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Abstract: Elderly persons with active tuberculosis may present with the classic features, such as cough, hemoptysis, and fever, but some patients present with less typical signs, such as hepatosplenomegaly, liver function abnormalities, and anemia. A high index of suspicion is required when a patient presents with cough or pneumonia unresponsive to conventional therapy. Acid-fast smear and mycobacterial culture of a sputum specimen are recommended for diagnosis. For an elderly patient who tests positive with purified protein derivative, 9 months of isoniazid prophylaxis is recommended. For patients who are intolerant of isoniazid or have been exposed to or infected by an isoniazid-resistant strain, rifampin single-agent preventive therapy may be an effective alternative. (J Respir Dis. 2006;27(7):307-315)

Patients with allergic rhinitis are genetically predisposed to producing specific IgE antibodies in response to environmental allergens, such as tree, grass, or ragweed pollen or cat, dog, or dust mite allergens. Patients must have symptoms suggestive of allergies and positive skin or serologic test results that correlate with their symptoms.

Rates of gonorrhea and chlamydial infection are highest among females 15 to 24 years old. Annual screening of all sexually active adolescents is warranted.

During a routine eye examination for contact lenses, a visual field defect was found in the left eye of a 27-year-old man. The patient had not noticed any vision changes.

Easy Gait Exam

The best place to evaluate a patient's gait is not the exam room, but the waiting room.

Patients often complain that ointments are greasy and stain clothing. Here's how to solve the problem and encourage compliance.

Grover Disease

A 60-year-old man presented with a pruritic rash on the chest and abdomen that had developed over a week in the summer, after a spate of yard work. The patient had multiple excoriated erythematous papules, some of which were hyperkeratotic. Joe R. Monroe, PA-C, MPAS, of Oklahoma City reports that biopsy of one of the lesions revealed epidermal hyperkeratosis and acantholysis, which confirmed the clinical diagnosis of Grover disease, or transient acantholytic dermatosis.