Clinical Questions

Why Does Our Hair Turn Gray?

March 30, 2017
Why Does Our Hair Turn Gray?

By Chio Yokose, MD and Aaron Smith, MD

Peer Reviewed 

All but a lucky few of us will one day see our locks lose their color. But what is the physiologic basis for this unsightly transformation, known scientifically as canities? Why does our hair turn gray?

Hair pigment is derived from the compound melanin, which is formed during melanogenesis in lysosome-like organelles called melanosomes, found in the cytoplasm of melanocytes . Melanocytes are ectodermal cells that migrate from the neural crest to the skin during …

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Gamechanger? Should Steroids be Added to Treat Community Acquired Pneumonia?

March 23, 2017
Gamechanger?  Should Steroids be Added to Treat Community Acquired Pneumonia?

By Martin Fried, 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. 

Why does this matter?

Community-acquired pneumonia (CAP) is a common and potentially serious infection that can lead to …

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What is the Evidence for Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema?

February 1, 2017
What is the Evidence for Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema?

By Jenna Conway, MD

Peer Reviewed

Introduction 

A 58-year-old man presents with worsening dyspnea and nonproductive cough for five days. Significant history includes a recent hospitalization for congestive heart failure. He is afebrile with a blood pressure of 95/55 mmHg, heart rate of 115 beats per minute, and oxygen saturation of 85% on room air. Physical exam is notable for rales bilaterally. Chest X-ray shows bilateral pulmonary infiltrates and an enlarged cardiac silhouette suggestive of cardiogenic pulmonary edema. Standard therapy is initiated with oxygen by …

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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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