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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.

After cimetidine was releasedin the late 1970s,case reports of clinicallysignificant drug interactionsquickly emerged.1-3Controlled trials soon validated theseinitial clinical observations. Since1983, when a comprehensive reviewof cimetidine drug interactions waspublished,4 more interactions havebeen reported, as use of this agenthas increased because of cost constraintsand the rapid growth of managedcare. Examples of well-documentedinteractions are listed in theTable.

Soaking a small child’s injured handsin water to clean them can be difficultand traumatizing.

When you examine a young child’sear, have him or her sit sideways onthe parent’s lap.

Three years ago, my patient sustained a burn from a hot greasespill. Biopsy has shown that the nubby areas (Figure)are live skin; however, I am unsure of how to treat thewound.

Use this ABCDE mnemonic to distinguishnecrotizing fasciitis, which usuallyrequires surgery, from cellulitis,which can be treated with antibioticsalone:

Cuts from coral are notorious forhealing slowly and painfully, primarilybecause proteinaceous material fromthe live coral is deposited into thewound.

A 38-year-old overweight woman presents with an asymptomatic rash ofat least 2 months’ duration that had not responded to a combinationcorticosteroid/antifungal agent. She has mild hypertension and type 2 diabetesmellitus that is being managed with diet and exercise. She is otherwisehealthy.

In response to Dr Joseph Schube’s inquiry about a puzzlingurine culture that showed &#946-hemolytic streptococci (CONSULTANT,July 2002, page 974), I suggest that he consider oralintercourse as a possible source of the infection.

My patient is a 10-year-old boy with asthma. After an exacerbation of his asthmawas treated with albuterol and solumedrol, his blood glucose level was 250 mg/dLwith 1+ glucosuria (no ketones).

One of every 4 women older than 45 years-and 9 of every 10 women older than75-has osteoporosis. Here the editors take a novel approach to this “silent epidemic.”Chapters dealing with basic science questions and findings are juxtaposed withchapters covering similar issues from a clinical standpoint. Traditional issues, suchas calcium supplementation and exercise, are coupled with state-of-the-art updateson molecular pharmacology and ultrasound imaging. On the basic science side,topics include the genetics of osteoporosis, molecular bone turnover markers, androgensand skeletal homeostasis, biology of estrogen and bone, and cellular and molecularaspects of immunosuppressant osteoporosis. On the clinical side, expertspresent the latest thinking on bone densitometry, therapy with vitamin D and itsmetabolites, salmon calcitonin, parathyroid therapy, bisphosphonates, and selectiveestrogen receptor modifiers. CT and ultrasound scans, photomicrographs, tables,and charts accompany the well-referenced text.

A 72-year-old farmer is brought by his daughter for a comprehensivegeriatric assessment. His previous history is unremarkable. The patientreports that he has had vivid visual hallucinations, which he calls "visitors." He becomes frightenedand hostile when these incidents occur; on several occasions, he has exhibited violent behavioras persons around him tried to calm him. Although the patient was able to recall each episode indetail, he felt as if he had watched it from a distance and had not been an active participant.