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Consultant Vol 51 No 1

Asymptomatic lesion on the dorsum of a 15-year-old boy’s left hand extends on to the first 2 fingers and has produced nail dystrophy. The patient is otherwise healthy and denies any history of trauma to the hand.

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier.

Those of us who have responded to overhead announcements for a doctor on the plane or tended to an ailing friend on the hiking trail know that medical care is rarely limited to the 4 walls of the office.

To make wound closure easier, position the patient so that the wound “points” to your solar plexus or xyphoid process.

When counseling patients about why they should receive the influenza vaccine, I remind them that each year the disease kills 250,000 to 500,000 persons worldwide and more than 37,000 persons in the United States. This means that influenza kills more people per year than auto accidents.

Sometimes patients, particularly children and adolescents, are very anxious during the abdominal examination.

A 54-year-old woman presents for an initial consultation. She has multiple chronic disorders, including type 2 diabetes mellitus and hypertension, for which she takes various medications—none of which are new.

For 2 months, a 29-year-old man had pain and circular, soft swelling (7 x 7 cm in diameter) over the anterior left knee, superficial to the patellar ligament. Pain was minimal and associated with extension and flexion.

A 48-year-old man was admitted with a sore throat, subjective fever, and cough of 2 days’ duration. Two days before admission, he had dysphagia, began to drool, and felt like he was choking.

For 4 months, a 45-year-old man with a history of alcohol abuse had made multiple visits to the emergency department (ED) and a dermatology clinic for evaluation of a diffuse, scaly, and intensely pruritic rash. The rash, which was photosensitive, had started on his upper extremities and spread proximally to the trunk and lower extremities.

During the past 24 hours, a 56-year-old man has experienced melena and 2 episodes of hematemesis. He has biopsy-proven cirrhosis that resulted from heavy, prolonged alcohol consumption; however, he no longer drinks. Previous endoscopy revealed esophageal varices.

Chronic kidney disease (CKD) has become a burgeoning epidemic. Patients with various stages of CKD initially seek care from their primary care physician; some of these patients sustain acute, reversible renal injuries as well.

Primary care is demanding for a host of reasons, not the least of which is the daunting breadth of issues practitioners grapple with. One issue is evaluating the risk of suicide. Two recent studies provide some intriguing data that may change the way we practice.

How best to manage ulcerative colitis? Here: highlights from guidelines from the American College of Gastroenterology on assessment, treatment, indications for surgery, and cancer surveillance.

As many as 25% to 35% of patients tend to have higher blood pressures in their provider’s office than they do on self-determination at home, particularly with one of the many oscillometric devices now available for single blood pressure measurements.

Yes, ACE inhibitors should be used with caution in patients with acute renal injury and high-grade renal vascular lesions, but these drugs are designed to help, not hurt kidneys. Now fast forward to another caveat: avoid or discontinue statins in patients who have elevated liver enzyme levels. Get ready for a therapeutic paradigm shift.

 
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