Clinical Questions

White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

March 20, 2013
White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

By Lauren Foster

Faculty Peer Reviewed

Hypertension is a pervasive chronic disease affecting approximately 65 million adults in the United States, and a significant cause of morbidity and mortality . Antihypertensives are widely prescribed due to their effectiveness in lowering blood pressure, thereby reducing the risk of cardiovascular events. However, the phenomenon of the “white coat effect” may be a complicating factor in the diagnosis and management of hypertensive patients. It is well established that a considerable number of people experience an elevation of their …

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Morgellons: Real Disease or Delusion Turned Internet Meme?

October 3, 2012
Morgellons: Real Disease or Delusion Turned Internet Meme?

By Robert Mazgaj

Faculty Peer Reviewed

Morgellons disease is an “unexplained dermopathy” characterized by fibers emerging from skin lesions, and associated with various cutaneous sensations. Inspired by a curious medical condition reported by a 17th century English physician, Morgellons was actually named in 2002 by Mary Leitao, a layperson, to describe the mysterious set of symptoms reportedly suffered by her then 2-year-old son. Leitao then launched the not-for-profit Morgellons Research Foundation (MRF) along with a (no longer active) website, www.morgellons.org. MRF successfully petitioned members of …

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Fractional Excretion of Sodium (FENa): Diagnostic Godsend or Gimmick?

September 5, 2012
Fractional Excretion of Sodium (FENa): Diagnostic Godsend or Gimmick?

By Jon-Emile S Kenny, MD

Faculty Peer Reviwed

A 62- year-old man with a history of hypertension, diastolic dysfunction and chronic kidney disease is admitted 4 days after beginning outpatient treatment of community acquired pneumonia with cefpodoxime and azithromycin; he had been intermittently vomiting for two days, but proudly states that he has been keeping all of his home medications down, including hydrochlorothiazide. The morning after his admission, he was noted to have a serum creatinine of 3.4 mg/dL (from a baseline of 1.7 mg/dL). …

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Are Dentists Really Causing Infective Endocarditis?

August 29, 2012
Are Dentists Really Causing Infective Endocarditis?

By Jeffrey Krutoy, DDS

Faculty Peer Reviewed

Bacterial infective endocarditis is a potentially devastating disease, and while it may be an easy tradition to blame the dentist, recent research and new guidelines from the American Heart Association (AHA) indicate that it may not be so simple.

Infective endocarditis (IE), while relatively uncommon (with yearly incidence rates ranging from 2 to 6 cases per 100,000 people), results in high rates of morbidity and mortality even when treated. For this reason, physicians have emphasized the importance of …

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Should We Measure Apolipoproteins to Evaluate Coronary Heart Disease Risk?

August 24, 2012
Should We Measure Apolipoproteins to Evaluate Coronary Heart Disease Risk?

By Navya Nair, MD

Faculty Peer Reviewed

Coronary heart disease (CHD) is the major cause of mortality worldwide. Lipoproteins play a major role in the development of this disease. Current guidelines advocate that low-density lipoprotein (LDL) cholesterol should be the primary target for lipid lowering therapy. However, there is a growing literature on the atherogenic potential of apolipoprotein B (apo B)-containing lipoproteins and the protective effect of apolipoprotein A-one (apo AI)-containing lipoproteins. Many studies suggest that these apolipoproteins be used as markers to evaluate risk …

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Xopenex: Is it worth the money?

August 16, 2012
Xopenex: Is it worth the money?

By Han Na Kim

Faculty Peer Reviewed

Case:

The patient is a 50-year-old woman with history of steroid-dependent, severe, persistent asthma since childhood and coronary artery disease who presented with dyspnea and URI symptoms admitted for management of asthma exacerbation. Patient received nebulized albuterol treatment every two to four hours, and on hospital day two, patient developed persistent sinus tachycardia to heart rate of 120s believed to be secondary to albuterol therapy. Given her tachycardia, would it be safer to prescribe levalbuterol rather than albuterol?…

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Should I Consider Antibiotics in My Patient with Irritable Bowel Syndrome?

July 26, 2012
Should I Consider Antibiotics in My Patient with Irritable Bowel Syndrome?

By Jason Chalifoux

Faculty Peer Review

The story of a patient with multiple office visits due to uncontrolled abdominal pain, bloating and diarrhea/constipation is common among primary care doctors and gastroenterologists. The workup is often extensive and rules out many etiologies. After discovering no metabolic, inflammatory, or anatomic pathology, physicians use the Rome III criteria to diagnose irritable bowel syndrome (IBS). IBS is a functional bowel disorder that is diagnosed by symptoms of recurrent abdominal pain or discomfort for at least 3 days per month …

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Is a VBG just as good as an ABG?

July 13, 2012
Is a VBG just as good as an ABG?

By Sunnie Kim, MD

Faculty Peer Reviewed

A rapid response is called overhead. As white-coated residents rush to the patient’s bedside, the medical consult starts to shout out orders to organize the chaos. “What’s the one-liner?” “Whose patient is this?” And of course, “Who’s drawing the labs?” Usually, at this point, the intern proceeds to collect the butterfly needle, assorted colored tubes, and the arterial blood gas (ABG) syringe. If lucky, there’s a strong pulse. The intern pauses, directs the needle, and hopes for that …

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Should Patients With Nephrotic Syndrome Receive Anticoagulation?

May 9, 2012
Should Patients With Nephrotic Syndrome Receive Anticoagulation?

By Jennifer Mulliken

Faculty Peer Reviewed

Case 1:

A 30-year-old African-American male with a history of bilateral pulmonary emboli presents with a 1-week history of bilateral lower extremity edema. Blood pressure is 138/83, cholesterol 385, LDL 250, albumin 2.9. Urinalysis shows 3+ protein. Twenty-four hour urinary protein is 7.2 grams.

Case 2:

A 47-year-old Hispanic male with a history of mild hypertension and venous insufficiency presents with a 3-month history of bilateral lower extremity edema. BP is 146/95, cholesterol 241, LDL 165, albumin 1.9. Urinalysis …

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From The Archives: How Does Alcohol Cause Cardiomyopathy?

April 19, 2012
From The Archives: How Does Alcohol Cause Cardiomyopathy?

Please enjoy this post from the archives dated November 4, 2009

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 …

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RTS,S/AS01: Is This The Beginning Of The End Of Malaria?

April 12, 2012
RTS,S/AS01: Is This The Beginning Of The End Of Malaria?

By Nicole Sunseri

Faculty Peer Reviewed

In Africa, there lurks a stealthy and powerful beast. Is it a lion, a black mamba, or a crocodile? No, it is the Anopheles mosquito. Although less than the size of a paperclip, these insects inflict an incapacitating blow, inoculating their larger human prey with Plasmodium spp., the parasites responsible for malaria. According to the World Health Organization, the worldwide incidence of malaria infection in 2009 was 225 million cases with a death toll of 781,000 Most of these …

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Use it or Lose it- Do cognitive leisure activities protect against the development of Alzheimer’s?

March 30, 2012
Use it or Lose it- Do cognitive leisure activities protect against the development of Alzheimer’s?

By Courtney Cunningham, MD

Faculty Peer Reviewed

As the world population ages, enormous resources will be required to adequately care for persons suffering from Alzheimer’s disease. The disease is the fifth leading cause of death for adults aged 65 years and older, and is estimated to affect 1 in 8 persons in this age group. Despite recent advances, the cause of Alzheimer’s disease is not well understood. The FDA-approved medications in common use—donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon), and memantine (Namenda)–help to manage symptoms; however …

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