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Consultant Vol 51 No 2

For 3 weeks, a 28-year-old man has had a pruritic, bilateral axillary rash. He stopped using deodorant, but the condition has not improved.

During a routine examination, these changes are noted on both thumbnails of a 56-year-old man. He denies any trauma or underlying diseases.

After 6 weeks of coping with itchy lesions on her arms and legs, a 43-year-old woman seeks medical advice. The rash first erupted with the onset of cold weather.

For several months, a 28-year-old man has had these changes to his nails, which have also become more brittle. He denies any history of trauma to the nails.

Here is a tip that can help you cover all the elements of the review of systems: Ask the question as you examine the relevant body part.

Assign one clinical staff member to check the expiration dates on all prescription samples once a month, and keep a log of these inspections.

Maintain a “murmur log” to record compliments and complaints from your patients.

At sites where cosmesis is critical, such as on the face, use aluminum chloride and pressure for hemostasis rather than electrocautery.

Be creative with performance rewards. Give movie tickets to employees who go “above and beyond” the call of duty.

I advise patients with diabetic neuropathy to break in new shoes gradually.

17-Year-old girl with a 7-month history of small, red papules on her arms and thighs. Rash is not painful or itchy. Otherwise in good health.

For 20 years, a lesion has been slowly growing on the penis of a 51-year-old man. He has noted bleeding and a foul-smelling discharge from the mass. Recently, the patient experienced a 30-lb weight loss. He has had 5 sex partners in his lifetime but has been monogamous for the past year.

Analysis of a number of studies led to a practical suggestion: persons at known risk for myocardial infarction (MI) as well as older adults should carry a few tablets of soluble aspirin with them at all times, and they should chew and swallow the tablets in the event of chest pain—the earlier the better.

Since it came onto the market in 1983, glyburide has been one of the most popular sulfonylureas. The American Diabetes Association (ADA) recommends the use of these agents as part of a stepwise approach to treating type 2 diabetes mellitus.

A 22-year-old woman presented to her primary care physician’s office with right lower quadrant and suprapubic abdominal pain. She stated that the pain had begun earlier that day; she had no symptoms on awakening that morning.

Bacterial meningitis and
herpes simplex virus type 1 (HSV-1) encephalitis are both associated with significant morbidity and mortality. Thus, hospitalization and prompt initiation of therapy are essential.

A 72-year-old obese man with chronic atrial fibrillation, hypertension, hyperlipidemia, and a history of tobacco use presented for a routine office visit. A year earlier, he began to experience recurrent chest pain, but an ECG had shown normal T waves.

While currently receiving chemotherapy with mitoxantrone for Gleason grade 7 prostate cancer, a 64-year-old man presented with rectal bleeding.

Chronic fatigue syndrome (CFS) is a distinct disorder characterized by debilitating and often recurrent fatigue that lasts at least 6 months but more frequently lasts for longer periods. Patients with CFS experience overall physical, social, and mental impairments and may subsequently qualify for medical disability.

About 70% of patients with gout are treated exclusively in the primary care setting. Because the prevalence of gout is rising, particularly among older patients, you are increasingly likely to encounter this disease in your practice.

A 41-year-old woman presents to the emergency department with chest pain and dysphagia. Routine laboratory studies reveal profound neutropenia. She denies recent fever, chills, or weight loss.

 
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