From the Archives

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

April 3, 2014
From The Archives: They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

Please enjoy this post from the archives dated 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.…

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

March 13, 2014
From The Archives: Intercessory Prayer: What Do Sneezes and Prayers Have in Common?

Please enjoy this post from the archives dated 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…

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

March 6, 2014
From The Archives: Should My Patient with a Solid Tumor be Anticoagulated in the Absence of Venous Thromboembolism?

Please enjoy this post from the archives dated 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…

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From The Archives: Low Dose Vitamin K Supplementation and Anticoagulation Control

February 6, 2014
From The Archives: Low Dose Vitamin K Supplementation and Anticoagulation Control

Please enjoy this post from the archives dated July 21, 2011

By Joanna Becker

Faculty Peer Reviewed

Patients who are placed on long-term warfarin (Coumadin) therapy are sent home with a lengthy list of restrictions to minimize variations in warfarin efficacy. The agents that can alter warfarin levels can be divided into 2 categories: (1) those that interact with cytochrome P450, which metabolizes warfarin and (2) those that alter phytonadione (vitamin K) levels.  The majority of inter- and intra-individual warfarin dose variability is attributable to…

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From The Archives: Forgoing the Fear: Contrast Nephropathy

January 30, 2014
From The Archives: Forgoing the Fear: Contrast Nephropathy

Please enjoy this post from the archives, dated June 15, 2011

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…

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From The Archives – The Hangover: Pathophysiology and Treatment of an Alcohol-Induced Hangover

January 16, 2014
From The Archives – The Hangover: Pathophysiology and Treatment of an Alcohol-Induced Hangover

Please enjoy this post from the archives, dated May 27, 2011

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…

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From The Archives: Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

January 9, 2014
From The Archives: Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

Please enjoy this post from the archives dated May 25, 2011

By Santosh Vardhana

Faculty Peer Reviewed

Please review Part 1 of this article here.

Mr. M is a 63-year old man with a history of coronary artery disease and systolic congestive heart failure (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to the Adult Primary Care Center complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0˚F, P…

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From The Archives: Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

December 12, 2013
From The Archives: Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

Please enjoy this post from the archives dated May 18, 2011

By Santosh Vardhana

Faculty Peer Reviewed

Mr. M is a 63-year-old man with a history of coronary artery disease and systolic CHF (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to Primary Care Clinic complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0º F, BP 122/76, HR 84 bpm. What are his therapeutic options?

A Race Against…

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From The Archives: The Polymyxins: Why am I using them all the time, and what are they?

November 21, 2013
From The Archives: The Polymyxins: Why am I using them all the time, and what are they?

Please enjoy this post from the archives dated December 8, 2010

By Jon-Emile S Kenny

Faculty Peer Reviewed

A 65-year-old female with locally advanced rectal cancer is admitted to the ICU, hypotensive and febrile. Her PICC line is removed and blood cultures drawn. Fourty-eight hours later all cultures return ESBL Klebsiella with susceptibility only to polymyxin.

I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘polymyxin’ like an endless antimicrobial mantra. What strange dosing it has, and…

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FROM THE ARCHIVES – Kayexalate: What is it and does it work?

November 7, 2013
FROM THE ARCHIVES – Kayexalate: What is it and does it work?

Please enjoy this post from the archives dated December 1, 2010

By Todd Cutler, MD

Faculty Peer Reviewed

A 62-year-old male is hospitalized with an acute congestive heart failure exacerbation. On hospital day three, the patient’s symptoms have significantly improved with twice daily furosemide 80mg IV. He is continued on IV diuretics and aggressive electrolyte repletion. On day five of his admission, his basic metabolic panel is significant for a creatinine of 2.3 mg/dL (increased from 1.3 on admission) and a potassium concentration of

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From The Archives: Creatine Kinase: How Much is Too Much?

October 24, 2013
From The Archives: Creatine Kinase: How Much is Too Much?

Please enjoy this post from the archives dated November 3, 2010

By Jon-Emile Kenny, MD

Faculty Peer Reviewed

A 37-year-old man, with no past medical history and taking finasteride for male pattern baldness, is admitted to Medicine with profound lower extremity weakness after a weekend of performing multiple quadriceps exercises. His measured creatine phosphokinase (CPK) is over 35,000 IU/liter. I wonder to myself, what is the risk to his kidneys and can I mitigate the damage?

Rhabdomyolysis means destruction of striated muscle. Physical manifestations range from…

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From The Archives: Asking the Potentially Answerable Clinical Question

October 3, 2013
From The Archives: Asking the Potentially Answerable Clinical Question

Please enjoy this post from the Archives, dated October 1, 2010

By Dorice L. Vieira M.A., M.L.S.

Faculty Peer Reviewed

The title to this feature may seem a bit odd, but there is a proper way to ask evidence-based clinical questions.  “What is the treatment for diabetes?” is not a well-defined question.  A PubMed literature search using the terms “diabetes” and “treatment” retrieves a total of 167,843 citations covering a myriad of approaches to the treatment of diabetes:  type I (26,884…

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