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.
To palpate the abdomen in a ticklishpatient, begin by placing the patient’shand on the abdomen in a pain-freearea.
Taking histories of upper respiratorytract infections in elderly persons orchildren can be difficult because thesepatients may have trouble describingthe color of sputum or discharge.
A 49-year-old man complains of sharp pain in the medial left ankle that begansuddenly 3 nights earlier, waking him up. That night he also felt feverish anddiaphoretic, but those symptoms have subsided. The pain is present whenhe moves the ankle or when a shoe compresses the area. No other joints areinvolved. He denies trauma to the ankle or foot.
A consensus panel of experts recently updated the Beerscriteria, one of the most widely used guidelines for medicationuse in older adults.1 Listed in the Table are medicationsthat should generally be avoided in persons aged 65and older-regardless of diagnosis or condition-eitherbecause the agents are ineffective in these patients or becausethey pose unnecessarily high risks.
Instilling a 1:1 solution of hydrogenperoxide and warm water with a dropperto remove cerumen is difficult forpatients to do by themselves.
After I have treated patients for ingrowntoenail, I suggest that they preventrecurrences by regularly filingthe central portion of the nail to keepit thin.
A 27-year-old woman with a 2-dayhistory of nausea, vomiting, andpostprandial abdominal pain is admittedto the hospital. Acute cholecystitisis suspected
In his "Consultations & Comments" response to a reader’scomments about statins and cancer risk in elderly patients(CONSULTANT, October 2003, page 1389), Dr David Nashnotes that the increased number of deaths from cancer thatoccurred in the second year of the Pravastatin in Elderly Individualsat Risk of Vascular Disease (PROSPER) study canprobably be attributed to disease that was already present beforethe start of the trial.
In his Hypertension Q&A, “When Snoring Has More OminousConsequences Than a Sleepless Spouse” (CONSULTANT,October 2003, page 1410), Dr Donald Vidt suggestsseveral questions that a physician can ask patients to screenfor obstructive sleep apnea (OSA).
A number of my patients have very high high-density lipoprotein cholesterol (HDL-C)levels as well as elevated total cholesterol and low-density lipoprotein cholesterol(LDL-C) levels. One such patient is a nonsmoking middle-aged woman whose weightand blood pressure are normal.
For 2 days, a 49-year-old man with hypertension and hypercholesterolemiahas experienced light-headedness and fatigue.Based on the presenting ECG, what is the most likely cause of hissymptoms?A. Accelerated junctional rhythm.B. First-degree atrioventricular (AV) block.C. Mobitz type I (Wenckebach) second-degree AV block.D. Mobitz type II second-degree AV block.E. Third-degree AV block (complete heart block).
I recently returned from an extended trip overseas during which my carry-on bagcontaining medications was scanned by several screening machines-both the conventionaltype and the new CT type.
