Diagnostic approach to pleural effusion.

Pleural effusion affects more than 1.5 million people in the United States each year and often complicates the management of heart failure, pneumonia, and malignancy. Pleural effusion occurs when fluid collects between the parietal and visceral pleura. Processes causing a distortion in body fluid mechanics, such as in heart failure or nephrotic syndrome, tend to cause transudative effusions, whereas localized inflammatory or malignant processes are often associated with exudative effusions. Patients can be asymptomatic or can present with cough, dyspnea, and pleuritic chest pain. Dullness to percussion on physical examination suggests an effusion; chest radiography can confirm the diagnosis. Thoracentesis may be indicated to diagnose effusion and relieve symptoms. Ultrasound guidance is preferred when aspirating fluid. Routine assays for aspirated fluid include protein and lactate dehydrogenase levels, Gram staining, cytology, and pH measurement. Light's criteria should be used to differentiate exudative from transudative effusions. Additional laboratory assays, bronchoscopy, percutaneous pleural biopsy, or thoracoscopy may be required for diagnosis if the initial test results are inconclusive.

Atypical chromhidrosis: a case report of orange sweat.

Chromhidrosis is a rare sweat gland disorder that produces pigmented sweat. The etiology of this disorder often is unknown and the clinical presentation can vary. We describe a previously asymptomatic patient who presented with bronzing of the skin and complained of orange stains on her clothing. The patient's symptoms began after a prophylactic hysterectomy with bilateral oophorectomy. She is the first reported patient with orange-pigmented sweat in chromhidrosis. She also is the first postmenopausal patient with chromhidrosis.

Teaching Clinical Precepting: A Faculty Development Workshop Using Role-Play.

Introduction: Precepting is when a medical educator listens to a learner's presentation and must teach and assess the learner while rendering safe patient care. A popular framework for this type of educational encounter is the one-minute preceptor model, which can work for learners at all skill levels. This workshop was created to develop skills of all teaching faculty, regardless of medical specialty, in precepting. Methods: The workshop is based on Kolb's experiential learning theory. A PowerPoint presentation delivers the core abstract concepts. The PowerPoint allows for discussion of participants' prior precepting experiences, including both challenges and successes. The workshop ends with role-plays for participants to practice their skills and a facilitated debrief to aid individual reflection. Twelve role-plays were created for use in the workshop; these were then reviewed by someone in the matching specialty to enhance authenticity. Participants completed a survey after the workshop to evaluate the session. Results: This presentation was delivered 26 times to 392 participants at 16 different teaching hospitals. Twenty-one different medical specialties and subspecialties were represented. Ninety-seven percent of participants stated they would use the information presented in the workshop often or daily. There were conflicting comments about the role-plays. The negative comments centered around (a) personal difficulty participating in the role-plays and (b) the role-plays not being related to the learning. Discussion: Discussion and role-play can be an effective way to instruct educators in use of the one-minute preceptor as a framework for teaching.