The management of diabetes is continuing to advance. Many new agents introduced during the past 20 years have steadily improved the outlook for effective and tolerable treatment. The last decade in particular has seen tremendous progress in the pharmacotherapy of diabetes.
Dizziness is a nonspecific term that describes an unpleasant sensation of imbalance or altered orientation in space. This common clinical problem affects at least a third of the population in one form or another at some point during their life. The prevalence increases significantly with age and is higher among those with diabetes.
There are many therapies for treating chronic pain ranging from medications to invasive techniques, including injections and surgery. Often overlooked and underused are the various nonpharmacologic therapies, such as psychotherapy, physical therapy (PT), occupational therapy (OT), and acupuncture (Table). Because of the limited education most physicians receive on chronic pain in medical school and postgraduate training, they often have little knowledge about the potential role these therapies have in managing this problem, much less any experience in utilizing them.
Primary care’s top online resource just got better. In conjunction with the January redesign of our journal and the launch of our tablet edition, we are proud to announce the revamping of our website, www.consultant360.com.
A 16-year-old girl is bothered by a spreading, itchy rash of 1 week’s duration on the left preauricular cheek. The otherwise healthy teenager denies taking any new medications or using new cosmetics.
Dermclinic A Photo Quiz to Hone Dermatologic Skills
For the past few days, a 63-year-old man’s lower leg has become painful, itchy, swollen, and red. The patient is afebrile and takes no medication. Another practitioner suspects an infectious cause and orders a complete blood cell count and bone films and a nuclear scan to rule out osteomyelitis. Pending the laboratory findings, a fluoroquinolone antibiotic is prescribed.
The patient comes to your office for a second opinion. What action(s) do you take?
A. Reassure the patient that there is no evidence of infection.
B. Recommend he undergo Doppler studies or a venographic examination to rule out deep venous thrombosis.
C. Change the antibiotic to a cephalosporin.
D. Examine and culture the toe webs for a possible infection.
A 32-year-old man was admitted to the hospital with progressive shortness of breath of 2 weeks’ duration. He had received a diagnosis of bronchial asthma nearly 6 months earlier and was being treated with inhaled corticosteroids and bronchodilators.
Despite being the “most preventable cause of death among hospitalized patients,” pulmonary embolic disease (PED) still manages to claim 100,000 to 180,000 lives a year in the United States.A recent “Top Paper” defined “massive” (5%) and “submassive” PED (20% to 25%). These 2 categories of PED, complicated by hypotension, syncope, cardiogenic shock, cardiac arrest (massive), and right ventricular (RV) dysfunction (submassive), are life-threatening. The information in the Top Paper, focusing on the submassive variety, is timely and should significantly change future practice.
A 13-year-old girl with intermittent episodes of bruising was referred to our hematology clinic after several visits to her private physician. The bruises appeared suddenly on her extremities, face, and chin after little or no trauma.
CASE: A 9-year-old boy with left-sided neck pain and stiffness is brought to your office by his mother. The pain started when the child awoke that morning; it has gradually worsened over the course of the day and is more severe when he attempts to turn his head to the left. He denies headache, fever, rash, cough, or recent trauma or illness.
Wound infection delays wound closure. It prolongs the inflammatory phase of healing and often causes distress and discomfort for patients. Increased bacterial burden may not be obvious in all wounds; in the chronic wound, signs of infection may be quite subtle and, therefore, overlooked. Prompt identification and management of infection is essential in the management of chronic wounds.
An 85-year-old woman was brought to the emergency department by her son, who stated that his mother had complained of a cough and generalized fatigue for 2 days. The cough was nonproductive, and she had not appeared to have a fever.
A 79-year-old woman presented with this highly pruritic rash of several weeks’ duration; it had erupted under her breasts with the onset of hot weather. Initially, she treated the rash with an over-the-counter topical corticosteroid cream, which seemed to have made it worse.
A 3-year-old boy was brought to the emergency department with left eye swelling, which had doubled in size since it appeared the day before, and purulent crusting (A). On the first day of the swelling, the child was evaluated at another facility and given the diagnosis of periorbital contusion, conjunctivitis, and left otitis media for which erythromycin ophthalmic ointment and oral cefuroxime were prescribed.
During routine exploration of the abdominal viscera before rectal carcinoma resection, diverticula were found in the jejunum of a 75-year-old woman. These outpouchings were located on the mesenteric side of the bowel. Because the patient was asymptomatic, no treatment was given. The rectal cancer was resected; her postoperative course was uneventful.
Cyanosis involving the hands and toes of a 12-year-old girl was first noted 3 months before medical evaluation was sought. Her fingers and palms were red, the nail beds were cyanotic, and her palms were cold and sweaty. The girl’s toes were cyanotic when she was standing. Her hands and feet reverted to a normal color when the limbs were elevated. The remainder of the physical examination was normal.
Febrile seizures—primary generalized seizures that last less than 15 minutes and do not recur within 24 hours—are the most common convulsive event in children under age 5. Between 2% and 5% of all children experience one or more such seizures during early childhood.
The residents and I recently evaluated a patient with midsubstance Achilles tendinopathy. I have a sensitive spot for sufferers of Achilles discomfort since I ruptured mine 20 years ago (ouch!). A recent “Top Paper” reviewed some helpful diagnostic hints with a focus on emerging therapies that were new to me. The discussion will be presented as numbered “take home” messages relevant to primary care.1
The management of diabetes is continuing to advance. Many new agents introduced during the past 20 years have steadily improved the outlook for effective and tolerable treatment. The last decade in particular has seen tremendous progress in the pharmacotherapy of diabetes.
Dizziness is a nonspecific term that describes an unpleasant sensation of imbalance or altered orientation in space. This common clinical problem affects at least a third of the population in one form or another at some point during their life. The prevalence increases significantly with age and is higher among those with diabetes. 
There are many therapies for treating chronic pain ranging from medications to invasive techniques, including injections and surgery. Often overlooked and underused are the various nonpharmacologic therapies, such as psychotherapy, physical therapy (PT), occupational therapy (OT), and acupuncture (Table). Because of the limited education most physicians receive on chronic pain in medical school and postgraduate training, they often have little knowledge about the potential role these therapies have in managing this problem, much less any experience in utilizing them.
Primary care’s top online resource just got better. In conjunction with the January redesign of our journal and the launch of our tablet edition, we are proud to announce the revamping of our website, 
A 16-year-old girl is bothered by a spreading, itchy rash of 1 week’s duration on the left preauricular cheek. The otherwise healthy teenager denies taking any new medications or using new cosmetics.
A 32-year-old man was admitted to the hospital with progressive shortness of breath of 2 weeks’ duration. He had received a diagnosis of bronchial asthma nearly 6 months earlier and was being treated with inhaled corticosteroids and bronchodilators.
A collage of images representing skin signs of vascular disorders.
Despite being the “most preventable cause of death among hospitalized patients,” pulmonary embolic disease (PED) still manages to claim 100,000 to 180,000 lives a year in the United States.
A 13-year-old girl with intermittent episodes of bruising was referred to our hematology clinic after several visits to her private physician. The bruises appeared suddenly on her extremities, face, and chin after little or no trauma.
CASE: A 9-year-old boy with left-sided neck pain and stiffness is brought to your office by his mother. The pain started when the child awoke that morning; it has gradually worsened over the course of the day and is more severe when he attempts to turn his head to the left. He denies headache, fever, rash, cough, or recent trauma or illness.
Wound infection delays wound closure. It prolongs the inflammatory phase of healing and often causes distress and discomfort for patients. Increased bacterial burden may not be obvious in all wounds; in the chronic wound, signs of infection may be quite subtle and, therefore, overlooked. Prompt identification and management of infection is essential in the management of chronic wounds.
An 85-year-old woman was brought to the emergency department by her son, who stated that his mother had complained of a cough and generalized fatigue for 2 days. The cough was nonproductive, and she had not appeared to have a fever.
A 79-year-old woman presented with this highly pruritic rash of several weeks’ duration; it had erupted under her breasts with the onset of hot weather. Initially, she treated the rash with an over-the-counter topical corticosteroid cream, which seemed to have made it worse.
A 
During routine exploration of the abdominal viscera before rectal carcinoma resection, diverticula were found in the jejunum of a 75-year-old woman. These outpouchings were located on the mesenteric side of the bowel. Because the patient was asymptomatic, no treatment was given. The rectal cancer was resected; her postoperative course was uneventful.
Cyanosis involving the hands and toes of a 12-year-old girl was first noted 3 months before medical evaluation was sought. Her fingers and palms were red, the nail beds were cyanotic, and her palms were cold and sweaty. The girl’s toes were cyanotic when she was standing. Her hands and feet reverted to a normal color when the limbs were elevated. The remainder of the physical examination was normal.
Febrile seizures—primary generalized seizures that last less than 15 minutes and do not recur within 24 hours—are the most common convulsive event in children under age 5. Between 2% and 5% of all children experience one or more such seizures during early childhood.
The residents and I recently evaluated a patient with midsubstance Achilles tendinopathy. I have a sensitive spot for sufferers of Achilles discomfort since I ruptured mine 20 years ago (ouch!). A recent “Top Paper” reviewed some helpful diagnostic hints with a focus on emerging therapies that were new to me. The discussion will be presented as numbered “take home” messages relevant to primary care.1
