Case Files Blue skin in an elderly woman

Blue skin in an elderly woman

The patient's use of minocycline was associated with patchy hyperpigmentation as a result of iron deposition in the dermal cells.

Clinical Pearls Treating patients with diabetic peripheral neuropathy

Treating patients with diabetic peripheral neuropathy

Alpha-lipoic acid, 600mg daily, is an effective treatment option for patients with diabetic peripheral neuropathy.

Your Comments Kratom and oxycodone

Kratom and oxycodone

Kratom might be a safer alternative than oxycodone or other narcotics.

Your Comments A differing opinion on the ACP's new diabetes treatment guidelines

A differing opinion on the ACP's new diabetes treatment guidelines

Pharmacotherapy and combination therapy may be a better alternative to the ACP's diabetes treatment guidelines.

Case Files An enlarging mass on the calf

An enlarging mass on the calf

Doppler imaging resulted in a solid mass with suggestion of increased vascularity.

Clinical Pearls Tip for treating minor lacerations

Tip for treating minor lacerations

Treating lacerations properly requires benzoin, Steri-Strips, and a Dermabond to cover.

Clinical Pearls Converting pounds to kilograms

Converting pounds to kilograms

Converting pounds to kilograms in your head is easier than you think.

Consultations Are prostate biopsies linked to the spread of cancerous cells?

Are prostate biopsies linked to the spread of cancerous cells?

Cases of prostate biopsies resulting in the spread of cancerous cells are rare.

Consultations Treating premenopausal women with fibroids and dysmenorrhea

Treating premenopausal women with fibroids and dysmenorrhea

The standard treatment option for premenopausal women who do not wish to get pregnant is hysterectomy.

Case Files Picking cherries leads to a case of pseudohyperglycemia

Picking cherries leads to a case of pseudohyperglycemia

The elevated blood glucose measurement was associated with the presence of fructose on the patient's fingers from picking cherries.

Case Files Premature thelarche in a young girl

Premature thelarche in a young girl

Premature thelarche can often be confused with precocious puberty and will resolve over time without intervention.

Clinical Pearls Educating patients on the proper use of contraception

Educating patients on the proper use of contraception

Unplanned pregnancies can occur when a patient misunderstands the proper use of contraception.

Clinical Pearls Monitoring vital signs and exercise

Monitoring vital signs and exercise

Asking for a patient's exercise regimen should be incorporated when checking for basic vital signs.

Your Comments Diagnosing Lyme disease in the early clinical stages

Diagnosing Lyme disease in the early clinical stages

Early Lyme disease is a clinical diagnosis, and a negative blood test does not completely rule out the possibility of Lyme disease.

Case Files Providing care for veterans exposed to Agent Orange

Providing care for veterans exposed to Agent Orange

Evidence suggests that exposure to Agent Orange is linked with a number of serious and potentially fatal diseases.

Clinical Pearls Vitamin D3 and type 1 diabetes

Vitamin D3 and type 1 diabetes

Vitamin D3 at 2000 IU reduced the incidence of type 1 diabetes by 88%.

Clinical Pearls Stopping the bleeding

Stopping the bleeding

Pressure on a wound is the key to stopping blood flow.

Clinical Pearls Treatment tips for tinea pedis and yeast infections

Treatment tips for tinea pedis and yeast infections

Creams, sanitizers, and antiperspirant are all acceptable forms of treatment for tinea pedis and yeast infections.

Case Files Genetic vascular anomaly

Genetic vascular anomaly

A young Caucasian woman presented with complaints of years regarding pain in her feet but did not know the cause.

Clinical Pearls Successful addiction recovery

Successful addiction recovery

Suboxone can curb drug addiction if it is used correctly.

Clinical Pearls Yeast infections in skinfolds

Yeast infections in skinfolds

Preventing yeast infections in skinfolds by using hand sanitizer.

Your Comments Sexual orientation, gender identity, and LGBT health care

Sexual orientation, gender identity, and LGBT health care

LGBT practice management includes routine cancer screening in accordance with current guidelines.

Your Comments Suboxone and methadone—our readers weigh in on the pros and cons

Suboxone and methadone—our readers weigh in on the pros and cons

Research has shown that use of suboxone and methadone, in conjunction with counseling, can be effective addiction treatment.

Consultations Zika virus: a primary care response

Zika virus: a primary care response

Healthcare professionals should be educated about the hallmark signs and symptoms of the Zika virus.

Case Files A case of G6PD deficiency

A case of G6PD deficiency

Patients with G6PD should avoid triggers of oxidative stress.

Clinical Pearls A tip for encouraging exercise

A tip for encouraging exercise

Patients should be encouraged to incorporate daily exercise into their treatment regimen.

Clinical Pearls Thyroid antibodies

Thyroid antibodies

When symptoms of thyroid disease are present, clinicians should check thyroid antibodies even if thyroid function is normal.

Clinical Pearls Alternative treatment options for chronic pain

Alternative treatment options for chronic pain

Ice is among alternative recommendations for treatment of chronic pain.

Clinical Pearls Assessing for rebound tenderness

Assessing for rebound tenderness

Pediatric clinicians can avoid causing pain by using an alternative technique to assess for rebound tenderness.

Clinical Pearls In place of vaginal steroid cream

In place of vaginal steroid cream

Itching is a serious concern for patients with atrophic vaginitis, and alternative treatments can help.

Your Comments Suboxone: the methadone of the decade

Suboxone: the methadone of the decade

One clinician feels that suboxone is not the answer to the opioid crisis.

Your Comments Improving health literacy

Improving health literacy


Rather than identify patients as having low health literacy, it is recommended that clinicians use Universal Health Literacy Precautions.

Your Comments Identifying cervical lesions

Identifying cervical lesions


One clinician took issue with the image published in a January 2016 Clinical Advisor article.

Case Files A miscommunication on how to take hemorrhoid medication

A miscommunication on how to take hemorrhoid medication

Clinicians should be sure that patients know how to properly take their medications.

Consultations How effective is a kenalog injection for seasonal allergies?

How effective is a kenalog injection for seasonal allergies?

Corticosteroids may relieve symptoms of allergic rhinitis, but are not always appropriate.

Clinical Pearls Applying ointment to a child

Applying ointment to a child

A clinician offers a tip for applying a small amount of nonsterile ointment.

Clinical Pearls An alarm clock can help patients remember to take their medication

An alarm clock can help patients remember to take their medication

Patients shouldn't turn off the alarm until their medication has been taken.

Case Files Salivary duct stone

Salivary duct stone

After 36 hours, a patient with a salivary duct stone shows limited improvement.

Clinical Pearls Clozapine use and neutropenia

Clozapine use and neutropenia

Low dose lithium can bring return absolute neutrophil count (ANC) to normal levels.

Clinical Pearls Obtaining a urine specimen in a child

Obtaining a urine specimen in a child

Turn a challenge into a game for your patient.

Your Comments Passing on full-practice authority

Passing on full-practice authority

A reader weighs in on suboxone prescribing practices.

Your Comments Readers weigh in on non-narcotic treatment options for patients with musculoskeletal pain

Readers weigh in on non-narcotic treatment options for patients with musculoskeletal pain


Readers provide more suggestions for treating musculoskeletal pain.

Consultations Non-narcotic analgesics for musculoskeletal pain

Non-narcotic analgesics for musculoskeletal pain

Which non-narcotic analgesics are best for treating musculoskeletal pain?

Your Comments Timing of meningococcal vaccine

Timing of meningococcal vaccine

Timing of a recent administration of the meningococcal vaccination cannot be ignored.

Your Comments Cannabidiol as medicine

Cannabidiol as medicine

Could cannabidiol (CBD) be an acceptable use of medical marijuana?

Your Comments A need for early autism screening

A need for early autism screening

Earlier interventions lead to better outcomes in autism.

Case Files Hair loss after steroid injections

Hair loss after steroid injections

A patient begins rapidly losing her hair after an epidural steroid injection.

Clinical Pearls Steroid and rescue inhalers

Steroid and rescue inhalers

A clinician offers a tip helping patients remember to use their steroid inhalers.

Your Comments MRI after breast cancer diagnosis

MRI after breast cancer diagnosis

Despite the guideline, clinicians may choose to order MRI's for patients with dense breasts.

Your Comments No thanks, on full practice authority

No thanks, on full practice authority

A clinician weighs in on the potential harms of full practice authority for Nurse Practitioners.

Consultations A side effect of the flu vaccine?

A side effect of the flu vaccine?

A clinician questions wonders if there is a connection between cardiac arrhythmia and the flu vaccine.

Clinical Pearls Erythromycin for facial lacerations

Erythromycin for facial lacerations

Erythromycin ointment may be prescribed in place of bacitracin when performing facial laceration repair or sutures.

Case Files Carcinoid appendix

Carcinoid appendix


A patient with a history of a carcionid tumor on their appendix did not return to a physician for follow up.

Your Comments Flu vaccine in pregnant women

Flu vaccine in pregnant women

A clinician expresses concerns about potentially misleading flu vaccination information for pregnant women.

Your Comments Contaminated water and cancer

Contaminated water and cancer

Contaminated water leads to high rates of birth defects, thyroid cancer, and spontaneous abortions.

Your Comments Avoiding labeling patients 
as noncompliant

Avoiding labeling patients 
as noncompliant

Clinicians should avoid labeling their patients as noncompliant.

Your Comments More reader comments on ethical issues regarding use of IUDs

More reader comments on ethical issues regarding use of IUDs

More readers weigh in on the ethical issues surrounding the use of intrauterine devices.

Consultations Laser therapy for onychomycosis of the toenails

Laser therapy for onychomycosis of the toenails


What is the mechanism of action for laser treatment for onychomycosis of the toenails?

Your Comments Ethical concerns with IUDs

Ethical concerns with IUDs


For women who are pro-life advocates, copper IUD devices that prevent fertilization may be an acceptable alternative.

Your Comments Pap smears, HPV, and screening
 for cervical cancer

Pap smears, HPV, and screening
 for cervical cancer


Confusion surrounds the current screening recommendations and guidelines.

Your Comments Enlarging brown spots:
 a misdiagnosed solar lentigo?

Enlarging brown spots:
 a misdiagnosed solar lentigo?

This patient presented for the evaluation of enlarging brown spots.

Clinical Pearls Pap smear testing
 in a patient who is obese

Pap smear testing
 in a patient who is obese


Correctly position your patient to ensure a proper Pap smear.

Clinical Pearls The right touch

The right touch

One clinician encourages the use of touch when taking a patient's history.

Your Comments Analogies for patients in the battle against medical noncompliance

Analogies for patients in the battle against medical noncompliance

Medical noncompliance is a huge deterrent to patients achieving their treatment goals.

Your Comments The CDC's statistics on influenza—fact or hype?

The CDC's statistics on influenza—fact or hype?


Clinicians debate the fact or hype present in the CDC's most recently released statistics on influenza death rate.

Your Comments Vaccination, parents, and children

Vaccination, parents, and children

Vaccinations cannot be equated to antibiotics.

Your Comments Stopping prescription drug abuse

Stopping prescription drug abuse

Emergency providers need to make every effort to be responsible prescribers.

Consultations The anti-inflammatory effects of statins

The anti-inflammatory effects of statins

Is the real benefit of statins their anti-inflammatory benefits?

Clinical Pearls Metformin XR for diabetes care

Metformin XR for diabetes care

Patients who forget to take Metformin SR twice daily can be switched to Metformin XR with once daily dosing.

Clinical Pearls How to distinguish bradykinesia from psychomotor retardation

How to distinguish bradykinesia from psychomotor retardation

If a patient is truly bradykinetic, their blink rate will be decreased.

Your Comments Antibiotics, urinary tract infections, and circumcision

Antibiotics, urinary tract infections, and circumcision

Find a foreskin-friendly urologist before agreeing to a child's circumcision.

Clinical Pearls Monitoring for pulmonary hypertension

Monitoring for pulmonary hypertension

Doctors must assess for the presence of pulmonary hypertension in patients with lung disease, COPD, or emphysema, among other conditions.

Clinical Pearls More tips for poison ivy, oak, and sumac

More tips for poison ivy, oak, and sumac

Providers from across the country share clinical wisdom for the treatment of poison ivy, oak, or sumac rashes and abrasions.

Your Comments The celebrity effect on healthcare

The celebrity effect on healthcare

While having a celebrity spokesperson can benefit a cause, they may also end up spreading misinformation about a particular cause.

Clinical Pearls Vaginal discharge and odor 
resulting from tampon use

Vaginal discharge and odor 
resulting from tampon use


A tampon lodged between the cervix and vagina can be the cause of vaginal discharge and odor.

Expert Opinion A perioperative approach
 for pediatric asthma

A perioperative approach
 for pediatric asthma


Pediatrics patients with asthma who have to undergo surgery are at risk for complications.

Consultations SGLT2 receptor blockers 
for diabetes

SGLT2 receptor blockers 
for diabetes


SGLT2 receptor blockers are only approved for type 2 diabetes.

Consultations Treatment for urinary tract 
infections in the uncircumcised
 male child

Treatment for urinary tract 
infections in the uncircumcised
 male child


Circumcision should be recommended for male, uncircumcised children with recurring UTIs.

Your Comments Grapefruit-drug interactions

Grapefruit-drug interactions


Grapefruit can safely be consumed with the majority of medications, and patients with concerns should consult with their physicians.

Your Comments Slipped capital femoral epiphysis
 in obese adolescents

Slipped capital femoral epiphysis
 in obese adolescents

Obese adolescents have an increased risk of slipped capital femoral epiphysis
 (SCFE).

Clinical Pearls Intra-articular injections
 for severe osteoarthritis

Intra-articular injections
 for severe osteoarthritis


For patients with severe osteoarthritis, dangling their legs can help with intra-articular injections.

Clinical Pearls Generic "caine" is effective 
for wound care

Generic "caine" is effective 
for wound care


Most pharmacies have a generic, affordable "caine" medication to relieve pain in wound care.

Clinical Pearls Neutrophils and lymphocytes

Neutrophils and lymphocytes


The number of neutrophils and lymphocytes in a blood count can determine if a condition is viral or bacterial.

Case Files UTI/Pyelonephritis

UTI/Pyelonephritis


A young girl with recurrent UTIs was diagnosed with a grade-3 VUR and mild hydronephrosis.

Your Comments Diagnosing myocarditis

Diagnosing myocarditis

While ECG can help diagnosis myocarditis, it cannot give a definitive diagnosis alone.

Clinical Pearls A tip for examining children

A tip for examining children

Diverting children's attention can help make exams go more smoothly.

Your Comments More caution urged regarding Xylitol and pets

More caution urged regarding Xylitol and pets

The death of an animal companion can have a profound effect on patients.

Your Comments More treatment recommendations for poison ivy

More treatment recommendations for poison ivy


Tegaderm, Zanfel, and diluted bleach can all be used to treat poison ivy rashes.

Consultations Black urine after a spinning class

Black urine after a spinning class

After taking a spinning exercise class, a woman developed acute kidney injury.

Consultations Reflex sympathetic dystrophy

Reflex sympathetic dystrophy

A man with worsening pain in his right arm is diagnosed with reflex sympathetic dystrophy.

Clinical Pearls Oxygen therapy in a patient with emphysema

Oxygen therapy in a patient with emphysema

Take caution when using oxygen therapy to treat patients with emphysema.

Consultations Xylitol, toxicity, and pets

Xylitol, toxicity, and pets

Xylitol can be used as an alternative medicine but is very toxic to dogs.

Consultations Pertussis vaccine efficacy

Pertussis vaccine efficacy


Whole cell pertussis vaccines are more effective than newer, acellular versions.

Consultations Trimethoprim/sulfamethoxazole-
induced aseptic meningitis

Trimethoprim/sulfamethoxazole-
induced aseptic meningitis


A young woman presented with symptoms consistent with aseptic meningitis after taking a dose of trimethoprim/sulfamethoxazole.

Clinical Pearls Offering a 'hand sandwich'
 to ticklish patients

Offering a 'hand sandwich'
 to ticklish patients

Using a simple mind trick can help clinicians handle ticklish patients during abdominal exams.

Clinical Pearls Viewing pupil response to light 
in a patient with brown eyes

Viewing pupil response to light 
in a patient with brown eyes


Clinicians can use two lights of different brightness to view pupil response in dark eyes.

Consultations Male with symptomatic
 benign prostatic hyperplasia

Male with symptomatic
 benign prostatic hyperplasia


Several pharmaceutical options exist for men with symptomatic benign prostatic hyperplasia who cannot tolerate alpha blockers.

Consultations A treatment approach 
for poison ivy

A treatment approach 
for poison ivy


For patients with poison ivy, decontamination should precede steroid treatment.

Clinical Pearls Providing a calendar page to use
 as a reminder to take medications

Providing a calendar page to use
 as a reminder to take medications


Use a calendar page to explain what medications patients should take when.

Clinical Pearls A mnemonic device for use in cardiology care

A mnemonic device for use in cardiology care

Use the acronyms PASS and PAID to remember important murmurs

Sign Up for Free e-newsletters