Systems

To Premed or Not to Premed: Are Tylenol and Benadryl Really Necessary Prior to All Transfusions?

January 19, 2012
To Premed or Not to Premed: Are Tylenol and Benadryl Really Necessary Prior to All Transfusions?

By Robert Gianotti, MD

Faculty Peer Reviewed

Case: Mr. T is a 32-year-old male being treated by the oncology service for Acute Myelogenous Leukemia. You are the night float intern covering overnight when you are called by the nurse to inform you that his CMV negative platelets have finally arrived from the blood bank. The nurse notices that the day team has not ordered Benadryl or Tylenol to be given prior to the transfusion, and asks if you could place the order. As you start…

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From The Archives: Why is Syphilis Still Sensitive to Penicillin?

January 13, 2012
From The Archives: Why is Syphilis Still Sensitive to Penicillin?

Please enjoy this post from the Archives, first published on July 30, 2009

By Sam Rougas MD

Faculty Peer Reviewed

It seems that every week a new article in a major newspaper is reporting what most infectious disease physicians have been preaching for several years. Antibiotic resistance is rapidly spreading. Infections such as Methicillin Resistant Staphylococcal Aureus, Extremely Drug Resistant Tuberculosis, and Vancomycin Resistant Enterococcus have journeyed from the intensive care units to the locker rooms of the National Football League. That being said, some…

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Why Are Asthma Patients Noncompliant With Their Inhalers?

January 11, 2012
Why Are Asthma Patients Noncompliant With Their Inhalers?

By Kristen Mattei

Faculty Peer Reviewed

I distinctly remember being 9 years old, sitting in my doctor’s office after a cold left me struggling for breath, doubled over and wheezing, when he told me that I had asthma. At first I didn’t believe the diagnosis, despite the fact that the albuterol inhaler he had given me was like a breath of life after running suicides on the soccer field. I wasn’t sick or weak! My father insisted I needed to “build my breath up,” and…

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Does Perioperative Smoking Cessation Improve outcomes?

January 6, 2012
Does Perioperative Smoking Cessation Improve outcomes?

By Benjamin Wu, MD

Faculty Peer Reviewed

Mr. T is a 53-year-old man, with history significant for cholelithiasis. He decides to have an elective cholecystectomy after years of biliary colic. Mr. T is an active smoker and wanted to know if he should stop smoking prior to surgery?

Smoking is associated with adverse outcomes in surgery, however debate continues regarding the safety of perioperative smoking cessation. The current understanding of perioperative smoking cessation follows that smokers who stop smoking close to surgery have a higher…

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What Is the Significance of Monoclonal Gammopathy of Undetermined Significance (MGUS)?

December 22, 2011
What Is the Significance of Monoclonal Gammopathy of Undetermined Significance (MGUS)?

By Maryann Kwa, MD

Faculty Peer Reviewed

Clinical Case:

A.D. is a healthy 65-year-old African American male with no prior medical history who presents to his primary care physician for an annual check up. He feels well and has no complaints. Physical exam is normal. Common laboratory tests are ordered which are significant for an elevated total serum protein with normal albumin. A serum protein electrophoresis (SPEP) is then performed. The patient is found to have a monoclonal protein (M protein) of 12 g/L, IgG…

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Myths and Realities: The Fishy Truth about Mercury Toxicity

December 17, 2011
Myths and Realities: The Fishy Truth about Mercury Toxicity

By Nicole Learned

Faculty Peer Reviewed

In an age when patients obtain medical news from the media, and celebrities initiate powerful health trends, clinicians have to be prepared to answer even the most obscure questions about health and nutrition. When Entourage star Jeremy Piven took a leave of absence in 2008 from the Broadway play Speed the Plow due to alleged mercury poisoning from eating sushi twice a day for years, it raised the question: How much fish is too much?

Where Does Mercury Come…

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Mystery Quiz- The Answer

December 14, 2011
Mystery Quiz- The Answer

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors
The answer to the mystery quiz is Kaposi’s sarcoma. The CXR shows bilateral confluent airspaceopacities which have a wide differential diagnosis in this case. The CT narrows the differential.  Specifically, the opacities appear to emanate from the central hilar areas, cuff the airways, and fan out into the more distal airspaces (Images 3 and 4).  This appearance is very suggestive of Kaposi’s sarcoma. CT scans may also reveal mediastinal lymphadenopathy and large

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Mystery Quiz

December 9, 2011
Mystery Quiz

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

The patient is a 52 year old African-American man who presented with breathlessness and weight loss over one month along with watery stools during the week prior to admission. He had a history of untreated HIV infection, a CD4 cell count of 5/cmm, oral candidiasis, and peri-rectal HSV infection. The patient reported occasional cough with variable sputum production but denied fever, night sweats, hemoptysis, recent travel, or sick contacts. His risk factor for HIV…

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Is There Really Any Role For Steroids In Acute Alcoholic Hepatitis?

December 8, 2011
Is There Really Any Role For Steroids In Acute Alcoholic Hepatitis?

By Keri Herzog, MD

Faculty Peer Reviewed

The patient is a 48-year-old male with a history of heavy alcohol use (he drinks about 1 pint of vodka daily) who presented to the hospital when he noticed that he had become increasingly jaundiced. The patient was hemodynamically stable on admission and afebrile, with jaundice and scleral icterus on exam. Laboratory data was significant for a total bilirubin of 6.6, an INR of 2.3, AST of 83, ALT 72, and a Maddrey’s discriminant function (MDF) that was…

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Dance Therapy in Parkinson’s Disease: Can the Argentine Tango Improve Motor Function?

December 2, 2011
Dance Therapy in Parkinson’s Disease: Can the Argentine Tango Improve Motor Function?

By Neha Jindal

Faculty Peer Reviewed

Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder that affects over 1 million people in the United States. People with PD often demonstrate postural instability, gait difficulties, and impaired functional mobility, which can lead to falls and decreased quality of life. Medical treatments for PD do not fully address gait and balance issues and, consequently, additional approaches are needed. One approach that has recently emerged in clinical studies is the use of dance, particularly the Argentine tango, as…

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Mystery Quiz

November 30, 2011
Mystery Quiz

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

The patient is a 52 year old African-American man who presented with breathlessness and weight loss over one month along with watery stools during the week prior to admission. He had a history of untreated HIV infection, a CD4 cell count of 5/cmm, oral candidiasis, and peri-rectal HSV infection. The patient reported occasional cough with variable sputum production but denied fever, night sweats, hemoptysis, recent travel, or sick contacts. His risk factor for HIV…

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Does Culturing the Catheter Tip Change Patient Outcomes?

November 17, 2011
Does Culturing the Catheter Tip Change Patient Outcomes?

By Todd Cutler, MD

Faculty Peer Reviewed

An 82-year-old man is admitted to the intensive care unit with fevers, hypoxic respiratory failure and hypotension. He is intubated and resuscitated with intravenous fluids. A central venous catheter is placed via the internal jugular vein. A chest x-ray showed a right lower lobe infiltrate and he is treated empirically with antibiotics for pneumonia. Blood cultures grow out S. pneumoniae. After four days he is successfully extubated. The night following extubation, the patient has a fever of 100.8…

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