Clinical Questions

How do you Manage the Adult with Perinatally Acquired Hepatitis B?

October 22, 2010
How do you Manage the Adult with Perinatally Acquired Hepatitis B?

Nathaniel Rosso Smilowitz, MD

Faculty Peer Reviewed

Hepatitis B virus is a DNA hepadnavirus affecting 1.25 million people in the United States and nearly 400 million worldwide.  The virus is transmitted perinatally, sexually, and percutaneously, and is endemic in many countries in South East Asia, Central Asia, and Africa.  When exposure occurs early in life, the likelihood of chronic infection is high; up to 90% of cases of vertical transmission result in the persistence of the viral envelope protein,…

Read more »

From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

October 14, 2010
From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

Please enjoy a post from the Clinical Correlations Archives, first posted 1/22/09

Commentary by Melanie Maslow, MD, FACP, Associate Professor of Medicine, NYUSOM, Chief, Infectious Diseases, New York Harbor Healthcare System, NY

Faculty Peer Reviewed

Cellulitis is an acute spreading infection of the skin extending to the deep subcutaneous tissue characterized by pain, swelling, erythema and warmth. Cellulitis in the non-neutropenic patient, in the absence of bite wounds, salt or fresh water exposure, and coexisting ulcers is…

Read more »

Circumcision as Primary Protection?

October 8, 2010
Circumcision as Primary Protection?

Emily Taylor, MD

Faculty Peer Reviewed

The earliest documented evidence of circumcision is in artwork from the Sixth Dynasty in Egypt (2345-2181 BC) found in a wall relief from Saqqara in Lower Egypt. Circumcised North Americans were described by Columbus upon arrival to the continent; circumcision was practiced by Australian aboriginals, native South Americans, and Pacific Islanders. It is unknown if circumcision was common amongst some earlier ancestor of all these peoples, or if it evolved independently in…

Read more »

Does Heyde Syndrome (The Association Between Aortic Stenosis And Intestinal Angiodysplasia) Exist?

September 29, 2010
Does Heyde Syndrome (The Association Between Aortic Stenosis And Intestinal Angiodysplasia) Exist?

By Lara Dunn, MD

Faculty Peer Reviewed

In 1958, EC Heyde published 10 cases of aortic stenosis (AS) and arteriovenous malformations (AVMs) of the gastrointestinal tract in the New England Journal of Medicine .  Thus, the association between aortic stenosis and intestinal angiodysplasia became known as Heyde Syndrome.  Yet the existence of this syndrome has been controversial.

Contrasting conclusions have been obtained by studies conducted to evaluate this association.  In a prospective study, Bhutani and colleagues…

Read more »

Why Does Multiple Myeloma Treat The Kidneys So Poorly?

September 22, 2010
Why Does Multiple Myeloma Treat The Kidneys So Poorly?

By Jon Emile Kenny, MD

Faculty Peer Reviewed

“You mean I’ve got cancer and my kidneys are failing, doc?” said my frail patient on the Bellevue oncology service shortly after a medical student had told him that his kidneys were damaged. Indeed, his new diagnosis of multiple myeloma was accompanied by an admission creatinine of 2.5 mg/dL.

About a quarter of patients with multiple myeloma have renal insufficiency at diagnosis . There are a number of clinicopathologic…

Read more »

Polycythemia Vera Presenting as a Hypercoagulable State: What is the Pathophysiologic Role of JAK2 in the Mechanism, Manifestations, and Treatment of the Disease?

August 11, 2010
Polycythemia Vera Presenting as a Hypercoagulable State:  What is the Pathophysiologic Role of JAK2 in the Mechanism, Manifestations, and Treatment of the Disease?

By Emily Slater

Faculty Peer Reviewed

Mr. R is a 46-year-old man with a past medical history of polycythemia vera on hydroxyurea and chronic hepatitis B and C who presented with acutely worsening left upper-quadrant abdominal pain.  This occurred in the context of 3 months of worsening abdominal pain and 1.5 years of increasing abdominal distension.  His physical exam was remarkable for massive splenomegaly (18cm span) and a non-palpable liver.

Laboratory findings are significant for microcytic anemia with an elevated

Read more »

Does Dietary Modification Help GERD?

June 18, 2010
Does Dietary Modification Help GERD?

By Ramya Srinivasan, MD

Faculty Peer Reviewed

The patient is a 29 year old overweight male presenting to clinic with complaints of reflux symptoms. He says that spicy foods aggravate these symptoms. In addition to weight loss counseling, he is given a prescription for esomeprazole along with a patient handout containing recommendations on foods to avoid and other behavior modifications that may ameliorate his symptoms.

Gastroesophageal reflux disease (GERD) is defined as the abnormal reflux of gastric contents into the…

Read more »

Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

May 21, 2010
Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

By Rachel Edlin, MD

Faculty peer reviewed

A 29-year-old female patient with a history of iron deficiency anemia and heavy menstrual periods comes into the clinic for a regular visit. She is tired of iron supplementation and its associated constipation. As she is currently on oral contraceptive pills, you recommend using these to reduce her menstrual period to four times a year. She asks, “Is that really safe?”

Is menstruation necessary?

Read more »

Motivational Interviewing: Can You Really Change Behaviors?

April 27, 2010
Motivational Interviewing: Can You Really Change Behaviors?

Emily Stamell

Faculty peer reviewed

As a well-trained fourth year medical student, I inquire about smoking habits as part of almost all my patient encounters. Yet, I do not recall properly counseling a patient on smoking cessation aside from the one liner “You know you should quit, right?” During first and second year of medical school we are taught the stages of change model, which is just as obscure two years later as cell signaling pathways. I was recently…

Read more »

Which Thyroid Antibody Assays Should be Checked in Patients with Thyroid Disease?

April 14, 2010
Which Thyroid Antibody Assays Should be Checked in Patients with Thyroid Disease?

Michael Chu MD

Faculty peer reviewed

Case:

A 44-year old female presented to the emergency room with complaints of a lower extremity rash and swelling.  The patient had been in her usual state of health when she presented to her primary care physician with complaints of palpitations, weight loss and insomnia.  Lab tests were performed and she was given a diagnosis of hyperthyroidism.  She was started on propranolol and methimazole, which the patient took intermittently due to…

Read more »

When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

March 3, 2010
When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

Laurel Geraghty

Faculty peer reviewed

Both stroke and heart attack require rapid treatment following the onset of symptoms to minimize morbidity and mortality, but few patients seek help in a timely manner. Only about half of patients with acute myocardial infarction (AMI) or stroke arrive to the emergency department within four hours of the onset of symptoms.,,, Every 30-minute delay in treatment following AMI increases one-year mortality by 7.5%, and almost half of the 167,000 annual stroke deaths in…

Read more »

Zinc Cold Remedies: Are They Safe and Effective–Who Nose?

February 11, 2010
Zinc Cold Remedies: Are They Safe and Effective–Who Nose?

Amanda Benkoff

Faculty peer reviewed

Each year doctors are presented with the dilemma of the common cold. Adults in the U.S. experience an average of 3 colds per year, and children up to 8-10, resulting in over 500 million colds annually.(1) Patients often visit the doctor with cold symptoms requesting antibiotics. Since the etiology of the common cold is viral, antibiotic therapy is ineffective and inappropriate, and only contributes to bacterial antibiotic resistance. More than 200 viruses can cause…

Read more »