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When treating a patient with an injuredhand, remove all rings as soonas possible.

A 66-year-old woman presents tothe emergency department(ED) with exertional dyspnea, generalizedweakness, and orthostaticdizziness; the symptoms startedabout 1 week earlier and have progressedinsidiously. The patient alsoreports diaphoresis and nausea withoutvomiting. She has no chest pain,palpitations, cough, or hemoptysis;she has not had a recent respiratorytract infection. While she is waitingto be admitted, she has an episode ofsyncope.

The continuous light projected intothe eye during a fundus examinationis unpleasant for patients.

For gynecologic examinations, coverstirrups with seasonally appropriatesocks that have patterns such ashearts, Christmas motifs, shamrocks,or American flags.

To expedite referrals, make multiplecopies of the letterhead of frequentlyused specialists.

I applaud Dr Anil Mandal’s 2 articleson edema (CONSULTANT, August2004, pages 1221 and 1245, respectively).

A 16-year-old boy presents with severe left shoulder pain that began 20 minutes earlier when heslipped while walking down an incline and attempted to prevent a fall by grabbing a nearby structurewith his left hand. As his body went forward, the left shoulder was abducted and externallyrotated. The accident caused him immediate pain, and any subsequent movement of the injuredshoulder increases the pain. Previously, the patient was healthy.

A 24-year-old man seeks medical attention 3 weeks after he injured his little finger playingfootball. He reports that the finger “came out of place” at the middle knuckle (proximal interphalangeal[PIP] joint); he quickly put the finger back into place himself, quit playing, andiced it. About 2 hours later, he was unable tomove the finger without significant pain, andthe following day, inability to move it interferedwith his performance of tasks that requiredfine manual dexterity. Since then, thepain has decreased, but the finger remainsswollen and he has not been able to fully extendit at the middle knuckle. In addition, thetip of the injured finger is hyperextended.

If elderly patients or those withchronic lung disease have troubleholding their breath in while you tryto listen for carotid bruits, have themtake a deep breath, exhale, and holdtheir breath out.

To allay children’s fears about immunizationsor allergy shots, keep apocket-sized, battery-operated radioin the office.

Long-term nasal spray use carriesthe potential for rebound congestion.

A 42-year-old man complains of persistent right shoulder pain that for the past 6 months hasprevented him from participating in his usual weight-lifting routine and affected daily activities.He is able to comb his hair and scratch his back with his right hand with no increase in pain, butreaching across his body causes discomfort. NSAIDs provide only modest relief.

Many women have difficulty in rememberingto take their birth controlpills every day.

A 101-year-old woman has had an occasionallypruritic and tender growthon her face for about 2 months. Thegrowth has doubled in size over the past2 weeks. She has no personal or familyhistory of cancer or significant dermatologicdisorders.

A 59-year-old woman complainsof progressively worsening bloatingand right upper quadrant pain thatbegan 1 day earlier. She denies feverand trauma. Her medical history includescholecystectomy for cholelithiasisand several emergency departmentvisits for treatment of woundssustained in falls. She has a history ofalcohol abuse, for which she now receivescounseling. However, she admitsthat she occasionally has boutsof heavy drinking.

Here's an effective and fun way tohelp toddlers with toilet training.

A painful scalp eruption of 4 days’duration brings an 81-year-old man toyour office. He has taken a lipid-loweringagent and an antihypertensivefor years but has not started any newmedications recently. One week earlier,he had a haircut. He denies recenttrauma to the scalp.

Thick, dry calluses on the heel canbe painful and can bleed if they crack.I have found this at-home treatmenteffective.