House Staff<p><span class="article-text"><span><img src="http://www.consultantlive.com/image/image_gallery?img_id=1406114&t=1240000663088" style="width: 96px; height: 162px; float: left; margin-right: 7px; margin-left: 7px;"></span></span>Sometimes we try to distill long experience into words, whether aphorisms or full paragraphs. Rilke’s wonderful prose poem expresses this very well in the part that begi<span class="article-text"><span></span></span>ns, “For the sake of a single verse, one must see many cities, men and things. . . .”<sup>1</sup> While medicine has only some features in common with poetry, what reverberates is the wish to impart an affecting draught of beauty or wisdom or insight, in the case of poetry, after many years and decades of immersion in life; and I here offer some fruits of long observation and participation “hip deep” in clinical care and in the teaching of residents.</p>
tips and tricks<p>Doxycycline and potassium tablets can cause ulceration and severe burning of the esophagus if they get stuck and dissolve in that location.</p>
Sun Exposure<p><img alt="" height="202" src="/sites/default/files/images/Sun%20Shine%20Half%20Day%20Long.jpg" style="float:left" width="150" />An Irish proverb says, “May the sun shine all day long and everything go right and nothing wrong.” A Top Paper featured in this column last year focused on the risks of sun and tanning booth exposure, which can lead to skin cancers, including melanomas.<sup>1,2</sup> The bottom line was that too much sun was to be avoided.</p>
Neurofibromatosis<div id="article-content-body"><p><img src="/sites/default/files/images/Neurofibromatosis%20Type%20I.jpg" style="float: left; margin-left: 8px; margin-right: 8px;" width="150" height="102">During a routine physical examination, multiple, randomly distributed, flesh-colored nodules were noted on the trunk, arms, and face of a 62-year-old man. The lesions measured 0.5 to 1.0 cm and appeared slightly pedunculated. The patient had had the lesions since he was a teenager; they were not painful. He also had hypertension, for which he was taking <span class="DrugLink">lisinopril<span></span></span> (20 mg once daily).</p></div>
Osler Nodes<div id="article-content-body"><p><a href="http://www.consultantlive.com/web/10162/photoclinic/full-image?img_url=http://www.consultantlive.com/image/image_gallery?img_id=1419304&t=1244128012177"><img src="http://www.consultantlive.com/image/image_gallery?img_id=1419265&t=1244128012143" style="float: left; margin-left: 8px; margin-right: 8px;" width="150" height="79"> </a>For 4 months, a 41-year-old woman had pain in the pulp of her fingers and dorsa of her feet that was associated with transient maculopapular lesions at different sites. During this period, she had been hospitalized twice for the same complaint. Findings from an extensive rheumatological workup were negative. </p></div>
Carotid DissectionCarotid dissection associated with sports and other physical activities is an increasingly recognized, although still underestimated, cause of stroke.
Raccoon Eyes<p><span class="article-text"><span><img src="/sites/default/files/images/Raccoon%20Eyes.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="150" height="99">A 58-year-old man with type 2 diabetes, nephrolithiasis, and benign prostatic hyperplasia presented with bilateral periorbital ecchymoses and left subconjunctival hemorrhage. The ecchymoses had spontaneously appeared 3 days earlier; the patient had no history of trauma or falls. He also had difficulty in voiding, characterized by increased frequency, hesitancy, and diminished urine stream. <br></span></span></p>
An Influenza PrimerPublicity about global influenza, a result of both potential and real avian and swine flu epidemics, has led to a plethora of theories as well as alarm.
- <div style="padding: 7px;"><img alt="" height="108" src="http://www.consultantlive.com/image/image_gallery?img_id=1419797&t=1244475079480" style="float:left" width="150" /></div> <p>An all-terrain vehicle—ATV—is described by the American National Standards Institute as one that "travels on low pressure tires, with a seat that is straddled by the operator, and with handlebars to be used for steering."<sup>1</sup> By this definition, an ATV is designed for interactive riding by a single operator. Drivers are able to shift their weight freely in all directions depending on the situation and terrain.</p>