Clinical Questions

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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How Safe Is That Tattoo?

April 27, 2011
How Safe Is That Tattoo?

By Farzon A. Nahvi

Faculty Peer Reviewed

 Once thought to be exclusively the domain of gang members, prisoners, and those in the military, tattoos are now increasingly popular with the general population. The increasing visibility of tattoos on high-profile individuals such as athletes, musicians, and actors, combined with the increasing acceptability of tattoos among professionals, have made tattoos a common part of modern culture. Nevertheless, tattoo artists are subject to little regulation, and tattoo art comes with some real…

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The Porcelain Terror: Can a Toilet Give You Gonorrhea?

April 13, 2011
The Porcelain Terror: Can a Toilet Give You Gonorrhea?

By Bradley Ching, Class of 2011

Faculty Peer Reviewed

 What do every road trip, football game halftime, and trans-continental plane flight have in common? Usually a disgusting toilet paired with the urgent need of people to use them. While no one takes pleasure from these encounters, could they in fact be a risk for acquiring a sexually transmitted disease?

Gonorrhea or “the clap,” as it is lovingly nicknamed, is caused by the bacteria Neisseria gonorrhoeae and…

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From The Archives: Does Acetazolamide Prevent Altitude Sickness?

March 31, 2011
From The Archives: Does Acetazolamide Prevent Altitude Sickness?

Please enjoy this post from the Clinical Correlations archives first posted May 7, 2009

Seema Pursnani, MD

Because your parents have designated you as the family doctor, your Uncle Joe calls to ask you if he should take this medication called Diamox before going trekking in the Himalayas. You work at Bellevue in New York City: who climbs mountains here? What do you say?

Why do illnesses develop from changes in altitude?

The essential culprit…

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Is Dark Chocolate Good For You?

March 30, 2011
Is Dark Chocolate Good For You?

By Lisa Parikh, MD

Faculty Peer Reviewed

I was recently counseling an overweight patient about nutrition and exercise when he asked, “Doc, is it true what they say about dark chocolate being good for you?” I told him that although I had heard about this, I was actually not too sure about the evidence behind this. As a strong supporter of the “I wish that the best tasting foods were good for you” club, I decided this was…

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From The Archives: The Skinny on Cachexia…Can it be Treated?

March 24, 2011
From The Archives: The Skinny on Cachexia…Can it be Treated?

Please enjoy this post from the Clinical Correlations archives first posted April 22, 2009

Michael T. Tees, MD, MPH

On the wards and in the clinic, the physician is frequently presented with a patient with a decreased appetite and alarming weight loss. The patient is likely frustrated with their own fraility, the family is upset at the poor nutritional state of their loved one, but the healthcare provider should be the most concerned. This clinical presentation without…

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