Class Act

Mental Health Considerations for Gay and Lesbian Patients

July 27, 2011
Mental Health Considerations for Gay and Lesbian Patients

By Benjamin Cox

Faculty Peer Reviewed

Gay men and lesbian women are members of a stigmatized minority group and evidence suggests that they may disproportionately utilize mental health services. This increased use of mental health services may be related to the concept of minority stress: that stigma, prejudice, discrimination, and violence create a hostile and stressful social environment that can contribute to mental health problems. Examples of external stressors that pose threats to mental health in gay and lesbian patients include verbal and physical…

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Tales of Survival: Physical Exam

July 15, 2011
Tales of Survival: Physical Exam


By John Hwang

General

Patient is a demented, chronically ill elderly male lying in bed attached to a ventilator, appearing anything but his stated age. Contracted in a fetal position, huddled under the bed sheet with only his bald head and wrinkled skin showing, he alternately resembles a centenarian or a newborn child—someone very much at the brink of life.

Mental Status Exam

Patient awake and alert, but severely cognitively impaired. Completely nonverbal and does not repeat or respond to commands. He…

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Understanding the Zoster Vaccine

July 13, 2011
Understanding the Zoster Vaccine

By Michael Cohen

 Faculty Peer Reviewed

The varicella-zoster virus (VZV) is well known to the majority of the population. In children, it strikes as varicella (chickenpox), characterized by pruritic, vesicular lesions in different stages of development dispersed over the body. A self-resolving and generally limited disease, this form of VZV infection is considered to be a nuisance more than a debilitating affliction, but rarely can have severe sequelae. In adults and the elderly VZV more commonly takes the form of zoster (shingles). This disease results…

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ANCA and Small-Vessel Vasculitis

July 7, 2011
ANCA and Small-Vessel Vasculitis

By Eugene Friedman, Class of 2012

Faculty Peer Reviewed

 The discovery of anti-neutrophil cytoplasmic antibodies (ANCA) was a serendipitous finding. In 1982, Davies and colleagues published a report detailing their discovery of antibodies that specifically localized to the cytoplasm of neutrophils in patients with necrotizing glomerulonephritis and small-vessel vasculitis–antibodies that disappeared after immunosuppressive therapy and reappeared with disease recurrence. Two years later, Hall and colleagues confirmed this observation , paving the way for the 1985 Lancet article where van der Woude and colleagues proposed…

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Red Yeast Rice: Nature’s Statin?

June 30, 2011
Red Yeast Rice: Nature’s Statin?

By Joshua Farhadian

Faculty Peer Reviewed

M. K.  is a 61-year-old female with hypercholesterolemia who presents to clinic complaining of muscle pain and weakness.  She reports that one month after beginning statin therapy she developed myalgias and immediately stopped taking her medication.  She states that she wants to control her cholesterol level, since both of her parents died of heart disease; however, she is hesitant to take a prescription medication due to the side effects she experienced.  She asks you about red yeast rice (RYR).…

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Hepatocellular Carcinoma Screening Guidelines and Bellevue’s High-Risk Population

June 22, 2011
Hepatocellular Carcinoma Screening Guidelines and Bellevue’s High-Risk Population

By Ramoncito David

Faculty Peer Reviewed

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death in the world.  The prevalence of this fatal disease greatly varies among different nations, due to the fact that almost 80% of cases are secondary to hepatitis B or C.  

 The implementation of an effective vaccine against the hepatitis B virus (HBV) has reduced the prevalence of HBV carriers in North America to 0.1-2%; however, hepatitis B remains a global public health problem due its high prevalence in…

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Forgoing the Fear: Contrast Nephropathy

June 15, 2011
Forgoing the Fear: Contrast Nephropathy

By Mario V Fusaro, MD

Faculty Peer Reviewed

There are certain laws in the universe that are just not meant to be broken.  One is gravity.  Another one is relativity.  The third, don’t give contrast to people with bad kidneys.   Perhaps the last one is not so much a law as something we seem to be terrified of doing.  While recently on service, I had a patient with unexplained right lower quadrant pain.  The obvious first or second or fifth step would be a contrast…

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How to Counsel Patients on Vision Preservation in Primary Care

June 10, 2011
How to Counsel Patients on Vision Preservation in Primary Care

By Nora Muakkassa, Class of 2011

Faculty Peer Reviewed

When patients bring up questions or concerns about their vision in the primary care setting, many providers feel ill equipped to handle them. While certain issues are better left for the ophthalmologists, primary care providers can offer patients basic information on how to protect their vision.

The first thing physicians can do is to refer their patients for comprehensive screening eye exams. Certain eye diseases with potentially therapeutic interventions may…

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If I Eat Candy and Fatty Foods, Will I Get Acne?

June 3, 2011
If I Eat Candy and Fatty Foods, Will I Get Acne?

By Timothy Wu, MD

Faculty Peer Reviewed

  A 17-year-old female comes into the clinic for an annual health checkup.  During the visit she reveals that she has been dealing with acne so severe that she is often embarrassed to go to school.  She states that her diet often consists of lots of candy, fast food, and soft drinks.  She asks, “Am I getting acne because of what I eat?”

 Introduction

Acne is a common skin…

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The Hangover: Pathophysiology and Treatment of an Alcohol-Induced Hangover

May 27, 2011
The Hangover: Pathophysiology and Treatment of an Alcohol-Induced Hangover

By Anthony Tolisano

Faculty Peer Reviewed

The sunlight forces its way into your eyes, stabbing at your cortex.  Suddenly, a wave of nausea and diarrhea grips your stomach, threatening to evacuate its contents.  You rush to the bathroom, tripping over the clothes that speckle your apartment.  Your heart pounds inside your chest and your hands shake ever so subtly.  Your mind is in a fog and the details of last night’s party are a blur.  Sound familiar?

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The Stories My Senses Tell Me

May 20, 2011
The Stories My Senses Tell Me

By David Ellenberg

Faculty Peer Reviewed

Mr. A is a 91 year old male with a history of hypertension and two myocardial infarctions. He presented with shortness of breath and worsening lower extremity swelling and was subsequently admitted to the medicine floor for a CHF exacerbation. While on the floor, he also complained of painful pressure ulcers on his lower buttocks. He was diuresed and given oxygen by nasal cannula during his 48-hour hospital stay, and his ulcers were…

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Warning: Drinking Cola May Be Dangerous To Your Health

May 11, 2011
Warning: Drinking Cola May Be Dangerous To Your Health

By Jessica Leifer

Faculty Peer Reviewed

As a new third year medical student excited to finally be seeing my own patients and still looking for my style as an interviewer, I approach the social history in the systematic way we have learned in the first 2 years of medical school. God forbid I leave something out. Over the past month of my first clerkship, I’ve grown comfortable with asking the uncomfortable questions: Are you currently sexually active? With men,…

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