An 84-year-old woman presents with a 3-year history of slowly progressivememory impairment accompanied by functional decline. Thepatient lives alone but has been receiving an increasing amount of support from her 2 daughters,who accompany her to the appointment. The daughters first noticed that their mother was havingtrouble driving. About a year ago, she started forgetting family recipes. She also left food cookingon the stove unattended and burned several pans. Currently, the daughters are providing mealsand transportation, assisting with housework, and doing their mother’s laundry. They have becomeincreasingly alarmed because she takes her medications only sporadically, despite the factthat they fill her pillboxes and call her regularly with reminders. Their chief concern is whether itis safe for their mother to continue to live alone.

Exercises that help strengthen themuscles that support the spinemay be especially helpful duringthe postmenopausal years. Theback extension series illustratedin Figures 1 through 5 is anexample of progressively moredifficult exercises that can beperformed several times perweek. These exercises can alsobe performed individually inconjunction with resistance andweight-bearing routines.

Pellets from a BB gun can lodgetoo deep in the flesh to be retrievedwith ordinary forceps.

This reference provides rapid access to a wealth of diagnostic and therapeuticinformation. The text is divided into 5 sections

During the past few weeks, a 14-year-old boy has noticed blood on the proximalnail folds of the second and third fingers of his dominant hand. He deniesany pain or pruritus. The patient is otherwise healthy and takes no prescriptionmedications.

A 13-year-old boy complains ofpain in his right hip. The pain began3 days earlier after he was tackledseveral times while playing footballwith his friends. He was able to walkhome. The pain has increased sincethat time. Although the patient is stillable to walk, he now has a limp andfavors his left leg. The patient isotherwise healthy and has no significantmedical history.

About 30% of American adults are obese, and an additional34% are considered overweight. As the prevalence of obesityincreases, so does the incidence of related medical disordersand mortality. Here a team of experts highlights the clinicalimplications of recent research on obesity.

A39-year-old man is brought to theemergency department (ED)after his car struck a tree. He experienceda transient loss of consciousnesswith a 3-minute episode of retrogradeamnesia at the scene of the accident,despite wearing a seat belt andshoulder harness. He was disorientedto date and place.

Tanisha, 12 years old, comes to your office with left knee pain. Her father says she has complainedfor about 10 days, but she insists that the pain began about 3 weeks ago. When askedabout the quality of the pain, she responds by saying, “It just hurts.” She denies any injury ordiscomfort involving the hip or ankle and direct trauma to the knee. She rarely plays sportsor games that involve intense running or other physical activity. There is no recent history offever or respiratory or GI symptoms.

To improve the results of your abdominalexaminations-while keepingpatients calm-start with yourhand flat in contact with the anteriorabdominal wall.

A 32-year-old man presents to the emergency department(ED) with generalized joint pain of several days'duration, which he believes is a sickle cell crisis similarto others he has had. He says that 4 to 6 mg of oralhydromorphone usually relieves the pain of these crises,but he recently ran out of his medication and is unableto contact his primary care physician because she ison vacation. He frequently interrupts to ask for a 6-mghydromorphone injection.

To reduce the terrible nausea andvomiting associated with chemotherapy,have patients drink club soda withlemon or lime an hour before mealtime.

Removal of a foreign body embeddedin a patient’s cornea can be a challenge.Needles so close to the eyecause patient apprehension.

A 51-year-old man with hypertension, type 2 diabetes mellitus, and hypercholesterolemiapresents with a 1-hour history of substernal chest discomfort anddyspnea. He was given sublingual nitroglycerin in the emergency department,but his symptoms did not resolve.

Chronic obstructive pulmonary disease(COPD) is the fourth leadingcause of chronic morbidity and mortalityin the United States.1 Its prevalenceand impact are increasing,and the World Bank/World HealthOrganization has projected that it willrank fifth in 2020 as a global burdenof disease.2,3 The economic and publichealth impact of COPD is staggering,because this chronic conditionrequires long-term care, frequentoffice visits, and use ofemergency department and hospitalservices. Thus, there is a pressingneed to discover new therapies thatcontrol symptoms and prevent diseaseprogression.

The parents of a 6-year-old child are concerned about blisterson her hands that erupted 3 days earlier and are spreading. The child isotherwise healthy and had attended a summer day camp. The parents areunaware of any trauma or exposure to allergens or toxic substances.

A major controversyin cardiologytoday iswhether loweringthe level oflow-density lipoprotein cholesterol(LDL-C) to substantiallybelow 100mg/dL-the current NationalCholesterol EducationProgram goal for patientswith existing coronaryheart disease1-willfurther reduce the incidenceof cardiovascularmorbidity and mortality.

An 88-year-old woman is admitted for severe dyspnea thathas worsened over the past month. Dyspnea on exertionis now elicited by everyday activities, even walking acrossthe room. Orthopnea and paroxysmal nocturnal dyspneahave progressed to the point that she has been unable tosleep at all the past several nights. She also tires very easilyand thinks her ankles are more swollen than previously.She denies chest pain or pressure.

For several months, a 16-year-old girl has had an asymptomatic papulosquamousdescending linear eruption on 1 leg.

A 34-year-old man has had Crohn disease for 12years. He presented initially with ileitis and has had 3surgeries for obstructive complications. Ileum resectionhas resulted in bile salt and fat malabsorption. Recently,the Crohn disease has spread to the large bowel. For thelast 2 years, he has also had seronegative spondyloarthropathy-another complication of Crohn disease.