Modern Medicine Cases
The primary care physician (PCP) faces several challenges in the diagnosis and treatment of gout. These are related to the nature of the primary care setting; the intermittent nature of gout flares; and the lack of established, evidence-based guidelines for treating gout, including when to initiate chronic therapy, how and when to used concomitant anti-inflammatory prophylaxis, and the need to consider multiple comorbidities in choosing treatments. The case study presented here can be used to assist PCPs in developing practical approcahes to manage gout. A rheumatologist discusses practical responses to assessment, diagnosis, treatment, patient education, and follow-up. Rationales supporting each decision are provided to exemplify approaches based on current evidence.
My patient is a man in his early 70s who complains of lack of strength. His testosterone level is low, and his B12 level is low-normal.
The morning after an 88-year-old woman with symptomatic second-degree type I (Wenckebach) atrioventricular block underwent placement of a dual chamber pacemaker without complication, she awoke with uncomfortable pulsations in her abdomen.
An 18-year-old girl presented with a red, scaly rash on her cheeks that had been scabbing over, peeling, and draining. She had had similar reactions to earrings and inexpensive jewelry. The appearance of the rash coincided with the use of a new cell phone.
This darkly pigmented lesion on the left arm of a 27-year-old man had been present since birth and had slowly enlarged over the past 2 months.
Each year, more than 4.7 million Americans are bitten by a dog. Of those, about 800,000—half of whom are children—seek medical attention.1 The majority of reported animal bites are dog bites.
A 54-year-old woman presents with an asymptomatic rash of sudden onset on both malar cheeks that developed 1 day earlier. She denies any facial trauma.
A 14-year-old boy presents with frequent severe headaches characterized by sharp, throbbing pain behind his left eye and left temple.