Clinical Questions

Is there such a thing as too much information?

December 1, 2016
Is there such a thing as too much information?

By Mariya Rozenblit, MD  

Peer Reviewed

On my first day of internship I was faced with the seemingly simple task of consenting a patient for a blood transfusion. I went over the informed consent form with the patient, explaining the benefits and possible risks, and asked the patient if he had any questions. He did not and happily signed the form. However, I was left wondering if he truly comprehended the information. How much did he know about hepatitis C and HIV and how these …

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Gamechanger? Is Spironolactone the Magic Bullet for Resistant Hypertension?

November 9, 2016
Gamechanger?  Is Spironolactone the Magic Bullet for Resistant Hypertension?

By Amar Parikh, MD

Peer Reviewed

Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my practice? Featuring thorough evidence-based review as well as expert commentary, our aim is for this series to help you decide if the results of a given study are, in fact, a gamechanger.

A 65 year-old Hispanic male with type 2 diabetes, hypertension, hyperlipidemia, and erectile dysfunction presents to clinic for

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Why It Isn’t So Cool To Go Gluten-Free

October 12, 2016
Why It Isn’t So Cool To Go Gluten-Free

Chloe Cipora Goldman, MD

Peer Reviewed

During a recent encounter with a 32 year-old female presenting for surgical clearance for knee surgery, the patient touted that she was in superb health, exercised daily, and even followed a “healthy” gluten-free diet, despite not having celiac disease. This patient is one of the millions of Americans that have jumped on the gluten-free bandwagon, which has been made popular with the help of athlete and celebrity endorsements. The idea that gluten is something that should be avoided has …

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PCSK9 Inhibitors: Who Could Need More than a Statin?

October 5, 2016
PCSK9 Inhibitors: Who Could Need More than a Statin?

By Rhodes Hambrick

Peer Reviewed

The atherosclerotic cardiovascular disease (ASCVD) risk associated with hyperlipidemia (HLD), readily apparent from the Framingham Heart Study1 of the mid-20th century, has been the target of innumerable attempted pharmacologic interventions ever since. One class of agents, the HMG-CoA reductase inhibitors, or statins, became – and have remained2 – the gold standard for managing HLD-associated ASCVD risk in the setting of the remarkably favorable findings of multiple studies in the 1990s.3-5 While other agents, including niacin, fish oil, and fibrates, have …

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Oxygen-Induced Hypercapnia in COPD: What is the Mechanism?

September 28, 2016
Oxygen-Induced Hypercapnia in COPD: What is the Mechanism?

By Jonathan Glatt

Peer Reviewed 

It was my first week on the wards as a third-year medical student, and I found myself huddled with the team in a busy corner of the Bellevue ED, listening to a man cough and wheeze his way through an interview. He was an elderly patient with an extensive smoking history–a lifetime of a destructive habit that had dilated and distorted his lungs beyond repair. He told us, between bouts of breathlessness, of worsening dyspnea and copious sputum production over …

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Little Knowledge, Large Problem: Lack of Nutrition and Obesity Education in Medical Curricula

September 23, 2016
Little Knowledge, Large Problem: Lack of Nutrition and Obesity Education in Medical Curricula

By Elissa Driggin

Peer Reviewed

At almost every single one of my medical school interviews, each interviewer, noting my college major in nutritional science, asked some variation of the question, “What should I be eating to stay healthy?” Each time, I was left unsure of whether or not this question was aimed to gauge my ability to hold a conversation in a stressful environment, articulate my thoughts in a logical manner, or fulfill some other mysterious goal of the infamous medical school interview process. Or, …

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Are We Too Clean or Too Dirty? The Hygiene Hypothesis in Asthma

September 21, 2016
Are We Too Clean or Too Dirty? The Hygiene Hypothesis in Asthma

By James Barger

Peer Reviewed

Asthma, an obstructive pulmonary disease characterized by bronchospasm and chronic airway inflammation, has afflicted mankind for millennia. In the 1st century AD, the Greek physician Aretaeus of Cappadocia described an attack thus:

“the cheeks are ruddy, eyes protuberant, as if from strangulation…voice liquid and without resonance…they breathe standing, as if desiring to draw in all the air which they possibly can inhale, and, in their want of air they also open the mouth as if thus to enjoy the more …

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Sex or Drugs: Why Do We See An Increased Incidence of Oropharyngeal Cancer?

July 13, 2016
Sex or Drugs: Why Do We See An Increased Incidence of Oropharyngeal Cancer?

By Tyler Litton, MD

Peer Reviewed

Oropharyngeal squamous cell carcinoma (OPSCC) is relatively rare but incidence has increased in the US over the past 40 years. Tonsillar cancer is the most common type of OPSCC followed by base of tongue cancer, which together account for 90% of all OPSCCs. The incidence of both tonsillar and base of tongue cancers individually have also increased in the US. OPSCC is more common in men than women and smoking and alcohol are well known risk factors for …

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Gun Violence: A Public Health Concern?

June 9, 2016
Gun Violence: A Public Health Concern?

By Matthew B. McNeill, MD

Peer Reviewed

One can often feel numb or indifferent to the seemingly nightly reports of gun deaths on American news programs. Individual homicides, suicides, or accidental gun deaths are tragic and tragically commonplace. However, over the last two decades, a tide of unrest with the current role of guns in America has arisen in the wake of mass school shootings in places such as Jonesboro, AR (1998, 5 killed, 10 injured), Columbine, CO (1999, 13 killed, 24 injured), Red Lake …

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Wearable Health Trackers: Better behaviors, or Fashion fads?

May 25, 2016
Wearable Health Trackers: Better behaviors, or Fashion fads?

By David Valentine, MD

Peer Reviewed

Currently, well over one third of US adults use at least one health-related online service or app, with almost half of those focused on physical activity 1. With the growing popularity of wearable health tracking devices such as the Fitbit, Nike Fuel, Jawbone and more, the prevalence of these technologies is only set to grow. However, while more and more people know more and more about their health and habits by the day, little is known about perhaps the …

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Can N-Acetylcysteine be Used in Non-Acetaminophen Induced Acute Liver Failure?

May 20, 2016
Can N-Acetylcysteine be Used in Non-Acetaminophen Induced Acute Liver Failure?

By David Pineles, MD

Peer Reviewed

In the early 1970’s, scientists discovered in animal models that a minor metabolite of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI), accumulates in the body after ingestion. This metabolite is normally conjugated by glutathione, but when acetaminophen is taken in excess, the body’s glutathione reserves are inadequate to inactivate all of the toxic NAPQI. This metabolite is then free to cause direct damage to hepatocytes. If present in high enough concentrations, the liver damage can be so extensive that it results in …

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Bedside Rounds: How Useful are the Kernig and Brudzinski signs for Predicting Meningitis?

April 27, 2016
Bedside Rounds: How Useful are the Kernig and Brudzinski signs for Predicting Meningitis?

By Chio Yokose, MD

Peer Reviewed

Even in this era of modern medicine, bacterial meningitis remains a widely feared diagnosis in both resource-rich and -poor settings worldwide. Bacterial meningitis is among the ten most common infectious causes of death and kills approximately 135,000 people around the world each year .

It is a medical, neurologic, and sometimes neurosurgical emergency that affects 4 to 6 per 100,000 adults annually .  Many healthcare providers may consider the diagnosis when evaluating a patient, but it can nonetheless be …

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