Selected Issue

Consultant Vol 44 No 8

This crusted eroded area on the lower lip of a 67-year-old man has been present
for several months.
Which of the following statements are true?
A. This condition preferentially affects the lower lip.
B. It is more common in women.
C. It is more common in immunocompromised patients.
D. It is more likely to metastasize than similar lesions on nonmucosal surfaces.
E. 5-Fluorouracil is contraindicated in this location.

This 17-year-old presented with a 1-month history of weight loss, increased appetite, mild insomnia, hand tremor, palpitations, sweating, heat intolerance, and quick loss of temper. The number of daily bowel movements had increased from 1 to 2. There was no family history of thyroid disorders.

A 17-year-old boy has
had severe pharyngitis, fever, and
dysphagia for the past 2 days. Although
he took an NSAID and tried
gargling with hydrogen peroxide, he
obtained no relief.

During an evaluation to detect metastatic disease in a 75-year-old
woman with recently diagnosed cecal cancer, a CT scan of the abdomen
and pelvis revealed an incidental finding of a heavily calcified
gallbladder. No metastases were found. The patient had no
symptoms related to gallbladder disease.

For 24 hours, a 62-year-old woman had had severe weakness, abdominal pain, and watery diarrhea that had become bloody in the past 12 hours.
She had no significant medical history.

A 17-year-old adolescent experienced an episode of generalized paralysis of
acute onset after physical exertion and consumption of a high-carbohydrate
meal. Despite a good appetite, the patient had lost between 2 and 3 lb during
the past month. He complained of heat intolerance and palpitations and reported
losing his temper easily.

Hyperpigmentation is seen on the cheeks and eyelids of a 36-year-old woman.
She became hyperthyroid at age 19 years, with accompanying exophthalmos
and hyperpigmentation, following the birth of her first child. Thyroidectomy
was carried out at that time, and the patient has been receiving thyroid replacement
therapy ever since. The hyperpigmentation, an uncommon accompaniment
of hyperthyroidism, has persisted.

A 79-year-old man presents to the
emergency department with a painful
lesion on his right forearm. Three days
earlier, he had scratched his arm while
removing crabs from a trap. Initially,
the scratch had bled slightly, and he
had self-treated with an over-the-counter
antibiotic ointment and an adhesive

Graves disease presents commonly with exophthalmos and stare and striking pretibial

A mildly painful, nonpruritic rash on the forearms and legs prompted a 42-year-old man to go to the emergency department. The patient noted the rash
when he awoke that morning. He had had joint pain and fever for the past
7 days and generalized malaise with chills that began about 3 days earlier.
He had no significant medical history.

A 48-year-old woman with a history
of hypertension and mild
asthma has been transferred to the
medical service because of an abnormal
postoperative ECG. She had
been admitted 2 weeks earlier to the
gynecology-oncology service for local
recurrence of a previously resected
uterine sarcoma and underwent laparotomy
for debulking of the pelvic
mass and resection of the rectosigmoid
colon. She did well until postoperative
day 14, when sudden chest
pain and dyspnea developed.

A 32-year-old woman presents with weight loss of 6.4 kg (14 lb) during the past 8 months and diarrhea of recent
onset. Menstruation had ceased 10 weeks earlier. She appears anxious, with pressured speech. Physical examination detects
baseline sinus tachycardia, sweaty palms, and a diffusely enlarged thyroid gland. Laboratory tests reveal a thyroid-stimulating
hormone (TSH) level of 0.00 µU/mL (normal, 0.45 to 4.5 µU/mL), a free thyroxine (FT4) level of 4.8 ng/dL (normal,
0.61 to 1.76 ng/dL), and a positive thyroid-stimulating immunoglobulin (TSI) level with high titer.

For 3 days, a 47-year-old woman had a painful red swelling on her finger.
The patient--a cellist--had tried to lance the lesion at home, but it
progressively worsened and was now “throbbing.” She denied fever and
nail biting.

A 78-year-old man presents with an
asymptomatic acute eruption on both
legs that extends from the ankles to
just above the knees. Individual macules
range from 4 to 10 mm in diameter
and from light brown to red. Almost
all of the lesions have multiple,
tiny, discrete red puncta.

Swelling of the lower legs brought
this 57-year-old woman to a family
practice clinic. She had a history of
hyperthyroidism with weight loss,
tachycardia, and anxiety. This condition
was confirmed with blood tests
and radioactive iodine uptake testing.

Several new drugs are being introduced—
and more are on the

Macrolides are commonly
used to treat a
variety of infections.
Erythromycin has
long been recognized
as having numerous highly important
drug interactions.1 Although
clarithromycin generally has somewhat
less of an effect on the clearance
of other drugs, it also has several
clinically relevant interactions.1-3

Because bariatric surgery has traditionally been associated with a high incidence of complications, it has been used primarily for superobese patients. A large body of evidence suggests that laparoscopic adjustable gastric banding is a much safer procedure that is also very effective. This procedure offers an additional option to patients who might benefit from bariatric surgery when diet, exercise, and pharmacologic approaches have failed. Here we address questions primary care physicians often ask about the procedure.

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