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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.
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Rendu-Osler-Weber SyndromeA 62-year-old man was admitted to the hospital with iron deficiency anemia, as demonstrated by low serum iron and ferritin levels and high total iron–binding capacity. He had had this condition for at least the last 5 years and had been treated with ferrous sulfate sporadically. The history coupled with the laboratory findings and the telangiectatic lesions on his lower lip led to a diagnosis of hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease.
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Atrial Myxoma That Mimics Mitral StenosisFor 2 years, a 60-year-old woman with long-standing hypertension had experienced worsening dizzy spells, fatigue, and chest discomfort. She also had cold extremities, significant dyspnea on exertion, and orthopnea. The patient was taking amlodipine and furosemide.
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OnychogryphosisThis patient, a woman, presented with onychogryphosis, a severe nail change seen on the toes, especially the great toe. Thickening and hardening of the nail substance with a curved growth pattern produces this abnormal clawlike configuration.
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Nonarteritic Anterior Ischemic Optic NeuropathyA 43-year-old white man presented to the emergency department with dyspnea, abdominal bloating, fever with chills, night sweats, decreased oral intake, and myalgia of 1 week's duration. He was found to have heart failure caused by systolic dysfunction. Viral myocarditis was the presumptive diagnosis after investigation for other causes.
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Pulmonary Arteriovenous MalformationA 47-year-old woman presented to the emergency department with chest pain of sudden onset. The patient had no history of coronary artery disease, peptic ulcer, gastroesophageal reflux disease, or similar episodes of chest pain. She had not traveled long distances or suffered trauma or injury recently.
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Infective Endocarditis:An update on developments in infective endocarditis by addressing a number of questions physicians commonly raise concerning prophylaxis, diagnosis, and management.
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Avulsion of the Ischial TuberosityA 13-year-old girl felt a “pop” while doing a split during gymnastics. She later complained of right hip pain and inability to bear weight on the right leg.
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Jellyfish StingWhile scuba diving in the Philippines, a healthy 36-year-old man noticed a red rash on his wrists and dorsa of both hands after he surfaced from a dive. Within a couple of hours, the rash had become painful, swollen, itchy, and papular.
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What caused this woman’s pneumomediastinum?A 35-year-old woman presented to the emergency department (ED) with vague abdominal complaints. The patient had a complex medical history that included diverticulosis and relapsing polychondritis. Initially, her polychondritis was limited to involvement of the ears and nose. Within the past few years, however, her polychondritis flares had been associated with progressive dyspnea, which prompted intermittent and then long-term use of high-dose oral corticosteroids.
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Urinary Incontinence:Choices in Medical Therapy for the Overactive BladderUrge incontinence, also referred to as overactive bladder (OAB)-wet, is the involuntary loss of urine accompanied by or immediately preceded by a sensation of urgency. It has a reported overall prevalence of 16.0% in men and 16.9% in women. Currently, the mainstay of management for symptomatic urgency and OAB-wet is medical therapy.
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Chronic Plaque PsoriasisChronic plaque psoriasis in this 37-year-old man was treated with systemic corticosteroids after topical medications proved ineffective. The corticosteroids provided initial relief, but the psoriasis recurred once the medication was discontinued. This patient had been in a county jail for about 18 months; during his confinement, he was not exposed to sunlight.
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Case In Point: Unilateral agenesis of the diaphragmUnilateral agenesis of the hemidiaphragm is a very rare congenital anomaly. We present the case of an adult who was evaluated for persistent cough. Unilateral agenesis of the diaphragm was an unexpected finding on a chest radiograph.
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A Risk-Based Approach to the Care of Survivors of Childhood Cancer: 3 Case StudiesSurvivors of childhood cancer frequently present to primary care practitioners for a routine physical examination or for urgent care. Knowledge of the patient's cancer history and of the specifics of the treatment are essential to providing proper care and addressing his or her unique risks.
