feverA 64-year-old man presents with a severe febrile syndrome of several days’ duration. The syndrome includes fatigue and severe myalgias and arthralgias. There is no cough, sputum production, rhinorrhea, or severe GI symptoms (such as vomiting or diarrhea). He has taken acetaminophen with minimal relief.
NevusA 44-year-old man presents for evaluation of a changing pigmented lesion on his trunk.
Port-Wine Stain<p class="p1"><img src="/sites/default/files/Screen%20Shot%202013-03-22%20at%2011.14.14%20AM.png" alt="port wine stain" title="port wine stain" width="90" height="90" style="float: left; margin-left: 5px; margin-right: 5px;">The mother of a 6-month-old girl was alarmed by the birthmark on her daughter’s lower back. The child is otherwise healthy.</p>
PhotoclinicAn 82-year-old African American woman presented to the emergency department with abdominal pain of 5 days’ duration; the pain was aggravated by movement and relieved somewhat by sitting down.
PhotoclinicIn January, a 14-year-old girl presented with purple coloration of the distal toes. During the week and a half before presentation, she had redness and swelling just proximal to the toenails.
Oral LesionWoman with history of diabetes, hypertension, multiple myeloma, and renal failure was hospitalized due to renal insufficiency; oral examination showed macroglossia.
Dermatophyte<p>For several years, a 72-year-old man has had a slightly itchy rash on his face. The rash waxes and wanes but never quite resolves despite the use of over-the-counter hydrocortisone, triple antibiotic creams, and antifungal creams. It seems to worsen slightly during hot weather.</p>
hyperpigmentation<p>Gingival hyperpigmentation was noted in a 27-year-old African American man during a routine physical examination (<strong>A</strong>). It had been present since birth, and the patient was unaware of similar hyperpigmentation in other family members.</p>
vaccination<p>What do you say to parents who express concern about the number of vaccinations their child receives at each visit and request flexibility, such as delaying one or more immunizations? A new report from the Institute of Medicine (IOM) underscores the safety of the current childhood immunization schedule prepared by the US Advisory Committee on Immunization Practices (ACIP).<sup>1</sup> This report is the most comprehensive examination of the immunization schedule to date.</p>
drug reactionA 56-year-old man presents with low back pain, fever, and chills; he has no history of trauma. He has type 2 diabetes mellitus and uses intravenous heroin. The only abnormalities noted on physical examination are needle track marks and pain on palpation over the lumbar spine.
What's Your Diagnosis?Impetigo is a superficial, highly contagious bacterial infection characterized by a localized inflamed and infected epidermis.
Blood, fever, kawasaki<p><img alt="kawasaki, lips" height="120" src="/sites/default/files/Screen%20Shot%202013-03-21%20at%2011.38.46%20AM.png" style="float:left" title="kawasaki, lips" width="120" />An 11-year-old Caucasian boy with intermittent fever for the past 5 days presented to the local school-based health center accompanied by his mother. The mother reported that her son had spikes in temperature up to 40.3°C (104.5°F), without associated symptoms.</p>
Microhematuria<p>Exactly what did we know about asymptomatic microscopic hematuria (AMH; 3 or more red blood cells per high-power field on at least 2 of 3 properly collected urine specimens) prior to this month’s “Top Paper”? AMH is common with a prevalence as high as 9% to 18%.<sup>1</sup> The American Urological Association has strictly delineated workup for AMH.<sup>2</sup> Guidelines propose imaging with multiphase computed tomography with and without contrast; and patients 35 years of age or older, as well as those younger than age 35 if they have risk factors for urinary tract malignancies, should also undergo a cystoscopic evaluation.</p>
Primary Care<p>Numerous direct connections exist between wine and medicine. Many physicians enjoy drinking wine, for example, and grateful patients sometimes express their appreciation by giving their physicians a bottle of wine. Other connections between wine and medicine are less direct, but references to grapes, wine, and wine paraphernalia can be found in many fields of medicine. The purpose of this brief article is to heighten awareness of some of the interesting connections between wine and medicine.</p>
sodium reduction, Cardiometabolic risk<p class="p1"><img src="/sites/default/files/1303Con_ECRutecki_SaltShaker.jpg" alt="salt" title="salt" style="float: left; margin-left: 5px; margin-right: 5px;" height="115" width="115">Many of Yogi Berra’s quips stop far short of substantive food for thought. A recent eulogy for Stan “The Man” Musial by Bob Costas contained a perplexing “Yogi-ism”: The late Mr Berra once opined that if you don’t go to other people’s funerals, they will not come to yours! Despite Yogi’s malapropisms, he may have offered sage advice on rare occasions. He was once quoted as saying, “Take it with a <em>grin</em> of salt.” Guess what, Yogi, politely smiling but not ingesting sodium has become the healthy way to go. Unfortunately, American culture is not there yet. A recent study suggests (once again) that excessive salt intake is a major public health hazard.</p>