contact dermatitis<p><img src="/sites/default/files/1206Con_DC_C4_0.jpg" alt="Contact dermatitis" title="Contact dermatitis" width="90" height="90" style="margin: 5px; float: left;">Persistent irritation confined to the right corner of his lips annoys a 39-year-old man. He is unaware of anything that may have precipitated it. The patient takes no medication; past episodes of mild psoriasis of the elbows and knees were well controlled with intermittent corticosteroid use.</p>
Tinea pedis<p>An itchy, blistering eruption on the side of a 67-year-old woman’s foot has worsened during the past 2 weeks. She has never had athlete’s foot and has not recently purchased new shoes.</p>
Tinea capitis<p class="p1"><img src="/sites/default/files/1206Con_DC_C2.jpg" alt="Tinea capitis" title="Tinea capitis" width="90" height="90" style="float: left; margin: 5px;">An 8-year-old boy has been complaining for the past month of an itchy rash on the right side of his scalp. The child has no lesions elsewhere and takes no medication.</p>
Folliculitis<p class="p1"><img src="/sites/default/files/1206Con_PCFolliculitis_0.jpg" width="90" height="90" style="float: left; margin: 5px;">Erythematous folliculocentric papules were noted on the flexor aspects above and below the elbows of a 25-year-old man. The asymptomatic lesions were symmetric </p>
eruptive xanthomas<p><img src="/sites/default/files/1206Con_PCXanthoma_0.jpg" width="90" height="90" style="float: left; margin: 5px;">These pruritic papules of acute onset had failed to respond to topical corticosteroids, oral antibiotics, and intra-muscular corticosteroid injection. The 42-year-old patient denied recent use of a hot tub, foreign travel, illness, and joint pain.</p>
pulmonary arteriovenous malformations<p class="p1"><img src="/sites/default/files/1206Con_PCPulmoAVM_0.jpg" width="90" height="90" style="float: left; margin: 5px;">Progressive dyspnea prompted a 24-year-old woman to seek medical attention. Initially, her symptoms occurred only with exertion, but they later occurred at rest as well. She had no fever, chills, hemoptysis, or chest pain. Physical examination findings were unremarkable with no expiratory wheezing, symmetric chest wall excursion, and good air movement in both lung fields.</p>
trichobezoars<p><img src="/sites/default/files/1206Con_PCTrichobez_A_0.jpg" width="85" height="90" style="float: left; margin: 5px;">For the second time in a week, a 6-year-old girl was brought to the hospital with poorly localized epigastric and periumbilical pain. The pain was crampy and when severe, the child would yell. There was no aggravating or relieving factor. She also had 8 to 10 episodes of nonbilious, nonbloody vomiting. At the previous hospital visit, the patient had similar complaints of vomiting and abdominal pain and was treated for constipation.</p>
WoundsWhen wounds become chronic—ie, have not proceeded expediently through the four stages of healing and/or have languished for 3 months or more, usually “stuck” in the inflammatory or proliferative phase—a number of patient and wound factors must be considered and addressed.
Oral LesionsA 10-year-old African American boy with lumps in the mouth for the past 2 years. The lesions had increased in size and number.
Sun Exposure<p>An assortment of cases documenting the consequences of sun exposure, including basal cell carcinoma, solar elastosis, and actinic keratoses.</p>
CancerAbout 68% of Americans who receive a diagnosis of cancer live longer than 5 years.
acute cholecystitis<p>A 50-year-old woman is hospitalized after she presents with abdominal pain. The pain is episodic and is located in the epigastric area and toward the right upper quadrant (RUQ). It awakened her from sleep, and there was an initial bout of nausea and vomiting at the onset. She has had similar, milder episodes during the previous months, but the current attack is far more severe and persistent.</p>
backache<p><strong>ABSTRACT:</strong><strong> </strong>The vast majority of episodes of low back pain have musculoskeletal causes and resolve on their own, although recurrence is common. Therapeutic exercise, aerobic fitness, and achieving an ideal body weight may help prevent recurrences. Consider imaging for patients who have recent significant trauma, unexplained weight loss, unexplained fever, immunosuppression, history of cancer, intravenous drug use, osteoporosis combined with prolonged use of glucocorticoids, age older than 70 years, focal neurologic deficit, progressive or disabling symptoms, or symptom duration of greater than 6 weeks. It is important to identify medical causes, lumbar radiculopathy, and spinal stenosis, since these diagnoses have potential neurological impact and have more specific treatments. Referral to a spine surgeon is indicated in cases of refractory radicular pain, cauda equina syndrome, spinal cord compression, or progressive neurological deficit; surgical referral may also be considered in the setting of persistent pain or neurological deficit after 6 weeks of non-operative management.</p>
Top PapersWhen discussing type 2 diabetes mellitus, there is good news and bad news. The good news is that the armamentarium for treatment has been growing with recent potent additions. The incretins have revolutionized contemporary management, and multiple insulin formulations are available. Hemoglobin A1c (HbA1c) measurements and home monitoring provide essential information.
Primary Care<p><img alt="" height="90" src="/sites/default/files/1206Con_GCShahady_Tb.gif" style="float:left" width="90" />Primary care clinicians view retirement in many ways. I wrote a guide to physician retirement that was published by the American Academy of Family Physicians (AAFP) in 2004.<sup>1</sup> The book included a randomized survey of 2000 AAFP members over the age of 50, and it also included a review of the retirement literature and stories from several physicians and their spouses.</p> <div> </div>