The Largest Online Global Physicians' Community

Is it mandatory to test for chlamydia after treatment? Or any other STD after treatment? When does the patient know it’s safe to have intercourse again? Of course I told him to use protection but still

A preteen is brought to the clinic because of involuntary and irregular movements affecting the face and upper limbs, which began over the past two weeks. The parentes present a picture, as shown bellow, of how his throat was approximately two months ago, which they say resolved spontaneously, with no medication. Neurological examination reveals choreiform movements that disappear during sleep. No fever or signs of active infection.

Which of the following mechanisms best explains this child’s current condition?

©

A 35-year-old woman, breastfeeding, presents with a 10-week history of unintentional weight loss, palpitations, heat intolerance, episodic tremor, and fatigue. Past medical history: uncomplicated laparoscopic cholecystectomy six months ago. On examination: pulse 115 bpm, blood pressure 130/70, and there is a diffusely enlarged, non-tender thyroid with a faint bruit. No dermopathy. 

Blood work: TSH <0.01 - free T3 9.2 - free T4 22.5 - thyroid receptor antibodies 2.1 - anti-TPO 8 - CRP 12 - ESR 28. Full blood count, liver enzymes and calcium remain normal. Ultrasound of the thyroid reveals diffuse hypoechogenicity and increased vascularity. As the breastfeeding, she is concerned about radiation, as well anxious about steroids and wants to avoid them if possible.

How do you balance starting anti-thyroid medication immediately vs. pursuing imaging/antibody results first, especially considering a possible transient thyroiditis? Would you treat empirically for Graves’, try corticosteroids, or follow a watch-and-review strategy before a definitive therapy?

Four mosquitoes are shown (A-D).

Which option correctly matches the mosquito genus with a disease it transmits?

©

Do you give Fosfomycin for resistant bacteria in upper UTI or complicated UTI? I have 80 year old with history of UTI, this time seems more upper with fever and diarrhea and some mild flank pain. Uultrasound is normal. Bacteria is resistant to everything except Fosfomycin and IV agents such as tazobactam and gentamycin. Will you give Fosfomycin 3 day regime in this case? It is the only agent to keep her out of the hospital (she will not manage him IV). 

I contracted Covid in October 2022, and was quite ill; within 12 hours of my positiver test for mild symptoms I developed chest tightness, shortness of breath, fever and significant malaise. A physician friend prescribed me paxlovid, and if it didn't help I feared I'd be in hospital, possibly intubated. I struggled through the night and felt the chest loosening a little by morning. I took the 5 day course and it helped my lungs quite a bit. After the 5 day course of Paxlovid my other Covid symptoms came back with a vengeance, and I was flat on my back for 14 days. since then I have had persistent "burning mouth syndrome, mild upon wakening, but worsening in the evenings, worst at bedtime. I have been using anesthetic lozenges for over three years. My lung function has  never been the same, and while for most activities I am OK, climbing several flights of stairs will have me out of breath. I have some scarring at my lung bases.

My main reason for this post is the relapsing bouts of long Covid illness I have every 4-6 weeks. I will go from feeling fine to bad flu-like symptoms, fatigue, headache, myalgias, sore throat and severe general malaise. I lose 3-4 days and then it fades away and I'm fine until it hits again. I have read everything out there and now understand I cannot overdo it and get stiffed, or this will be more likely to bring on the next episode. I have taken multiple measures to improve sleep quality, as that is important in long Covid. Every blood test has been normal. Otherwise I am healthy, non smoker, non drinker, 70 years old, fit and active. No diabetes, heart disease, high blood pressure, arthritis. My CRP is always negligible.

I have read about the clinical trials of low dose Naltrexone ( LDN ) at UBC and the postulates mechanism(s) of action. That is the only thing I've seen that may help in this troublesome chronic illness. 

Can anyone on this platform suggest anything i can do, anywhere I could go, any tests I could take? I would greatly appreciate any information this learned group can offer.

I'm sick of prescribing GLP1s. I'm amazed at the breakthroughs but it seems like my patients too. 90% of them who have diabetes continue to eat what they want. Chocolate, cakes everyday. Of course it reduces their appetite too.. So now they are just snacking now on all of rubbish. I'm wondering if any one else is seeing this problem.

A 47-year-old otherwise healthy patient presents with a sudden-onset, well-defined circular patch of complete hair loss on the scalp. The skin within the patch appears smooth, without erythema or scale. Gently pulling at the lesion’s border results in several loose hairs with tapered bases (exclamation point hairs). He has no pets or contact with animals, and has not been to a new hairdresser.

What is the most likely diagnosis?

©

My 11-year-old son is developing diffuse urticaria and mild dyspnea everytime after soccer practice. No anaphylaxis yet, but I'm so worried is worst and worst everytime. Food diary non-contributory as far as we know. He has all vaccines updated. Is there a treatment for this exercise-induced anaphylaxis/cholinergic urticaria?

A 22-year-old male presented after waking up with multiple erythematous, non-follicular papules and tiny vesicles on his upper back. The rash is mildly pruritic, and there's no systemic involvement. There is no fever, pain, or purulent discharge. Below is an image of the rash -

Which of the following is the most appropriate initial treatment for this condition?

©

I ask for an advice regarding duration and treatment choice in a special case. The patient is a female coleague , 72 years old, with thyroidectomy for papilar cacinoma 25 years ago, with substitution treatment with 100mcg Euthyrox. Osteoporosis treatment included 2 yaers of bisfosfonates, 2 yaers of Terparatide an 2 years of Prolia. The patienthad 2 fractures of radius (both hands after trauma by falling), also a vertebra farcture by falling and recently another radius fracture with clogged in carpian bones and  alittle frament detached.. After traction it was contented in gypsum for 6 weeks.Radiological result showed no pathological movement.The question is if Prolia will be continued and is sufficient for the future risk of fracture.

The DEXA made periodically showed a little benefit 6 months ago.Of course she receives D3 and Calcium supplements.

Thank you in advance for your patience and advice.

There is a specific kind of exhaustion that comes from treating adults. It is a gray, heavy fatigue born from explaining A1C levels to people who refuse to change their diet, or arguing with insurance companies, or navigating the endless, grinding bureaucracy of the EMR. You spend your day in a world of chronic problems and slow declines. And then, just when you think your cynicism has calcified permanently, you open the door to Room 3, and you get hit in the face with the smell of bubblegum amoxicillin and fear.

Treating a child isn’t a medical consult; it’s an improv comedy routine performed for a hostile audience of one. The moment you cross that threshold, your board certifications and your pristine white coat cease to matter. You are no longer a respected physician; you are a strange giant who might be a threat. To survive the encounter, you have to shed your dignity at the door. I have spent years perfecting my "serious doctor face" for grand rounds, only to trade it in instantly for a duck noise and a game of peek-a-boo just to get a look at a tympanic membrane.

The honesty is what jars you at first. Adult patients are polite liars. They nod when they don't understand, they smile when they are angry, and they hide their true habits. Children are incapable of this social contract. They are brutal mirrors. I once walked into a room feeling fairly confident, only to have a four-year-old point a sticky finger at me and ask why my teeth looked "like corn." There is no medical school class that prepares you for that level of roasting. You just have to take the hit, agree that corn is delicious, and move on.

But there is a relief in that brutality. You don’t have to guess if a kid is drug-seeking or malingering. If they are screaming, they are in pain (or hungry). If they are quiet, they are terrified. If they like you, they will hand you a rock they found in the parking lot. The emotional transaction is pure. In a profession where we spend so much mental energy trying to decipher the "hidden agenda" of a patient, dealing with a human being who has zero guile is surprisingly restful.

The medicine itself changes, too. It shifts from science to magical realism. When an adult has stomach pain, we talk about anatomy and physiology. When a child has stomach pain, we talk about the fact that they swallowed a watermelon seed and are worried a garden is growing inside them. And honestly? I prefer the watermelon seed theory. It is a problem I can actually solve. I can look them in the eye and promise, with the full authority of my medical license, that no trees will grow in their belly. It is a much easier conversation than explaining why antibiotics won’t fix a viral cold.

Of course, the price of admission is the stickiness. There is a fundamental law of the universe that pediatric patients are coated in a mysterious, adhesive substance. It’s on their hands, it’s on the iPad they hand you, and by the end of the exam, it’s on your stethoscope. You don’t ask what it is. You don't send it to the lab. You just sanitize up to your elbows and accept that this is the cost of doing business.

Yet, we keep coming back for the resilience. That is the drug. You see a forty-year-old man with a mild flu, and he is writing his last will and testament. Then you see a toddler with a fever of 104 and a double ear infection, and they are trying to do a backflip off the exam table because they saw a shiny object. They are made of rubber and optimism. They bounce back from illness with a speed that makes adult physiology look pathetic. It reminds you that the human body was actually designed to survive, not just to complain.

Ultimately, we love the pediatric break because it is the only time we get to win. So much of modern medicine is managing decline—slowing down the inevitable. But with a kid, you usually fix the problem You give them a sticker, and they look at you like you are a wizard. You walk out of that room, sticky and insulted, but you walked out with a high-five. And on a long shift, that high-five is the only thing keeping you going.

Pre-teen boy recovering from a mild viral illness with 3 weeks of persistent fatigue, plus intermittent but significant knee pain. No fever, rash, or morning stiffness. Physical exam and labs are ALL normal. I’m leaning toward post-viral fatigue/dysautonomia, but early juvenile idiopathic arthritis remains on the differential. He is okay with pain controll medication but I can't make up my mind. In your experience, how long do you observe before escalating the workup or referring to rheumatology? I try to avoid ordering extensive testing, especially in pre-teens, unless clearly necessary.

A 25-year-old woman presents for evaluation of a palpable, non-tender breast lump in the upper outer quadrant of her left breast. She reports that the lump has been stable in size over the past few months. On physical exam, it is smooth, mobile, and well-circumscribed. Breast ultrasound is performed. 

What is the most likely diagnosis based on the clinical presentation and ultrasound image?

©