Coronary Artery Disease<p><img alt="hepatotoxicity" height="90" src="/sites/default/files/images/1301Con_PCHepatotox.jpg" style="float:left" title="hepatotoxicity" width="90" />Coronary artery disease was diagnosed in a 39-year-old African American woman with a history of hypertension, hyperlipidemia, and sarcoidosis. She underwent a coronary catheterization with placement of a drug-eluting stent in the left anterior descending artery. Clopidogrel 75 mg/d was prescribed.</p>
appendicitis<p><img alt="appendicitis" height="90" src="/sites/default/files/images/1301Con_PCAppendi.jpg" style="float:left" title="appendicitis" width="90" />Over the past 24 hours, an 18-year-old boy had generalized abdominal pain and fever. On presentation to the emergency department, he was febrile, with a temperature of 38.3°C (101°F), and tachycardic (heart rate, 120 beats per minute); blood pressure and respiration rate were normal. He had a past history of intermittent asthma. Abdominal examination elicited tenderness over the right iliac fossa. The remaining examination findings were unremarkable.</p> <div> </div>
Heart<p><img alt="mitral valve" height="90" src="/sites/default/files/images/1301Con_PCMitral.jpg" style="float:left" title="mitral valve" width="90" />Palpitations of 1 week’s duration prompted a previously healthy 29-year-old woman to seek medical attention. She had no other symptoms. Physical examination, ECG, and 24-hour Holter monitoring results were normal. An echocardiogram (shown here) revealed a central double orifice mitral valve (DOMV) with equally divided orifices attached to 2 papillary muscles. A central bridge connected both leaflets. No significant regurgitation, stenosis, or other structural abnormalities were noted. The systolic and diastolic functions were also normal.</p>
Granuloma Annulare<p class="p1"><img src="/sites/default/files/images/1301Con_DC_C2.jpg" alt="granuloma annulare" title="granuloma annulare" style="margin: 0px 5px; float: left;" height="90" width="90">Asymptomatic bumps first erupted on a 55-year-old woman’s elbows 6 months earlier. She reports no history of trauma or insect bites.</p>
Skin, Nevus<p><img src="/sites/default/files/images/1301Con_DC_C1.jpg" alt="voigt's lines" title="voigt's lines" width="90" height="90" style="float: left; margin: 5px;"></p><div><p class="p1">A 54-year-old woman is bothered by a long-standing, distinct pigment line on the anterior of both upper arms. She <span class="s1">states that the demarcation is accentuated </span>by sun exposure.</p></div>
ExercisePhysical activity may increase already high levels of glucose and ketone bodies and thereby precipitate ketoacidosis.
eating disorders<p><strong><img alt="bulimia, eating disorder" height="90" src="/sites/default/files/1301Con_WDEffron_IndxFg.jpg" style="float:left" title="bulimia, eating disorder" width="90" /></strong>A 29-year-old woman presents to your office with bilateral facial swelling (<strong>A</strong>). She had seen her dentist 3 weeks earlier and had sustained a small laceration to the buccal mucosa during a routine cleaning. Two days later, facial edema developed, which was localized to her parotid glands.</p> <p> </p>
Genital Lesions, zoon balanitis<p><strong><img alt="zoon balanitis" height="90" src="/sites/default/files/1301Con_CPParks_Fg2.jpg" style="float:left" title="zoon balanitis" width="90" /></strong></p> <div> <p>Zoon balanitis, or plasma cell balanitis, is a chronic, benign, rare inflammatory disorder that manifests as lesions localized on the glans penis and prepuce. The cause is unknown. It typically occurs in middle-aged and elderly uncircumcised men. Here we present the case of a middle-aged man with Zoon balanitis who was treated with topical corticosteroids and tacrolimus.</p> <p> </p> </div>
Hematuria and Dysuria<p>A 21-year-old woman presents with a 3-day history of dysuria and increased urinary frequency and urgency. These symptoms began suddenly but have been worsening over the past few days. On the morning of her visit, she experienced some gross hematuria. She denies fever, chills, flank pain, or other systemic symptoms. She has not previously experienced similar or related symptoms.</p>
von Recklinghausen Disease<p>A 46-year-old woman presents to the emergency department (ED) with pain in the left hand after an injury. Radiographs obtained in the ED are normal. On physical examination, however, multiple “nodule-like” lesions are observed on the patient’s face (shown here) and body. Similar lesions are present on the face and the body of her daughter. The patient states that she has undergone an extensive investigation; a biopsy performed by a dermatologist confirmed the diagnosis.</p>
Drug Eruption, drug reactionIn the United States, adverse drug reactions are a major cause of morbidity and mortality in both the outpatient and inpatient settings.1 Many of these adverse events could have been avoided by timely diagnosis and treatment—or by appropriate preventive measures.</p>
drug reaction<p>Painful, erythematous plaques had erupted 4 to 6 weeks earlier on the left upper arm and lower abdominal wall of a 54-year-old woman. The lesions had since increased in size and become more tender.</p>
Frostbite, Injuries, trauma<p><strong><img alt="winter injuries" height="90" src="/sites/default/files/Screen%20Shot%202013-01-15%20at%203.40.43%20PM.png" style="float:left" title="winter injuries" width="90" /></strong>Sledding down a snowy hill, skating on a frozen pond, cross-country skiing along a woodland trail—these wintertime activities can pose the risk of frostbite and traumatic injury, particularly for children. Some of the injuries commonly associated with winter sports are listed in the <strong>Table</strong>.</p> <p> </p>
Top Papers Of The MonthComplaints of knee pain are very common in primary care practice. Osteoarthritis is the cause in many instances, especially in an aging, obese population. A recent “Top Paper” offers practical advice for the diagnosis and management of this problem.
Primary Care<p><img alt="florence nightingale" height="90" src="/sites/default/files/1301Con_GCColgan_FNPic.jpg" style="float:left" title="florence nightingale" width="90" />If asked to identify one woman throughout history whose name is synonymous with providing care to the sick, most people would likely answer: Florence Nightingale. A British nurse, pioneer of modern nursing, public health advocate, and noted statistician, Nightingale (1820–1910) dedicated her life to serving others. She truly stands out as one of the greatest healers history has known.</p>
CONSULTANT<p>You may have noticed something different about this latest issue of CONSULTANT. We have redesigned the publication to improve your overall readership experience from page to screen. CONSULTANT is no longer bound by the printed page. With the launch of our tablet edition, we’ve updated the look of our journal to ensure that you have the best possible viewing experience on your tablet device (eg, iPad). In addition to all the features and articles that appear each month in our journal, the tablet edition offers new interactive features, videos, and live links to exclusive online content. The free app is available through Apple and Google Play platforms and you can navigate the download process by registering at www.consultant360.com/tablet_apps.</p>