tips and tricks<p>Using the Patient Health Questionnaire– 9 (PHQ-9) makes office visits for depression (both initial and follow- up) go faster and more smoothly. The questionnaire provides objective corroboration of the diagnosis and evidence of whether treatment is working.</p>
Pectoralis Major Partial Tear<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1366468&t=1232566634869" alt="D" style="margin-left: 8px; margin-right: 8px; float: left;" width="150" height="123"><span class="article-text"><span>A 36-year-old man presented with persistent right shoulder weakness and pain (4 out of 10 on the visual analog scale). He also had an “odd pulling sensation” with arm adduction. During a wrestling match 2 years earlier, his arm was abducted and extended, after which he heard a popping noise and felt burning pain in his shoulder. This was followed by localized swelling with noticeable arm weakness, particularly when he pulled something heavy toward him using the injured arm.</span></span></p>
Chronic Cocaine Abuse<p style="text-align: left;"><span class="article-text"><span><a href="http://www.consultantlive.com/image/image_gallery?img_id=1366432&t=1232566634617" target="_blank"><img src="http://www.consultantlive.com/image/image_gallery?img_id=1366436&t=1232566634626" alt="Image 1" style="float: left; margin-left: 8px; margin-right: 8px;" width="150" height="116"></a></span></span>For 18 months, a 50-year-old man had sporadic epistaxis that had worsened and become uncontr<span class="article-text"><span></span></span>ollable. The patient also had saddle-nose deformity, with erosion of the surrounding structures of the face, and reddish discoloration of the skin with severe dryness.</p>
- The population of elderly nursing home residents who have dementia has been steadily increasing. It is not unusual to be called early in these patients’ course, day or night, and be asked to prescribe something for agitation—triggered by strange new surroundings and people.
Tinea<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1366360&t=1232565711239" alt="Figure" style="float: left; margin-left: 8px; margin-right: 8px;" width="150" height="163"><span class="article-text"><span>In 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. </span></span></p>