An 86-year-old woman complains that she has felt "not at all well" for the past day. Her symptoms include diffuse generalized weakness and nausea; she denies chest pain, shortness of breath, abdominal pain, leg swelling, palpitations, and light-headedness. Five years earlier, a pacemaker was implanted as therapy for sick sinus syndrome and atrial fibrillation.

The mother of this 3-year-old boy noticed that his smile was asymmetric when he awoke that morning. He had been seen 3 days previously for left ear discomfort, sore throat, and a low-grade fever. Otitis media was diagnosed, and amoxicillin was prescribed.

An 82-year-old woman presents with a history of sporadic episodes of light-headedness that began several months earlier and are becoming progressively more frequent. The episodes are unrelated to time of day, degree of activity, or posture. They cause her to feel as if she will lose consciousness, although she has never experienced total syncope.

Our goal here is to help you master the shoulder examination. We review the basics of the examination, and we evaluate emerging concepts in the diagnosis of the more common shoulder conditions.

What tests are recommended for monitoring a patient with sarcoidosis? Should Holter monitoring, eye examination, and measurement of ionized calcium levels be routinely included?

Learn from the mistakes of your colleagues--don't end up in the emergency room for an accidental needle stick!

The posterior aspect of the throat and the tonsils can be difficult to see in some patients because they gag or are unable to open their mouth wide enough.

Help your patients keep track of any allergies they have to medications.

Despite major advances in contraception that occurred during the 20th century, about 49% of pregnancies in the United States are unintended. More than half of these pregnancies end in abortion.

A 16-year-old football player complains of increasing pain in the ring finger of his right hand. It began 2 days earlier, when he tried to tackle a running back by grabbing the player's jersey; he felt immediate pain and was unable to continue holding on to the jersey.

The most common chronic blood-borne infection in the United States is caused by hepatitis C virus (HCV), an RNA virus transmitted through blood-to-blood contact. In this article, we identify risk factors for HCV infection and discuss which patients should be tested and treated.

My patient complains of chronic fatigue. Her complete blood cell count and thyroid-stimulating hormone level are normal. Would it be worthwhile to measure her dehydroepiandrosterone sulfate (DHEA-S) level?

Rheumatoid arthritis (RA) affects 1% ofadults during their most productiveyears and can result in significant disability.The goals of therapy are to reducepain, limit joint destruction, andpreserve function.

A34-year-old woman presents to the emergency department(ED) with rapidly progressive dyspnea.The patient has a history of metastatic vaginal clearcell adenocarcinoma secondary to diethylstilbestrol exposurein utero. Following her diagnosis in 1990, she wastreated with surgery, chemotherapy, and radiation. Shehad done well for years until a recurrence of the cancer tothe left lung was found last year. She completed a courseof chemotherapy with doxorubicin hydrochloride andcisplatin 1 month ago.

Patients who are told how to breatheinto a peak flow meter often try formaximum volume rather than flow.

To facilitate insertion of an anoscopeor sigmoidoscope in a tense and anxiouspatient, ask him or her to beardown, simulating defecation.

I suspect that my patient has hereditary angioedema (HAE). During her lastpregnancy 2 years earlier, she had severe preeclampsia.

A 34-year-old woman awoke with apainful, crusted ulcer on her upperarm. She has been repairing dry wallin her home but recalls no trauma.The necrotic ulcer features an erythematousborder.

An 83-year-old man complains of weakness, easy fatigability, and poor appetitethat began 4 to 6 weeks ago. He becomes short of breath on his daily walksand has lost about 20 pounds over the last 3 months. He denies nocturia,paroxysmal nocturnal dyspnea, exertional chest pain, fever, cough, melena,and hematochezia. His only GI symptom is occasional crampy abdominal painwith bowel movements.

Many of the approximately 12.4 million Americans whohave cardiovascular disease are not being treated with themost up-to-date risk-reduction therapies.1 Strong evidencefrom recent studies, such as the National Heart, Lung, andBlood Institute’s Adult Treatment Panel III report2 and theHeart Outcomes Prevention Evaluation (HOPE) trial,3demonstrate the need for more aggressive use of appropriatemedical and lifestyle therapies for these patients.