A 62-year-old woman presented with a rash and intermittent pain of the right upper quadrant. The reticular, brown hyperpigmentation was also seen on her right flank and around the umbilicus. The patient reported that she often applied heating pads to these areas for pain relief.
Instead of throwing away the label from an injectable medication, peel it off and tape it to the patient’s chart. The nursing staff will not have to write the drug information on the chart because the label contains the name, unit dose, and lot number.
Lend a stethoscope to hard-of-hearing patients who are not wearing a hearing aid. Speak directly into the stethoscope diaphragm, and the patient may hear well enough to communicate with you. Be sure to clean the stethoscope's ear tips before and after the patient uses it.
To reduce discomfort when administering potassium in a peripheral line, mix in 2 mL of a 1% lidocaine solution. This may also work with other painful IV medications, but first check with the pharmacy for drug interactions.
A 63-year-old woman seeks evaluation of a persistent, rough, red area onthe dorsum of her left index finger. The lesion has been present for severalmonths. The patient’s manicurist is convinced it is a wart.
A 13-year-old boy presents with swelling of the left eyelidsthat started 12 hours earlier; the eyelashes are mattedwith yellow discharge. He does not wear contact lenses oreyeglasses and denies ocular trauma or foreign bodies. Hehas been nauseated and has vomited once; his motherattributes these symptoms to an antibiotic that was prescribed5 days earlier for a sinus infection. Medical historyis noncontributory; there is no family history of ocularproblems.
Antihistamines, corticosteroids, andepinephrine can take time to relieveangioedema of the uvula.
This 40-year-old man was punched inthe left eye the night before his evaluation.Traumatic ptosis of the left uppereyelid with accompanying edema andperiorbital ecchymosis (A) were found.When the ptotic eyelid was lifted andheld in place with tape, conjunctivalinjection and traumatic mydriasis wereseen (B). The patient had no complaintsof diplopia; the remainder of theeye examination was unremarkable.
A 35-year-old woman noticed that herright upper eyelid started to droop asthe day progressed. She denied otherocular problems, including decreasedvisual acuity, pain, or diplopia. The patienthad no generalized fatigue, difficultyin swallowing, or weakness ofher arms or legs.
The parents of a 3-year-old boy wereconcerned about their son's "droopy"right eyelid; the abnormality hadbeen present since birth. All other aspectsof the child's eyes and his generaldevelopment had been normal.
In their article, “Dyslipidemia in Patients With CAD: How to Make Best Useof Drug Therapy” (CONSULTANT, October 2000, page 2097), Drs Harry Yu,Richard Pasternak, and Geoffrey Ginsberg discuss the adverse effects associatedwith statin therapy, including myositis.
My patient reports that erythemanodosum occurred when she took anoral contraceptive (OC) in the1990s.
Heart failure(HF), the mostcommon Medicarediagnosisrelatedgroup,has a significant and growingimpact on health careresources. The incidenceof HF has tripled during thelast decade. Almost 5 millionAmericans have HF, and anestimated 500,000 new casesare diagnosed yearly. Thelifetime risk of HF is about20%.1 Drug therapy has improvedconsiderably in recentyears, but the magnitudeand severity of theproblem has created a needfor newer therapies--particularlysince HF is associatedwith an increased risk ofsudden death and a diminishedquality of life.2
The parents of a 3-year-old boy were concerned about their son's "droopy" right eyelid; the abnormality had been present since birth.
A 58-year-old man recently underwent coronary artery bypass graft (CABG)surgery after emergent cardiac catheterization for a myocardial infarction revealeddiffuse 3-vessel disease.
The most appropriate choice is B. The history andphysical findings suggest that the patient may have afracture or contusion of the foot from trauma. There areno systemic signs that suggest an underlying infectious,chronic inflammatory, or oncologic process. A plain x-rayfilm of the foot is necessary to seewhether a fracture is present andwhether immobilization will be necessary.In the absence of fever and localerythema, infection appears unlikely,and a CBC count is unwarranted.
My patient is a 48-year-old woman who has no significant medical history andtakes no medications or supplements.
Approximately 2 weeks earlier, a pruritic,papular eruption had developed overthe abdomen of a 33-year-old womanwho was 34 weeks' pregnant. Therash was confined mainly to the striaedistensae (Figure 3). Because thesite was severely pruritic, the patientwas unable to sleep. Based on theclinical presentation, pruritic urticarialpapules and plaques of pregnancy(PUPPP) was diagnosed.
Many of my older women patients think theyare at much higher risk for breast cancer thancoronary heart disease (CHD). How can we raise women'sawareness about their risks of CHD and therebyencourage them to take measures to prevent it?
A 24-year-old woman's firstpregnancy was uneventful until thesixth month when mild malaise and ahighly pruritic abdominal rash occurred(Figure 1). A biopsy and directimmunofluorescence confirmedthe suspected diagnosis of herpesgestationis.
