pityriasis rubra pilaris<p><img src="/sites/default/files/images/1203Con_PC_Pityriasis.jpg" alt="Pityriasis Rubra Pilaris " width="90" height="90" style="float: left; margin: 5px;">This long-standing eruption on a 52-year-old woman’s palms and soles had resisted treatment with oral and topical antifungals, corticosteroid creams, and antibiotics. Her symptoms included pruritus and pain from the fissures that developed at the involved sites. </p>
PhotoclinicFor 2 months, a pruritic rash had been present on the upper back of a 48-year-old woman with a 1-year history of chronic myelogenous leukemia and a 2-year history of hepatitis C.
spontaneous pneumomediastinum<p><img src="/sites/default/files/images/1203Con_PCPneumo_A.jpg" alt="Spontaneous Pneumomediastinum" width="90" height="90" style="float: left; margin: 5px;">A 16-year-old girl presented to the emergency department with substernal chest pain exacerbated by deep inspiration, throat pain, difficulty in swallowing, and pain when turning her head to the side. She had no shortness of breath.</p>
carbohydrate counting<p><img src="/sites/default/files/images/1203Con_DQACarbs_Fg_thumb.jpg" width="90" height="90" style="float: left; margin: 5px;">Carbohydrate counting helps manage blood glucose levels in patients with diabetes mellitus. This dietary tool has been used since the 1920s when Dr Elliott Joslin taught it to his patients. Carbohydrate counting is effective for both patients with type 1 diabetes and those with type 2 diabetes.</p>
cyst, unicameral bone cyst<p>A 9-year-old boy presents with a 10-day history of left leg pain and limp. The pain waxes and wanes, and it increases with ambulation. The limp worsens with activity. The boy plays soccer but has no history of specific trauma to his leg.</p>
allergy, food allergyPatients often attribute an adverse reaction to food contaminants to “food allergy,” but a true food allergy is hypersensitivity triggered by the immune system.
Tremor, tremors<p>Although estimates of its prevalence vary widely, essential tremor is one of the most common neurologic disorders in adults.<sup>1,2</sup> It may be up to 20 times more prevalent than Parkinson disease.<sup>3</sup></p> <div> </div>
nevi, NevusTest your diagnostic acumen with 7 cases of nevi. Can you identify them all?
hepatorenal syndrome<p>The combination of acute/subacute renal failure in the setting of cirrhosis can be caused by many factors, but one entity—hepatorenal syndrome (HRS)—is the most serious, with a prohibitive prognosis. Although it is considered a subspecialty disease—managed by gastroenterologists-hepatologists and nephrologists—it can be prevented, in some instances, through informed primary care. A recent “Top Paper” provides an important perspective.</p>
WoundsChronic wounds are notorious for copious exudate production. Too much exudate can inhibit wound repair and cause periwound maceration because chronic wound fluid can break down extracellular matrix proteins and growth factors, prolong inflammation, inhibit cell proliferation, and potentially degrade the wound tissue matrix.
What’s The Take Home?<p>Hepatitis C virus (HCV) infection was recently diagnosed in an asymptomatic 53-year-old African American fireman. He had applied for a new life insurance policy prior to retirement some months earlier, and routine blood testing revealed an elevation of serum alanine aminotransferase (ALT) to approximately twice normal values, confirmed by repeated testing.</p> <div><strong> </strong></div>
Granuloma Annulare<p class="p1"><img src="/sites/default/files/1203Con_DC_C4_0.jpg" alt="granuloma annulare" width="90" height="90" style="float: left; margin: 5px;">A 34-year-old woman has been bothered for 1 month by itchy bumps on her elbows and knees.</p>
Basal cell carcinoma<p class="p1">During a general skin examination, a lesion is noted on the chest of a 44-year-old man. The patient was completely unaware of this erythematous, scaly patch and is unable to provide any history.</p>
diabetic dermopathy<p><img src="/sites/default/files/1203Con_DC_C2.jpg" alt="diabetic dermopathy" style="float: left; margin: 5px;" height="90" width="90">A 52-year-old man with diabetes mellitus presents for evaluation of an asymptomatic rash on his right leg. The lesions have been present for 2 months.</p>
candidiasis<p class="p2"><span class="s1"><strong><img src="/sites/default/files/images/1203Con_DC_C1.jpg" width="90" height="90" style="float: left; margin: 5px;"></strong>After 1 month of scratching a worsening inframammary rash, a 68-year-old woman seeks medical evaluation. She has tried over-the-counter hydrocortisone followed by clotrimazole, but to no avail.</span></p><div><span class="s1"><br></span></div><div><strong><br></strong></div>
nickel hypersensitivity<p>A 10-year-old boy was brought for evaluation of a spreading, intensely pruritic erythroderma of 6 days’ duration. The mother, a nurse, reported that the child had intermittent low-grade fever and 1 episode of vomiting and poor appetite, but no cough or other antecedent constitutional symptoms.</p>
Hearing impairment<p>In this age of “technological gadgetry,” everything and everyone seems a pushbutton away. We are constantly reminded of the ubiquity of “real time,” when mundane occurrences in the work place are so “15 seconds ago.” Some of these hot devices—such as cell phones, for example—are already perceived as dangerously distracting when they serve as a source for text messages sent from automobiles by inattentive drivers.</p>