severe gag reflex<div id="article-content-body"><p>The next time you need to perform a routine oral examination in a patient with a severe gag reflex, try this: have the patient use the tongue blade to depress his or her own tongue while you shine the light.</p></div>
Ocular Genetic DiseaseA 23-year-old woman is brought to the emergency department after being found unconscious in her apartment.
Exercise<div id="article-content-body"><p>When patients' deep tendon reflexes in the ankle and knee are diminished, have them clasp their hands together and pull outward with both arms.</p></div>
Tea Tree Oil<div id="article-content-body"> <p>The sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.</p> </div>
Herpesviruses, Herpes simplex, Staphylococcal folliculitis<p><img src="/sites/default/files/old/img_4db964e8564c9.jpg" alt="Figure" width="150" height="150" style="margin-left: 8px; margin-right: 8px; float: left;" class="imageBorderBlue"></p><p class="MsoNormal"><strong></strong>A 37-year-old woman complains of “itchy bumps” that erupted just above her waist 2 or 3 days earlier. She has never had this condition in the past. The patient is otherwise healthy and takes no medications. An avid gardener, she claims to be able to identify and avoid poisonous plants.</p><p><strong><em><br></em></strong></p>
Apologies<div id="article-content-body"><p>Apologies and appreciation can work wonders for both patient and physician. One afternoon at our noon-to-5 clinic, a flood of patients arrived all at once at 4:00.</p></div>
Antibiotic Resistance<p><strong><em><img alt="" src="/sites/default/files/images/Gregory%20W%20Rutecki%2C%20MD.jpg" style="height:176px; margin-left:8px; margin-right:8px; width:150px; float:left" /></em></strong>Patients with upper respiratory tract infections (URTIs) have come to expect an antibiotic even if their clinical presentation is consistent with a viral infection. In a <em>Consultant</em> editorial last year, I discussed the “scourge” of <em>Clostridium difficile</em> colitis that has resulted from the expanding use of traditional as well as newly discovered antibiotics.<sup>1</sup> The issue has become prominent because an increasing number of persons have severe <em>C difficile</em> colitis that requires surgery.</p>
Cryotherapy<p>Young children are prone to scrapes and bruises. I recommend to their parents keeping a tray of miniature party-type ice cubes in the freezer.</p>
acute myocardial infarctionA 67-year-old woman arrived via ambulance in ventricular tachycardia. She had been experiencing crushing substernal chest pain and shortness of breath that had worsened over the past several hours. She received oxygen (by mask) and lidocaine (100 mg intravenously) en route to the emergency department (ED), but there was no change in the rhythm.
Lipoprotein(a)<div id="article-content-body"><p>Should I prescribe niacin for a patient whose lipoprotein(a) (Lp[a]) level is 65 mg/dL?</p></div>
What’s Your Diagnosis?®One facet of the rarity of making a diagnosis of penile in situ cancer in the primary care setting is underexamination of the genitalia.
- The incidence of melanoma has risen faster than any other malignancy and is currently the leading cause of death from diseases of the skin.
Eye Pain<div id="article-content-body"><!-- START FIGURE CODE --> <p>A 42-year-old man presents with severe pain, decreased vision, photophobia, and purulent discharge in his right eye.</p> </div>
Virtual Patient<div id="article-content-body"><p>As a teacher of medical students and residents in an academic medical center hospital, I am more and more concerned about the increasing distance placed between patients and those who are learning to be doctors. This results in large part from forces that, taken together, place a disproportionate premium on efficiency in our teaching hospitals.</p></div>
COPD, Tripod SignDr Henry Schneiderman invited readers to examine the photograph of a man with severe obstructive airways disease and psoriasis and offer additional observations.
Nail-Patella Syndrome<div id="article-content-body"><p>This 33-year-old Guatemalan man presented to a medical mission camp with generalized bilateral knee pain and inability to extend his leg without pain.</p></div>
Paramandibular Abscess<p><img alt="Figure" class="imageBorderBlue" src="/sites/default/files/old/img_4db964da1df94.jpg" style="height:100px; margin-left:8px; margin-right:8px; width:100px; float:left" />A 22-year-old man complained of jaw pain, sore throat, and dysphagia to solids and liquids. A month earlier, he presented to another hospital with similar symptoms; an infection of the lower right third molar (tooth no. 32) was diagnosed, and oral penicillin and hydrocodone were prescribed. He finished the course of the antibiotic but failed to follow up with a dentist.</p>
Labile Blood Pressure<div id="article-content-body"> <p>At a routine blood pressure check, a 63-year-old woman has 2 readings of 165/100 mm Hg. The patient has had essential hypertension since age 41 years. For more than a decade, it was easily controlled with a β-blocker; however, in recent years, her blood pressure has been more variable, with occasional readings of higher than 150/90 mm Hg.</p> </div>