To remove impacted cerumen, attacha 16-gauge catheter to a 10-mL syringe(you may use a smaller or largersyringe if you prefer).

I usually collect a urine sample aspart of a complete physical examination.

For nearly 3 years, my patient has had frequent recurrences (now, almost monthly)of erythematous, slightly pruritic lesions on the lower back, inguinal area, orbuttocks-but never on the genitalia.

An 84-year-old man complains of worsening angina pectoris that started3 months earlier. The patient has had aortic stenosis for about 10 years. Healso has diabetes, which is controlled with oral agents.

When a patient presents with a handinjury, here is a quick and simple wayto assess the integrity of the nervesthat supply the muscles in the hand.

Which antithrombotic regimen is most appropriate for apatient with systemic lupus erythematosus and anticardiolipinantibody syndrome who has had a previous infarct?

A 75-year-old man with coronaryartery disease presents to the emergencydepartment with abdominalpain and light-headedness. The painbegan as a dull ache 4 days earlierand recently became considerablyworse. The patient denies recenttrauma, fever, nausea, vomiting, and diarrhea.

Instead of shaving a patient’s head toprepare a scalp wound for suturing,apply a sterile water-based lubricantto the surrounding hair.

Long-standing chorioretinal scarring in both eyes didnot affect a 67-year-old woman’s vision. The scars wereroundish, irregular, and yellowish white with interior pigmentation(A and B).

A painful scalp eruption of 4 days’duration brings an 81-year-old man toyour office. He has taken a lipid-loweringagent and an antihypertensivefor years but has not started any newmedications recently. One week earlier,he had a haircut. He denies recenttrauma to the scalp.

When you need to obtain a specimenfor throat culture, ask the patient toexhale while you swab the pharynx.

A 76-year-old woman complains of gradually worsening back pain thatbegan 6 weeks earlier, after she fell off a ladder rung 3 feet from the ground(she landed on her feet). She is otherwise in good health and denies fever andloss of sensation or control in the lower extremities.

It is difficult to visualize the pharynxof patients who gag whenever youuse a tongue blade, but you can frequentlydispense with its use.

Rapid, accurate diagnosisof acute myocardialinfarction(MI) in patientswith chest pain isa formidable challenge.

In his “What’s Your Diagnosis?” case of an older man with a prolapsed internalhemorrhoid (CONSULTANT, October 2002, page 1487), Dr Henry Schneidermanstates that the “patient and his family preferred a conservative approach.”

An eye magnet can remove metallic objects lodged in the ear or nose, as wellas the occasional subcutaneous foreign body.

At the end of an office visit, write medication instructions, follow-up appointments,tests, diagnoses, and warning symptoms on a small note pad and givethe sheet to the patient.

Rub a small amount of warm lotionon your fingertips before you performan office breast examination(you can warm the lotion in yourhand).

Francisella tularensis is anonsporulating, nonmotile,aerobic gram-negative coccobacillusthat is usually transmittedto humans frominfected rabbits and other small animalsvia ticks, fleas, or deer flies orby direct contact

Dr Mohammed M. Basha’s “Practical Pointer” recommendationthat patients determine how much medication is leftin their inhaler by placing the canister in a glass of water(CONSULTANT, April 1, 2003, page 502) is, unfortunately,not sound.