Mystery Quiz

May 3, 2007
Mystery Quiz

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

The patient is an 81 year old male with severe obstructive lung disease who was referred to the pulmonary service for an abnormal chest x-ray prior to femoral-popliteal bypass surgery.   The patient complained of chronic dyspnea on exertion but specifically denied hemoptysis, increased cough, fever or night sweats.   Initial cxr revealed the following:

A chest ct showed only a spiculated appearing mass in the left upper lobe…

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Is the PPD obsolete?

May 1, 2007
Is the PPD obsolete?

In February of this year the New York City Department of Health released a new policy paper indicating that they will no longer use the PPD as a screening tool for tuberculosis in their clinics.They have switched to the QuantiFERON-TB Gold, (QFT-G), a blood test. This test is an ELISA, which measures interferon-gamma secretion by t-lymphocytes in response to tuberculosis specific antigens. The test requires heparinized whole blood and must be processed within 12 hours of the blood draw.

The test exposes the patients t-lymphocytes…

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ShortCuts-This Week in the Journals

April 30, 2007
ShortCuts-This Week in the Journals

In the present era of almost daily “landmark trial” publications, the literature this past week took a slightly more introspective turn. Two separate journals turned the spotlight back on the uneasy relationship between commerce and science – and well written and thoughtful editorials accompany each.

An analysis in the week before last’s BMJ called attention to the increasing trend toward designing trials with composite endpoints – and suggested that this tendency is potentially misleading. In a sample of 114 cardiovascular trials with composite primary end…

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Statin Pleiotropy: Unique Roles for a Common Medication

April 26, 2007
Statin Pleiotropy: Unique Roles for a Common Medication

By: Melissa Freeman, MD, PGY1

For over a decade now, statins, or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, have facilitated millions of patients in the management of their atherosclerosis. Statins are known for their ability to reduce hepatic lipoproteins, up-regulate hepatic LDL receptors, and increase apoprotein E- and B-containing lipoproteins. They have become a household name in the genre of lipid-lowering and a touted hero in cardiovascular risk reduction amongst physicians. Excitingly, research has found that statins may be valuable in disease…

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How Do You Estimate Stroke Risk After a Transient Ischemic Attack?

April 24, 2007
How Do You Estimate Stroke Risk After a Transient Ischemic Attack?

By: Alana Choy-Shan, MD PGY-3
Transient ischemic attacks (TIAs) are known to be a harbinger of stroke, however it is difficult for physicians to estimate individual stroke risk. Previously, the two systems used to predict short-term risk of stroke after a TIA were the California and ABCD scores. Both scores are based on clinical factors with several key elements in common. However, neither scoring system was devised to predict stroke within 48 hours of TIA, a time period which may be most clinically relevant.…

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ShortCuts-This Week in the Journals

April 23, 2007
ShortCuts-This Week in the Journals

I think an unfortunate result of the ACC meetings is the feeling that if a study is not released early and does not make the front page of the New York Times then it is not relevant or worth talking about. We’ll save the debate about releasing results early for another time (although it frequently seems to be a self-serving public relations move by the journal publishing the article) …let’s march forward with several articles that were released this week with little fanfare.…

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Quick Thinking Part 4-The Conclusion

April 20, 2007
Quick Thinking Part 4-The Conclusion

Welcome to Quick Thinking. A case is presented in short sections to a faculty expert who will comment on their approach to the patient as the case unfolds. These posts will focus on determining the initial differential diagnoses and diagnostic workups of complicated patient presentations.

Part 1 can be found here.  Part 2 can be found here.  Part 3 can be found here.

Part 3 Case Presentation by Elizabeth Ross, PGY-3:

The patient continued to complain of headache and dizziness and given the patient’s persistent and intermittent fevers…

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New Guidelines on the Diagnosis and Treatment of Venous Thromboembolism-Part 2

April 19, 2007
New Guidelines on the Diagnosis and Treatment of Venous Thromboembolism-Part 2

Commentary By: Margaret Horlick, MD, PGY-3

New guidelines on the diagnosis and treatment of venous thromboembolism (VTE) were recently jointly issued by the American Academy of Family Physicians and the American College of Physicians. The guidelines are based on a systematic review of the evidence and are published, along with the systematic reviews, in the 2/2007 and 3/2007 issues of the Annals of Internal Medicine.

Part 1-Diagnosis

Part 2 Treatment

The treatment recommendations are summarized as follows:

Low-molecular-weight heparin (LMWH), as opposed to unfractionated

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