The Problem

A 56-year-old man is referred to you after he was evaluated for enrollment in a smoking cessation clinical trial, but was declined enrollment due to elevated blood pressure (BP). He was unaware of his elevated BP, as he has not interfaced with the medical establishment in over 20 years. He has no significant medical history and he takes no... »

The Problem

A 74-year-old female with a history of breast cancer, hypertension, and impaired fasting glucose presents to you for blood pressure recheck. She reports a several-month history of left "great toe" pain. She denies history of trauma, gout, generalized joint pain, joint swelling, or constitutional symptoms. Pain is worse when she walks... »

The Problem

A 57-year-old male with a history of chronic obstructive pulmonary disease (forced expiratory volume in 1 second, 26%) and history of alcoholism presents to you for shortness of breath and increasing productive cough. He is currently on budesonide/formoterol, tiotropium, and albuterol inhalers as well as albuterol/ipratropium nebulizers. He has... »

The Problem

A 36-year-old mechanic presents to you for a 4-week history of feeling as if he is "walking on a pebble." You examine his foot and determine that he has a plantar wart. You pare it down and apply liquid nitrogen. No specific follow-up plan was provided. He returns to you 5 weeks later with the same problem. You pare it down and... »

The Problem

A 67-year-old male with a history of hypertension, hyperlipidemia, atrial fibrillation, and knee degenerative joint disease presents to you for increasing left knee pain. He is currently on atenolol, pravastatin, and warfarin. His CHADS2 score is 1. Prior knee x-rays have shown bilateral tricompartmental narrowing with subchondral sclerosis, in... »

The Problem

A 76-year-old female with a history of hypertension, coronary artery disease, and degenerative joint disease of the spine presents with her husband because of a several-month history of depression. She denies suicidal ideation but admits to a seasonal component to her mood changes. Her score on the 9-item Patient Health Questionnaire is... »

The Problem

A 52-year-old male with a history of hypertension and hyperlipidemia presents to you for follow-up. On this visit, he mentions that he has been using "snuff" (moist, ground oral "smokeless" tobacco) for about 30 years and wishes to quit. On examination, he has a "snuff dipper’s pouch," referring to the... »