Class Act

Breast Self-Examination: Worth the Effort?

October 5, 2011
Breast Self-Examination: Worth the Effort?

By Katherine Husk

Faculty Peer Reviewed

A healthy 40-year-old woman comes into your office for a routine health exam.  After you have performed a clinical breast exam, she asks you whether she should be examining her breasts on her own at home…

Breast self-exam (BSE) seems sensible. Empowering a patient to develop a sense of a personal norm could allow for easier recognition of breast changes, and could perhaps lead to earlier evaluation by a medical professional. There is a great deal of controversy,…

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Stemming the Tide: The Promise and Pitfalls of HIV Prevention Research

September 28, 2011
Stemming the Tide: The Promise and Pitfalls of HIV Prevention Research

By Benjamin Bearnot

Faculty Peer Reviewed 

Since the discovery of zidovudine (AZT) in the mid-1980s, advances in antiretroviral (ARV) therapy for patients with chronic human immunodeficiency virus (HIV) infection have, until recently, outpaced concomitant improvements in methods for HIV prevention. Over the past few years, HIV prevention research has been building an impressive head of steam. While a completely effective vaccine for HIV prevention has continued to prove elusive, results of a modestly successful (~30% protective) vaccine trial based in Thailand were announced in 2009,…

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They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

September 23, 2011
They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

By Santosh Vardhana, MD

A 36-year-old obese male with hypertension and hyperlipidemia presents to the ER with new knee pain, swelling, and erythema.  Joint aspiration reveals negatively birefringent crystals.  He is started on oral prednisone.

A 26-year-old woman with lupus presents to ER with edema, hematuria, and fevers.  On exam she hypertensive, febrile to 100.4C, and has periorbital and lower extremity edema.  Urine dipstick reveals 2+blood and protein.  She is started on IV methylprednisolone.

A 60-year-old man with HIV on HAART presents to the ER…

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Intercessory Prayer: What Do Sneezes and Prayers Have in Common?

September 21, 2011
Intercessory Prayer: What Do Sneezes and Prayers Have in Common?

By Alon Mass

Faculty Peer Reviewed

The overlap between religion and medicine is ancient. On a recent medical volunteer trip to India I met a medical student who proudly wore a school sweatshirt with the saying: In God we trust. The rest we dominate.

This arrogant approach is probably uncommon, but praying to God for healing–self or intercessory–is not. 

Intercessory prayer is a form of prayer conducted by a group or individual who petitions a god on behalf of another individual…

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Advance Directives: A Move in the Right Direction

September 16, 2011
Advance Directives: A Move in the Right Direction

By Sara-Megumi Naylor

Faculty Peer Reviewed

“Tell me…If you were ever unable to make your own decisions about your medical care, is there someone you would trust to make those decisions for you?”

There is silence.

But then a response. We discuss. I record.

Then I proceed.

“I want to know…Have you given any thought to the goals of your hospital stay? I want to know what’s important to you.”

The only audible sounds in the quiet hospital room are the shallow breaths…

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What is Sister Mary Joseph’s Nodule And Why Is It Significant?

September 15, 2011
What is Sister Mary Joseph’s Nodule And Why Is It Significant?

By Keri Herzog, MD
Faculty Peer Reviewed

The patient is a 62-year-old male who presented to an outpatient medical clinic complaining of a growing, slightly painful, periumbilical mass, and mild lower gastrointestinal discomfort over the last 4 months. On examination, the patient appeared cachectic with an erythematous soft nodule within the umbilicus. Laboratory evaluation revealed anemia (Hct: 28%) and colonoscopy detected a tumor in the sigmoid colon. Both biopsies of the sigmoid mass and the umbilical nodule revealed the presence of adenocarcinoma. Due to the…

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Should My Patient with a Solid Tumor be Anticoagulated in the Absence of Venous Thromboembolism?

September 8, 2011
Should My Patient with a Solid Tumor be Anticoagulated in the Absence of Venous Thromboembolism?

By David Altszuler, Class of 2012

Faculty Peer Reviewed

An empiric association between occult malignancy and thrombophlebitis has been recognized since Trousseau first reported the syndrome in 1865.  The mechanism by which cancer predisposes to thrombophilia has not been fully elucidated; however, it is now clear that this is a symbiotic relationship.  The second leading cause of death in hospitalized cancer patients (and a leading cause of death in ambulatory cancer patients) is venous thromboembolism.  There are algorithms to identify cancer patients at high risk…

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Should you Treat a COPD Exacerbation with Antibiotics?

September 3, 2011
Should you Treat a COPD Exacerbation with Antibiotics?

By: Aviva Regev

Mr. S is a 68-year old man with longstanding COPD and a 40-pack-year smoking history.  He presents to clinic with three days of increasing shortness of breath, and complains that he has been coughing up “more junk” than usual.  As I watch him spit a wad of chartreuse sputum into his tissue, I reach for the prescription pad and tell him he’ll need a week of antibiotics.  He wants to know why he can’t just go up on his inhaled medications instead…

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Does Medical School Erode Student Empathy?

August 10, 2011
Does Medical School Erode Student Empathy?

By Nandini Govil

Faculty Peer Reviewed

Empathy is an elusive concept, espoused by many as an integral component of effective doctoring. In the medical literature, empathy is defined as a physician’s ability to recognize and validate a patient’s experiences and perspectives,  and to convey this understanding back to the patient. A firm distinction is drawn between sympathy (an emotional attribute) and empathy (a cognitive skill that can be modeled, taught, and assessed).

Research indicates that physician empathy results in better patient compliance…

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More Pills, More Problems: The Polypill Revisited

August 3, 2011
More Pills, More Problems: The Polypill Revisited

By Jonathan Leventhal

Faculty Peer Reviewed

Polypharmacy has become an integral part of daily life for millions of chronically ill patients worldwide, and rightfully so. Evidence-based studies have repeatedly demonstrated that multiple drugs are required for optimal therapeutic management in chronic diseases including diabetes, hypertension, and heart disease. A typical patient with cardiovascular disease will likely be on aspirin, a statin, an ACE inhibitor, a diuretic, a calcium channel- or beta-blocker, and possibly antidiabetic medications. Cardiovascular disease is only one area in which effective…

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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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