Clinical Questions

Chronicles of a Second Year Medical Student

August 6, 2015
Chronicles of a Second Year Medical Student

By Matthew Siow

Peer Reviewed 

Day 1 of the medicine rotation: complete. I was on long call today, which meant three things. One, the hours during which I had to pretend I knew something were longer. Two, I saw a lot of things I had never seen before, from more common things like COPD exacerbations and acute pancreatitis to more obscure things like erythrodermic psoriasis and multiple brain abscesses. And third, it’s 8 PM and I am absolutely exhausted.

As I lie down and start …

Read more »

UV Nail Lamps and Cancer: A Correlation?

July 24, 2015
UV Nail Lamps and Cancer: A Correlation?

By Jennifer Ng, MD

Peer Reviewed 

Beauty and suffering are often thought to be intertwined.  It is hard to have your cake and eat it too.  In the quest for beauty, women (and men) have subjected themselves to toxic and potentially deadly practices, such as applying lead-based cosmetics to whiten their faces historically , or more recently, going to tanning beds and/or laying out in the sun for prolonged periods to get a “healthy glow.”  As we have become increasingly health-conscious and vigilant, more and …

Read more »

Diagnostic Challenges in Latent Tuberculosis Infection: A Brief Review of Available Tests and their Appropriate Use

July 15, 2015
Diagnostic Challenges in Latent Tuberculosis Infection: A Brief Review of Available Tests and their Appropriate Use

By: Miguel A. Saldivar, MD

Peer Reviewed 

“Indeterminate.” Many clinicians have expressed frustration when reading this word on a Quantiferon-TB Gold test result. The obligate follow-up question is: what is the next best step? Repeat the Quantiferon? Ignore it altogether and perform a Tuberculin Skin Test (TST) instead? Even worse, what happens when both tests are performed with discordant results? In order to answer some of these questions, this article begins with a very brief overview of Mycobacterium tuberculosis (TB) infection epidemiology. This is followed …

Read more »

Why Do We Do What We Do: Common Hospital Practices Revealed

February 27, 2015
Why Do We Do What We Do: Common Hospital Practices Revealed

By Dana Zalkin

Peer Reviewed

A code is called on the overhead speaker and the on-call teams rush to the scene to see what awaits them. EKG leads are being placed, medications are being ordered, and labs are being drawn. A medical student stands with a bag of ice, ready to grab the arterial blood gas (ABG) and run it down to the lab. “Why do we put the ABG on ice right away?” the student wonders. But in this moment, while a patient teeters …

Read more »

Approach to the Hospitalized Patient with Community-Acquired Pneumonia: Should Procalcitonin Be Part of the Initial Evaluation?

November 21, 2014
Approach to the Hospitalized Patient with Community-Acquired Pneumonia: Should Procalcitonin Be Part of the Initial Evaluation?

By Matthew Light, MD

Peer Reviewed

A 79 year-old female, 20 pack-year ex-smoker with history of mild systolic congestive heart failure is referred to the emergency department (ED) after an outpatient visit with her primary care physician where she complained of fever, sinus congestion, myalgias, and productive cough. On arrival she is febrile, mildly tachypneic and tachycardic, but normotensive and with a normal oxygen saturation on room air. On exam she has bronchial breath sounds and rales in her left chest. The patient has a …

Read more »

Why Do Toenails Grow More Slowly Than Fingernails?

November 14, 2014
Why Do Toenails Grow More Slowly Than Fingernails?

By Alice Drain

Peer Reviewed

Warm weather heralds the arrival of flip-flops and the exposure of toes previously tucked away in socks and boots. This sudden pedal presence makes one wonder, why do toenails grow more slowly than fingernails?

 

 

 

 

 

 

 

 

 

First, to what degree does speed of nail growth vary? Anyone who has ever had to wait as a broken toenail gradually grows in, treated a toe fungus, or gotten a mani-pedi is familiar with this difference, …

Read more »

Get Your Caffeine fix while lowering your diabetes risk – too good to be true?

July 17, 2014
Get Your Caffeine fix while lowering your diabetes risk – too good to be true?

By Jennifer Ng, MD

Peer Reviewed

Addiction, by definition, is a negative word. It implies the overindulging of something with a high or uncertain risk to benefit ratio, such as coffee. Yet recently, writer Markham Heid informed coffee addicts all over the world, “Drink Coffee, Lower Your Diabetes Risk” . To add to that, it’s not just coffee; tea and decaf can do it too, or so his article proclaims. Skeptical? Let’s review the evidence and judge for ourselves.

It turns out that this same …

Read more »

The Rise in Tick-Borne Diseases: Is Climate Change Responsible?

June 4, 2014
The Rise in Tick-Borne Diseases: Is Climate Change Responsible?

By Nadia Jafar

Peer Reviewed

As a resident of Connecticut, I grew up acutely aware of tick-borne diseases. Nonetheless, I was surprised to see at least 3 cases of tick-borne infections during the month of my Medicine clerkship. This drove me to research the incidence of tick-borne diseases, specifically in the US, and the possible factors contributing to their increased prevalence.

In 1998, the list of reportable tick-borne pathogens in the US included Rocky Mountain spotted fever, tularemia, Lyme disease, human granulocytic ehrlichiosis/anaplasmosis, and human …

Read more »

Are Probiotics Effective In Preventing Clostridium Difficile Associated Diarrhea?

May 30, 2014
Are Probiotics Effective In Preventing Clostridium Difficile Associated Diarrhea?

By Theresa Sumberac, MD

Peer Reviewed

Antibiotic associated diarrhea is a common complication of antibiotic therapy, occurring in 5% to 39% of all patients receiving treatment. Nearly one third of these cases are attributed to the gram –positive spore forming rod, Clostridium difficile . A primary Clostridium difficile associated diarrhea (CDAD) is estimated to add $2871 to $4846 to in hospital costs while a recurrent infection is estimated to cost $13,655 to $18,067 . The emergence of the hyper-virulent NAP1/B1/027 strain of C. difficile together …

Read more »

From The Archives: Metabolic Syndrome: Fact or Myth?

May 22, 2014
From The Archives: Metabolic Syndrome: Fact or Myth?

Please enjoy this post from the archives dated September 30, 2011

By Vicky Jones, MD

A 40-year-old female presented to her primary care provider with a chief complaint of weight gain over the past year.  She wants to be fully evaluated for any kind of medical disorder that could have caused it.  She has been seen by multiple specialists but no one can give her a “straight diagnosis”.  Their advice is for her to lose weight.  She insists she never had problems with her weight …

Read more »

New Cholesterol Guidelines: How Safe Are High-Potency Statins?

May 14, 2014
New Cholesterol Guidelines: How Safe Are High-Potency Statins?

By Molly Anderson

Peer Reviewed

Managing hyperlipidemia is a mainstay of cardiovascular risk reduction. The 2013 ACC/AHA guidelines no longer target specific low-density lipoprotein (LDL)-cholesterol levels, but recommend lipid-lowering therapies of varying intensity based on the predicted risk of cardiovascular events . Adoption of the new guidelines would result in millions more Americans receiving high-potency statins; it is therefore important to investigate potential dangers associated with aggressive therapy and the long-term implications for patients.

Many studies have shown that strict adherence to lipid-lowering medications improves …

Read more »

Is the Funduscopic Exam Worthwhile For the General Practitioner?

May 2, 2014
Is the Funduscopic Exam Worthwhile For the General Practitioner?

By Emily Fisher

Peer Reviewed

Some have said that physical examination is a dying art and the nondilated funduscopic exam may be one of the best examples of this. With the increasing perception that the use of imaging and labs allows physicians to diagnose diseases with more confidence than a history and physical exam alone , the days when an ophthalmoscope was almost as important as the white coat or the stethoscope and was part of a “bag of tools,” are quickly becoming a distant …

Read more »