Class Act

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

September 23, 2011

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…

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

September 21, 2011

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…

Advance Directives: A Move in the Right Direction

September 16, 2011

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…

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

September 15, 2011

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…

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

September 8, 2011

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…

Should you Treat a COPD Exacerbation with Antibiotics?

September 3, 2011

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…

Does Medical School Erode Student Empathy?

August 10, 2011

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…

More Pills, More Problems: The Polypill Revisited

August 3, 2011

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…

Mental Health Considerations for Gay and Lesbian Patients

July 27, 2011

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…

Tales of Survival: Physical Exam

July 15, 2011

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…

Understanding the Zoster Vaccine

July 13, 2011

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…

ANCA and Small-Vessel Vasculitis

July 7, 2011

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…

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Clinical Correlations

Class Act

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

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

Advance Directives: A Move in the Right Direction

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

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

Should you Treat a COPD Exacerbation with Antibiotics?

Does Medical School Erode Student Empathy?

More Pills, More Problems: The Polypill Revisited

Mental Health Considerations for Gay and Lesbian Patients

Tales of Survival: Physical Exam

Understanding the Zoster Vaccine

ANCA and Small-Vessel Vasculitis

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