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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.

During the last few weeks of gestationor shortly after birth, the layersof the processus vaginalis normallyfuse together and obliterate the entranceto the inguinal canal in thevicinity of the internal inguinal ring.An indirect hernia results from a failureof fusion of the processus vaginalis;the bowel subsequently descendsthrough the inguinal canal.

Abstract: For some patients with allergic rhinitis, symptoms can be reduced substantially by the use of allergen avoidance measures. However, many patients require pharmacotherapy, including antihistamines, decongestants, and intranasal corticosteroids, to adequately control their symptoms. The oral antihistamines are effective in reducing rhinorrhea, itching, and sneezing but are not effective against nasal congestion. Intranasal azelastine has been shown to be beneficial in patients with moderate to severe symptoms that are not sufficiently controlled by an oral antihistamine. Additional therapies include intranasal ipratropium, which specifically targets rhinorrhea, and cromolyn, which can reduce many of the symptoms of allergic rhinitis and can be used prophylactically. (J Respir Dis. 2005;26(4):150-162)

In their photographs of a 73-year-old woman with an itchy, painful rash on one side of her face and 3 lesions on the forehead, Drs Leslie Trope and Glen Marin identified the 3 lesions as molluscum contagiosum

In his response to a reader's query about the connection between celiac disease and type 1 diabetes, Dr David Wyatt recommends that all children with type 1 diabetes be screened for celiac disease.

An 82-year-old woman presented with a 4-day history of "filmy vision" in the right eye. Her history included mitral valve prolapse with regurgitation, for which she took warfarin and digoxin, and mild hyperlipidemia, which was controlled with diet. The results of recent carotid artery studies were negative.

A 70-year-old man sought medical attention for a white lesion with surrounding erythema on the thumb of his right hand. The lesion had been present for many years and had recently become inflamed and painful. He had no other symptoms. No other areas were affected. His medical history was unremarkable, and he was not taking any medications.

Now that the role of inflammation in the pathogenesis of cardiovascular disease has been recognized, biomarkers of inflammation have become the subject of intense research interest. Once considered a novel cardiovascular risk factor, the inflammatory biomarker C-reactive protein (CRP) is currently believed to improve global risk prediction in patients not previously deemed at high risk.

When a patient presents with unilateral abdominal pain, always consider shingles--especially if the patient is elderly.

To save time, decrease writing, reduce pharmacy calls, and ensure that specimens are properly labeled.

I use an analogy to help patients understand patellofemoral syndrome (chondromalacia). I ask them to imagine a sliding closet door that always goes off its tracks.

For 2 years, a 79-year-old man had postprandial fullness and epigastric discomfort. He also experienced regurgitation and substernal pain after eating that was relieved by belching. He had a history of hypertension and gout. The patient’s vital signs were normal. Laboratory test results were within normal limits.

Silent Thyroiditis, Standard Treatment, Hypothyroidism

These painful eczematous lesionsat the angle of the mouth and thebase of the nostrils had been presentin a 52-year-old woman for 3days (A). Some of the vesicles hadulcerated and left a crust over theregion. The patient said she had hadsimilar attacks in the past. The diagnosisof recurrent herpes simplexvirus 1 (HSV-1) infection was made.The patient was treated with acyclovirfor 1 week, and all the lesionsdisappeared.