May 2015

You see a 48-year-old white man for his annual examination. . The patient is overweight with a body mass index (BMI) of 32. A screening chemistry panel is normal except for an aspartate aminotransferase (AST, formerly SGOT) level of 85 U/L (normal 15-50 U/L) and an alanine aminotransferase (ALT, formerly SGPT) level of 98 U/L (normal 5-50 U/L). He says you are the first doctor he has seen in more than 10 years and does not recall the last time he had a blood test.

The IBIS-I randomized control trial included women of ages 35-70 from 37 health centers in eight countries from April, 1992, until March, 2001 that were deemed to be at increased risk of developing breast cancer (by virtue of family history of breast cancer or abnormal benign breast disease), and randomized to treatment with oral tamoxifen or placebo for 5 years.

This 25-year-old African-American man has had this papular rash for the last 2 years following a short haircut. Initially he had pustules, itching and inflammation but currently only has itching papules that are slowly enlarging. Triamcinolone 0.1% ointment has helped the itching. Past history and remainder of physical examination is noncontributory.