Photo quiz

When patients' deep tendon reflexes in the ankle and knee are diminished, have them clasp their hands together and pull outward with both arms.

The next time you need to perform a routine oral examination in a patient with a severe gag reflex, try this: have the patient use the tongue blade to depress his or her own tongue while you shine the light. For some reason, the exam goes more smoothly when the patient is involved.

Clinical Images to Help You Hone Your Diagnoses

This 33-year-old Guatemalan man presented to a medical mission camp with generalized bilateral knee pain and inability to extend his leg without pain. The 4-ft 11-in patient had mild scoliosis, increased elbow carrying angles, and hypoplastic patellae. He had had dysplasia of the nails with triangular lunulae since birth. The fingernails were absent on the first and second digits of both hands. His mother had had similar physical findings. He had not had regular medical care.

An 82-year-old man is seen for annual physical examination in the nursing home. He has resided there for 1 year because of the aggregate impact of multiple medical problems including, most prominently, laryngeal swallowing dysfunction associated with vocal cord paralysis.

ROCKVILLE, Md. -- Veggie Booty snack food, sold in all 50 states and Canada, may be contaminated with Salmonella wandsworth, and consumers should throw away any of the product they have on hand, the FDA advised.

STOCKHOLM -- Breast cancer prognosis may be inherited along with the propensity for breast cancer, researchers found.

ROCHESTER, Minn. -- Women with atypical hyperplasia in three or more places in the breast have a sharply increased risk of developing breast cancer, researchers here said.

BOSTON -- Excess deaths from the heat of global warming will not be counteracted by a corresponding drop in cold-related mortality, investigators here estimated.

NEWCASTLE UPON TYNE, England -- Cerebral palsy does not impair children's perception of their quality of life unless they are in pain, researchers found.

INNSBRUCK, Austria -- A novel treatment to relieve stress incontinence in women, strengthening the urinary rhabdosphincter with cultured autologous tissue, has panned out.

PORTLAND, Ore. -- Non-smokers who worked in bars and restaurants where smoking was allowed had significantly higher levels of a tobacco-specific carcinogen than those who worked where the air wasn't tainted.

SAN FRANCISCO -- The rate of methicillin-resistant Staphylococcus aureus in U.S. hospital patients is now nearly 5% -- dramatically higher than previously thought, according to a nationwide survey of healthcare facilities.

CHICAGO -- The American Medical Association wants third-party payers to put the brakes on pay-for-performance initiatives until there is evidence that such plans benefit patients.

CHICAGO -- The American Medical Association has decided not to soften its 1995 position that it is unethical to patent surgical procedures.

TORONTO -- Two well-accepted adjuvant therapies for early breast cancer proved cost-effective for improving survival, according to a pair of studies.

PHILADELPHIA -- Children with complex chronic conditions are more likely to die at home today than they were two decades ago, researchers here said.

INDIANAPOLIS -- Polypharmacy represents a potential problem for patients of any age, but it can be managed safely through diligence on the part of caregivers and patients.

AMSTERDAM -- Children who survive childhood cancer -- especially those who had radiation therapy -- grow up to an increased risk of later adverse effects, researchers here said.