September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Man With Nausea, Fever, and Rash Following a Diarrheal Illness
April 2nd 2004A 52-year-old man complains of nausea, fever, and malaise following a 2-day diarrhealillness that developed at the end of a family vacation in New England.Two family members suffered a similar illness, characterized by watery diarrhea.Symptoms developed in all who were affected within 24 hours of eatinghamburgers at a local restaurant.
Cutaneous Signs of Vascular Disorders: Small-Vessel Leukocytoclastic Vasculitis
April 2nd 2004A 70-year-old man who had just completeda course of trimethoprim-sulfamethoxazolefor a urinary tract infectionpresented with palpable purpuraand cutaneous erosions of acute onseton his legs (A). He also had massivescrotal edema and purpura (B).
Varied Presentations of Tinea Versicolor: Case 2 Truncal Tinea Versicolor
March 2nd 2004Large, reddish tan, asymptomatic patches recently developedon the trunk of a 36-year-old man. Five years earlier,a similar outbreak had resolved after a 10-day course oforal ketoconazole; this episode was the first recurrence.
Tinea Types: Common Dermatophyte Infections Case 3 Bullous Tinea Pedis
February 1st 2004A 24-year-old man presented for evaluation of pruritic vesicles on both feet.Ten days earlier, dyshidrotic eczema had been diagnosed by another physicianwho prescribed triamcinolone ointment. The patient reported that the footeruption worsened after the topical medication was applied.
Tinea Types: Common Dermatophyte Infections Case 2 Moccasin-Variety Tinea Pedis
February 1st 2004A 70-year-old man first noticed thisskin condition when he returned fromthe South Pacific at the end of WorldWar II. Over the years, the rash hasitched only occasionally; however,during a recent spate of hot weather,the eruption became highly pruritic.Applications of an over-the-counter1% hydrocortisone ointment exacerbatedthe condition
Tinea Types: Common Dermatophyte Infections Case 9 Tinea Faciei
February 1st 2004An eruption on the face of a 49-year-old woman had been misdiagnosed as astaphylococcal infection; the rash failed to respond to oral and topical antibiotics.A mid-potency topical corticosteroid also had been tried, but the eruptionworsened.
Tinea Types: Common Dermatophyte Infections Case 8 Tinea Capitis
February 1st 2004The parents of a 3-year-old girl sought evaluation of their daughter’s hair loss.During the past several months, a large patch of alopecia with scaling had developed.The differential diagnosis included seborrhea, trichotillomania, andtinea capitis.
Tinea Types: Common Dermatophyte Infections Case 6 Negative-Culture Tinea Corporis
February 1st 2004A 49-year-old man was concerned about a right flexor forearmlesion that had been increasing in size for 6 weeks.The light pink, well-demarcated, 5-cm, circular lesion featuredslight peripheral elevation with ulceration, crusting,and a relatively clear central area. A culture of materialfrom the lesion was negative for fungi. A potassium hydroxideevaluation was not performed.
Tinea Types: Common Dermatophyte Infections Case 4 Tinea Manuum and Tinea Unguium
February 1st 2004For about 4 months, a very dry, diffuse,fine scaly, asymptomatic eruptioncovered the palms of a 28-yearoldman; several fingernails weredystrophic bilaterally as well. Beforethe onset of this condition, bilateralonychomycosis of the toenails hadbeen diagnosed. The toenails had notbeen treated and were still affectedat the time of presentation. Branchinghyphae were seen on a potassiumhydroxide preparation of a fingernailcutting. The patient had tinea manuumand tinea unguium
The 10 Most Common Prescribing Errors: Tips on Avoiding the Pitfalls
February 1st 2004Numerous 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.
Is There a Medical Explanation?
February 1st 2004A 13-year-old girl of African American descent is brought to the pediatrician’s office becauseof a lesion on her neck. The girl’s mother had telephoned the office before the visit, statingthat the lesion resembled a blister at first, but now looked like a burn.
A Woman With a Big Bump in the Mouth
January 2nd 2004A 67-year-old Hispanic woman is seen for routine physical examination. Has mild hypertension but no other known medical problems. Feels well. No weight loss. No reported difficulty with eating, speaking, or swallowing. Denies any discomfiture in the mouth. States that nothing has changed in her mouth “ever since I lost my baby teeth.” Does not smoke cigarettes nor drink alcohol.
Eye Signs of Systemic Disease: Case 5 Central Retinal Vein Occlusion
January 1st 2004An 87-year-old woman complained ofseeing a red tinge on the wallpaper inher house through her right eye. Thepatient had mild memory loss andmoderate hypertension, for whichshe took atenolol. She had quit smokingcigarettes many years earlier.
Eye Signs of Systemic Disease: Case 6 Diabetic Maculopathy
January 1st 2004During an annual eye examination, a 65-year-old womanwith a 5-year history of type 2 insulin-dependent diabetescomplained that her vision had slightly worsened in botheyes. Her best corrected visual acuity was 20/30 in botheyes.
Colorectal Cancer Screening: Old Obstacles, New Tests
January 1st 2004Colorectal cancer (CRC) is highly preventable; however, it remains a significant cause of morbidity and mortality in Western countries. CRC develops in more than 125,000 Americans each year, and about 50,000 die of it.1 Screening and early intervention significantly reduce morbidity and mortality, and a number of organizations have published screening recommendations (Table). Nevertheless, only 1 of every 3 eligible adults elects to be screened.2