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Volume 51 - Issue 7 - July 2011

Consultant

07/08/2011

DAVID L. KAPLAN, MD—Series Editor

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 EditorDr Kaplan is clinical assistant professor of dermatolo...
<p>Asymmetric hair growth is noted on the back of a 25-year-old man when he seeks treatment of severe sunburn. The patient first noticed this pattern 7 or 8 years earlier.<br> <br> What do...
07/08/2011
07/08/2011
<p>A 28-year-old man presents with pruritic lesions on his forearms of 4 to 6 weeks’ duration. Over-the-counter hydrocortisone 1% cream has provided some relief.</p>
07/08/2011
Type 1 Diabetes
Type 1 Diabetes
07/08/2011

KIM A. CARMICHAEL, MD—Series Editor
Washington University

Dr Carmichael is associate professor of medicine, department of internal medicine, division of endocrinology, diabetes, and lipid research at Washington University School of Medicine in St Louis, Missouri.

The author does not have any disclosures relevant to the content of this manuscript.

KIM A. CARMICHAEL, MD—Series EditorWashington UniversityDr Carmichael is associate prof...
<p>Many persons with diabetes mellitus, particularly those with type 1, are completely dependent on exogenous insulin to sustain vital functions, even life itself, and without it may rapidly...
07/08/2011
07/08/2011

CHRISTIAN ROSAS-SALAZAR, MD
University of Pittsburgh

PREM ARORA, MD, HAZAR KOBAYAA, MD
and JOCELYN Y. ANG. MD
Wayne State University

Dr Rosas-Salazar is a pediatric pulmonary fellow in the division of pulmonary medicine, allergy and immunology at Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center. Dr Arora is a neonatology fellow in the division of neonatology and Dr Kobayaa is an infectious disease fellow and Dr Ang is assistant professor in the division of pediatric infectious diseases at Children’s Hospital of Michigan and Wayne State University in Detroit.

CHRISTIAN ROSAS-SALAZAR, MD University of Pittsburgh PREM ARORA, MD, HAZAR KOBAYAA, MD...
<p>A 3-year-old girl was hospitalized because of purulent drainage from a right middle finger wound  and a tender right axillary mass of 2 days’ duration. She was febrile,...
07/08/2011
Pain
Pain
07/08/2011

JIMMY Y. SAADE, MD, ERGENT M. ZHIVA, MD,
ANTHONY M. SALIBI, and DAVID EFFRON, MD

Dr Saade is a staff physician in the department of emergency medicine and a resident in radiology at MetroHealth Medical Center, and consultant emergency physician at the Cleveland Clinic. Dr Zhiva is a resident in radiology at MetroHealth Medical Center. Mr Salibi is a B.S. candidate in kinesiology at Arizona State University. Dr Effron is assistant professor at Case Western Reserve University, attending physician in the department of emergency medicine at the MetroHealth
Medical Center, and consultant emergency physician at the Cleveland Clinic, all in Cleveland.

JIMMY Y. SAADE, MD, ERGENT M. ZHIVA, MD, ANTHONY M. SALIBI, and DAVID EFFRON, MDDr Saad...
<p>A 50-year-old man, who is right hand dominant, presents to the emergency department (ED) with swelling of the left hand and intense pain. He is an intravenous drug user with multiple prior...
07/08/2011
07/08/2011

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>An 82-year-old woman reports vision changes in her right eye that have developed gradually over the past several months. She needs significantly brighter light when sewing, reading, and doing other...
07/08/2011
07/08/2011

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...
Tuberculosis (TB) is uncommon in the United States, especially when rates here are compared with those in endemic locations, such as Cambodia, Thailand, Kenya, Malawi, and Cameroon.1 In fact, in the United...
07/08/2011
07/07/2011

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 prof...
<p>The skin is transformed as we age; its hue and texture evolve with time and with disease. These changes are important to understand so that we can distinguish the pathologic from the normal in the...
07/07/2011
07/07/2011

NATHAN HITZEMAN, MD
Sacramento, Calif

NATHAN HITZEMAN, MDSacramento, Calif
<p><span>When a prescription medication is not needed, patients often appreciate </span><span>advice on nonprescription treatments.</span><span> A field...
07/07/2011
07/07/2011

RUTH TRECKER, ARNP
Ackworth, Iowa

RUTH TRECKER, ARNPAckworth, Iowa
<p><span>I find it helpful to set a gestation </span><span>wheel to a pregnant patient’s due date</span><span> and then make a copy of the wheel for...
07/07/2011
07/07/2011

RICHARD HONAKER, MD
Carrollton, Tex

RICHARD HONAKER, MDCarrollton, Tex
<p>Younger patients are sometimes reluctant to have you use a liquid nitrogen spray gun to freeze their warts, because it can be painful. Try applying the liquid nitrogen <span>with a...
07/07/2011
07/07/2011

WILLIAM J. SCIALES
Flushing, NY  

WILLIAM J. SCIALES Flushing, NY  
<p>With patients who say that they usually faint when blood is drawn or when given an injection, have them lie down and tell them that they “cannot faint when lying...
07/07/2011
hypertensive urgency
hypertensive urgency
07/07/2011

BRADLEY M. WRIGHT, PharmD, BCPS, MOLLY ADAMS, PharmD, BCPS, and
RAKHI KARWA, PharmD, BCPS
Auburn University and University of South Alabama

GLORIA VARELA, MD, JASON NESMITH, MD, and GREGORY W. RUTECKI, MD
University of South Alabama

Dr Wright is assistant clinical professor of pharmacy practice at Auburn University Harrison School of Pharmacy in Auburn, Ala. He is also adjunct assistant professor of internal medicine at the University of South Alabama College of Medicine in Mobile. Dr Adams is assistant clinical professor of pharmacy practice at Auburn University Harrison School of Pharmacy and is adjunct assistant professor of internal medicine at the University of South Alabama College of Medicine. Dr Karwa is assistant clinical professor of pharmacy practice at Auburn University Harrison School of Pharmacy and is adjunct assistant professor of internal medicine at the University of South Alabama College of Medicine. Dr Varela is a PGY-2 neurology resident and Dr NeSmith is a PGY-2 internal medicine resident at the University of South Alabama College of Medicine. Dr Rutecki is professor of medicine at the University of South Alabama College of Medicine.

BRADLEY M. WRIGHT, PharmD, BCPS, MOLLY ADAMS, PharmD, BCPS, and RAKHI KARWA, PharmD, BC...
<p>Acute elevations in blood pressure (also known as hypertensive crises or severe hypertension) can cause significant morbidity and mortality. The key to management of these episodes is to keep in...
07/07/2011
Severe Hypertension
Severe Hypertension
07/07/2011

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>Events in Germany and other European countries during the past several weeks have made me queasy every time I see vegetables. The fallout of the recent Shiga...
07/07/2011
Antihypertensives
Antihypertensives
07/07/2011

BRADLEY M. WRIGHT, PharmD, MOLLY ADAMS, PharmD, BCPS
and RAKHI KARWA, PharmD, BCPS
Auburn University andUniversity of South Alabama

BCPS GLORIA VARELA, MD, JASON NESMITH, MD,
and GREGORY W. RUTECKI, MD
University of South Alabama

Dr Wright is assistant clinical professor of pharmacy practice at Auburn University Harrison School of Pharmacy in Auburn, Ala. He is also adjunct assistant professor of internal medicine at the University of South Alabama College of Medicine in Mobile. Dr Adams is assistant clinical professor of pharmacy practice at Auburn University Harrison School of Pharmacy and is adjunct assistant professor of internal medicine at the University of South Alabama College of Medicine. Dr Karwa is assistant clinical professor of pharmacy practice at Auburn University Harrison School of Pharmacy and is adjunct assistant professor of internal medicine at the University of South Alabama College of Medicine. Dr Varela is a PGY-2 neurology resident and Dr NeSmith is a PGY-2 internal medicine resident at the University of South Alabama College of Medicine. Dr Rutecki is professor of medicine at the University of South Alabama College of Medicine.

The authors report that they have no relevant financial relationships to disclose.

BRADLEY M. WRIGHT, PharmD, MOLLY ADAMS, PharmD, BCPS and RAKHI KARWA, PharmD, BCPS...
<p>Here, we will review the contemporary armamentarium for severe hypertension. The pros and cons of the drugs used to manage hypertensive crises will be highlighted.</p>
07/07/2011
07/07/2011

DAVID L. KAPLAN, MD

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, MDDr Kaplan is clinical assistant professor of dermatology at the Univ...
<p>A 53-year-old man reports that the painful growth on his upper chest wall had been rubbed by a seat belt 1 week earlier. The lesion had been asymptomatic for months before becoming...
07/07/2011
Schamberg disease
Schamberg disease
07/07/2011

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 61-year-old woman presents with asymptomatic red spots that appeared on her legs 3 days earlier. The patient is taking warfarin, which was prescribed following artificial mitral valve...
07/07/2011
Nummular Eczema
Nummular Eczema
07/07/2011

DAVID L. KAPLAN, MD—Series Editor

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 EditorDr Kaplan is clinical assistant professor of dermatolo...
<p><span>A 69-year-old woman has had a red patch on the dorsum of one hand for 5 weeks. She states that the lesion began as a pimple and has grown larger; it is occasionally pruritic but not...
07/07/2011
07/07/2011

AHMED TARIG AHMED, MD
Stroger Hospital of Cook County, Chicago

AHMED TARIG AHMED, MDStroger Hospital of Cook County, Chicago
<p>This painless, hard mass was noted on the palate of a 73-year-old woman with hypertension during a routine follow-up visit. The mass had been present for more than 30 years.</p>
07/07/2011
07/07/2011

CHRISTIAN R. HALVORSON, MD
University of Maryland School of Medicine, College Park

BRIDGET M. BRYER GROFF, MD and BARBARA B. WILSON, MD
University of Virginia School of Medicine, Charlottesville

CHRISTIAN R. HALVORSON, MDUniversity of Maryland School of Medicine, College ParkBRIDGE...
<p>For 4 years, a 10-year-old boy had a recurrent rash on his left leg. He had been treated for presumed ringworm with multiple topical antifungal medications, including terbinafine, ciclopirox, and...
07/07/2011
07/07/2011

GERMAINE L. DEFENDI, MD
Olive View-University of California Los Angeles Medical Center

GERMAINE L. DEFENDI, MDOlive View-University of California Los Angeles Medical Center ...
<p>For 2 weeks, this 13-year-old girl felt tired and achy. She had persistent fevers (temperature up to 38.8°C [102°F]) and an erythematous facial rash above her eyebrows that extended to her cheeks...
07/07/2011
07/06/2011

MICAEL L. STERNBERG, MD and NATE LISENBEE, MS
University of South Alabama Medical Center, Mobile

MICAEL L. STERNBERG, MD and NATE LISENBEE, MSUniversity of South Alabama Medical Center...
<p style="text-align: left;"><strong><span style="text-decoration: underline; font-size: large;"></span></strong><span style="font-size:...
07/06/2011
07/06/2011

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

LEONID SKORIN, Jr, DOMayo Clinic Health System–Albert Lea, Minnesota
<p>An 83-year-old woman presented for her annual eye examination. She had a history of previous cataract surgery with pseudo­phakia and mild dry age-related macular degeneration. She also had a...
07/06/2011