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Consultant Vol 42 No 5

The sudden onset of asymptomatic red streaks on several sites alarms a
14-year-old girl. The patient is otherwise healthy; she denies any symptoms of
depression.

Osteoporosis is no longer considered
age- or sex-dependent, although prevalence
varies by sex and race. Postmenopausal
white women suffer almost
75% of all hip fractures and have
the highest age-adjusted rate of fracture.
Thanks to progress in our understanding
of causes and treatments, this
disease is largely preventable, and significant
improvements in morbidity
and mortality are possible. The best
strategy for prevention and treatment
uses a team approach that involves the
patient, physician, health educators, dietitians,
and physical therapists.

A 47-year-old woman who has a history of breast cancer returns to your office
for a routine examination. She has questions about what constitutes optimal
follow-up care for breast cancer survivors; she has read and heard conflicting
recommendations.

In 2 recent “Dermclinic” cases (CONSULTANT, December 2001, page 1812),
Dr David Kaplan describes young women with lesions that arose on their extremities
after they used hormonal agents:

A 79-year-old woman with a 37-year history of type 2 diabetes mellitus complains of head pain that began more than
a month ago and is localized to the left frontotemporal region. She characterizes the pain as constant and burning, with minimal
fluctuations in intensity. The pain does not increase with any particular activity but is quite disabling; it has caused
emotional lability and insomnia. She denies nausea, visual disturbances, weakness of the extremities, dizziness, or tinnitus.
Her appetite is depressed; she has experienced some weight loss.

A 32-year-old woman tells you that she has had generalized weakness;
swelling of the face, arm, and legs; diffuse myalgias; and a facial rash
for several weeks. Her main concern is her inability to keep her arms elevated
or get out of bed. Her history is significant for cervical cancer.

An 80-year-old woman complains of left hip pain
that started after she fell while feeding her cat. The pain
is moderately severe and is localized to the left hip; it
does not radiate. The patient is unable to bear any weight
on the injured hip but denies numbness in her left leg.
There are no other injuries.

A boy was born to a gravida 2, para 1, 26-year-old woman at 37 weeks’ gestation. The pregnancy had been complicated by gestational diabetes. The infant was delivered vaginally; Apgar scores were 6 at 1 minute and 9 at 5 minutes.

My patient is a 30-year-old woman who has used metoclopramide for years for
abdominal pain.

What are the birth control options for a teenager who has a
history of surgical excision of bilateral tubular adenomas
of the breasts?

A 24-year-old woman presents to
the emergency department with
increasing left lower quadrant pain,
nausea, and persistent retching and
vomiting of 48 hours’ duration. The
pain ranges from dull and aching to
cramping; it has become generalized,
and there is no specific relieving factor.
During the last 12 hours, she has
also had fever and chills. She has no
urinary symptoms, hematemesis,
melena, diarrhea, constipation, or abdominal
distention.

Q:What constitutes the optimal management of asthma in
a pregnant patient?

A 75-year-old Hispanic woman presented with a slowly growing, asymptomatic facial lesion of about 3 years’ duration.

Levofloxacin, 500 mg/d, had been prescribed for a 74-year-old woman who had a urinary tract infection. The patient had type 2 diabetes and hypertension. She was allergic to sulfa drugs. Two hours after taking the first oral dose of the antibiotic, painful blisters developed on the lower lip and soft palate.

For 3 days, a 23-yearold woman had been bothered by pruritic vaginal and vulvar lesions. A cheesy white vaginal discharge was associated with the itching. She denied being sexually active.

How common is “dual” (ectopic and intrauterine) pregnancy in women who use
fertility drugs?

 

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