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CRS is the most common chronic disease in the United States, affecting 17.4% of adults, with an estimated direct cost of $5.6 billion yearly.1,2 There frequently is no definitive or quick cure. The clinical diagnosis of CRS is based on the presence and persistence of certain symptoms. The finding of mucosal thickening on coronal CT scan of the paranasal sinuses strengthens the clinical diagnosis.

Most of the symptoms of allergic rhinitis, including nasal obstruction, rhinorrhea, sneezing, and nasal itching, respond to intranasal corticosteroids administered once or twice daily. However, many patients also need to take an antihistamine for adequate control of symptoms. While an antihistamine/decongestant combination can provide symptomatic relief, it fails to address the inflammatory component of allergic rhinitis. Thus, combining an intranasal corticosteroid or oral leukotriene modifier with an antihistamine might be a more effective strategy. Factors that can facilitate treatment adherence include minimizing the number of daily doses, allowing patients to select their own dosing schedules, and providing written instructions. Specific immunotherapy can be beneficial in select patients whose allergic rhinitis symptoms are not sufficiently controlled by pharmacotherapy. (J Respir Dis. 2005;26(5):188-194)

Menstrual disorders are one of the most common complaints of women seen in primary care. Abnormal uterine bleeding (AUB) is a broad term that encompasses bleeding at abnormal or unexpected times or excessive flow at times of expected menses.

A 17-year-old girl had a "mole" on the chin since childhood. The ovoid lesion had grown slightly over the previous few years, but it had maintained the same general configuration. A prominent duality of pigmentation, with the center being darker than the periphery, was noted.

My healthy 74-year-old patient exercises 30 minutes 3 times a week and 60 minutes twice a week at a rate of 3.5 to 3.8 miles per hour. He perspires considerably after 20 minutes without any other adverse effects and has done this for more than 30 years.

An 8-year-old boy was evaluated because of widespread lesions on his face, arms, and legs. The lesions had been present for 3 years and were occasionally pruritic, especially when scratched. The child was otherwise healthy.

A 71-year-old woman presents to the emergency department accompanied by her daughter. The patient woke up in the morning "feeling fine" and then complained of a headache. She became progressively less oriented over the next 45 minutes.

A 13-year-old boy presented with an explosive eruption of numerous, small, round, erythematous, itchy plaques on his lower back and lower limbs of 2 weeks' duration. Some of the lesions were scaly. His nails were normal. There was no evidence of arthritis or joint deformity. He had a sore throat a month before the onset of the rash but did not seek medical attention. He was not taking any medication and had no history of joint pain or family history of skin problems.

A 55-year-old right-handed house painter has had a constant dull ache in his right shoulder for 3 weeks. The pain worsens when he steers his car or elevates his arm, and the inability to raise his arm above his head interferes with his work.

Several popular diets, such as the South Beach Diet and Sugar Busters, are based on the glycemic index; however, many patients are confused about its significance.

Is there a role for statins in the treatment of chronic progressive renal disease?Inflammation is a component of the pathophysiology of progressive renal disease and may also be associated with other major modifiable risk factors, such as atherosclerosis, hypertension, and diabetes mellitus.

Lesions on the tongue and lips prompted a 61-year-old woman to seek medical attention. She also complained of craving ice and cold liquids. Her history included depression, which was treated with ser-traline, and lifelong recurrent epistaxis. She denied pulmonary or neurologic symptoms.

An 80-year-old man complains of lancinating pain in his right axilla and chest that began 2 days earlier and has kept him awake at night. He has had no fever, cough, sputum production, dyspnea, or symptoms suggestive of congestive heart failure.

Primary care physicians are usually the first to see patients with joint pain; consequently they represent the "front line" of RA care. This fact-coupled with the projection that the number of rheumatologists is expected to decline by 20% during the next 2 to 3 decades-underscores the pivotal role that primary care clinicians are now expected to play in the early diagnosis of RA.

A 32-year-old woman complained of increased blurring of her distance vision. Results of a refraction showed that she had worsening myopia in both eyes. An increase in her prescription corrected her visual acuity to 20/20 in both eyes.

Inability to focus and blurred vision in the right eye of recent onset prompted a 71-year-old woman to seek medical attention. Her vision had deteriorated progressively over 2 weeks; now her visual acuity measured 20/100 in the right eye and 20/25 in the left eye. There was no afferent pupillary defect, and the intraocular pressure was normal in both eyes.

To help elderly patients avoid stumblingand falling, advise them to“walk like a drum major” and lift theirknees high.

To remove impacted cerumen, havepatients pour a drop or two of baby oilin the affected ear before going to bed(just enough to fill the canal), then occludethe ear with a cotton ball.