The authors of the Women’s HealthInitiative (WHI) study involving50,000 postmenopausal women concluded thata low-fat diet (goal: 20% of total calories) had no significant effect on the incidence of breast cancer, coloncancer, or heart disease. What should we be telling our patients?
A 3-day history of intermittent fainting spells brings a 49-year-old man to youroffice. His only significant medical history includes seasonal allergic rhinitis,for which he takes terfenadine, and mild depression, which is being treatedwith amitriptyline. A week ago, he began taking erythromycin, 500 mg qid,for acute pharyngitis.
A 41-year-old man is admitted for evaluation of acutechest pain, which started while he was watchingtelevision after dinner. The retrosternal pain was sudden,severe, pressing, and stabbing; it radiated to the neck andwas associated with dizziness and diaphoresis. The patientrated the pain as 9 on a scale of 1 to 10 (10 being the mostsevere). In the emergency department, he was given2 sublingual nitroglycerin tablets, which promptly relievedhis pain.
The pyoderma gangrenosum on theright anterior tibial area of a 40-yearoldman was thought to be associatedwith his rheumatoid arthritis. However,the cause of many of these ulcersis unknown. The patient could not recallany recent trauma. At least half ofall pyoderma gangrenosum lesionsoccur in persons who do not have associateddiseases.1
A tiny papule that arose after minortrauma to her finger marked theonset of this lesion, according to the48-year-old patient. She reports thatthe papule rapidly evolved into apustule that grew within 2 weeks intoa painful, undermined, purple-edgedulcer. The lesion did not respond toantibiotic therapy. The patient had rheumatoid arthritis.
A 57-year-old man was referred forevaluation of an enlarging, painful,irregular ulceration on his lower abdominalwall. The patient recalledhaving a small, red, “blister-like” lesionthat had rapidly expanded to itscurrent size of 2.5 * 4.5 cm. Hedenied specific injury to the skin;however, he often wore jeans thatrubbed the area. The patient wastaking ibuprofen for seropositiverheumatoid arthritis.
Delirium in older adults needs to berecognized early and managed as amedical emergency. Prompt detectionand treatment improve both shortandlong-term outcomes.1,2 Becausedelirium represents one of the nonspecificpresentations of illness in elderlypatients, the disorder can be easilyoverlooked or misdiagnosed. Misdiagnosismay occur in up to 80% of cases,but it is less likely with an interdisciplinaryapproach that includes inputfrom physicians, nurses, and familymembers.3
Q:What is the best screening test for suspectedrenal artery stenosis?
Although inhaled corticosteroids play a major role in the management of asthma, their effects on bone mineral density (BMD) are a concern for some patients. Fuhlbrigge and associates evaluated the cost-effectiveness of such therapy in light of the potential adverse effects on BMD. They found that inhaled corticosteroid therapy compares favorably with other standard medical interventions. However, the use of high doses over an extended period can affect overall costs and health.
A 66-year-old man presented with weight loss for 2 months, loss of appetite for several weeks, and abnormal chest radiographic findings. He denied chest pain, cough, fever, chills, shortness of breath, and chest trauma. He was an active smoker, with a 50-pack-year history of smok- ing, and a cocaine and alcohol abuser. His history included treatment of hypertension for 10 years and treatment of pulmonary tuberculosis 14 years previously.
Although most patients with frontal rhinosinusitis improve with medical therapy, those with persistent symptoms resulting from anatomic obstruction of the frontal sinus drainage pathways may be candidates for surgery. Over the past decade, traditional external approaches to the frontal sinus have been largely replaced by endoscopic procedures.1 These are performed with a small-diameter rigid endoscope that is passed through the nostril, avoiding the need for facial incisions. Instruments passed alongside the endoscope are used to remove obstructing tissue and drain the infected sinus.
Your elderly patients may not report a fall to you. Unless they are hospitalized for a severe injury, such as a hip fracture or subdural hematoma, many patients do not discuss falls. What constitutes an optimal strategy for evaluation and prevention of falls?
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.
