September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Young Woman With Atypical Presentation of Fitz-Hugh-Curtis Syndrome
February 18th 2011A 22-year-old woman presented to her primary care physician’s office with right lower quadrant and suprapubic abdominal pain. She stated that the pain had begun earlier that day; she had no symptoms on awakening that morning.
Chronic Fatigue Syndrome:An Update on Diagnosis in Primary Care
February 17th 2011Chronic fatigue syndrome (CFS) is a distinct disorder characterized by debilitating and often recurrent fatigue that lasts at least 6 months but more frequently lasts for longer periods. Patients with CFS experience overall physical, social, and mental impairments and may subsequently qualify for medical disability.
The Physical Exam and Society’s Regard for Physicians: A History
January 25th 2011The physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It's one way a physician attempts to determine the cause of a patient's complaint.
Pellagra in a Man With a History of Alcohol Abuse
January 12th 2011For 4 months, a 45-year-old man with a history of alcohol abuse had made multiple visits to the emergency department (ED) and a dermatology clinic for evaluation of a diffuse, scaly, and intensely pruritic rash. The rash, which was photosensitive, had started on his upper extremities and spread proximally to the trunk and lower extremities.
How to “Sell” the Flu Shot to Healthy Adults
January 12th 2011When counseling patients about why they should receive the influenza vaccine, I remind them that each year the disease kills 250,000 to 500,000 persons worldwide and more than 37,000 persons in the United States. This means that influenza kills more people per year than auto accidents.
Are Liver Tests Now “Irrelevant” When Prescribing Statins?
January 12th 2011Yes, ACE inhibitors should be used with caution in patients with acute renal injury and high-grade renal vascular lesions, but these drugs are designed to help, not hurt kidneys. Now fast forward to another caveat: avoid or discontinue statins in patients who have elevated liver enzyme levels. Get ready for a therapeutic paradigm shift.
Ventricular Septal Defect Following Myocarditis
December 14th 2010A previously healthy 55-year-old woman complained of fever, weakness, and generalized malaise for the past 3 to 4 weeks. She had been treated with ciprofloxacin, amoxicillin, and azithromycin for 21 days with no resolution of her symptoms. Five days before she was hospitalized, multiple nonspecific constitutional complaints developed.
Infectious Disease Emergencies: Part 2, Septic and Nonseptic Febrile Syndromes
December 14th 2010The diagnosis of many serious infectious diseases relies heavily on clinical suspicion, particularly in the early stages of the illness. In this 3-part series, we provide useful clues to the triage and diagnosis of these diseases. Here we discuss staphylococcal toxic shock syndrome (TSS) and streptococcal TSS.
Ulcerative Colitis in Adults: Summary of the Latest Practice Guidelines
December 8th 2010Ulcerative colitis affects about 500,000 persons in the United States and accounts for more than 30,000 hospitalizations and 1 million workdays lost each year. The exacerbations and remissions that characterize the clinical course of the disease can make its management particularly challenging. What is the optimal approach to treatment? And which agents are most effective for maintenance therapy?
Podcast: Gout: A Primary Care Primer, Part 2
December 4th 2010The gold standard for diagnosis is joint aspiration and synovial fluid analysis; however, compensated polarized light microscopy is not available in most primary care practices. In part 2 of his 3-part podcast, Dr Lieberman discusses the diagnosis of gout in real-world practice.
Disseminated Histoplasmosis in a Woman With History of Polymyositis and Possible Dermatomyositis
November 10th 2010For 3 days, a 28-year-old woman with a history of polymyositis and possible dermatomyositis had fever, chills, and nonproductive cough. She complained of rash, joint pain, and progressive immobility because of severe muscle weakness. For the past 6 years, she had been taking prednisone (60 mg/d), hydroxychloroquine (200 mg bid), and tramadol (100 mg q6h prn for pain).
Is this painful swelling a spider bite?
November 10th 2010For 5 days, a 68-year-old woman has been bothered by a painful swelling on her left cheek. There is no history of trauma or bite. She takes a diuretic for mild hypertension. Amoxicillin/clavulanate was started 2 days earlier pending the results of a bacterial culture.What is the likely diagnosis?
Preparing for Board (Re)Certification-in Bite-Size Pieces
November 10th 2010Every year thousands of physicians must take-and pass-an examination to become board certified in internal or family medicine. Thousands more must pass a board recertification examination to maintain their license to practice medicine- and similar exams are required of physician assistants and nurse practitioners. To pass a certification or recertification examination requires up-to-date and in-depth knowledge in at least a dozen areas of clinical medicine.
A Spicy Weapon Against C difficile Infection?
October 23rd 2010Turmeric, a spice used in curry, may help prevent Clostridium difficile infection. Rattan Patel, MD, of Cedars Sinai Medical Center in Los Angeles, and his colleagues found that curcumin (the active ingredient in turmeric) inhibited the growth of various strains of C difficile in vitro.
Clinical Case Challenges in IBD: 5 Take-Home Messages
October 22nd 2010In this engaging session, 5 patients with complex and difficult cases of ulcerative colitis were presented to an expert panel, which consisted of Maria Abreu, MD, Edward Loftus, MD, and David Rubin, MD. The panel moderator was Jean-Paul Achkar, MD.
Marcus Welby vs. the Specialists
October 16th 2010In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: "The future of the general practice of medicine, if any." The year was 1969.