Mystery Quiz #2

January 22, 2007
Mystery Quiz #2

Posted By Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

The patient is a 77 year old male whose chief complaint was severe left hip pain of five years duration.  As part of a preoperative evaluation for hip surgery, a routine chest x-ray was obtained as below.  Click on the thumbnails below for full size images:

   

A prior film done six months previously showed similar but less impressive findings. Upon review, the patient denied any pulmonary symptoms…

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Medical Malpractice 101

January 19, 2007
Medical Malpractice 101

Commentary By: Sandeep Mangalmurti, MD, JD PGY-1

For many physicians, medical malpractice is like paying taxes; inevitable, but incomprehensible.  This is unfortunate, since most physicians offer unique insights into the current debate on malpractice reform.  Hopefully this article will begin to familiarize the reader with the general landscape of current trends in medical malpractice law.

When a physician complains of the current “malpractice crisis,” the complaint is usually about rising premiums.  The concern is generally not only over their…

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How Aggressively Should You Treat a Patient with a Pulmonary Embolus?

January 17, 2007
How Aggressively Should You Treat a Patient with a Pulmonary Embolus?

An otherwise healthy 57 year old patient presents with shortness of breath and pleuritic chest pain.  The patient is hemodynamically stable without evidence of shock.  A chest CT reveals a pulmonary embolus.

Questions: 1. When should an echocardiogram to assess for right heart strain be performed in a patient with a pulmonary embolism?  Should stable patients without evidence of shock have a routine echo once a diagnosis of pulmonary embolism is made?

2. If the echo shows signs of right…

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Morning Report: How Do You Approach a Patient With Bronchiectasis

January 16, 2007
Morning Report: How Do You Approach a Patient With Bronchiectasis

Chief complaint: 85 year old female presents with worsening shortness of breath for one day.

History of present illness:

The patient's history of present illness begins at the age of 60 when she was diagnosed with asthma, for which she had been treated with inhaled anticholinergics, beta agonists and intermittent oral steroids.  Twelve years prior to admission, the patient was diagnosed with diabetes, which was managed with oral medications.  Two years prior to admission, the patient was diagnosed with Mycobacterium avium complex…

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A Debate: Should Smokers be Denied Surgery?

January 12, 2007
A Debate: Should Smokers be Denied Surgery?

In last week's issue of the British Medical Journal, two physicians argue about the merits of refusing to perform elective surgeries on smokers. The debate has been spurred by a primary care group in the UK who announced last year that it would take smokers off waiting lists for surgery in an attempt to contain costs. The proponent, Matthew Peters, argues that, for elective procedures such as plastic, reconstructive, and orthopedic surgeries, the rates of complications in smokers are so high that the increased…

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To Lavage or Not to Lavage?

January 10, 2007
To Lavage or Not to Lavage?

Case and Commentary by Minisha Sood PGY-3 and Ilseung Cho Fellow, Division of Gastroenterology

The patient is a 57 year-old man with a past history of hypetension, hyperlipidemia, hepatitis B/C cirrhosis and coronary artery disease status/post a non-st-elevation mi in August 2006, during which time he was on a heparin drip and developed an upper gastrointestinal bleed. Upper endoscopy at that time revealed non-bleeding esophageal varices and he was discharged on a beta blocker. He again presented to Tisch hospital in December 2006 with complaints…

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Why Are Breast Cancer Rates Trending Down?

January 9, 2007
Why Are Breast Cancer Rates Trending Down?

The recent finding of decreasing breast cancer rates made headlines throughout the media; including a NY Times article entitled, Reversing Trend, Big Drop is seen in Breast Cancer on December 15, 2006.

Striking epidemiological facts tells us that breast cancer is the most common cancer in women in the U.S., and only second to lung cancer as the most common cause of cancer deaths. It is estimated that approximately 212,920 American women will be diagnosed with breast cancer in…

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A Bad Break for the Purple Pill…

January 8, 2007
A Bad Break for the Purple Pill…

Commentary By Josh Remick, PGY-2

In the December 27th 2006 issue of JAMA, Yang et al. reported the results of a nested case-control study of United Kingdom patients entitled “Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture.” Using the General Practice Research Database (GPRD), a computerized medical record system used by several of the general medical practices in the UK, new hip fracture cases were found in patients at least 50 years old (n=13,556) and matched them with…

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