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Renal Colic:ABSTRACT: In patients with renal colic, the location of the urinary tract obstruction largely determines the nature of the symptoms (eg, an obstruction in the distal ureter typically produces boring pain that radiates to ipsilateral groin, testicle, or labium). The initial evaluation includes urinalysis, a complete blood cell count, and a renal function panel. A full metabolic evaluation is warranted if the patient has risk factors for or a family history of stone disease, a history of bilateral stone disease, or chronic recurrent urinary tract infection, or if nephrocalcinosis is found on radiographic studies. Noncontrast CT is the imaging study of choice; it is nearly 100% accurate for detecting stone disease. Analgesia and volume expansion are the mainstays of management.
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Pulmonary nocardiosis mimicking empyema necessitatisNocardia asteroides is a rarecause of pulmonary or disseminatedinfection in immunocompetentpersons. Pleuralcompromise is common, butempyema necessitatis is veryrare. The authors describe anapparently immunocompetentpatient with N asteroides infectionwho had chest wallcompromise mimicking empyemanecessitatis.
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Bronchoscopy Clinic: A patient with "worsening asthma"A 45-year-old man was referred to our pulmonary clinic for progressive dyspnea and worsening asthma. His shortness of breath had been worsening over the past 2 years. He denied fever, weight loss, and other systemic complaints.
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Erysipelas in a 60-Year-Old ManA 60-year-old man presented with redness, swelling, and pain on his right lower leg of 3 day's duration. He recalled being scratched by underbrush while hiking in the woods a few days earlier; the patient denied other recent trauma or insect bites.
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Case In Point: A case of bilateral hilar lymphadenopathyThe authors describe a rare cause of diffuse thoracic lymphadenopathy--Cogan syndrome. This case was remarkable for the temporal development of extensive lymphadenopathy independent of other hallmark symptoms and signs of this syndrome. In the appropriate clinical setting, Cogan syndrome should be considered in the differential diagnosis of thoracic lymphadenopathy.
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Autosomal Dominant Polycystic Kidney Disease in a 38-Year-Old WomanAutosomal dominant polycystic kidney disease (ADPKD) is common. Presenting symtpoms include hypertension, hematuria, proteinuria, and renal insufficiency.
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Sleep Problems Disturb Children With Autism Spectrum DisorderWith proper assessment and treatment, primary care physicians can help improve their sleep habits and quality.
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HIV/AIDS and Starfish: "It Makes A Difference to This One"Millions of years of life have been saved by antiretroviral therapy. For more lives to be saved, for more years of life to be gained, patients and doctors need to be aware of the risk of HIV infection and to be amendable to screening.
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Introducing a New CONSULTANT Series "Primary Care Procedures: A Photo Guide"When should buried stitches be used in closing a laceration? Which tools are best for removing a popcorn kernel lodged in a 2-year-old's nose? How do you determine the appropriate site for a shoulder injection? These are just some of the questions that will be answered in our new feature, "Primary Care Procedures: A Photo Guide," which launches in this issue on page 1035.
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Oroesophageal Candidiasis in a Patient With AIDSTopical treatment for oral candidiasis is not as effective when there is esophageal involvement. Topical treatments include nystatin, amphotericin B solution, and miconazole tablets. Systemic therapy given orally includes the azoles, of which fluconazole remains the most effective commonly prescribed. Voriconazole is effective against some resistant strains of Candida. Echinocandins, a newer class of drugs, inhibit cell wall synthesis.
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Type 2 Diabetes: After the Diagnosis, Resist InertiaDiabetes is a progressive disease and takes advantage of inaction. How would you manage our patient Mrs Davis?
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Esophageal Foregut Cyst Presenting as Suprahilar MassA chest roentgenogram from a 42-year-old man with asthma, primary hypoparathyroidism, and pectus excavatum showed a left suprahilar mass-like density.
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Drug Interactions With Azole Antifungals: Focus on Fluconazole and ItraconazoleAzole antifungals are widelyused to treat numerousinfections.1 Manywell-documented, clinicallysignificant drug interactionsare associated with these agents1,2
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Migraine Management during the Holidays: How to Help Patients Identify, Manage TriggersCommon triggers, such as stress, travel, and disrupted routines, can impact patients with migraine this holiday season. Practical strategies and short-term preventive measures to help, here.
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Primary Care Compensation: Incomes are Up, Job Satisfaction Not So MuchWhat does primary care compensation look like these days? Would you choose primary care all over again? Here: key highlights that shed light from a Medscape Physician Compensation Report.
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65-year-old man with nonpruritic yellowish lesions on his eyelidsA 65-year-old man consults his primary care physician because of concern about nonpruritic yellowish lesions on his eyelids. He says they have been present for the past few years but have recently become more numerous.
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Help for Osteoarthritis Pain: Exercises to Stretch and Strengthen the Hip, Thigh, and KneeExercise is a key part of your care plan. It promotes strength and flexibility, helps you maintain a healthy weight, reduces pain, and improves overall mobility and quality of life.
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Second-Degree Burn From IontophoresisHalf way through a 15-minute iontophoresis treatment for de Quervain tenosynovitis of the right wrist, a 42-year-old woman felt exquisite pain but completed the session. After the therapist returned to the room and removed the electrodes, a light gray circular mark about 5 mm in diameter was noted on the skin. The epidermis was gone, and the underlying dermis was also injured. Within 6 hours, a tender, dark red-brown lesion developed.
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Melanoma of the ScalpA 60-year-old African American woman presented with an asymptomatic, nonpruritic lesion on the left temporal scalp that bled intermittently. She had noticed the lesion after she used a hair relaxant 5 to 6 months earlier. Since then, the lesion had slowly enlarged. She had a history of type 2 diabetes mellitus and hypertension. She denied alcohol consumption and tobacco use.
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Treating Sepsis: An Update on the Latest Therapies, Part 1A milestone has been reached in the treatment of sepsis-the institution of protocolized management that starts in the emergency department. Early goal-directed therapy, with targeted fluid resuscitation and measures of oxygen delivery, has been shown to improve survival in patients with septic shock. Although initiating aggressive fluid resuscitation is the first priority, it is also essential to obtain cultures rapidly and infuse broad-spectrum antibiotics. Norepinephrine is a more potent vasoconstrictor than dopamine and may be more effective in treating hypotension in patients with septic shock. Vasopressin is an effective second-line agent. Treatment with recombinant human activated protein C at 24 µg/kg/h for 96 hours has been shown to reduce mortality in patients with sepsis; its benefit is greatest in the most acutely ill patients. (Infect Med. 2009;26):134-143)
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What caused these findings in a patient with atrial fibrillation?A 69-year-old man with a history of atrial fibrillation, pulmonary embolism, asthma, and obstructive sleep apnea presented to the emergency department for evaluation of dyspnea and light-headedness. He had been treated for paroxysmal atrial fibrillation over the past 5 years; fairly good control had been achieved with metoprolol and amiodarone. However, over the past several months, he had been experiencing intermittent episodes of atrial fibrillation.
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Man With Abdominal Bruit of Unusual OriginA 52-year-old man with a 29-year history of type 1 diabetes mellitus and mild diabetic retinopathy and nephropathy presents for a regular checkup.
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Suspected Avascular Necrosis in a RunnerA 34-year-old man has had bilateralknee pain for the past 16 months andbilateral hip pain for the past 8 months.The pain is exacerbated by running, byweight bearing, and recently even by sittingfor extended periods. Moving froma sitting to a standing position is especiallydifficult. A week earlier, he visitedan urgent care center and was given naproxen and a 7-day course of prednisone,but neither medication alleviatedthe pain; in fact, he now feels worse.
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Raynaud Phenomenon as a Manifestation of Systemic DiseaseThe young female presented with a 1-month history of violaceous papules, petechiae, and healing ulcerations on the distal digits of both hands and feet.
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ECG Changes in PericarditisA 26-year-old otherwise healthy man presents to the emergency department with a 3- to 4-hour history of left-sided chest pain. The pain is pleuritic and accompanied by nausea and discomfort in the left arm.
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Intoxication with street drugs: Cocaine and amphetaminesCocaine and amphetamine intoxication continue to be common causes of emergency department and hospital admissions.
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Excessive Sleepiness Lingers in TBI PatientsMany patients who've suffered TBIs have persistent sleep problems, but won't necessarily go to a doctor about them.
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Atypical Tuberculin Skin Test ResponsesTuberculin-type hypersensitivity is characterized by marked spongiotic dermatitis with intraepidermal and subepidermal vesiculation and scattered eosinophils.
