A 14-year-old boy presented with a 3-day history ofrunny nose, cough, and fever. His temperature was37.7°C (100ºF); heart rate, 78 beats per minute; and respirationrate, 26 breaths per minute. Several symmetric,circular ecchymotic lesions that measured 4 cm in diameterwere noted on the upper chest. There was no evidenceof external injury to other parts of the body. Thechild reported that the bruises resulted from cupping,performed by a Chinese practitioner in an attempt torelieve the fever.
A 7-year-old Chinese boy presented with fever, cough,and sore throat of 2 days’ duration. His temperature was38.3°C (101°F); heart rate, 85 beats per minute; andrespiration rate, 26 breaths per minute. The throat waserythematous but without any exudate. There weresmall cervical lymph nodes bilaterally. The chest wasclear.
This 9-year-old girl had a slightlypruritic perioral rash for 6 months.The skin around her mouth wasred, scaly, thickened, and hyperpigmented.She also had eczematouslesions in the antecubital andpopliteal fossae.
A 16-year-old girl of normal weight for height (body mass index, 21) was evaluated for a 6-month history of binge-purge cycles and amenorrhea. She met the diagnostic criteria for bulimia nervosa and began treatment that involved a multidisciplinary team. During the second month of therapy, the patient presented to the emergency department after she accidentally swallowed a toothbrush while trying to induce vomiting with the brush’s handle.
A 14-year-old girl was concerned about this 1-cm, red, nodulocystic lesion on her left posterior shoulder that had been present for several months. The lesion had developed over the site at which a 0.5-cm pilomatrixoma had been excised a year before. Four years earlier, another 1.9-cm pilomatrixoma had been excised from the girl’s right outer upper arm. There was no family history of the lesion.
A 58-year-old man with type 2 diabetes mellitus and hypertension was hospitalized with acute diarrhea characterized by several brown, liquid depositions per day. He also complained of lower abdominal pain and bloating and a 10-lb weight loss in the past 2 months. He denied fever or chills, use of corticosteroids, and travel outside the United States.
ABSTRACT: Glenohumeral joint osteoarthritis may result from trauma, concomitant shoulder pathology, or crystal deposition disease, or it may have no discernible cause. The physical examination reveals muscular atrophy, abnormalities during palpation, and limited range of motion, particularly in external rotation and flexion. Treatment includes both nonpharmacologic and pharmacologic interventions. Nonpharmacologic strategies include patient education, activity modification, and structured rehabilitation followed by transition to a long-term home exercise program. Pharmacologic treatment may involve progressively potent oral analgesics and perhaps corticosteroid injections. Surgical procedures, such as shoulder arthroplasty and arthroscopic debridement, are indicated for intractable pain and loss of function.
For 2 years, a 66-year-old woman had a winglike structure on the nasal sideof her right eye. She had normal vision. A diagnosis of pterygium was made.
A 36-year-old woman was concerned about the diffuseyellow pigment at the temporal aspect of the conjunctivaof her right eye.
The irides of a legally blind 19-year-old woman had been absent since birth.When she was 6 weeks of age, her parents noted that she was not focusingon objects the way her siblings had. They consulted an ophthalmologistwho diagnosed aniridia. The woman is able to read book print close up andcan ambulate independently, although she has difficulty at times, such aswhen stepping off a curb in unfamiliar surroundings.
Brown pigmentation of the medial 60% of the left iris was noted in a 40-yearoldwoman. The remainder of the iris was blue, as was the entire right iris.She stated that she had a “spot” of brown in the left iris at birth. The pigmentedarea had gradually enlarged until puberty and had not changedsince then. Her vision was normal.
For a year, a 35-year-old man had an asymptomatic, slowly growing, semifirm nodule on the lateral aspect of his hand. He was concerned that it was malignant.
A 37-year-old man is referred after a routine employment physical reveals anabnormal blood cell count. He has felt well and noticed no obvious symptomsexcept for mild fatigue, which he attributes to excessive work. He denies fever,unusual or frequent infections, and abnormal bleeding.
Until recently, celiac diseasewas considered a rare disorder.However, new evidencesuggests that about1% of Americans are affected.As serologic tests that detect autoantigensinvolved in celiac diseasebecome more widely used, morecases will likely be identified.1
A 31-year-old man with a history of traumatic brain injury was hospitalized because of failure to thrive, constipation, and intermittent diarrhea with soiling.
Instruct patients to add a 255-gbottle of PEG solution to 64 oz ofGatorade in any flavor that does notcontain red or purple dye.
If you miss the artery on your firstattempt to draw blood for arterialblood gas determinations, don’t subjectthe patient to more blind probes.
My patients have been more satisfiedwith my care and more compliantwith medical advice since I starteddictating my notes in front ofthem at the conclusion of our officevisits.
ABSTRACT: The diagnosis of urinary tract infection (UTI) can be difficult in elderly patients, who may present with vague complaints or atypical symptoms. Office-based urine testing is less sensitive and specific in these patients because they are less likely to have pyuria and more likely to have contaminated specimens than younger adults. Antibiotics used to treat uncomplicated UTIs in the elderly include trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, fosfomycin, nitrofurantoin, cephalosporins, carbenicillin, and trimethoprim. When you select an agent, consider the side-effect profile, cost, bacterial resistance, likelihood of compliance, and the patient's renal function. The optimal duration of treatment of uncomplicated UTIs in elderly women is still a matter of debate. Options for prophylaxis in patients who have recurrent uncomplicated UTIs include estrogen replacement therapy (vaginal or oral) and nitrofurantoin.
A 53-year-old man with a 20-year history of type 2 diabetes mellitus (for which he required insulin) sought evaluation of a hot, swollen right foot that seemed to have become “flat.” He had no pain, fever, or chills. The patient’s metatarsal bones were readily movable, consistent with Charcot joint. Further workup ruled out osteomyelitis. Plain films demonstrated extensive deformity of the tarsal and metatarsal bones with Lisfranc fracture/dislocation through the base aspects of all 5 metatarsals.