September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Prudent Prescribing for Women of Reproductive Age
April 2nd 2009About 50% of pregnancies in the United States are unplanned.1 Thus, an awareness of which medications are safe and which are contraindicated in pregnancy is essential for good primary care-even in practices that do not include obstetrics.
Woman With Recent Respiratory Tract Infection and Anemia
April 1st 2009A 50-year-old woman presents to the emergency department with severe dizziness, weakness, and dyspnea of 1 week’s duration. Ten days earlier, an upper respiratory tract infection (URTI) was diagnosed; over-the-counter cough syrup and acetaminophen were prescribed. However, the patient’s condition has steadily deteriorated since then. In addition, her urine has darkened over the past few days.
Something Wrong on the Face of an Old Man
April 1st 2009A 76-year-old man is seen because of redness below the right eye. Has long-standing “lazy eye” on the left, which is chronically deviated outward. Has lived in nursing home for some years due to self-care deficit from memory loss. No recent eye surgery, conjunctivitis, sinus infection, or periocular trauma.
Case 3: Pruritic, tender lesions persist after antibiotics and corticosteroids-what next?
March 4th 2009For 6 months, a 54-year-old woman has had a chronically pruritic and tender eruption that is confined to her arms. She has been treated with ciprofloxacin, clarithromycin, mupirocin, and topical corticosteroids. About 2 years earlier, she underwent spinal fusion. She takes unknown pain medications, omeprazole, buspirone, propranolol, and estrogen.
Boy With Ankle Pain, Erythema, and Edema
March 2nd 2009THE CASE: A 7-year-old boy has had left ankle pain for 2 days. Neither he nor his mother can recall any recent trauma to the joint. He is usually very active, but he has been unable to bear weight on the left foot and has been resting in bed. His mother reports that he had some tactile fevers, which were transiently relieved with ibuprofen, and that he has been eating and drinking normally. Despite the application of ice and elevation, the ankle has become red and swollen.
Bilateral Leg Ulcers in a Cachectic Man
March 2nd 2009A 51-year-old man is admitted to the hospital with painful ulcers on both lower extremities, severe anemia, and a 45-kg (100-lb) weight loss over the past year. Pain from the ulcers prevents him from walking. The ulcers developed about 5 years earlier, as a result of his wearing high boots for work; they began as small sores and grew over time.
Aged Man With Disfigured Tip of Penis
March 2nd 2009An 83-year-old man examined on admission for end-of-life care due to profound dementia. His wife states that his penis has not changed in appearance, but knows that he always had concerns about it. To her knowledge he never had trouble voiding. Patient too impaired to discuss any topic coherently. Wife considers it unlikely he would have disclosed any symptom of this type to her.
HIV-Related Oral Lesions: Clues for Early Diagnosis
March 2nd 2009A 30-year-old man with a 15 packyear smoking history presented for a follow-up evaluation of an asymptomatic whitish lesion on the tongue of 4 months’ duration. The lesion had not responded to oral therapy with either nystatin or fluconazole. The patient was distressed about the lesion’s appearance and his inability to remove it with a toothbrush.
Onychomycosis Tx Monitoring That’s a Notch Above the Rest
March 2nd 2009In a patient receiving antifungal therapy for onychomycosis, it can be difficult to tell how much change has occurred in a treated nail from one visit to the next. To make it easier to monitor treatment progress, I notch the nail at the most proximal point affected by the fungal infection when antifungal therapy is initiated. Keeping track of the notch can help you determine whether the infection is receding.
Fixed Drug Eruption Caused by Amoxicillin
February 2nd 2009This lesion appeared on the left outer thigh of a 28-year-old man after he took amoxicillin. The antibiotic had been prescribed for an upper respiratory tract infection with fever. Two years earlier, a lesion had appeared in the same anatomical region after ingestion of amoxicillin. A skin biopsy of the current lesion confirmed the diagnosis.
A Therapeutic Double-edged Sword: Weighing the Good, the Bad, and the Ugly of Antibiotics
February 2nd 2009When a prescription is written for warfarin, all the risks of therapy are usually appreciated. The same may be said for other potentially problematic drugs, including lithium and phenytoin. Is the same circumspect reflection exercised during the all-too-common practice of prescribing antibiotics for trivial illnesses, such as viral upper respiratory tract infections (URTIs)?
Benign Prostatic Hyperplasia: Current Treatment Strategies
February 2nd 2009Benign prostatic hyperplasia (BPH)-histologically defined as stromal and epithelial hyperplasia beginning in the periurethral transitional zone of the prostate-affects up to 80% of 80-year-old men.[1,2] With progressive prostatic enlargement, bladder outlet obstruction can result. Although the exact mechanism is unknown, lower urinary tract symptoms (LUTS) can signal progressive BPH.
Aged Woman With Sudden Striking and Unfamiliar Oral Lesion
February 1st 2009An 89-year-old woman is seen because of a white area on the tongue. She has been hospitalized on a behavioral health unit for 2 weeks; 1 day ago, enoxaparin was begun for a new left leg deep venous thrombosis. Recent antibiotic therapy for a urinary tract infection; candidal vulvitis followed and was treated with topical clotrimazole. Has penicillin allergy.
Fever in a Woman With an Abnormal White Blood Cell Count
January 2nd 2009The patient has a small-fiber sensory neuropathy that is managed with lamotrigine. She is a physical therapy student who has frequent patient contact. She drinks alcohol occasionally but denies smoking and illicit drug use; she says she is not sexually active.
What Treatment for Family Pet When Tot Has Tinea?
January 2nd 2009In his “Dermclinic” discussion of tinea corporis (CONSULTANT, June 2008, page 517), Dr David Kaplan stated that “the family was advised to have their dog examined by a veterinarian because the pet was the suspected source of the dermatophyte.” Examination of the family dog is probably not necessary and can be an expensive recommendation. It is true that ringworm is a zoonotic infection that can be passed to and from both dogs and cats.
Prevention of Recurrent MRSA Skin Infections: What You Need to Know
December 2nd 2008Methicillin-resistant Staphylococcus aureus (MRSA) was once considered a strictly nosocomial pathogen. Over the past decade, however, MRSA has emerged as a prominent cause of community-associated infections in both adults and children. Although community-associated MRSA strains occasionally cause severe invasive infections, they are most frequently isolated from patients with skin and soft tissue infections.