DermclinicFor the past few days, a 63-year-old man’s lower leg has become painful, itchy, swollen, and red.
impregoImpetigoA 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.
cyanosis<p class="p3"><img src="/sites/default/files/Screen%20Shot%202013-04-29%20at%203.38.45%20PM_0.png" alt="Acrocyanosis" title="Acrocyanosis" width="110" height="110" style="float: left; margin-left: 5px; margin-right: 5px;">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.</p>
Diverticulosis<p class="p3"><img src="/sites/default/files/Screen%20Shot%202013-04-29%20at%203.07.39%20PM.png" alt="Jejunal Diverticulosis" title="Jejunal Diverticulosis" width="110" height="110" style="float: left; margin-left: 5px; margin-right: 5px;">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.</p>
Abscess<p class="p3"><img src="/sites/default/files/Screen%20Shot%202013-04-29%20at%201.57.12%20PM.png" alt="Subperiosteal Abscess" title="Subperiosteal Abscess" width="110" height="110" style="float: left; margin-left: 5px; margin-right: 5px;">A <span class="s2">3-year-old boy was brought to the emergency </span>department with left eye swelling, which had doubled in size since it appeared the day before, and purulent crusting (<strong>A</strong>). 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.</p>
candidiasis<p class="p1"><img src="/sites/default/files/Screen%20Shot%202013-04-29%20at%201.49.40%20PM_0.png" alt="Candidal Intertrigo" title="Candidal Intertrigo" width="110" height="110" style="float: left; margin-left: 5px; margin-right: 5px;">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.</p>
Respiration<p><img alt="pneumonia" height="110" src="/sites/default/files/Screen%20Shot%202013-04-26%20at%201.56.29%20PM.png" style="float:left" title="pneumonia" width="110" />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.</p>
infections, WoundsWound infection delays wound closure. It prolongs the inflammatory phase of healing and often causes distress and discomfort for patients.
torticollis<p><strong><img alt="torticollis" height="110" src="/sites/default/files/Screen%20Shot%202013-04-26%20at%2010.39.55%20AM.png" style="float:left" title="torticollis" width="110" />CASE:</strong> 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.</p>
tendinopahty<p>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.<sup>1</sup></p> <div> </div>
Pulmonary embolism<p>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.<span style="font-size:xx-small"> </span>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.</p>
Photo Essay, Leukocytoclastic Vasculitis, Vasculitis, VasculopathyA collage of images representing skin signs of vascular disorders.
Seizure<p>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.</p>
DyspneaThe patient had an anterior mediastinal mass caused by the lymphoma compressing the trachea, which presented initially as features of bronchial asthma.
CONSULTANT, Primary Care<p><img alt="con360" height="115" src="/sites/default/files/Screen%20Shot%202013-04-23%20at%201.15.50%20PM.png" style="float:left" title="con360" width="115" />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.</p>