Many of my patients are confused. So aremany of my colleagues. Official bodies ofexperts barrage the media with pronouncementson what constitutes goodpreventive medicine: screening tests, eatingor abjuring certain foods, avoidance of exposures tosun or environmental hazards, "correct" behaviors. Althoughthey acknowledge that the data are, and alwayswill be, imperfect, these experts try their best to directpeople in the way that the evidence points-for now.
Reiter Syndrome (also called reactive arthritis) manifests as peripheral arthritis that is sometimes accompanied by such extra-articular findings as urethritis, conjunctivitis, and uveitis
Psoriatic Arthritis develops in approximately 20% of patients who have psoriasis.
For 6 weeks, a 29-year-old previously healthy man had between 10 and 15 episodes daily of small-volume bloody diarrhea with intermittent paraumbilical pain. Anorexia and the loss of 25 lb accompanied the diarrhea. The patient had no significant medical history, took no medications, had not traveled recently, and had no contact with sick persons. He denied fever, chills, nausea, vomiting, and all other symptoms.
The manifestations of this multisystemdisorder range from relativelybenign, self-limited cutaneous involvementto severe, potentially fatal systemicillness. Skin lesions associatedwith lupus erythematosus (LE) areclassified histologically as LE-specificor LE-nonspecific.
Twenty-four hours after a car accident, a 47-year-old man with chronic low back pain-which had been diagnosed years earlier as "arthritis" of the spine-presented with back and chest pain and requested an opioid analgesic. The patient had a history of alcoholism and illicit drug use. Tenderness of the thoracic area was noted.
A 59-year-old man, who was unable to walk, was brought to the emergency department with severe leg pain, worsening weakness, increasing fatigue, chills, and fever of 3 days' duration. The symptoms began after a round of golf. In addition to the leg pain, which particularly affected the calf muscles, the lower extremities were red and swollen.
Persons with a systolic blood pressure (BP) of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg are now considered, according to the latest Joint National Committee (JNC) report on hypertension.
ABSTRACT: Regardless of the specific underlying pathology, most patients with low back pain benefit from a program of rehabilitative exercise. The goal of such a program is to increase muscle activity while minimizing stress to the spine. Low-intensity, high-frequency endurance training accomplishes both objectives. Include in the program flexibility exercises, exercises to strengthen the abdominal muscles, exercises for the proximal paraspinal and periscapular muscles, extensor exercises, and exercises to strengthen the legs and stabilize the trunk. Introduce the exercises in this order and advise patients not to progress to a new exercise until they are comfortable performing the less difficult ones.
ABSTRACT: When a patient presents with low back pain, ask about the location and quality of the pain, what makes the pain increase or decrease, associated symptoms, and risk factors. Clues to systemic causes of low back pain include fever; arthritis; iritis; signs and/or symptoms of GI disease, pelvic disease, or renal disease; tachycardia; and integumentary abnormalities. Perform a neurovascular evaluation as well as a detailed musculoskeletal examination. Imaging studies are not necessary for most patients initially. Acute therapy consists of the application of cold and heat and analgesics such as acetaminophen or an NSAID. Early exercise-not bed rest-is the cornerstone of treatment. Follow-up is mandatory: in 3 to 7 days for patients with severe pain, inconsistent findings, mild neurologic abnormalities, or a history of progres- sive symptoms; and in 10 to 14 days for patients with no neurologic compromise.
Progressive abdominal distention, nausea, constipation, and mild abdominal pain developed in an 82-year-old woman 5 days after she underwent surgical repair of a left hip fracture. Her medical history was significant for Parkinson disease, type 2 diabetes mellitus, and hypertension.
A 77-year-old African American man with type 2 diabetes mellitus and coronary artery disease presented to the emergency department with acute scrotal swelling and pain. His testicles were erythematous with focal areas of necrosis and associated tissue destruction. Similar skin changes were apparent in the lower abdominal and inguinal regions.
A 45-year-old woman presents with multiple injuries she sustained during a skiingaccident. She has fractures of her right arm and 3 ribs, as well as numerouscontusions. An abdominal CT scan shows no hemorrhage or other traumarelatedfindings; however, a 6.7-cm left adrenal mass is detected.
A 29-year-old man presents with right ankle paincaused by a basketball injury he sustained 1 day earlier.He fell after he had jumped up and landed on anotherplayer’s foot. The patient’s foot was “turned in” during thefall; this position indicates an inversion injury. He says hehas injured his ankle before but never this severely. Therest of the medical history is noncontributory.
A 63-year-old woman presents withdiffuse hyperkeratosis of the solesand palms. She also has onycholysis-separation of the nail plate fromthe nail bed-and salmon-coloredplaques behind her ears. Biopsy ofone of the plaques confirms the suspecteddiagnosis of psoriasis.
A middle-aged man with"jock itch" that has failed torespond to antifungal creams.An older woman who has diffusehyperkeratosis of predominantlyweight-bearing surfaces.A young man with mildlypruritic, small, salmon pinkpapules and thick white scaleon his trunk and arms.
A 30-year-old man presents with scalingand erythema of the scalp that extendspast the anterior hairline. Thepatient has a family history of psoriasis.For the past 5 years, he has experiencedwintertime flares of the diseasethat affect his scalp and the extensorsurfaces of the extremities.
A 46-year-old man complains that his"jock itch" failed to respond to antifungalcreams. The patient has hadpsoriasis on his elbows and knees formany years.
A 72-year-old man presents with skinlesions and nail abnormalities. Erythematous,sharply defined, demarcatedpapules and rounded plaquescovered by silvery micaceous scaleare noted on the elbows, knees, andscalp. Involved areas appear to be bilaterallysymmetric. Localized psoriasisvulgaris is diagnosed.
4A:Small, slightly pruritic, salmonpink papules with thick white scalehave arisen over the past 5 days onthe trunk and arms of a 24-year-oldman. The patient has a history ofvery mild psoriasis vulgaris of the elbows,knees, and scalp; he deniesstreptococcal pharyngitis or other recentinfections. Guttate psoriasis isdiagnosed.
