Clinical Questions

Should Physicians Offer The HPV Vaccine To Men And Boys?

March 23, 2012
Should Physicians Offer The HPV Vaccine To Men And Boys?

By Kevin Burns

Faculty Peer Reviewed

On December 22, 2010, the US Food and Drug Administration (FDA) approved the quadrivalent human papillomavirus (HPV) vaccine (Gardasil; Merck, Whitehouse Station, New Jersey) for prevention of anal cancer and anal intraepithelial neoplasia (AIN) for males and females 9 to 26 years old. HPV is the most common sexually transmitted infection in the United States and the high-risk subtypes 16 and 18 are linked to development of cervical, vaginal, vulvar, anal, penile, and oropharyngeal malignancies. The FDA-approved uses for …

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From The Archives: How to interpret troponins in renal disease?

March 15, 2012
From The Archives: How to interpret troponins in renal disease?

Please enjoy this post from the archives first posted on October 21, 2009.

By 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. …

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Is There a Long-Term Mortality Benefit From Bariatric Surgery?

March 8, 2012
Is There a Long-Term Mortality Benefit From Bariatric Surgery?

By Marc O’Donnell

Faculty Peer Reviewed

Obesity is defined as a body mass index (BMI) of ?30 kg/m2. The rate of obesity in the United States has skyrocketed over the last several decades, becoming a disease of epidemic proportions. According to the Centers for Disease Control and Prevention, in 2009, 32 states had a prevalence of obesity of ?25%, while 9 of these states had a prevalence of ?30%. It has been estimated that the economic costs of treating obesity and its complications, including type …

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FROM THE ARCHIVES: How Do You Diagnose Polymyalgia Rheumatica?

March 1, 2012
FROM THE ARCHIVES: How Do You Diagnose Polymyalgia Rheumatica?

Please enjoy this post from the archives dated August 12, 2009

By Eve Wadsworth MD

Faculty Peer Reviewed

Polymyalgia rheumatica (PMR) is a condition that resembles several different disorders including osteoarthritis and can be difficult to diagnose. In addition to osteoarthritis, PMR can resemble conditions as diverse as depression, fibromyalgia, myopathic drug reactions, and malignancy. PMR, however, can be associated with dangerous consequences, namely blindness, and is responsive to well-established treatment regimens. As such, familiarity with PMR’s presentation and its unique features is critical so …

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How Should You Choose the Best Anti-platelet Agents for Secondary Stroke Prevention?

February 16, 2012
How Should You Choose the Best Anti-platelet Agents for Secondary Stroke Prevention?

By Demetrios Tzimas, MD

Faculty Peer Reviewed

You are about to discharge a 75-year-old female with hyperlipidemia, hypertension, peripheral vascular disease, who was admitted to the hospital for an ischemic stroke. Being an astute physician, you would like to mitigate this patient’s risk of having a second stroke. But you ask yourself, “with all of the agents available today, what anti-platelet agents should I put this patient on to decrease her risk for a second stroke?”

The etiology of an ischemic stroke, as defined by …

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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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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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