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Consultant Vol 50 No 8

These asymptomatic bumps that developed on the groin area of a 16-year-old girl after her first sexual exposure are molluscum contagiosum. Central umbiliication distinguishes these lesions from warts.

During a routine checkup, a 14-year-old girl inquires about a large red spot on her right ankle. The asymptomatic, erythematous area overlying the malleolus has been present for several months.

When dealing with children, I always try to sit so that I am at eye level with them.

Because infants often start to cry as soon as a stethoscope makes contact with their skin, it can be difficult to hear defects during a cardiac examination.

In adults who present with persistent cough following an upper respiratory tract infection but who have no history of asthma or chronic obstructive pulmonary disease, lung findings are usually “normal” on auscultation.

Hair around a laceration can get in the way when you are trying to close the wound.

To confirm that I have sufficiently irrigated an eye that has been exposed to an alkaline substance, I use nitrazine paper strips to test the pH of the conjunctival fluid.

Measure your cycle time from patient entry to patient exit.

A 29-year-old Ukrainian man presents with a mildly pruritic generalized rash, which started 4 days earlier as a widespread eruption. The patient has no contacts who have a similar rash.

A 71-year-old woman presents to the emergency department for evaluation of a blistering, intensely pruritic generalized rash that started 5 days earlier. Multiple ruptured and intact hemorrhagic bullae are obvious on the hands, arm, neck, chest, back, and abdomen and to a lesser extent on the lower extremities. The mucous membranes are spared. The Nikolsky sign is absent. The patient reports recent use of furosemide for periodic leg swelling.

An 18-year-old woman from Mexico was hospitalized because of severe headache with nausea and vomiting. Her headaches had started 4 years earlier and had progressively worsened. They occurred mainly in the occipital region and were pulsating, worse on bending down, and unrelieved by any medication. They were often accompanied by dizziness and presyncope.

These pruritic pustules had appeared on the lower back of a 45-year-old white man and progressively spread to the entire back over a month. He had recently completed chemotherapy for chronic lymphocytic leukemia. Results of HIV testing were negative.

A 23-year-old woman presents to the emergency department (ED) with left-sided burning chest pain that radiates to the epigastrium. The pain, which woke her from sleep 12 hours earlier, is intermittent and is not associated with eating or exertion. She had a single bout of nausea and emesis.

A new patient with a history of atrial fibrillation (AF) and heart failure presents for an initial visit. The 72-year-old man denies exertional chest pain and paroxysmal nocturnal dyspnea. He is able to perform all his routine daily activities and can even climb 2 flights of stairs without dyspnea—although with more vigorous effort, he does become short of breath. He occasionally experiences pedal edema at the end of the day, but the condition resolves by morning.

A 36-year-old woman presented to the emergency department with loss of vision in the right eye that had initially involved the peripheral field and progressed over 2 months to the central and nasal fields. During this period, she also had headaches, vomiting, and generalized weakness. She had had amenorrhea for 1 year.

Your patient is a previously sedentary, overweight 39-year-old woman who has recently taken up running. She now presents with pain and swelling anteroinferior to the lateral malleolus after she twisted her ankle while running on uneven pavement 1 day earlier. Your diagnosis: an uncomplicated lateral ankle sprain.

A 71-year-old African American man presented to the emergency department (ED) with chest pain, dyspnea, and hemoptysis. He had had a few ED visits for similar symptoms within the previous 4 weeks.

How effective is antibiotic therapy for long-standing reactive arthritis?

Here Dr Scheinfeld provides a pictorial guide to neurotic excoriation, perforating folliculitis, chondrodermatitis nodularis chronica helicis, hyperkeratosis, and intertrigo.

Discussions that focus on health care costs have created a specialized vocabulary, such as comparative effectiveness research. The concept undergirding this field may be defined as “the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat, and monitor health conditions in ‘real world’ settings.”

For 10 weeks, a 34-year-old woman had refractory sinusitis, epistaxis, painful sores in her mouth with erosions in the nasal cartilage and palate, and otitis media in the left ear.

 

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