Smallpox, which is caused byinfection with poxvirus variola,may follow variouscourses. An erythematouseruption can precede theappearance of tense, deep-seatedpapules that rapidly transform intovesicles. The lesions may be sparseor so numerous that they becomeconfluent.
The emphasis in this clinically focused text is on syndromesand patient care rather than on pathogens. Among the topicscovered are antimicrobial pharmacokinetics and pharmacodynamics;head and neck infections; upper respiratory tractinfections; bronchitis and pneumonia; endocarditis; pericarditisand myocarditis; peritonitis, liver abscess, and biliary tractinfections; viral hepatitis; CNS infections; skin and soft tissueinfections; animal and human bites; osteomyelitis and infectiousarthritis; foot infections in patients with diabetes; scarletfever and toxic shock syndromes; fever of unknown origin;bacterial, viral, and protozoal diarrhea; obstetric-gynecologicinfections; urinary tract infections; sexually transmitted diseases;infectious complications of HIV infection; tuberculosis;tropical diseases; zoonoses; bioterrorism; and fungal infections.Color and black-and-white photographs, photomicrographs,CT scans, radiographs, drawings, tables, and flowchartshighlight seminal points in the text.
A 32-year-old woman is admitted to the hospital because of nausea, vomiting,and mild jaundice. For 4 days, her health has steadily deteriorated: hepatictransaminase and bilirubin levels are elevated, prothrombin time is prolongedand, most recently, obtundation and changes in mentation have developed.Serologic studies for infection with hepatitis A, B, and C viruses are negative,as are tests for Epstein-Barr virus mononucleosis.
Any discussion of theutility and reliabilityof mammography mustfocus on what is good forindividual patients-not onwhat the results of a Europeanpublic health researchproject have determined isgood for society as a whole.What is good for most patientsis annual screeningmammography beginningat age 40 years (and for patientsat very high risk forbreast cancer, mammogramsbeginning much earlier,and possibly performedmore frequentlythan once a year).1
In the recently published Seventh Report of the Joint NationalCommittee on Prevention, Detection, Evaluation, and Treatment ofHigh Blood Pressure (JNC 7), a new category, called "prehypertension,"was added in the classification of blood pressure (BP). What was therationale for this addition?
A 52-year-old woman is hospitalized because she has had jaundice, anorexia,and occasional nausea and vomiting for about 2 weeks. She has also had moderatepain in the epigastrium and right upper quadrant, but it has not been severeenough to require analgesics. She denies hematemesis and hematochezia.
To improve compliance in patientswith diabetes mellitus who measureglucose levels 4 times a day (beforeeach meal and at bedtime), offerthis alternating, twice-daily option.
An 87-year-old man had recently been hospitalized for5 days for treatment of hypernatremia and dehydration.His condition improved following hydration and cautiouscorrection of the hypernatremia, and he was discharged.However, within 48 hours the patient's caregiver notedthat he was obtunded and less responsive; she broughthim to the emergency department.
Highlights:Unique features of depression in the elderly.Keys to picking up the diagnosis.Pharmacologic treatment.When to recommend referral.
An 81-year-old woman is hospitalizedwith localized nonradiating low backpain of 3 weeks’ duration. She has nohistory of trauma, weakness of the legs,or urinary or bowel incontinence.
A 23-year-old woman has had 2 episodesof syncope during the past month.Her mother witnessed 1 episode inwhich the patient collapsed and lostconsciousness for a few minutes. Sheexperienced tonic-clonic seizure activitybut no subsequent confusion.
In his article “High-Risk Hypertensive Patients: How to Optimize Therapy UsingACE Inhibitors and ARBs” (CONSULTANT, October 2003, page 1390), Dr JanBasile recommends angiotensin-converting enzyme (ACE) inhibitors for patientswith type 1 diabetes with or without hypertension, whether or not nephropathyis present.
An 84-year-old man with back and abdominal pain ofrecent onset arrives at the emergency department(ED) of a small community hospital at 5 AM. Sudden,severe back pain awakened him from sleep 2 hours earlier.The patient has had back pain for 12 hours and intermittentcolicky pain in the suprapubic region for the past2 hours.
A 45-year-old woman is admitted for evaluation of intermittentmidsternal chest pain that began 48 hours earlier.The pain is intense and radiates down both arms to theelbows; it has been accompanied by several episodes ofnausea and diaphoresis. She denies classic angina pectorisbut reports that she has experienced episodes of chestdiscomfort that is similar to her current pain-but muchless severe and without radiation-for about 3 months.She has no history of dyspnea on exertion, orthopnea, orparoxysmal nocturnal dyspnea.
Oral corticosteroids arecommonly used inambulatory patientsas short- or long-termtherapy for a numberof diseases. For example, patientswith acute exacerbations of asthmaor chronic obstructive pulmonary diseaseare routinely given 1- to 2-weekcourses of prednisone, methylprednisolone,or another oral corticosteroid.In addition, oral corticosteroidsare used as maintenance therapy inpatients with such conditions assystemic lupus erythematosus, sarcoidosis,and post-organ transplantcomplications.
An 18-year-old college studentpresents with a 4-day history ofincreasing throat pain, low-gradefever, and extreme exhaustion. Previously,she had been healthy and participatedactively in sports, includingmarathon running. Her appetiteand intake have been poor. No historyof cough, chest pain, shortness ofbreath, nausea, vomiting, diarrhea,or abdominal distention. She has noallergies, takes no medications, anddoes not smoke or drink alcohol.She is sexually active with a single partner.
The scientific literatureon screeningmammography can be confounding.This poses a continuingdilemma for bothpatients and clinicians. Nevertheless,objective analysisof the available data canprovide reasonable guidelinesfor the primary careclinician who must decidewhether screening mammographyhas benefit foran individual patient.
A 52-year-old man presented to theemergency department (ED) with a12-hour history of cramping abdominalpain, nausea, vomiting, andwatery, brown diarrhea. Mid upperquadrantpain had begun suddenlythe night before, 1 hour after the patienthad lifted heavy bags of rocks.The GI symptoms persisted with varyingintensity throughout the night.
If you are a long-time reader of this journal, you may rememberthe photographs of authors that once gracedthe cover of every issue of Consultant. The May 1979issue of Consultant featured the picture of Donald Vidtyou see here; for that issue, Dr Vidt wrote “FiveMajor Vasodilators: How They Work” and advised readersabout the cardiovascular and renal hemodynamics ofhydralazine, prazosin, diazoxide, nitroprusside, and (atthat time the investigational agent) minoxidil. A quarter of a century later,Dr Vidt is still writing on the treatment of hypertension for readers of thisjournal-and it is with real pleasure that we introduce him here as a memberof our editorial board.
When a peak flow meter is not immediately available, testfor obstructive lung disease by asking the patient to fill hisor her lungs completely and then rapidly expel the air.