Many of my patients with chronic pain are women who are depressed and whohave experienced a tragedy of some sort in their past.

To facilitate the swallowing movementsthat are key to the examinationof neck swellings-particularlythose of the thyroid gland-give thepatient a full cup of water and askhim or her to drink it slowly whileyou examine the neck.

Children and adults who have troubleswallowing pills can practice with anempty over-the-counter drug capsule.

Pandemics attributable to different influenza A virus subtypes occurredat irregular intervals throughout the 20th century. Because the timingof a pandemic cannot be predicted, we must be prepared for such an outbreak.Although influenza is generally viewed as an illness with potentiallydeadly effects primarily for elderly persons, it can lead to significant morbidityand mortality in otherwise healthy infants and toddlers and in other highriskgroups.

An electric heating pad can burn patientsif they fall asleep while usingit.

A 68-year-old man with severe emphysema complains ofchest pain that began that morning. He has also had intermittentdiarrhea and occasional blood in his stool for thepast 2 weeks.

When you examine patients withGraves disease, be careful when youpalpate the enlarged thyroid gland.

A 2-month-old infant is brought to the office by his parents becausehe has been crying inconsolably for the past 4 to 5 hours. The childhas been well since birth and has no history of vomiting, diarrhea, fever, orrash. The infant is being breast-fed, is not taking any medication, and hasnot been in contact with any sick persons.

Right hip pain in a high schoolfootball playerA 15-year-old boy complains ofright hip pain that began the day before,when he felt a "pop" during footballpractice. His medical history issignificant only for several ligamentousinjuries in both ankles and fracturesof the right lateral malleolusand the left medial malleolus, whichhealed uneventfully. He denies anabolicsteroid use and alcohol use.

Place domestic violence pamphlets inthe women’s restroom.

In his article, "Dyslipidemia: Closing the Treatment Gap"(CONSULTANT, April 1, 2003, page 451), Dr David Nashrecommends statin therapy for all eligible elderly patients.

Here is a painless way to locate andremove splinters. First, inject the areawith a local anesthetic. Then, startingat the point of entry, use a scalpelto make an incision along the track ofthe splinter while you simultaneouslyapply pressure at the opposite, deepend.

Instead of using a catheter to documentpatent nares on a newborn, firstevaluate the quality of the neonate’ssuck with a clean, bare finger andthen place the wet finger under thenose to feel exhalation.

To reduce children’s anxiety aboutblood drawing and immunization,keep a toy bear or doll in the examinationroom and let your young patientsuse a syringe without a needleto give it a “shot.”

I have been a pediatrician/family physician for about 40years, and I have been exposed to most diseases.

When should children who have a family history of either type 1 or type 2 diabetesbe screened for prediabetes?

Good nutritional care can improve the short-and longtermcourses of many illnesses that are common in olderadults. The experts who have contributed to this handbookdiscuss the disorders that can seriously affect andbe affected by nutrition, and they present specific recommendationsfor secondary prevention and management.

I read with interest Dr Robert Blereau’s “Photoclinic” caseof a young woman with epulis of pregnancy (CONSULTANT,May 2002, page 784) (Figure), in which the author notesthat the condition usually regresses spontaneously after delivery.

A46-year-old white man is hospitalized with increasing dyspnea of 3weeks’ duration. He has a history of stable chronic obstructive pulmonarydisease secondary to heavy smoking (2 packs of cigarettes a day for 27years, discontinued 6 years previously) and uses inhaled bronchodilators.

A healthy 11-year-old boy complains of a “bump below his kneecap” that hurts to touch and whenhe jumps. He first felt slight pain a month earlier. Since then, he has occasionally complained ofpain and a bump on the right knee.