Class Act

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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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…

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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…

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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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How Does Alcohol Affect Hypertension?

June 24, 2011
How Does Alcohol Affect Hypertension?

By Benjamin Kenigsberg

Faculty Peer Reviewed

Alcoholic beverages have been part of human culture for thousands of years and cross nearly every political and demographic boundary. Despite this long history, the interaction between alcohol and human health is still poorly understood. This confusion is particularly true with regard to blood pressure, as multiple studies have debated the association between alcohol intake and the development or management of hypertension.  For this discussion, in America a standard drink is defined as 12 ounces of regular beer, 5…

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