Urticaria<p><span class="article-text"><span><img src="/sites/default/files/photoclinic-c.jpg" width="150" height="194" style="float: left; margin-left: 8px; margin-right: 8px;" /></span></span></p><p><span class="article-text"><span>This rash on the face and neck of a 27-year-old man appeared periodically over a 2-month period. During this time, the patient’s work involved welding inside a steel oil tank. This photo was taken immediately after the patient had stopped working. He had no accompanying fever or respiratory symptoms. The urticaria was pruritic and resolved the following morning.</span></span></p>
Disseminated Histoplasmosis<p class="DrugLink"><a href="/sites/default/files/photoclinicb-1.jpg"><img src="/sites/default/files/large_photoclinicb-1.jpg" width="150" height="150" style="float: left; margin-left: 8px; margin-right: 8px;"></a>A 38-year-old man had fever and fatigue for the past 6 days and tenderness in the left upper abdominal quadrant for the past 3 days. He also had a facial butterfly rash that had been present for 10 years and a 1-year history of lupus nephritis, treated with <span class="DrugLink">prednisone</span> and mycophenolate. He denied respiratory complaints or recent weight loss.</p>
Lymphocytic Hypophysitis<p><span class="article-text"><span><img src="/sites/default/files/photoclinic.jpg" width="150" height="154" style="margin-left: 8px; margin-right: 8px; float: left;" /></span></span><span class="article-text"><span>A 26-year-old woman at 30 weeks’ gestation presented to the emergency department with a throbbing frontal headache of 1 month’s duration. She had also had peripheral blurred vision for the past 2 weeks. Acetaminophen initially decreased her pain but was no longer effective. She had had a previous miscarriage.<br /></span></span></p>
doctor's stories"Doctors, especially primary care doctors, love stories.” So says Consultant editorial board member Faith T. Fitzgerald, MD. To back up her claim, Dr Fitzgerald (who is also Professor of Medicine and Associate Dean of Humanities and Bioethics at the University of California, Davis, School of Medicine) here shares a story of a memorable patient that is among her personal favorites.
Multiple Bumps<p><img alt="" height="104" src="/sites/default/files/images/Stroke%20and%20Multiple%20Bumps.jpg" style="float:left" width="150" />A 79-year-old man admitted for mental status changes, with neuroimaging that reveals lacunar brain infarct.</p> <p>Cannot report whether other family members have had changes on scalp resembling his own striking ones, nor whether anybody has had brain tumors or tumors of nerves. Denies that his tumors hurt or itch.</p>
and Renal Lithiasis, Eating Habits, LifestyleUrologists and pediatricians are puzzling over an apparent substantial increase in renal lithiasis among children.
Hypovolemia<div id="article-content-body"> <p>Dr Rutecki’s thoughtful note, "Diagnosing Dehydration: What Would Osler Do?" resonated strongly with me. I would add 2 domains in which review of the laboratory data in isolation will be most misleading, if we utilize an elevated BUN:creatinine ratio as a marker of hypovolemia-related prerenal azotemia.</p> </div>