Volume 51 - Issue 8 - August 2011

Consultant

08/08/2011

DAVID L. KAPLAN, MD—Series Editor
University of Missouri Kansas City, University of Kansas

Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.

DAVID L. KAPLAN, MD—Series EditorUniversity of Missouri Kansas City, University of Kans...
<p>A 44-year-old woman presents with slightly pruritic, purplish papules near the elbows and shins of several weeks’ duration. She has no history of trauma and takes no...
08/08/2011
08/08/2011

DAVID L. KAPLAN, MD—Series Editor
University of Missouri Kansas City, University of Kansas

Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.

DAVID L. KAPLAN, MD—Series EditorUniversity of Missouri Kansas City, University of Kans...
<p>Fifteen years after his last outbreak of acne, a 38-year-old man notices an acne-like eruption on his face. The asymptomatic rash appeared 3 days earlier. Last month, the patient had poison ivy...
08/08/2011
08/08/2011

DAVID L. KAPLAN, MD—Series Editor
University of Missouri Kansas City, University of Kansas

Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.

DAVID L. KAPLAN, MD—Series EditorUniversity of Missouri Kansas City, University of Kans...
<p>The mother of a 6-year-old girl is concerned about the enlarging bump on her daughter’s chin. The slightly itchy lesion first appeared as a “pimple” 1 week earlier.</p><p>Do you...
08/08/2011
Hair Loss
Hair Loss
08/08/2011

DAVID L. KAPLAN, MD—Series Editor
University of Missouri Kansas City, University of Kansas

Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.

DAVID L. KAPLAN, MD—Series EditorUniversity of Missouri Kansas City, University of Kans...
<p>For several months, a 70-year-old man has experienced patchy hair loss and mild itching on the top of his scalp. Over-the-counter shampoos containing tar or zinc have not been effective....
08/08/2011
What's Your Diagnosis?
What's Your Diagnosis?
08/08/2011

SIOBHAN MA, MD, PATRICK T. S. MA, MD, 
ALEXANDER K. C. LEUNG, MD, and ALEXANDER A. C. LEUNG, MD

Dr S. Ma is a resident in internal medicine at the Royal College of Surgeons in Ireland. Dr P. T. S. Ma is clinical assistant professor of medicine and Dr A. K. C. Leung is clinical professor of pediatrics both at the University of Calgary in Alberta. Dr A. A. C. Leung is a clinical scholar in medicine at the University of Calgary in Alberta and a research fellow at the Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts.

SIOBHAN MA, MD, PATRICK T. S. MA, MD,  ALEXANDER K. C. LEUNG, MD, and ALEXANDER A....
A 50-year-old woman has a 6-month history of severe generalized itchiness and fatigability. There is no associated fever, abdominal pain, or joint pain.
08/08/2011
08/08/2011

RONALD N. RUBIN, MD—Series Editor

Dr Rubin is professor of medicine at Temple University School of Medicine and chief of clinical hematology in the department of medicine at Temple University Hospital in Philadelphia.

RONALD N. RUBIN, MD—Series Editor Dr Rubin is professor of medicine at Temple Universi...
<p>For several days, a previously healthy 12-year-old girl has had a sore throat. She was given acetaminophen, which provided minimal relief. During the past 24 hours, she has been coughing because of...
08/08/2011
08/08/2011

D. BRADY PREGERSON, MD
Los Angeles

D. BRADY PREGERSON, MDLos Angeles
<p>Rather than relying on a gag or a wide-mouthed cry after otoscopy to examine a very young child’s posterior pharynx, consider a happier alternative. Ask the parents if they can make their...
08/08/2011
08/08/2011

ANTHONY TITUS, MD
Chapel Hill, NC

ANTHONY TITUS, MDChapel Hill, NC
<p>To irrigate a contaminated wound quickly, punch 3 holes in the lid of a 500-mL container of normal saline with a 14- or 16-gauge sterile needle. </p>
08/08/2011
08/08/2011

JOAN R. SHEPHERD, NP
Richmond, Va 

JOAN R. SHEPHERD, NPRichmond, Va 
<p><span style="color: #888888;"><span style="color: #000000;">Patients want and need information about diet. I recommend that they “shop the...
08/08/2011
08/08/2011

WILLIAM J. SCIALES, MD
Flushing, NY

WILLIAM J. SCIALES, MDFlushing, NY
<p>I have found that the best agent <span>for removing blood from clothing is hydrogen peroxide. </span></p>
08/08/2011
Interactive Features
Interactive Features
08/08/2011
Four patients with very different problems, all have one thing in common: an increased risk of osteoporosis as a result of long-term treatment with glucocorticoids.
08/08/2011
08/08/2011
<p>I offer the following hypothetical scenario: A patient who is taking dabigatran is referred to the hospital for emergent surgery. The surgeon wants to know whether he can operate. Is there any...
08/08/2011
08/08/2011

GREGORY W. RUTECKI, MD—Series Editor

Dr Rutecki is professor of medicine at the University of South Alabama College of Medicine in Mobile. He is also a member of the editorial board of CONSULTANT.

GREGORY W. RUTECKI, MD—Series Editor Dr Rutecki is professor of medicine at the Univer...
<p>It would be a mistake to minimize the syndrome of obstructive sleep apnea (OSA). It should not be characterized merely as obesity, a large neck, snoring, and daytime sleepiness; rather, it is a...
08/08/2011
08/08/2011

GREGORY W. RUTECKI, MD—Series Editor

Dr Rutecki is professor of medicine at the University of South Alabama College of Medicine in Mobile. He is also a member of the editorial board of CONSULTANT.

GREGORY W. RUTECKI, MD—Series EditorDr Rutecki is professor of medicine at the Universi...
<p>A cursory search of “bedbugs” on PubMed and “Emerging Infectious Diseases” (from the CDC) resulted in 437 and 386 “hits,” respectively. Now here is a super bug to contend with!...
08/08/2011
Case In Point
Case In Point
08/03/2011

KAVITA BAPAT, MD, SAMER H. A. ZAID KAYLANI, MD, 
CURTIS TURNER, MD, and OSVALDO REGUEIRA, MD
Texas Tech University Health Sciences Center, Amarillo

At the time this was written, Drs Bapat and Zaid Kaylani were pediatric residents at Texas Tech University Health Sciences Center in Amarillo. Dr Zaid Kaylani is currently a hematology/oncology fellow in the department of pediatrics at University of Alabama School of Medicine in Birmingham. Dr Turner is professor and residency program director and Dr Regueira is associate professor in the department of pediatrics, division of hematology/oncology at Texas Tech University Health Sciences Center, Amarillo.

KAVITA BAPAT, MD, SAMER H. A. ZAID KAYLANI, MD,  CURTIS TURNER, MD, and OSVALDO RE...
<p>A 13-year-old girl with intermittent episodes of bruising was referred to our hematology clinic after several visits to her private physician. The bruises appeared suddenly on her...
08/03/2011
08/03/2011

IBRAHIM M. ELALI, MD
University of Arizona College of Medicine, Phoenix

JOSE C. MISSRI, MD
Temple University School of Medicine, Philadelphia

IBRAHIM M. ELALI, MDUniversity of Arizona College of Medicine, PhoenixJOSE C. MISSRI, M...
<p>The acute onset of substernal chest pain during vigorous exercise prompted a 70-year-old woman to seek emergency medical attention. She reported chest pressure, left arm numbness, shortness of...
08/03/2011
08/03/2011

MRUGESH PATEL, MD
Orlando Health Internal Medicine Residency, Florida

MARIO J. MADRUGA, MD
Florida State University College of Medicine
University of Central Florida College of Medicine

MRUGESH PATEL, MDOrlando Health Internal Medicine Residency, FloridaMARIO J. MADRUGA, M...
<p>An 80-year-old woman presented with difficulty in swallowing, which had gradually worsened over 4 weeks. She complained that food was getting stuck and that she frequently had to sit upright to be...
08/03/2011
08/03/2011

LEONID SKORIN, Jr, DO
Mayo Clinic Health System–Albert Lea, Minnesota

LEONID SKORIN, Jr, DOMayo Clinic Health System–Albert Lea, Minnesota
<p>One month after successful cataract surgery, an 80-year-old man with moderate dementia was brought in for examination. He had recently been fitted with a new hearing aid.</p><p>His wife...
08/03/2011
08/03/2011

GREGORY W. RUTECKI, MD
University of South Alabama

Dr Rutecki is professor of medicine at the University of South Alabama College of Medicine in Mobile. He is also a member of the editorial board of CONSULTANT.

GREGORY W. RUTECKI, MD University of South Alabama Dr Rutecki is professor of medicine...
<p>A critique of the movie <em>Barbershop</em> was right on target. Calvin, the African American protagonist in the film, learns that the Chicago barbershop he has...
08/03/2011
08/03/2011

RENATE G. JUSTIN, MD
Lakewood, Colorado

Dr Justin is a retired family physician in Lakewood, Colorado

RENATE G. JUSTIN, MD Lakewood, Colorado Dr Justin is a retired family physician in Lak...
<p>His parents, professors at the local university, came to see me repeatedly. Their son, John, age 17, a gifted student, had been suspended from high school because of drug abuse. He was not...
08/03/2011
08/03/2011

WARREN HEFFRON, MD
University of New Mexico

CHRISTOPHER JENKINS, MD
In His Image Family Medicine Residency Training Program, Tulsa, OK

Dr Heffron is professor and chair emeritus, department of family and community medicine, University of New Mexico, Albuquerque, New Mexico. He is a past president for the Americas of the World Organization of Family Doctors, and the chairman of the board of In His Image International in Tulsa, Oklahoma. Dr Jenkins is a faculty member of In His Image family medicine residency in Tulsa, and is a staff physician at St John Health System, also in Tulsa. He is conference director for Family Medicine Education International.

WARREN HEFFRON, MDUniversity of New MexicoCHRISTOPHER JENKINS, MDIn His Image Family Me...
<p>Family medicine has become a global movement as a medical specialty. From small beginnings over a half century ago, it has now spread from its Western roots to all continents. The origins of family...
08/03/2011
08/02/2011

NOAH S. SCHEINFELD, MD, JD
Columbia University

Dr Scheinfeld is assistant clinical professor of dermatology at Columbia University and assistant attending physician at St Luke’s–Roosevelt and Beth Israel Hospitals in New York.

NOAH S. SCHEINFELD, MD, JD Columbia University Dr Scheinfeld is assistant clinical pro...
<p>Various neoplastic, vascular, inflammatory, physical, and infectious processes can cause cutaneous ulcers. Accurate diagnosis requires close attention to clinical findings, an accurate history, and...
08/02/2011
diabetic
diabetic
08/02/2011

EDWARD J. SHAHADY, MD
University of Miami and University of Florida

Dr Shahady is clinical professor of family medicine at the University of Miami and University of Florida in Florida; an associate faculty member in the residency program at St Vincent’s Hospital in Jacksonville, Fla; and medical director of the Diabetes Master Clinician Program of the Florida
Academy of Family Physicians Foundation in Jacksonville. He is also a member of the editorial board of CONSULTANT.

Dr Shahady reports that he is a consultant for Merck and is on the speakers bureaus of Merck and Pfizer.

EDWARD J. SHAHADY, MDUniversity of Miami and University of FloridaDr Shahady is clinica...
<p>The American Diabetes Association now recommends hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) as an additional criterion for the diagnosis of diabetes and...
08/02/2011