Clinical Questions

When and How Should We Examine the Spleen?

January 28, 2016
When and How Should We Examine the Spleen?

By Jenna Tarasoff

Peer Reviewed

A 65-year-old African woman presents with two months of fevers and 25-pound weight loss along with a month of nausea and retching, accompanied by left-sided abdominal pain. The exam is significant for axillary lymphadenopathy, abdominal distension, splenomegaly, and palpable purpura on her arms, legs, and back. Labs are significant for leukocytosis, lymphopenia, microcytic anemia, increased ferritin, and positive hepatitis C virus PCR. Abdominal CT shows multiple enlarged nodes and an enlarged spleen (splenomegaly). 

As I prepare to present my diagnosis …

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The Quest for the HIV Vaccine: Are We Closer Than We Think?

January 20, 2016
The Quest for the HIV Vaccine: Are We Closer Than We Think?

By Amar Parikh, MD 

Peer Reviewed

Amidst the global panic over the recent Ebola outbreak, another well-known pathogen that has been devastating the world for decades continues to smolder—the human immunodeficiency virus (HIV). According to the World Health Organization (WHO), in 2013 there were 35 million people worldwide living with HIV, 2.1 million of who were newly infected that year . HIV/AIDS has claimed the lives of nearly 40 million people to date, with 1.5 million people dying from AIDS in 2013 alone. Although highly …

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Is It Time to Reconsider Who Should Get Metformin?

December 11, 2015
Is It Time to Reconsider Who Should Get Metformin?

By Lauren Strazzulla

Current FDA guidelines for the use of metformin stipulate that it not be prescribed to those with an elevated creatinine (at or above 1.5 mg/dL for men and 1.4 mg/dL for women). It is also contraindicated in patients with heart failure requiring pharmacologic treatment, and people over age 80, unless their creatinine demonstrates that renal function is not reduced. These guidelines are in place to prevent lactic acidosis, an understandably feared complication of metformin. However, metformin is, by consensus, the initial drug …

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Are We Overusing Proton Pump Inhibitors?

November 13, 2015
Are We Overusing Proton Pump Inhibitors?

By Shimwoo Lee
Peer Reviewed
Case: A 31-year-old man with poorly controlled type 2 diabetes was hospitalized for community-acquired pneumonia. His home medications included esomeprazole. When asked why he was receiving this medication, the patient said it was first started during his prior hospitalization for “ulcer prevention” eight months ago and that he had continued to take it since. He denied any history of upper gastrointestinal symptoms. Esomeprazole was tapered off during this admission. When being discharged after successful treatment of his pneumonia, he was …

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Beta-blockers in Uncomplicated Hypertension: Is it Time for Retirement?

October 7, 2015
Beta-blockers in Uncomplicated Hypertension: Is it Time for Retirement?

By Robin Guo, MD

Peer Reviewed 

Beta-blockers were one of the first modern medications used for the treatment of blood pressure. Before 1950, treatment options for hypertension were limited. The alphabet soup of medications—reserpine, pentaquine, hydralazine, and guanethidine—were notorious for inducing orthostasis, sedation, constipation, impotence, or blurry vision . Then in the 1960s, propranolol and chlorothiazide were developed. Initially designed to treat angina pectoris, propranolol was serendipitously discovered to also lower blood pressure. Oddly, propranolol, like the other beta-blockers in its generation and thereafter, did …

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There’s an App for That: Fitness Apps and Behavior Change Theory

September 18, 2015
There’s an App for That: Fitness Apps and Behavior Change Theory

By Alyson Kaplan

Peer Reviewed

According to recent reports by the CDC, more than one-third (78.6 million) of American adults are obese. Approximately 17% (12.7 million) of children and adolescents ages 2-19 also meet criteria for obesity . Obesity-related health conditions, including diabetes, heart disease, certain types of cancer, and stroke are among the leading causes of preventable death. Yet, obesity is not the sole contributor to these diseases. Other health risk behaviors, including smoking, alcohol abuse, and lack of physical activity all interact to …

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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 …

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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 …

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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 …

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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 …

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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 …

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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, …

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