, for which he is undergoing hemodialysis. His longtermmedications include a hypoglycemic agent and adiuretic.

A 62-year-old woman was found on thefloor of her bathroom at home with herwheelchair partially on top of her.She was unresponsive except to painfulstimulus.

Persistent dermatitis in the region ofthe umbilicus can be caused by contactwith the metal back of a pantssnap.

Case 1: A 42-year-old woman presents for anevaluation of an acute pruritic eruptionthat began 2 days earlier on herface, trunk, and extremities. The lesionsresolve and recur at differentsites from one day to the next. Theoutbreak began after the patient ateChinese food the night before; shealso had a recent sinus infection. Shetakes vitamins and hormone replacementtherapy.

To hear carotid bruits more clearly,ask patients to inhale deeply andhold their breath.

It struck me when reading Dr Thomas Petty’s “PulmonaryQ&A” on when to treat latent tuberculosis (TB) infections(CONSULTANT, January 2003, page 48) that it is importantto remind clinicians how misleading tuberculin testingin the elderly can be if the 2-step testing procedure is notfollowed.

In his article, “The Primary Care Physician’s Role in Treating Mental Illness”(CONSULTANT supplement, April 15, 2003, page 24), Dr Joseph Lieberman correctlyasserts that “more and more primary care physicians are prescribing psychotropicmedications.”

Patients with diabetes can use anempty laundry detergent jug to disposeof used insulin needles at home.