September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Woman With Fever, Malaise, and Lesions on Her Hands and Feet
June 1st 2006A 22-year-old woman presents with fever and malaise of1 month’s duration. About 3 weeks earlier she went to theemergency department. Erythromycin was prescribed,and the patient was told to seek medical attention if hercondition did not improve. Since that time, her healthhas worsened, the fever has continued, and she has lostweight. She says she has had painful areas on her handsand feet but no rash.
Cardiac Tamponade: A Classic Presentation
June 1st 2006A 43-year-old woman presents to the emergency departmentwith fatigue, dyspnea, and intermittent chest painof 3 days’ duration. Her symptoms have worsened sinceshe arose, and 2 hours ago palpitations developed. She describesthe chest pain as a heavy pressure under her sternumthat does not radiate; she denies fever, nausea, vomiting,and diaphoresis.
Young Man With Swelling and Purulent Discharge in His Left Eye and Urethral Discharge
June 1st 2006A 25-year-old man reports that he has had a swollen eye for thepast several days. He noticed a small amount of yellow discharge the previousevening. He denies systemic complaints, including fever, chills, nausea, vomiting,and recent trauma. He also tells you that he has a drip in my private area.
Can You Identify These Pathogenic Organisms That Creep, Float, or Fly?
June 1st 2006Match each picture with the phrase below that best describes it. The organisms in these pictures might be microscopicor macroscopic, and they can be recovered from skin lesions or clothing by the patient and/or clinician.Answers and discussion appear on the following page.
Latest CDC Guidelines on Treating Sexually Transmitted Diseases: Part 1, Bacterial Infections
June 1st 2006Some sexually transmitteddiseases (STDs), such assyphilis and gonorrhea, arecenturies-old scourges; othershave attained clinicalsignificance only in recent years.Despite the availability of effectivetherapy for many of these diseases,they remain an important publichealth problem.
Bipolar Disorder: How to Recognize and Treat in Primary Care
June 1st 2006Patients with psychiatric disordersoften present a diagnostic challenge-even for psychiatrists. Their demeanormay not readily reveal the nature orseverity of the problem. Nevertheless,there are clues that can help you sortthrough the differential and arrive atthe correct diagnosis.
Anemia: Discerning the Cause in Different Clinical Settings
June 1st 2006A 77-year-old woman who had hadanorexia and weakness for 3 monthswas seen after a syncopal episode. Sheappeared pale but alert. Heart rate was110 beats per minute; respiration rate,22 breaths per minute; and blood pressure,170/70 mm Hg. Her hematologicindices were: hemoglobin level, 4.3 g/dL;mean corpuscular volume (MCV), 60fL; mean corpuscular hemoglobin concentration(MCHC), 29 g/dL; red bloodcell count, 1.6 million/μL; white bloodcell count, 7500/μL; and platelet count,452,000/μL.
Clinical Consultation: Pertussis in adults
June 1st 2006Although pertussis is generally considered to be a pediatric illness, it is important to note that approximately 60% of cases of pertussis in the United States occur in adolescents and adults.1 The incidence of pertussis in adults in the United States increased 400% from 1990 to 2001.2-4
Case In Point: Does this woman with cough and dyspnea really have CHF?
June 1st 2006A 47-year-old African American woman presented to the hospital after a 5-day history of cough and shortness of breath. The patient also described worsening cough with yellow sputum production over that same time but denied any fevers, chills, nausea, vomiting, abdominal pain, and urinary symptoms. Her condition began to rapidly deteriorate on arrival to the emergency department (ED).
Guidelines for evaluating pulmonary arterial hypertension
June 1st 2006Pulmonary arterial hypertension (PAH) can be difficult to diagnose because the symptoms are nonspecific and the physical findings are usually subtle (Table). In 2004, the American College of Chest Physicians (ACCP) published clinical practice guidelines for the diagnosis and management of PAH.1 Highlights of the ACCP's recommendations for patient assessment include the following:
Pyoderma Gangrenosum on Abdomen of a Man Following Laparoscopic Partial Nephrectomy
June 1st 2006Two weeks after undergoing a laparoscopic partial nephrectomy for renal adenocarcinoma, a 78-year-old man with myelodysplastic syndrome was hospitalized with nonhealing abdominal wounds. The patient had started a course of oral cephalexin 4 days before admission to treat erythematous areas at 2 of the trocar port sites.
How best to diagnose and control asthma in the elderly
June 1st 2006Abstract: A number of factors can complicate the diagnosis of asthma in elderly patients. For example, the elderly are more likely to have diseases such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) that--like asthma--can cause cough, dyspnea, and wheezing. Spirometry can help distinguish asthma from COPD, and chest radiography and measurement of brain natriuretic peptide levels can help identify CHF. Important considerations in the management of asthma include drug side effects, drug interactions, and difficulty in using metered-dose inhalers. When discussing the goals of therapy with the patient, remember that quality-of-life issues, such as the ability to live independently and to participate in leisure activities, can be stronger motivators than objective measures of pulmonary function. (J Respir Dis. 2006;27(6):238-247)
Something Bizarre in a Urine Collection Bag
June 1st 2006A staff nurse calls the physician to see "something really bizarre-we have no idea what this is": the plastic of a urine collection bag of an 81-year-old woman has turned purple, although the urine within is more orange-brown and distinctly less odd looking.