End of life care<p>Teachers taught their students to respect the rules. Against that stood: A doctor is an advocate for his patient. Two hours later, following a plea to a ballpark executive, a road trip to a stadium with my resident, and transport in an unusually packed white coat, my patient's eyes lit with delight.</p>
PhotoclinicChronic plaque psoriasis in this 37-year-old man was treated with systemic corticosteroids after topical medications proved ineffective.
Eyes<div id="article-content-body"><p><img src="/sites/default/files/old/img_4db8c72408d2e.jpg" width="150" style="margin-left: 8px; margin-right: 8px; float: left;"></p><p>A 45-year-old man of Hispanic ancestry presents for evaluation of what he describes as a "growth in both eyes." This growth has been present for some time; however, it has recently become more prominent. The patient has had mild redness and irritation in both eyes, but he denies any change in vision.</p></div>
Splenectomy<div id="article-content-body"><p>Elective splenectomy has been scheduled for a 60-year-old man with severe idiopathic thrombocytopenic purpura (ITP) that has responded poorly to treatment. His current platelet count ranges from 5000/μL to 10,000/μL despite several months of aggressive therapy, including 2 courses of high-dose corticosteroids and 2 courses of intravenous immunoglobulin.</p></div>
Quiz<div id="article-content-body"><p><img src="/sites/default/files/old/img_4db8c723144c2.jpg" width="150" style="margin-left: 8px; margin-right: 8px; float: left;"></p><p>For 5 days, a 68-year-old woman has been bothered by a painful swelling on her left cheek. There is no history of trauma or bite. She takes a diuretic for mild hypertension. <span class="DrugLink"></span></p><p><em><strong>What is the likely diagnosis?</strong></em></p></div>
Dermatitis<div id="article-content-body"><p><img src="/sites/default/files/old/img_4db8c72239a60.jpg" width="150" style="float: left; margin-left: 8px; margin-right: 8px;"></p><p>Eczema is confined to the dorsum of a 37-year-old woman's hands. She had been applying an over-the-counter, topical antifungal cream but noted no change in the rash.</p><p><em><strong>What is your course of action?</strong></em></p><p> </p></div>
Board (Re)Certification<div id="article-content-body"><p>Every year thousands of physicians must take—and pass—an examination to become board certified in internal or family medicine. Thousands more must pass a board recertification examination to maintain their license to practice medicine— and similar exams are required of physician assistants and nurse practitioners. To pass a certification or recertification examination requires up-to-date and in-depth knowledge in at least a dozen areas of clinical medicine.</p></div>