Systems

Chronic Stable Angina 2.0

August 4, 2010
Chronic Stable Angina 2.0

By Brad Pfeffer, MD

Faculty Peer Reviewed

Case: A 75- year-old non-smoking male with a history of type II diabetes, hypertension and hyperlipidemia comes to clinic with several months of stable anginal chest pain provoked by ten blocks of exercise with no change in exercise tolerance. He has seen you several times over the past year and has been placed on aspirin, beta blockers, calcium channel blockers and long acting nitrates with some relief of symptoms. In addition, he is on atorvastatin with an LDL …

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Appropriateness for Revascularization in Stable Angina

July 22, 2010
Appropriateness for Revascularization in Stable Angina

Ramin Shayegan Hastings MD, Jonathan Willner MD, and Steven Sedlis MD

Introduction to Cases:

During the past several weeks, we have posted a series of cases addressing the appropriate treatment for patients with stable coronary artery disease. We have focused on indications for revascularization in stable angina. In all of the cases, the patients have been at high enough risk that stress tests and coronary angiography are performed.

There has been recent data and recommendations on the appropriate indications for revascularization in stable angina. These …

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Do I have a Concussion?

July 21, 2010
Do I have a Concussion?

By Radhika Sundararajan, M.D., Ph.D

Faculty Peer Reviewed

A healthy 18 year-old female presents to Urgent Care after slipping and falling this morning in the bathroom and hitting her head on the tile floor. She denies any loss of consciousness, vomiting, or current neurological deficits, but does have a mild occipital headache where she struck her head. She has heard a lot about recent research regarding concussions in young athletes and asks if you think she suffered a concussion and what this means for her.…

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Mystery Quiz- The Answer

July 9, 2010

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is pleural effusion that is loculated in both the horizontal and right oblique fissures. Pleural effusion is seen as blunting of the right costophrenic angle and tracking of fluid laterally (Image 3, arrowhead). The horizontal fissure thickens due to fluid which becomes an ovoid density more medially (Image 3, arrow). This ovoid density, representing loculated fluid in the horizontal fissure, is often referred to as a pseudotumor. It …

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Mystery Quiz

July 4, 2010
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 61 year old man presenting with one month of worsening shortness of breath. The patient has a history of alcoholism and was diagnosed with atrial fibrillation during a hospital admission for detox three years earlier. Warfarin therapy was not begun due to a history of poor medication compliance. One year prior to admission an echocardiogram showed a normal global ejection fraction and mild mitral regurgitation. One month prior to admission, …

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Appropriateness for Revascularization in Stable Angina

July 1, 2010
Appropriateness for Revascularization in Stable Angina

Introduction to Cases:

During the upcoming weeks, we will post a series of cases addressing the appropriate treatment for patients with stable coronary artery disease. We will be focus on indications for revascularization in stable angina. In all of the cases, the patients will be at high enough risk that stress tests and coronary angiography will be performed.

There has been recent data and recommendations on the appropriate indications for revascularization in stable angina. These recommendations are based on clinical symptoms, non-invasive imaging, and catheterization …

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Myths & Realities: Is Shiftwork Tumorgenic?

June 23, 2010
Myths & Realities: Is Shiftwork Tumorgenic?

By David Ecker, MD

Faculty Peer Reviewed

Over the last several decades, Westernized countries have become 24-hour societies.  Approximately 21 million workers in the US are on non-standard work shifts, including almost 4 million on regular overnight shifts. In 1972, Taylor and Pocock published a mortality study, in which they reported a significantly increased incidence of neoplasms in shift workers compared to the general population. After several published cancer incidence studies, Kerenyi explicitly proposed that changes in light exposure could be an important etiologic factor …

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Does Dietary Modification Help GERD?

June 18, 2010
Does Dietary Modification Help GERD?

By Ramya Srinivasan, MD

Faculty Peer Reviewed

The patient is a 29 year old overweight male presenting to clinic with complaints of reflux symptoms. He says that spicy foods aggravate these symptoms. In addition to weight loss counseling, he is given a prescription for esomeprazole along with a patient handout containing recommendations on foods to avoid and other behavior modifications that may ameliorate his symptoms.

Gastroesophageal reflux disease (GERD) is defined as the abnormal reflux of gastric contents into the esophagus at least once a …

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