A patient’s belligerence rattles PA
Would a severed nerve have been recognized had the patient been less confrontational in the ED?
Print Issue: November 10, 2008
Verruca vulgaris
Dr. Fox is a family physician in private practice in Defiance, Ohio, and editor for DynaMed (ww.dynamicmedical.com), a database of comprehensive updated summaries covering nearly 3,000 clinical topics. Dr. Brier is an editor for DynaMed. Description• Benign cutaneous papilloma (common wart) • Single or grouped, rough keratotic papules, nodules, or plaques ICD-9 codes • 078.10 viral warts, unspecified…
An irregular white patch on the back
After presenting to the dermatologist for a full-body skin examination, a 48-year-old man was found to have a pale white patch on the right side of his back…
Recurrent deep ulceration exposes the nasal septum
A 72-year-old woman sought treatment for a deep nasal ulceration that had perforated the skin and cartilage and exposed her nasal septum
Dyslipidemia in a diabetic patient
I would like to comment on treatment of dyslipidemia in the diabetic patient with total cholesterol 195 mg/dL, HDL 32 mg/dL, LDL 98 mg/dL, and triglycerides 195 mg/dL (Item 120-8). According to my calculations, the patient’s LDL should be 124. It’s important to know, however, whether the HDL was measured by the older indirect method…
Optimal vitamin D for good bone health
The currently accepted lower limit of 25-hydroxyvitamin D (25[OH]D) for optimal bone health is 32 ng/mL, which is higher than previously stated (Item 120-10).—Robert Blereau, MD, Morgan City, La. Dr. Blereau is correct: The optimal level of 25(OH)D is 32 ng/mL in most labs. Some authorities recommend levels of 40 or even higher, based on…
Fibromyalgia management without antidepressants
What are the most effective treatment modalities available for fibromyalgia or other myofascial pain syndromes when tricyclic antidepressants are not well tolerated?—Mary Anderson, FNP, Visalia, Calif. Fibromyalgia affects an estimated 4.2% of people in the United States (predominantly women). Largely because researchers still cannot pinpoint the exact cause of fibromyalgia, there is no specific treatment.…
Salmonella symptoms with negative stool culture?
Can a patient exhibit signs of salmonella poisoning (e.g., nausea, vomiting, diarrhea, and elevated WBCs) and still have a negative stool culture?—Leslie Pryor, MSN, CRNP, Shamong, N.J. The short answer to this question is “Yes,” as there is no test that is 100% sensitive and specific. Stool testing is no exception. The real question is:…
Do patients comply with medications?
Have there been any studies on the rate of patient compliance with drug regimens prescribed by their clinicians?—Felix N. Chien, DO, Newport Beach, Calif. You see it every day—the medication you prescribed, say an antihypertensive or a lipid-lowering agent, has not achieved the desired effect. You ramp up the dose, but is your patient taking…
Stroke prevention with aspirin
A recent multicenter study showed that warfarin (Coumadin) was better than aspirin 75 mg daily for the prevention of stroke (Lancet. 2007;370:493-503). About 12 years ago, I heard a presentation in which Coumadin compared with two 325-mg aspirin per day had a better stroke rate but a little higher hemorrhage rate, resulting in virtually identical…
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