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My patient is a 30-year-old woman who has used metoclopramide for years forabdominal pain.

An 80-year-old woman complains of left hip painthat started after she fell while feeding her cat. The painis moderately severe and is localized to the left hip; itdoes not radiate. The patient is unable to bear any weighton the injured hip but denies numbness in her left leg.There are no other injuries.

Osteoporosis is no longer consideredage- or sex-dependent, although prevalencevaries by sex and race. Postmenopausalwhite women suffer almost75% of all hip fractures and havethe highest age-adjusted rate of fracture.Thanks to progress in our understandingof causes and treatments, thisdisease is largely preventable, and significantimprovements in morbidityand mortality are possible. The beststrategy for prevention and treatmentuses a team approach that involves thepatient, physician, health educators, dietitians,and physical therapists.

Are there any generally accepted guidelines for performing arthrocentesis in patients who are receiving anticoagulants?

Students have asked me about the supplement phosphatidylserine (PS), which is used by body builders and is also touted as a memory aid. I have searched the medical literature but have found PS discussed only in conjunction with cell apoptosis. Can you give me any information about this supplement?

What's the best way to treat iron deficiency in patients who are unable to tolerate oral iron?

An 89-year-old hemiplegic man is seen for a routine physical examination. Major right brain stroke produced permanent dense left-sided motor deficit years ago. Has related vascular dementia.

A 28-year-old woman complains of intermittentright upper quadrant pain.The patient is thin, and she is not inacute distress.

Infection with hepatitis C virus (HCV) was recently diagnosedin a 45-year-old man when a positive enzyme-linked immunosorbentassay was followed by a polymerase chain reaction assaythat showed a viral load of 835,000 copies/mL. The patient probablyacquired the infection when he was using intravenous heroin, a practice he quit 10 yearsago. The patient is immune to both hepatitis A and hepatitis B viruses, and there is no coinfectionwith HIV. Liver biopsy shows moderate cellular inflammation (grade 3) and bridging fibrosis(stage 3) but no evidence of cirrhosis. Iron staining shows no abnormal iron deposition in theliver. The HCV genotype is 1A.

My patient, a 33-year-old man who works with his hands, presented with a growthunder his left thumb nail (Figure).

Two of my patients are older men (aged 62 years and 68years) who have benign prostatic hyperplasia; their prostatesare soft and nontender.

We read with great interest the “Dermclinic” case of a 44-year-old man with achanging pigmented lesion on his trunk (CONSULTANT, March 2001, page 354).

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.