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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.

This tip can enhance the effectivenessof cryotherapy for warts.

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.

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.

Urinary incontinence affects as many as 22% of men aged 65 years and older1 and 50%of postmenopausal women.2 Yet many patients are reluctant to seek treatment of theirsymptoms, even though the impact on quality of life is significant.

When parents ask how to dose acetaminophenfor a child under 2 yearsof age, base the dosage on the child’sweight.

My patient is a woman in her midtwentieswho recently presented with anerythematous, slightly pruritic lesionon her thigh.

If patients who lift weights complainthat their teeth ache after lifting,advise them to wear a tooth guard.

An effective way to coax children tolie down for an abdominal examinationis to announce that you canguess what they ate for their lastmeal by feeling their belly-then invitethem to lie down so that you candemonstrate your powers.

Elderly patients with Alzheimer diseaseor dementia frequently refuseto be examined or have a physical.

A 64-year-old woman complainsof neck fullness that has increased inthe last few months. She has occasionaldyspnea but denies fever, cough, andhemoptysis. Hypertension is well-controlledwith propranolol.