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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.

“Put yourself out of business"

A 59-year-old woman presents with generalized facialswelling and dyspnea that has progressed graduallyover the past month. The patient also reports a sensationof pressure in her neck and ears and swelling of the lowereyelids, neck, upper chest, and upper limbs. The bloodvessels on her upper chest are prominent. A dry, irritatingcough has worsened.

When you examine a tender abdomen,palpate as lightly as possible while youask about the patient’s job, family, andhobbies.

I recommend a simple exercise tohelp would-be joggers avert laterproblems.

I recently diagnosed type 2 diabetes mellitus in a 33-year-old man who has no diabeticsymptoms, proteinuria, or evidence of nephropathy. His blood pressure is low(100/60 mm Hg).

Patients on a low-fat diet who dislikethe color, taste, or consistency of fatfreemilk can try adding nonfat milkpowder.

My patient has a test-proven Candida allergy. Because hepatitis B virus (HBV)vaccine contains yeast, another physician would not give it to him. I administereda diluted dose and then a full-strength dose of the HBV vaccine, and the patienthad no adverse reaction.

What is bovine spongiform encephalopathy(BSE), or “mad cow disease,” and how is itthought to infect cattle?

All too often, when lancing a sebaceouscyst or abscess, or when relievingpressure from a traumatizednail bed, both practitioner and assistantare splattered with the materialthat is released.

Many of my patients with chronic pain are women who are depressed and whohave experienced a tragedy of some sort in their past.

To facilitate the swallowing movementsthat are key to the examinationof neck swellings-particularlythose of the thyroid gland-give thepatient a full cup of water and askhim or her to drink it slowly whileyou examine the neck.

Children and adults who have troubleswallowing pills can practice with anempty over-the-counter drug capsule.

Pandemics attributable to different influenza A virus subtypes occurredat irregular intervals throughout the 20th century. Because the timingof a pandemic cannot be predicted, we must be prepared for such an outbreak.Although influenza is generally viewed as an illness with potentiallydeadly effects primarily for elderly persons, it can lead to significant morbidityand mortality in otherwise healthy infants and toddlers and in other highriskgroups.

An electric heating pad can burn patientsif they fall asleep while usingit.

A 68-year-old man with severe emphysema complains ofchest pain that began that morning. He has also had intermittentdiarrhea and occasional blood in his stool for thepast 2 weeks.

When you examine patients withGraves disease, be careful when youpalpate the enlarged thyroid gland.