September 20th 2024
FluMist is the first influenza vaccine that does not have to be given by a health care professional.
A Photo Quiz to Hone Dermatologic Skills
December 31st 2006A painful scalp eruption of 4 days’duration brings an 81-year-old man toyour office. He has taken a lipid-loweringagent and an antihypertensivefor years but has not started any newmedications recently. One week earlier,he had a haircut. He denies recenttrauma to the scalp.
Breast Cancer Survivor With Fatigue and Musculoskeletal Pain
December 31st 2006For 2 weeks, a 58-year-old woman has experienced increasingfatigue with activity. She has needed to nap duringthe day, has not been able to perform her usual activities,and has missed 3 days of work. She also complains of“muscle aches”-mainly in her back. She denies headache,dyspnea, fever, hot or cold intolerance, and alteredmentation.
Older Woman With Nonhealing Foot Ulcer
December 31st 2006A 67-year-old woman has had an ulcer on her left heel for at least several weeks.She applied a homemade dressing and cut her shoes to try to relieve pressureon the ulcer; however, in the past week, areas around the ulcer have becomepainful. These areas, as well as the dorsum of the foot, are red and swollen.
Elderly Man With Fatigue and Backache
December 31st 2006A70-year-old African American man, who is a retiredelectrician, presents with increasing fatigue anddull back pain of 4 months’ duration. Although he usuallywalks about 2 miles a day, he now becomes exhaustedafter half a block. He reports exertional dyspnea but noparoxysmal nocturnal dyspnea or orthopnea. Recently, henoticed ankle edema.
Progressive Dysphagia and Weight Loss in an African American Woman
December 31st 2006Over the past 6 months, a 76-year-old African American woman has had increasingdifficulty in swallowing solid food and has lost 40 lb. She can now tolerateonly liquids and foods with a pudding-like consistency. Ingestion of moresolid food produces the sensation that it is “sticking in her chest,” and shesubsequently regurgitates it undigested. She denies heartburn, reflux, nausea,hematemesis, abdominal pain, and melena.
Young Man With Loud, Asymptomatic Heart Murmur
December 31st 2006A 27-year-old man is referred by an occupational health clinic for evaluation ofa heart murmur. The murmur was detected during a company-mandated examinationfor a flu-like illness that had caused him to miss several days of work.Before the onset of this illness, he had felt well and had no unusual complaints.He denies symptoms of congestive heart failure.
Infectious Vulvovaginal Disease:Obstacles to Performing Wet Mount Exams
December 31st 2006Accurate diagnosis of nonviralinfectious diseases ofthe vagina is largely contingenton the clinician’s abilityto do a sophisticated wetmount/potassium hydroxide (KOH)preparation examination-more specificallywhat is termed a “level II wetmount examination” (Table). Clinicalassessment in conjunction with a properwet mount/KOH analysis will usuallyidentify the causative organism orsuggest exclusion of diagnostic possibilities(Figure).
Worsening Back Pain in an Injection Drug User
December 31st 2006For several weeks, a 29-year-old woman has had worsening left lower backpain that is aggravated by sitting and walking. The pain is most severe aboveher left buttock; it radiates into the buttock and very slightly into the leg. Overthe-counter analgesics have been ineffective. Assuming a supine position providessome relief, but the pain still occasionally awakens her at night. She deniesweakness, other neurologic symptoms, and any symptoms of bowel orbladder dysfunction.
THERAPY OF INFECTIOUS DISEASES
December 31st 2006The emphasis in this clinically focused text is on syndromesand patient care rather than on pathogens. Among the topicscovered are antimicrobial pharmacokinetics and pharmacodynamics;head and neck infections; upper respiratory tractinfections; bronchitis and pneumonia; endocarditis; pericarditisand myocarditis; peritonitis, liver abscess, and biliary tractinfections; viral hepatitis; CNS infections; skin and soft tissueinfections; animal and human bites; osteomyelitis and infectiousarthritis; foot infections in patients with diabetes; scarletfever and toxic shock syndromes; fever of unknown origin;bacterial, viral, and protozoal diarrhea; obstetric-gynecologicinfections; urinary tract infections; sexually transmitted diseases;infectious complications of HIV infection; tuberculosis;tropical diseases; zoonoses; bioterrorism; and fungal infections.Color and black-and-white photographs, photomicrographs,CT scans, radiographs, drawings, tables, and flowchartshighlight seminal points in the text.