A 53-year-old man became concerned when ever-increasing numbers of painful oral lesions developed on the buccal mucosa and tongue. A bland diet did not help. What does this look like to you? Test your clinical acumen with this week's quiz questions.

Test your clinical skills in this week’s 5-question quiz.

Test your clinical skills in this week’s 5-question quiz.

Children often resist examinations for otitis externa because of pain and tenderness.

Approximately 2 weeks earlier, a pruritic, papular eruption had developed over the abdomen of a 33-year-old woman who was 34 weeks' pregnant. The rash was confined mainly to the striae distensae (Figure 3). Because the site was severely pruritic, the patient was unable to sleep. Based on the clinical presentation, pruritic urticarial papules and plaques of pregnancy (PUPPP) was diagnosed.

Many of my older women patients think they are at much higher risk for breast cancer than coronary heart disease (CHD). How can we raise women's awareness about their risks of CHD and thereby encourage them to take measures to prevent it?

A 24-year-old woman's first pregnancy was uneventful until the sixth month when mild malaise and a highly pruritic abdominal rash occurred (Figure 1). A biopsy and direct immunofluorescence confirmed the suspected diagnosis of herpes gestationis.

ABSTRACT: A focused history taking and physical examination directed toward uncovering signs that suggest a serious underlying cause of low back pain are crucial. "Red flags" include pain that lasts more than 6 weeks; pain in persons younger than 18 years or older than 50 years; pain that radiates below the knee; a history of major trauma; poor rectal tone; constitutional symptoms; atypical pain (eg, that which occurs at night or that is unrelenting); the presence of a severe or rapidly progressive neurologic deficit; and a history of malignancy. These markers provide a cost-effective means of guiding your selection of laboratory and diagnostic imaging studies.

ABSTRACT: Recent advances in the management of hepatitis C virus (HCV) infection have improved the response to therapy. Predictors of a favorable response include infection with HCV genotype 2 or 3 (rather than genotype 1), low viral load, no fibrosis or only portal fibrosis, female sex, and age less than 40 years. Liver biopsy remains the best method of assessing disease severity. Therapy is recommended for patients with aggressive disease, such as stage 2 to 4 fibrosis. Pegylated interferon alfa-2b in combination with ribavirin is currently the treatment of choice for patients with newly diagnosed HCV infection. This regimen results in a sustained viral response in more than half of patients treated. Counsel patients about the side effects of therapy. Interferon is associated with flu-like symptoms, depression and other psychiatric problems, and bone marrow suppression; ribavirin can produce hemolytic anemia as well as adverse GI and dermatologic effects.

In their report of a young man who had dislocated his shoulder during a fight, Drs Gary Quick and Gale Joslin described a well-known technique for reduction of the dislocation (CONSULTANT, July 2001, page 1100y).

Foot ulcerations and infections are the leading cause of hospitalization among patients with diabetes; they occur in about 15% of these patients. Given the rapidly increasing incidence of diabetes, physicians can expect to see a growing number of diabetic foot problems. Here, a group of experts, many of whom practice at the renowned Joslin-Beth Israel Deaconess Foot Center in Boston, offer guidance on all aspects of diabetic foot care. The topics covered range from proven preventive strategies to cutting-edge wound care techniques that draw on such new developments as growth factors and living skin equivalents. A detailed review of the pathophysiology of the diabetic foot is also included. The emphasis throughout is on a multidisciplinary approach that incorporates the services of diabetologists, podiatrists, orthopedic surgeons, orthotists, diabetic nurse educators, and others. Numerous black-and-white and color photographs, drawings, algorithms, and charts illustrate the text.

Although many patients with primary HSV-1 infection have no clinical recurrences, the failure to seroconvert occurs very seldom—in no more than 1% of patients.

Dr Gregory Rutecki's interactive teaching case, “A Middle-Aged Man With Polyuria: The Initial Visit” (CONSULTANT, March 2001, page 357), provided a welcome opportunity for me to review the care I provide to my patients with type 2 diabetes, who comprise a very large percentage of my practice.

The associated pain is often described as burning. In most cases of CRPS, sudomotor and vascular changes will occur, most notably edema and changes in blood flow resulting in skin temperature changes in the affected body part.

The etiology of this often baffling pain disorder remains unknown to much of the medical community and causes extreme suffering among those afflicted. Here, an overview of what we do know—and have yet to learn.

At a recent retreat I led for doctors on the brink of total burnout, all hands went up when I asked if anyone had lost a colleague to suicide. All but one hand was raised to confirm having considered their own suicide. Many in the room had signed up for this weekend hoping to learn how to avoid becoming the colleague behind someone else's raised hand.