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Chest Film Clinic: What caused progressive dyspneain this patient with chronic asthma?A 51-year-old man with a 20-year history of asthma and seasonal allergies presented with low-grade fever, progressive dyspnea on exertion, and wheezing that had persisted for 2 weeks. Four days earlier, he had been seen by his primary care physician and had started levofloxacin therapy. However, his respiratory symptoms had worsened, warranting hospitalization. He also reported pain in the abdomen and left flank and pain and swelling in the right metacarpophalangeal and right shoulder joints.
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Abnormal Uterine Bleeding: A Primary Care PrimerAbnormal uterine bleeding can be defined as bleeding that deviates from the patient's normal pattern; it may be heavier, more frequent, or abnormal in timing. Bleeding of any kind in a postmenopausal patient should be considered abnormal unless she is receiving hormonal therapy that is associated with regular cyclic withdrawal bleeding.
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Cutaneous Leukocytoclastic VasculitisThis hypersensitivity reaction may be secondary to medications, infection, collagen-vascular disorders, or an occult malignancy. When it is localized to the skin, prognosis is excellent.
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Beer Brews Up Good Medicine for the BrainThis adult beverage may actually provide health benefits, specifically for Alzheimer, Parkinson, and other neurological conditions.
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The 10 Most Common Prescribing Errors: Tips on Avoiding the PitfallsNumerous factors contribute to the medication errors that kill up to 98,000 patients each year. Unnecessarily high dosages can result in increased side effects with only a small therapeutic benefit, especially in elderly patients. Lack of patient information-such as a history of allergies or adverse drug reactions-is another cause of error and injury. Communication failures include the use of ambiguous abbreviations, misinterpretation of verbal orders, and lack of timely response to a patient's medication-related symptoms. Dosing errors are common in children because of variability in dosage expressions in drug references. Remedies for prescribing errors are described in detail here.
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A Rare Reversal of Clostridium perfringens Necrotizing FasciitisWhile currently receiving chemotherapy with mitoxantrone for Gleason grade 7 prostate cancer, a 64-year-old man presented with rectal bleeding.
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We Have Too Many Specialists and Too Few General Practitioners"Primary care docs should be paid more, specialists less. More reimbursement for talking...less for testing and procedures." And, there's more.
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A practical guide to managing asthma in childrenAbstract: All children with asthma should have periodic office visits, usually every 3 to 6 months, in which asthma action plans are updated. Periodic assessment of lung function by peak expiratory flow or office spirometry can help determine the appropriate treatment strategy. Low daily doses of inhaled corticosteroids remain the first and most effective choice of therapy for persistent asthma. If this approach is inadequate, adding a second medication, such as a leukotriene modifier or a long-acting ß2-agonist, is suggested. Short-acting ß2-agonists remain the most important therapy for intermittent asthma. For most children, the best route is via a metered-dose inhaler with either a spacer or valved holding chamber. If these agents are inadequate, a short course of oral corticosteroids may be required. (J Respir Dis. 2005;26(8):348-358)
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Liver Enzyme Abnormalities:What to Do for the PatientYou routinely order laboratory screeningpanels, including serum liver enzymemeasurements, for nearly everypatient who has a complete physicalexamination or who is seen for any ofa host of other complaints. If you findabnormal liver enzyme levels, your familiaritywith the common causes andthe settings in which they occur mayenable you to avoid costly diagnosticstudies or biopsy.
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Anorectal Complaints: Office Diagnosis and Treatment, Part 2Anorectal abscesses and fistulae, pilonidal disease, rectal prolapse, pruritus ani, and anal masses are discussed, with an emphasis on diagnosis and treatment of these conditions in the primary care office setting.
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Heart Disease and SyncopeSyncope is defined as a sudden, brief loss of consciousness and postural tone followed by spontaneous complete recovery. It accounts for 3% of emergency department visits and 1% of hospital admissions.
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Congenital ClubfootThis 3-month-old boy has an untreated right clubfoot deformity. The foot is stiff and uncorrectable. The vertical midfoot crease indicates significant deformity. An anteroposterior (AP) simulated weight-bearing radiograph shows parallelism of the long axis of the talus and calcaneus; this indicates varus alignment of the hindfoot. There is also forefoot adduction.
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Approved Treatments for Osteoporosis and What’s in the PipelineAlong with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.
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Pearly Pink Chest LesionsCan you identify the 2 slowly expanding growths on the chest of this 68-year-old man?
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Approved Treatments for Osteoporosis and What’s in the PipelineAlong with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.
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Eruptive Vellus Hair Cysts in a 4-year-Old Black GirlAsymptomatic flesh-colored papules were noted on the chest of a healthy 4-year-old black girl. Some of the 1- to 2-mm papules had central, comedo-like crusts. The remainder of the skin was normal.
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A case of pseudo-Meigs syndromeWe present a case of a 52-year oldwoman with exudativepleural effusion. Her workuprevealed an ovarian tumor,and the effusion completely resolvedafter resection of the tumor.Pathology revealed granulosacell tumor, which is anunusual cause of Meigs syndrome.This case shows theimportance of considering abdominopelvicpathology in unsolvedcases of pleural effusion.
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New Once-Weekly Exenatide for Type 2 DiabetesOnce-weekly exenatide, the recently approved GLP-1 receptor agonist, may help improve treatment adherence and outcomes in patients with type 2 diabetes.
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Penicillin- and Carbapenem-Induced Neurotoxicity: How to Reduce the RiskPenicillin-induced neurotoxicity was first recognized by Johnson and Walker in 1945 after intraventricular administration of benzylpenicillin.1,2 Subsequently, the β-lactams have been shown to have a higher rate of CNS effects than other classes of antibiotics.3,4
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Young Woman With Abdominal Pain and AnemiaA 27-year-old woman with a 2-dayhistory of nausea, vomiting, andpostprandial abdominal pain is admittedto the hospital. Acute cholecystitisis suspected
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Allergic Contact Dermatitis From Tea Tree OilThe sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.
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Woman With Type 2 Diabetes and AcromegalyA 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.
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Travel Risks: How to Help Parents Protect Infants and Young ChildrenChildren are at greater risk than adults for many travel-related problems, such as barotitis and barotrauma associated with flying, cold and heat injury, drowning, and infection with geohelminths. Most of these problems can be avoided with appropriate measures. Here, a summary of the most important steps.
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Giant Fundic Gland PolypFundic gland polyps are the most common form of gastric polyps. Giant FGPs, however, are extremely rare.
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Recognizing lung disease in patients with rheumatoid arthritis, part 2ABSTRACT: Patients with rheumatoid arthritis (RA) often havepulmonary manifestations, such as interstitial lung disease.The most common cause of upper airway obstruction is cricoarytenoidarthritis. Patients often complain of a pharyngeal foreign-body sensation or hoarseness, but some present with severestridor. Bronchiolitis obliterans is characterized by a rapidonset of dyspnea and dry cough, with inspiratory rales andsqueaks on examination. This presentation, particularly in middle-aged women with seropositive disease, distinguishes bronchiolitisobliterans from other pulmonary manifestations ofRA. High-resolution CT may be more sensitive than pulmonaryfunction tests for detecting small-airways disease, and it frequentlyshows moderate to severe air trapping on expiratoryimages. (J Respir Dis. 2008;29(8):318-324)
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Inflammatory Breast CancerA 40-year-old woman was concerned about an area of redness and tenderness on her left breast. Despite antibiotic therapy prescribed by another physician, the rash had progressed during the past month to erythema and nodules that involved the anterior chest and right breast.
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Eosinophilic Esophagitis-Related Dysphagia in a Young WomanEoE is a chronic, immune/antigen-mediated esophageal disease. Clinical symptoms reflect esophageal dysfunction; histology is characterized by eosinophil-predominant inflammation.
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A rare diagnosis: Endobronchial schwannomaEndobronchial schwannomas are rare and often benign neoplasms that develop from the nerve sheath of the peripheral nervous system.
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HIV-Positive Woman With DyspneaA 48-year-old African Americanwoman with HIV infection who hadbeen hospitalized several days earlierfor presumed Pneumocystis cariniipneumonia (PCP) is readmittedbecause of worsening dyspnea and atemperature of 38.8oC (102oF).She also complains of painful swellingand erythema on her right arm.Her symptoms have worseneddespite treatment with trimethoprimsulfamethoxazole.
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Therapeutic Strategies for Hepatitis CCombination therapy with pegylated interferon alfa-2a or alfa-2b and ribavirin (RBV) results in a greater rate of sustained virologic response (SVR) than that seen with standard interferon alone. Patients infected with hepatitis C virus genotype 1 require higher doses of RBV and a longer duration of therapy than do patients infected with genotype 2 or 3. Closely monitor patients for neuropsychiatric effects, especially depression, and hematologic and other toxicities. Because of the teratogenicity of RBV, strict birth control must be used throughout the course of treatment and for 6 months afterwards. Patients who have not demonstrated a 100-fold reduction in viral load after 12 weeks of therapy are unlikely to achieve SVR; discontinuation of therapy may be considered.
