tips and tricks<p><span class="article-text"><span><strong></strong>When patients experience discomfort with Foley catheterization, fill a 2-mL syringe with <span class="DrugLink">lidocaine<span></span></span> jelly and inject this (without using the needle!) through the urethral meatus and into the urethra. <br></span></span></p>
tips and tricks<p>Frequently, patients are confused about what is included in a low cholesterol diet.</p>
tips and tricks<p><span class="article-text"><span>Advise patients who are receiving continuous positive airway pressure (CPAP) therapy and who use a corticosteroid nasal spray for allergies to spray in the morning rather than at bedtime.</span></span></p>
Dyspnea and Large Abdominal EcchymosisA 77-year-old woman who has had shortness of breath and intermittent left flank pain for the past 2 to 3 days is brought by her family for evaluation. The dyspnea worsens when she lies down. She denies chest pain, back pain, and syncope. She has also had mild nonbloody diarrhea of 2 days’ duration but no vomiting or oral intake intolerance.
Pneumatosis Intestinalis<p><a href="http://www.consultantlive.com/image/image_gallery?img_id=1470041&t=1254843003920"><img src="http://www.consultantlive.com/image/image_gallery?img_id=1470041&t=1254843003920" width="150" style="margin-right: 8px; margin-left: 8px; float: left;" /></a><span class="article-text"><span>A 70-year-old woman with poorly controlled type 2 diabetes mellitus (hemoglobin A1c, 12.5%) and hypertension was brought to the emergency department for evaluation of abdominal pain and loose bowel movements.</span></span></p><p>The patient complained of diffuse abdominal pain. She had an erythematous swelling around the right iliac fossa, abdominal guarding, and palpable crepitations. CT scan of the abdomen without contrast showed extensive portal venous air from the small branches in the periphery to the main portal and splenic veins.</p>
Spontaneous Embolization of a Thrombus-in-Transit<p><a href="http://www.consultantlive.com/image/image_gallery?img_id=1470011&t=1254841911983"><img src="http://www.consultantlive.com/image/image_gallery?img_id=1470011&t=1254841911983" width="150" height="109" style="margin: 2px 8px; float: left;" /></a>Chest pain and dyspnea of acute onset prompted a 49-year-old man to seek urgent medical attention. Two months earlier, he had sustained fractures to the right arm and both ankles after a 25-ft fall. Ten days before presentation, the patient’s rehabilitation physician had discontinued daily enoxaparin because of improved mobility and a presumed decreased risk of thromboembolism.</p>
Mycobacterium marinum Granuloma<p><img src="/sites/default/files/images/Mycobacterium%20marinum%20Granuloma.jpg" width="150" height="161" style="margin-left: 8px; margin-right: 8px; float: left;" />While fishing in the Chesapeake Bay, an 81-year-old man slipped and fell into the water. Afterward, he noticed a superficial abrasion over his right knee. During the next 10 days, red bumps, pustules, and slight tenderness developed. He was treated empirically with <span class="DrugLink">mupirocin</span> ointment, <span class="DrugLink">amoxicillin<span class="DrugLink"></span></span>/clavulanate and subsequently with cephalexin. However, new papular lesions continued to develop adjacent to the area of involvement, which showed no signs of healing.</p>
QuizSeveral weeks earlier these slightly tender nodules erupted on the arms and legs of a 75-year-old woman with extensive sun damage.
Quiz<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1466379&t=1254490161101" width="150" height="143" style="margin: 2px 8px; float: left;"></p><p>This rash on a 60-year-old man’s nose has worsened over the past few months.</p><p><strong>What does this look like to you?</strong></p>
Quiz<p><strong> </strong></p><p>This 39-year-old man from India has had an itchy eruption on his face for a few months. He is otherwise healthy, takes no medications, and has no other rashes.</p>
Commentary<p><img alt="" height="219" src="http://www.consultantlive.com/image/image_gallery?img_id=1465506&t=1254410688726" style="float:left" width="101" /></p> <p>What meaning resides in the series as a whole? To me, it embodies deep-seated belief and central practice: the primacy of time spent with the patient, gathering meaningful information and building the relationship that is often the most powerful therapeutic instrument we have. From the second year of medical school I planned to become a good physical examiner. I hungered for patient contact amidst a sterile curriculum. Also, I arrogantly, short-sightedly failed to see how the unpalatable basic science years formed a crucial, deep, and rational foundation for clinical understanding. Thirty-five years on, I have honed my skills. But daily I doubt some findings and interpretations; any clinician who is always sure is a fraud and a fool.</p>