PhotoclinicRight upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors.
Subacute Cutaneous Lupus Erythematosus<p>This rash erupted on the upper body of a 58-year-old woman in late August. It was mildly pruritic and nontender.</p>
Bilateral Leg Ulcers<p>A 51-year-old man is admitted to the hospital with painful ulcers on both lower extremities, severe anemia, and a 45-kg (100-lb) weight loss over the past year. Pain from the ulcers prevents him from walking. The ulcers developed about 5 years earlier, as a result of his wearing high boots for work; they began as small sores and grew over time.</p>
Disfigured Penis<p><strong></strong><span class="article-text"><span><img src="http://www.consultantlive.com/image/image_gallery?img_id=1387407&amp;t=1236798724047" style="float: left; margin-left: 8px; margin-right: 8px;" width="150" height="125"></span></span>An 83-year-old man examined on admission for end-of-life care due to profound dementia. His wife states that his penis has not changed in appearance, but knows that he always had concerns about it. To her kn<span class="article-text"><span></span></span>owledge he never had trouble voiding.</p>
tips and tricks<p>In a patient receiving antifungal therapy for onychomycosis, it can be difficult to tell how much change has occurred in a treated nail from one visit to the next.</p>
tips and tricks<p>Painful cracks in the fingertips are a common problem, especially during cold weather.</p>
tips and tricks<p>During a review of systems, I find it helpful and timesaving to ask the patient if he or she experiences symptoms that are out of the ordinary for the typical person. <em><br></em></p>
HIV-Related Oral LesionsOral lesions are often the harbingers of early HIV infection. Common oral manifestations include HPV-associated warts and hairy leukoplakia.
Vaginal Estrogen<div id="article-content-body"><p>My patient is a 52-year-old woman who is premenopausal but who experiences dyspareunia as a result of vaginal dryness. She has tried over-the-counter lubricants, but they have not relieved her symptoms. She takes <span class="DrugLink">warfarin<span class="DrugLink"></span></span>, 5 mg qod/7 mg qod, to prevent recurrent deep venous thrombosis (DVT).</p></div>
Skin<p>I applaud Dr Henry Schneiderman for his remarks in a recent “What’s Your Diagnosis?” column regarding the proper way to perform auscultation and percussion of the chest. I am a family practitioner, and I examine my patients on their bare skin.<em> <br></em></p>
Coin Ingestion<p>A 7-year-old girl was brought to the emergency department because of moderate pain on swallowing and mild upper abdominal discomfort. A few hours earlier, she had been given a piggy bank in order to save money for a family trip planned for the next day.</p>