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3 February 2011

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Year of the Rabbit Tea Pot
Description: Year of the Rabbit Tea Pot Chinese Zodiac Series Tetsubin (Cast Iron) Teapots The Year of the Rabbit tetsubin was modeled after a hare. Two hares are shown casing one another in an open meadow, which is a common springtime behavior.Year of the Rabbit: 1915, 1927, 1939, 1951, 1963, 1975, 1987. 1999, 2011, 2023. 1915, 1927, 1939, 1951, 1963, 1975, 1987, 1999

People born in the Year of the Rabbit are articulate, talented, and ambitious. They are virtuous, reserved, and have excellent taste. Rabbit people are admired, trusted, and are often financially lucky. They are fond of gossip but are tactful and generally kind. Rabbit people seldom lose their temper. They are clever at business and being conscientious, never back out of a contract. They would make good gamblers for they have the uncanny gift of choosing the right thing. However, they seldom gamble, as they are conservative and wise. They are most compatible with those born in the years of the Sheep, Pig, and Dog.

1)40 year old male in with recruitment officer with BP 190/140
Hypertensive Emergencies EMMAG

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2 February 2011

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How Health Happened
The Physical Exam and Society’s Regard for Physicians: A History
By Jan Henderson, PhD | January 24, 2011

http://www.thehealthculture.com/2011/01/the-physical-exam-and-societys-regard-for-physicians-a-history/

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1)25 year old female with hip pain
Click on Link below

http://www.orthosupersite.com/view.aspx?rid=20421

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1 February 2011

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1)60 year old male with scrotal mass
Click on Link below

http://www.aafp.org/afp/2008/1115/p1165.html

2)74 year old female with persistent cough
Click on Link below

http://www.aafp.org/afp/2004/0501/p2159.html

3)32 year old with neck pain after falling on ice
Click on Link below

http://www.aafp.org/afp/2006/0515/p1787.html

4)61 year old male with PE
Click on Link below

http://www.aafp.org/afp/2004/0615/p2829.html

5)29 year old female with PE

5)54 year old thyroid nodule
Click on Link below

http://www.aafp.org/afp/2003/0201/p559.html

6) 70 year old with MGUS,
Click on Link below
mgus
MGUS Complications Mayo AUG2009

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31 January 2011

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Birthday of musicologist Alan Lomax Alan Lomax (January 31, 1915 – July 19, 2002) was an American folklorist and ethnomusicologist. He was one of the great field collectors of folk music of the 20th century, recording thousands of songs in the United States, Great Britain, Ireland, the Caribbean, Italy, and Spain.

1)24 year old with Cluster headache
Click on Link below

http://www.aafp.org/afp/2005/0215/p717.html

2)40 year hx of BP 236/134
Hypertensive Emergency
Hypertensive Emergencies
SecondaryHypertension2

3)24 year old man with dizziness
DIZZINESS and ER Docs
Imprecision in Patient Reports Mayo 2007
OverReliance on Sx Quality Mayo 2007

AAFP quiz answers
1C,2C,3A,b,c 4c 5 a,b 6 c,d 7 B 8 abcd 9 a,b,c

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29 January 2011

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1)30 year old woman with blue sclera

http://emedicine.medscape.com/article/947588-overview

2)32 with conjunctivitis
Click on Link below

http://www.aafp.org/afp/980215ap/morrow.html

3)64 year Old with plantar fasciitis
Click on Link below

http://www.aafp.org/afp/2001/0201/p467.html

4)45 year of women with breast implants
Women with breast implants should follow the same American Cancer Society (ACS) program of recommended mammograms as women without breast implants (click here to view the ACS guidelines). However, due to the implant, several special mammography views must be taken to allow visualization of both the breast tissue and the implant. For this reason, diagnostic mammography is usually performed on patients with breast implants (as opposed to screening mammography that is typically performed on asymptomatic women without implants).

Examination of the augmented breasts is more time consuming; therefore, the imaging location performing the mammography should be informed of the presence of implants when the mammogram is scheduled. Patients with implants should also inform the physician and the technologist performing the exam that they have implants. Imaginis.com is unaware of any documented cases where mammography has been the direct cause of implant rupture.

The x-rays used for mammographic imaging of the breasts cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. Therefore, some breast tissue (approximately 25%) will not be seen on the mammogram, as it will be covered up by the implant. In order to visualize as much breast tissue as possible, women with implants undergo four additional views as well as the four standard images taken during diagnostic mammography. In these additional x-ray pictures, called Eklund views or implant displacement (ID) views, the implant is pushed back against the chest wall and the breast is pulled forward over it. This allows better imaging of the forward most part of each breast. The implant displacement views are not as successful in women who have contractures (formation of hard scar tissue around the implants). The ID views are easiest to obtain in a women whose implants are placed underneath (behind) the chest muscle.
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Breast Implant Rupture

5)81 year old with biceps tear

6)70 year old female on FOSAMAX
Click on Link below

http://www.medpagetoday.com/Endocrinology/Osteoporosis/25018

QUIZ
AAFP quiz
CME quiz AAFP Jan 15

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28 January 2011

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Med Article of the Day
The Ethics of CPR NEJM 27 January 2011
The Ethics of CPR

Case of the Day
1)35 year old Female with Relapsing Polychondritis
elapsing polychondritis, initially dx Jul ’06 by Johns Hopkins hospital w/ recurrent HA, sore throat, high F, LE swelling, myositis, rash, uveitis – Has been treated with prednisone, ocular steroids, NSAIDS, MTX. No known underlying vasculitis, CTD or MDS. No known visceral involvement.
The patient presents today for follow-up of Relapsing Polychondritis (RP). Last Flare – approx 9 months ago. JAN 2008 – scleritis – treated with oral prednisone 10mg. Current dose: 0 mg.

Click on Link below

http://emedicine.medscape.com/article/331475-overview

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27 January 2011

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1)65 year old male with bronchitis

http://emedicine.medscape.com/article/807035-overview

2)73 year old male with fronotemporaldementia

http://emedicine.medscape.com/article/1135164-overview

3) 25 year old with mass in lower jaw

TORUS MANDIBULARIS

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Clinical Cases 26 January 2011

February 13, 2011 Leave a comment

TODAYS BIRTHDAY
Langston Hughes (1902)
Hughes was an American poet and a central figure of the Harlem Renaissance. His writing is largely concerned with depicting African-American life, particularly the experience of the urban African American, and often uses dialect and jazz rhythms. Along with several collections of poetry, Hughes published numerous other works, including several plays, books for children, and novels.

2)50 year olf African American male with hyperpigmented area under toenail of big toe similar to

Must be worked up for acral lentiginous melanoma,
Acral Lentiginous Melanoma
In the United States, acral lentiginous melanoma (ALM) accounts for about 5% of all diagnosed melanomas. It also is the most common form of melanoma in Asians and people with dark skin, accounting for 50% of melanomas that occur in people with these skin types.

ALM is sometimes referred to as a “hidden melanoma” because these lesions occur on parts of the body not easily examined or not thought necessary to examine. ALM develops on the palms, soles, mucous membranes (such as those that line the mouth, nose, and female genitals), and underneath or near fingernails and toenails.
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Under a nail – The first sign may be a “nail streak” — a narrow, dark stripe under the nail. ALM usually develops on the thumb or big toe; however, it can occur under any fingernail or toenail. Many individuals, especially dark-skinned people, have fixed nail streaks that are completely benign. A new nail streak not associated with recent trauma, an enlarging nail streak, a wide or very darkly pigmented streak, or a nail that is separating or lifting up from the nail bed should be examined by a dermatologist. A possible indication of advanced ALM is a nail streak with associated pigmentation in the nail fold skin or destruction of the nail plate.

ALM of the fingers or toes also can develop without an obvious nail streak — particularly the non-pigmented variety. ALM may, for example, look very much like a chronic infection of the nail bed.

As an ALM tumor increases in size, it usually becomes more irregular in shape and color. However, some ALM lesions can be lightly colored or colorless. The surface of the ALM lesion may remain flat, even as the tumor invades deeply into the skin. Thickening ALM on the sole of the foot can make walking painful and be mistaken for a plantar wart.

Most famous patient was

Marley was advised to get his toe amputated, but he refused because of his Rastafarian beliefs that the body must be whole, that to have an amputation would be a sin, that his faith would ensure him living forever regardless of the cancer and because he saw medical doctors as samfai, confidence men who cheat the gullible by pretending to have the power of witchcraft. He also was concerned about the impact the operation would have on his dancing. Still, Marley based this refusal primarily on his Rastafarian beliefs, saying, “Rasta no abide amputation. I don’t allow a mon ta be dismantled.” (Catch a Fire, Timothy White) He did agree to undergo some minor surgery to try to excise the cancer, which was kept secret from the wider public.

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Clinical Cases 25 January 2011

February 13, 2011 Leave a comment

Water surges from a ruptured pipe in an industrial park near the Capital Beltway in Capitol Heights, Md. The break caused massive damage to the parking lot and office building and closed a section of the interstate during morning rush hour.

It’s the birthday of blues, soul, and gospel singer Etta James, (books by this author) born Jamesetta Hawkins in Los Angeles (1938) to a single mom who was 14 years old

1)26 year old active duty– lost his narcotics
NARCOTICS

2)Laceration finger in diabetic

http://www.fpnotebook.com/DER/Endo/SknInfctnsInDbtsMlts.htm

3)76 year old AA male Poorly controlled HBP
HBP in AA JAMA 2009

4) 65 year old male with hallucinations while on an airplane flight from China

F/u after recent hospitalization for delusions following transcontinental flight. Pt reports that he was returning from trip to Indonesia and observed 14 people being forced to leave the plane and jump into the ocean, one at gunpoint. Later in the flight he said that 6 young men sat behind his wife and were threatening her life. Once they landed at JFK he and his wife ran off the plan and sought medical attention to quickly get them away from the danger. Per his report he was refused admission and son came to bring him to hospital. At times he referred to this as a dream, however when asked about this he said that the folks at hospital told him it was a dream and he finally agreed that it was a dream just so he could leave. He is adamant that this wasn’t a dream and continues to feel that he may be in danger. Doesn’t feel that there are people in his home or around him, but did state that he double checks the locks on the doors and locks doors even when he is home. He also feels he is more aware of his surrounding and people around him just in case.
DX-Progressive Supranuclear Palsy (http://emedicine.medscape.com/article/1151430-overview)

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