Clinical Questions

Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

May 21, 2010
Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

By Rachel Edlin, MD

Faculty peer reviewed

A 29-year-old female patient with a history of iron deficiency anemia and heavy menstrual periods comes into the clinic for a regular visit. She is tired of iron supplementation and its associated constipation. As she is currently on oral contraceptive pills, you recommend using these to reduce her menstrual period to four times a year. She asks, “Is that really safe?”

Is menstruation necessary?

Monthly menstruation is not the historical norm. Compared with modern women, women in prehistoric …

Read more »

Motivational Interviewing: Can You Really Change Behaviors?

April 27, 2010
Motivational Interviewing: Can You Really Change Behaviors?

Emily Stamell

Faculty peer reviewed

As a well-trained fourth year medical student, I inquire about smoking habits as part of almost all my patient encounters. Yet, I do not recall properly counseling a patient on smoking cessation aside from the one liner “You know you should quit, right?” During first and second year of medical school we are taught the stages of change model, which is just as obscure two years later as cell signaling pathways. I was recently introduced to what seemed like an …

Read more »

Which Thyroid Antibody Assays Should be Checked in Patients with Thyroid Disease?

April 14, 2010
Which Thyroid Antibody Assays Should be Checked in Patients with Thyroid Disease?

Michael Chu MD

Faculty peer reviewed

Case:

A 44-year old female presented to the emergency room with complaints of a lower extremity rash and swelling.  The patient had been in her usual state of health when she presented to her primary care physician with complaints of palpitations, weight loss and insomnia.  Lab tests were performed and she was given a diagnosis of hyperthyroidism.  She was started on propranolol and methimazole, which the patient took intermittently due to intolerance of side effects, which she perceived as …

Read more »

When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

March 3, 2010
When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

Laurel Geraghty

Faculty peer reviewed

Both stroke and heart attack require rapid treatment following the onset of symptoms to minimize morbidity and mortality, but few patients seek help in a timely manner. Only about half of patients with acute myocardial infarction (AMI) or stroke arrive to the emergency department within four hours of the onset of symptoms.,,, Every 30-minute delay in treatment following AMI increases one-year mortality by 7.5%, and almost half of the 167,000 annual stroke deaths in this country occur before the patient …

Read more »

Zinc Cold Remedies: Are They Safe and Effective–Who Nose?

February 11, 2010
Zinc Cold Remedies: Are They Safe and Effective–Who Nose?

Amanda Benkoff

Faculty peer reviewed

Each year doctors are presented with the dilemma of the common cold. Adults in the U.S. experience an average of 3 colds per year, and children up to 8-10, resulting in over 500 million colds annually.(1) Patients often visit the doctor with cold symptoms requesting antibiotics. Since the etiology of the common cold is viral, antibiotic therapy is ineffective and inappropriate, and only contributes to bacterial antibiotic resistance. More than 200 viruses can cause the common cold, including rhinoviruses, coronaviruses, …

Read more »

Oldies but Goodies: How should you approach a low titer +RPR?

February 5, 2010
Oldies but Goodies: How should you approach a low titer +RPR?

Please enjoy a post from the Clinical Correlations Archives, first posted November 28, 2006…

45 year old male with a history of Hepatitis B ( Hep B Surf Ag + but Hep B E Ab+ and E Ag – and DNA viral load was not sent) and syphilis treated in the past. He has RPRs in the past that were 1:1 for years and then negative x 2 a year apart, the last being over two years ago. He had labs drawn last week and …

Read more »

Dix-Hallpike Positive, No Red Flags, Now What?

January 23, 2010
Dix-Hallpike Positive, No Red Flags, Now What?

The Proper Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

Carly Oboudiyat

Faculty peer reviewed

You finally have the “dizzy” patient whose eyes actually beat torsionally upwards when you do that silly maneuver you have done countless times to no avail. Hallelujah, you think, a positive Dix-Hallpike sign, reassuring you that you have a case of benign paroxysmal positional vertigo (BPPV). But now what? Do you try that other acrobatic maneuver to reposition the canaliths in the posterior canal, or should you give meclizine?

Benign …

Read more »

What is the Role of Drug Therapy in Treating Obesity?

November 19, 2009
What is the Role of Drug Therapy in Treating Obesity?

Arlene Chung

Faculty Peer Reviewed

Despite the high prevalence of obesity1 and its associated morbidity2 and mortality 3,4, it represents one of the most difficult chronic conditions to treat. Barriers include a metabolically toxic environment, a history of ill-fated weight-loss regimens, and a general view of obesity as primarily a social, not a medical problem. 5 Deep down, the belief that obesity really is the result of gluttony and sloth probably persists. However, as we learn more about the physiology of energy balance, appetite regulation, …

Read more »

How Does Alcohol Cause Cardiomyopathy?

November 4, 2009
How Does Alcohol Cause Cardiomyopathy?

Charles Levine

Faculty peer reviewed

Excessive consumption of ethanol (EtOH) has many deleterious effects on the human body. The heart is a target of damage from EtOH consumption, as chronic consumption of EtOH leads to decreased cardiac function and structural heart disease, including dilated cardiomyopathy.(1) The exact mechanism by which EtOH exerts its deleterious effects on the heart remains poorly understood and is an area of active research. This report will focus on some of the proposed mechanisms and some recent advances in the understanding …

Read more »

How to interpret troponins in renal disease?

October 21, 2009
How to interpret troponins in renal disease?

Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities. Troponin I levels drawn at 0, 6, and 12 hours after initial presentation are …

Read more »

What is Wellens’ Syndrome?

October 7, 2009
What is Wellens’ Syndrome?

Erin Ducharme MD

Faculty peer reviewed

Wellens’ syndrome refers to a pattern of ECG signs occurring during chest-pain free periods in patients with unstable angina, heralding critical, proximal left anterior descending artery (LAD) stenosis . The eponym honors Dr. Hein J.J. Wellens who first described this ECG phenomenon in 1982. Wellens and colleagues identified a subgroup of patients with unstable angina who demonstrated a pattern of inverted precordial T-waves which strongly correlated with early large anterior myocardial infarction (MI) and a poor prognosis . In …

Read more »

When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

September 30, 2009
When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

Frederick Gandolfo MD

Faculty peer reviewed

At a recent conference on renal transplantation, the importance of early renal biopsy for the diagnosis of acute rejection was emphasized. As busy practitioners of general internal medicine, we rarely have the opportunity to learn the details of a subspecialty procedure such as renal biopsy. However, knowing the details of these procedures is important in providing care for these specific patients. What are the indications, risks, and follow-up care required for the renal biopsy patient? In the native kidney …

Read more »