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

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

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

This condition, which accounts for about 30% of cases of intestinal obstruction among neonates, is characterized by the inspissation of thick, tenacious meconium in the bowel. The most common cause is cystic fibrosis; approximately 6% to 20% of infants with cystic fibrosis have meconium ileus. Hyperviscous mucus secreted by abnormal intestinal glands, an abnormal concentrating process in the proximal small intestine, and a deficiency of pancreatic enzymes have been implicated in the pathogenesis. The histologic hallmark is distention of the goblet cells in the intestinal mucosa.

Inspissated, sticky, immobile meconium causes this transient form of distal colonic or rectal obstruction in newborns. The incidence has been estimated at 1 in 500 to 1000 live births. The condition is thought to result from dehydration of the meconium.

A 72-year-old man presented after several months of dyspepsia and 1 day of hematemesis. He was not taking NSAIDs.

Syndrome The mother of a 7-year-old boy with cardiofaciocutaneous syndrome sought treatment for the cutaneous aspects of her son’s disease. Dry skin and keratosis pilaris of the upper outer arms were noted. Cardiofaciocutaneous syndrome— a rare autosomal dominant genetic disorder—had been diagnosed when the child was 3 years old.

A 42-year-old woman presented with a papular eruption that first appeared during childhood. Severe pruritus, which worsened during the summer, accompanied the lesions. The patient reported that family members, including her mother and brother, had a similar skin problem. A biopsy of a characteristic lesion on the patient’s chest revealed diffuse acantholytic dyskeratosis, which confirmed the clinical diagnosis of Darier’s disease.

An 83-year-old man with a history of hypertension and coronary artery disease presented with a 4-day history of mental status changes, slurred speech, and difficulty ambulating. He reported a lack of appetite and weakness of several days.

The parents of a 2-year-old boy with a 3-day history of fever took him to the emergency department. The child’s temperature fluctuated between 38°C (100.4°F) and 39°C (102.2°F).

This patient with long-standing insulin-dependent diabetes has difficulty closing his hand because of “tight skin.” Diabetes is the cause: this finding occurs more often in persons with microvascular complications, such as retinopathy and nephropathy. The condition may occur even in patients with well-controlled diabetes.

Diabetic retinopathy is the most common cause of legal blindness in persons between the ages of 20 and 65 years. In this 56-year-old man with a 20-year history of type 2 diabetes, multiple, scattered intraretinal (dot-blot) hemorrhages and superficial nerve fiber layer (splinter) hemorrhages can be seen. An occasional Roth spot—an intraretinal hemorrhage with a white center that represents a fibrin thrombus which occludes a ruptured blood vessel—is also evident. Numerous yellow, waxy, hard exudates are seen between the inner plexiform and inner nuclear layers of the retina. Cotton-wool spots are also present, although no neovascularization is present.

The past several years have witnessed important advances in the evaluation and management of chronic heart failure (HF). Drugs such as β-blockers and spironolactone have been shown to reduce morbidity and mortality, and strategies that employ new devices, such as pacing and defibrillator therapy, are evolving. This has prompted the American College of Cardiology (ACC)/American Heart Association (AHA) to update guidelines first published in 1995.1 The guidelines highlight the importance of early and accurate recognition of the clinical syndrome of chronic HF and offer an outline for evidence-based therapeutic decision making.

To suggest today that condoms are “obsolete” sounds heretical and like a topic ripe for heated debate. Here, HIV/AIDS blogger Dr. Rodger MacArthur lays out the science for your review.

I’ve been in practice for 20 years and have never lost a patient to suicide. But I have lost colleagues, friends, and lovers – ALL male physicians—to suicide. I have a long list of answers to the question, “Why?” Maybe the most fundamental answer is that doctors are human..

My first patient had so many things wrong; he left before I could examine his heart and lungs, ask about chest pain, or reconcile his medication list. After his visit, veteran clinic staff noted they hadn’t seen Jim for years and were surprised he had come in at all. I felt the totality of my medical education had been squandered. They kindly reminded me it had just begun.