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.
A 14-year-old boy presents with frequent severe headaches characterized by sharp, throbbing pain behind his left eye and left temple.
My patient is a 26-year-old woman who has severe aphthous ulcers. These ulcers first appeared after a motor vehicle accident in which the patient saw her fiancé die.
As part of his preparation for retirement, a 66-year-old executive undergoes a complete physical examination. He is in good health and has no symptoms to report. Along with other age-appropriate screening studies, you discuss testing for vascular disease with him.
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.