Clinical Questions

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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Is There Really Any Role For Steroids In Acute Alcoholic Hepatitis?

December 8, 2011
Is There Really Any Role For Steroids In Acute Alcoholic Hepatitis?

By Keri Herzog, MD

Faculty Peer Reviewed

The patient is a 48-year-old male with a history of heavy alcohol use (he drinks about 1 pint of vodka daily) who presented to the hospital when he noticed that he had become increasingly jaundiced. The patient was hemodynamically stable on admission and afebrile, with jaundice and scleral icterus on exam. Laboratory data was significant for a total bilirubin of 6.6, an INR of 2.3, AST of 83, ALT 72, and a Maddrey’s discriminant function (MDF) that was…

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Does Culturing the Catheter Tip Change Patient Outcomes?

November 17, 2011
Does Culturing the Catheter Tip Change Patient Outcomes?

By Todd Cutler, MD

Faculty Peer Reviewed

An 82-year-old man is admitted to the intensive care unit with fevers, hypoxic respiratory failure and hypotension. He is intubated and resuscitated with intravenous fluids. A central venous catheter is placed via the internal jugular vein. A chest x-ray showed a right lower lobe infiltrate and he is treated empirically with antibiotics for pneumonia. Blood cultures grow out S. pneumoniae. After four days he is successfully extubated. The night following extubation, the patient has a fever of 100.8…

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The Diagonal Earlobe Crease: Historical Trivia or a Useful Sign of Coronary Artery Disease?

November 2, 2011
The Diagonal Earlobe Crease: Historical Trivia or a Useful Sign of Coronary Artery Disease?

Nicholas Mark, MD & Sarah Buckley, MD

Faculty Peer Reviewed

Background

Publius Aelius Hadrianus, better known as Hadrian, emperor of Rome (117-138 CE), traveler, warrior, and lover of all things Greek, fell ill at the age of 60. He developed progressive edema and episodic epistaxis, fell into a depression soothed by rich food and drink, and succumbed to death within 2 years. The exact cause of Hadrian’s death–whether by heart failure, glomerulonephritis, or even hereditary hemorrhagic telangiectasia–has been a topic of debate among paleopathologists. It was…

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Should Women Be Screened For Abdominal Aortic Aneurysms?

October 26, 2011
Should Women Be Screened For Abdominal Aortic Aneurysms?

By Michael Boffa

Faculty Peer Reviewed

Laura K. sits in the office of her cardiologist waiting for the results of her follow-up aorto-iliac duplex scan. Six months ago, Laura had an endostent placed in her abdominal aorta after a 5.2 cm x 5.4 cm abdominal aortic aneurysm (AAA) was discovered.  Though she has recently quit, Laura, now 70, smoked for a large portion of her life. Her advanced age and smoking put her at increased risk of suffering a potentially life-threatening aortic aneurysm rupture. …

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Bariatric Surgery: A Cure for Diabetes?

October 20, 2011
Bariatric Surgery: A Cure for Diabetes?

By Amy Dinitz

Faculty Peer Reviewed

The lifetime risk of developing diabetes for persons born in 2000 is around 35% and the NHANES database has suggested a greater than fourfold increase in prevalence over the last three generations.  While bariatric surgery has become the most effective treatment for obesity, it has also been found to be an extremely effective treatment for type 2 diabetes.  It was initially thought that the weight loss experienced by patients after bariatric surgery was responsible for improved glycemic…

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Subclinical Hypothyroidism: To Screen or Not to Screen?

August 17, 2011
Subclinical Hypothyroidism: To Screen or Not to Screen?

By Addie Peretz, MD

Faculty Peer Reviewed

Despite the ease of screening for hypothyroidism with hormone assays and the availability of thyroxine replacement therapy, no recommendations regarding routine screening for hypothyroidism in adults are universally accepted. The American Academy of Family Physicians and the American Association of Clinical Endocrinologists recommend periodic assessment of thyroid function in older women.  The American Thyroid Association advocates for more frequent earlier screening, recommending measurement of thyroid stimulating hormone (TSH) beginning at age 35 and every 5 years…

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Do Soft Drinks Cause Hypertension?

July 8, 2011
Do Soft Drinks Cause Hypertension?

By Ivan Saraiva, MD

Faculty Peer Reviewed

Sugared soft drinks are among the most heavily consumed drinks in the US. Carbonated soft drinks were first invented as a way to make “healthier” water that looked like natural carbonated waters that were found in European spas in the mountains. The name soda came from the use of bicarbonate of soda, which was used to produce carbonation (for an excellent review of the history of beverages, refer to Wolf et al..  Unfortunately, we no longer…

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Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

May 25, 2011
Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

By Santosh Vardhana

 Faculty Peer Reviewed

Please review Part 1 of this article here.

Mr. M is a 63-year old man with a history of coronary artery disease and systolic congestive heart failure (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to the Adult Primary Care Center complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance.  His vital signs on presentation are T 98.0˚F, P 84, BP 122/76.  What are his…

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Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

May 18, 2011
Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

By Santosh Vardhana

Faculty Peer Reviewed 

Mr. M is a 63-year-old man with a history of coronary artery disease and systolic CHF (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to Primary Care Clinic complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance.  His vital signs on presentation are T 98.0º F, BP 122/76, HR 84 bpm.  What are his therapeutic options?

 A Race Against Time: Tachycardia in the Failing Heart

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