Diagnosis & Disease Information

If you can’t seem to start an IV, use a BP cuff.When the cuff is inflated to around 80 mm Hg,deep veins will be more apparent and the patient easier to stick.—Cindy Robertson,MSN, FNP, ACNP, Columbus,Miss.(114-30)

To obtain a skin scraping for microscopic examination, use asoft spiral Pap smear brush instead of a scalpel and rub alongthe leading edge of the rash. Hold the brush down on a glassslide,and place a drop of KOH on it to transfer the sample.Thebrush will pick up plenty of skin cells for examination andavoids any…

To minimize discomfort during removal of a Jackson-Pratt drain,have the patient cough deeply multiple times in succession until the tube is removed.—Leslie Leveille, MSN-NPC, Cotuit, Mass. (114-28)

In his response about monitoring amiodarone levels (Item 113-6), Dr. Cohn missed an opportunity to remind readers ofthe need for yearly eye exams as well as regular annual monitoring of thyroid function tests,chest radiography,and spirometry. I also make sure my patients understand the risk of thyroid disease,pulmonary toxicity, and optic neuropathy and counsel them to…

After reading about combining oral antidiabetics, such as acarbose (Precose) and sitagliptin (Januvia) (Item 113-12), I wonder if there are any data regarding the use of sitagliptin and glyburide (Glynase, Diabeta, Micronase)?—Tom Perry, MD, Phoenix As was true of the scenario using acarbose and sitagliptin in combination, I could find no published data on the…

When should we treat non-group A streptococcal pharyngitis, e.g., group B, C, or G?—Jeffrey D. Smith, MD, Lubbock, Tex. To be safe, non-group A strep pharyngitis should always be treated. Penicillin is the treatment of choice for either B, C, or G streptococcal species. Non-group A streptococcal pharyngitis has been described with both group C…

What do you advise for a patient who has left-sided ear pain despite a normal ear exam? There is no pharyngitis, no temporomandibular joint disease, and no dental problems. The patient has no history of allergies. She tried pseudoephedrine (Sudafed), but it did not relieve her symptoms.—Jolly Philip, MD, Sunnyvale, Calif. The differential diagnosis for…

A 67-year-old white female who was treated for exacerbation of her chronic obstructive pulmonary disease returned a week later with the same shortness of breath. This time she had new-onset bilateral pleural effusions that were not present the first time. Thoracentesis revealed transudative fluid. Two-dimensional echocardiography performed at her first visit showed ejection fraction 80%…

What is the next step if the bone mineral density (BMD) of an osteoporosis patient taking alendronate (Fosamax) or risedronate (Actonel) is worse after a year of therapy? Conversely, what follow-up is required in the near and distant future if the BMD is stable or improved?—Craig Freyer, MD, Ft. Worth, Tex. The first thing to…