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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.

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.

To make a tool for checking nearvision, use glue to attach a spring clipto the end of a 16-inch-long 1/2-inchwooden dowel, then place a Snellennear vision card in the clip.

To remove impacted cerumen, attacha 16-gauge catheter to a 10-mL syringe(you may use a smaller or largersyringe if you prefer).

I usually collect a urine sample aspart of a complete physical examination.

For nearly 3 years, my patient has had frequent recurrences (now, almost monthly)of erythematous, slightly pruritic lesions on the lower back, inguinal area, orbuttocks-but never on the genitalia.

An 84-year-old man complains of worsening angina pectoris that started3 months earlier. The patient has had aortic stenosis for about 10 years. Healso has diabetes, which is controlled with oral agents.

When a patient presents with a handinjury, here is a quick and simple wayto assess the integrity of the nervesthat supply the muscles in the hand.

Which antithrombotic regimen is most appropriate for apatient with systemic lupus erythematosus and anticardiolipinantibody syndrome who has had a previous infarct?

A 75-year-old man with coronaryartery disease presents to the emergencydepartment with abdominalpain and light-headedness. The painbegan as a dull ache 4 days earlierand recently became considerablyworse. The patient denies recenttrauma, fever, nausea, vomiting, and diarrhea.

Instead of shaving a patient’s head toprepare a scalp wound for suturing,apply a sterile water-based lubricantto the surrounding hair.