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A 29-year-old man presents with a recent episode of light-headedness of sudden onset. Although he denies associated loss of consciousness, witnesses report that he was briefly unresponsive to verbal stimuli. He also denies chest pain, dyspnea, palpitations, and diaphoresis; he is currently asymptomatic.

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Statins (HMG-CoA reductase inhibitors) are the most effective drugs in the management of elevated low-density lipoprotein cholesterol (LDL-C) levels. Recent large clinical trials continue to demonstrate the remarkable efficacy of these agents, including improved outcomes.

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Microscopic colitis is a noninfectiouscolitis that is characterizedby chronic nonbloodydiarrhea and macroscopicallynormal colonic mucosa. Extraintestinalmanifestationsare rarely seen. In this report,we describe a nonspecific interstitialpneumonitis in a patientwith lymphocytic colitis.

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Dr Bobby Lazzara spends a Medical News Minute reminding you to pay close attention to all the fine print.

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Abstract: In the assessment of community-acquired pneumonia, an effort should be made to identify the causal pathogen, since this may permit more focused treatment. However, diagnostic testing should not delay appropriate empiric therapy. The selection of empiric therapy can be guided by a patient stratification system that is based on the severity of illness and underlying risk factors for specific pathogens. For example, outpatients who do not have underlying cardiopulmonary disease or other risk factors can be given azithromycin, clarithromycin, or doxycycline. Higher-risk outpatients should be given a ß-lactam antibiotic plus azithromycin, clarithromycin, or doxycycline, or monotherapy with a fluoroquinolone. If the patient fails to respond to therapy, it may be necessary to do bronchoscopy; CT of the chest; or serologic testing for Legionella species, Mycoplasma pneumoniae, viruses, or other pathogens. (J Respir Dis. 2006;27(2):54-67)

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Exercises that help strengthen themuscles that support the spinemay be especially helpful duringthe postmenopausal years. Theback extension series illustratedin Figures 1 through 5 is anexample of progressively moredifficult exercises that can beperformed several times perweek. These exercises can alsobe performed individually inconjunction with resistance andweight-bearing routines.

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This enigmatic, destructive, and deforming condition most often affects persons who have diabetes.

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ABSTRACT: Unless the cause of back pain is obvious, order anteroposterior and lateral radiographs of the spine, a complete blood cell count, erythrocyte sedimentation rate, and urinalysis. If you suspect infection, tumor, or bony abnormalities, obtain an MRI or CT scan. MRI has surpassed bone scanning as the gold standard for diagnosing spinal infections, because it confirms a specific anatomic diagnosis. Spondylolysis and spondylolisthesis are 2 of the most common causes of back pain in adolescents; the diagnosis is made with plain radiographs, which show slippage on the later-al view in patients with spondylolisthesis and fracture through the pars interarticularis on the oblique views in those with spondylolysis.

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A 77-year-old woman is brought for evaluation by her family. The patient had previously been alert and active; however, for the past week, she has been difficult to arouse and, when awake, has been delusional and has behaved abnormally. In addition, for the past 2 weeks, she has complained of abdominal discomfort related to constipation.

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An examination of the evidence on the cardioprotective benefits associated with various intensity levels, types, and amounts of physical activity, as well as tips on a beneficial yet realistic exercise program.

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A 54-year-old African American man with a history of type 2 DM, hypertension, and gout presents for diabetes follow-up. What’s the best therapy for his hypertension?

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FDA is requiring a class labeling change that will allow many more diabetes patients to benefit from metformin.

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A woman in her mid-50s arrives at the ED for suspected anaphylaxis; SOB has not responded to epinephrine and steroids. Does the CT scan suggest a Dx?

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Tinea corporis typically presents as an annular erythematous plaque with a raised leading edge and scale. Granuloma annulare classically presents with 1 or more indurated, erythematous or violaceous annular plaques on the extremities. Here, more on diagnosis and treatment.

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The patient described here was treated for pneumonia, but a chest wall mass and CT changes suggested that more was going on.

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Löfgren syndrome is a form of acute sarcoidosis characterized by a triad of symptoms: hilar adenopathy, erythema nodosum, and arthralgias.

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A 9-year-old boy, who has no significantmedical history, presents with a generalizedpruritic eruption of 2 weeks’ duration.One week earlier, another practitionerruled out scabies and treatedhim presumptively for varicella.

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A 3-year-old boy was brought into the office for vague abdominal pain of 5 days’ duration. His mother stated that he had had several episodes of nonspecific pain in the abdomen that lasted a few minutes and resolved spontaneously.

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A 75-year-old woman presented with worsening dyspnea of about 6 to 8 months' duration. Her symptoms were initially associated with exercise, after about 30 minutes on the treadmill, and now were present at rest. Her breathing pattern had changed to "panting" to improve airflow during minimal activity.

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Research Focus: Recent Developments in HIV Therapeutics

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ABSTRACT: Patients with obstructive sleep apnea (OSA) are at increasedrisk for motor vehicle crashes as a result of excessivesleepiness. However, a number of factors complicate risk assessment.For example, self-reported sleepiness and the severityof OSA do not appear to be good predictors of accident risk.Many persons with OSA do not accurately perceive their levelof drowsiness-self-reported sleepiness does not correlate wellwith objective measures, such as results of the Multiple SleepLatency Test. Moreover, it is not clear whether objective testscan reliably predict accident risk in the real world, as opposedto during simulated driving. The indications for-and benefitsof-restricting driving in patients with OSA have not been established.However, there is good evidence that the use of continuouspositive airway pressure significantly reduces the riskof crashes in these patients. (J Respir Dis. 2008;29(12):459-464)

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ABSTRACT: Exercise can be an effective way to stabilize or slow the degenerative process of osteoarthritis-provided convenient, safe, and enjoyable activities are selected and achievable goals are set. Implement an osteoarthritis exercise plan in phases, and progress gradually from one phase to the next; this will help both you and your patient anticipate difficulties and gauge progress. The first phase-the initial evaluation-includes gathering baseline data, targeting an area of the body to focus on first, and identifying potential contraindications to activities. Subsequent phases include range of motion exercises (stretching), isometric and isotonic strengthening exercises, and recreational or functional activities. Encourage patients to continue stretching exercises throughout the program.

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Shortly after arriving from Puerto Rico, a 59-year-old man presented with right-sided frontal head pain and decreased vision in his right eye. He was concerned about a “sore” that first developed 9 months earlier on his head. The patient denied fever, chills, and syncope.

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A 68-year-old woman was hospitalized because of confusion and agitation of sudden onset. Her history included dementia and multiple infarcts of both cerebellar hemispheres, bilateral basal ganglia, bilateral parietal lobes, and the right occipital lobe.

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Sporotrichosis is a fungal infection that typically results in cutaneous or lymphocutaneous disease, although other, more severe, life-threatening manifestations do occur. This article reviews updated treatment guidelines, which state that itraconazole has become the preferred therapy for most forms of infection. Amphotericin B remains the mainstay of treatment for severe cases, but lipid formulations are now preferred because of their more favorable toxicity profile. Also, fluconazole has been shown to be less effective than itraconazole and is no longer recommended except as an alternative for cutaneous and lymphocutaneous disease. [Drug Benefit Trends. 2010;22:49-52]

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Although widely regarded as a raredisorder, hereditary hemochromatosisis the most common genetic disease inCaucasians. In certain populations ofnorthern European descent, 1 of every200 persons is homozygous for thecausative mutation.1

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ABSTRACT: Flexible bronchoscopy was clinically introduced byShigeto Ikeda in 1968 and is now used widely for diagnosticand therapeutic interventions. A combination of advancingtechnology and ingenuity has fostered the development of anexpanded array of devices and applications. The newer videobronchoscopes offer higher-resolution images than fiberopticbronchoscopes. The advantages of fiberoptic technology arelower cost and greater technical ease of adapting to smallerdiameterbronchoscopes. Hybrid bronchoscopes have an imaginglens and fiberoptic bundles that transmit the viewingimage to a charge couple device (CCD) chip in the body of theoperator end of the bronchoscope. The digital image is transmittedfrom the CCD chip to the external processor for viewingon a monitor, for digital storage, or for printing. (J Respir Dis.2008;29(11):423-428)

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ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

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n the United States, the number of cases and geographic range of West Nile virus infection have increased since 1999, when the virus first surfaced in the Western Hemisphere. This year, the virus is expected to spread to all states except Alaska and Hawaii.