Conditions

MKSAP: 25-year-old woman comes for a preconception evaluation

mksap

Conditions

January 24, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no …

The profound wisdom of the nursing diagnosis

Shirie Leng, MD

Conditions

January 22, 2015

When I was in nursing school there was always a lot of eye-rolling when it came time to discuss nursing diagnoses. This was mostly because nursing diagnoses were followed by book-length nursing care plans that we had to produce for various imaginary patients. There was also a faction, including myself, who thought a medical diagnosis was just fine, thank you, no need to reinvent the proverbial wheel.

For example, for a …

Why is diagnosing ear infections so hard?

Chad Hayes, MD

Conditions

January 17, 2015

Ear infections (or, what we like to call “acute otitis media”) are one of the staple diagnoses of pediatrics. Most kids have at least one before their third birthday. And most pediatricians see at least one every day by 11. You would think we would always get it right. But I have a confession — we don’t. In fact, children are misdiagnosed and over-treated at an alarming rate.

There are several reasons for …

3 ways to use bacon as medical treatment

Jennifer Gunter, MD

Conditions

January 8, 2015

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You might think of bacon, that thing of gustatory beauty that is salted, cured pork, as just pleasure for your taste buds. However, one of the first medical facts I learned in 2015 was that bacon has medicinal purposes (apart from making you feel better after eating it). With this new knowledge at hand, the time just seemed right for a …

The hidden costs of an inadequate bowel preparation for colonoscopy

Adewale Ajumobi, MD, MBA

Conditions

January 6, 2015

Colonoscopy is the most effective test for the detection and prevention of colorectal cancer, the second leading cause of cancer death in the United States. An estimated 14 million colonoscopies are performed in the United States every year. About 20 to 40 percent of these colonoscopies have inadequate bowel preparation according to multiple studies.

Inadequate bowel preparation is costly to the patient, the health care system, and society.

In one study, poor …

The hardest and often worst part of medicine: The waiting

Sarah Mongiello Bernstein, MD

Conditions

January 5, 2015

My brother wears a scar around his neck. It represents his second surgery for papillary thyroid cancer. The first started off the same way. Ugly, red and angry. Curving like an ominous smile around his neck, like a noose. That’s how it felt too — the lump in his throat growing as he sat quietly, alone in a doctor’s office. It’s interesting how physical scars are a visual manifestation of …

You could get fat from eating healthy foods. Here’s how.

Peter Ubel, MD

Conditions

January 2, 2015

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Have you ever eaten a healthy meal, maybe some brown rice and stir-fried veggies, and found yourself ready for another meal just a short while later? Or, more often couldn’t overcome a hankering for a satisfying dessert to top off (and undermine the healthiness of) that meal?

As it turns out, this lack of satiety is not merely a function of the …

Tongue cancer in an elderly patient: Thinking of my grandmother

Bruce Campbell, MD

Conditions

December 17, 2014

Old age is no place for sissies.
-Bette Davis

“I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!”

She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had …

Antibiotics during gynecological surgery: When are they necessary?

Jennifer Gunter, MD

Conditions

December 9, 2014

Preventing infection after surgery is very important as not only are these infections often uncomfortable and make you feel very sick, but they also increase the risk of more serious complications. For example, if you are less mobile because of an infection after surgery you are at higher risk for a blood clot or if you need a prolonged hospitalization because of an infection in your surgical wound you are …

After a miscarriage: Answers to your difficult questions

Brian Enggano, MD

Conditions

December 6, 2014

I chose to become an OB/GYN because I love delivering babies and bringing joy to expectant parents. It is by far the most rewarding part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new …

Consider the lipstick sign in your next physical exam

Elizabeth Horn, MD

Conditions

December 1, 2014

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The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.

Fine motor skills and concentration can be correlated with a positive …

After a prostate cancer diagnosis: The urgency to treat

Anne Katz, RN, PhD

Conditions

November 2, 2014

Hearing the words “you have cancer” changes everything. In my role as clinical nurse specialist in a busy prostate clinic, I see the effects of these three words on men and their families every day. The shock and disbelief, the fear and confusion as most men feel perfectly well with no symptoms at all. Many men want to do something …

MKSAP: 72-year-old woman with severe COPD

mksap

Conditions

November 1, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 …

Primary care physicians: 7 tips to treat health anxiety

Lynne S. Gots, PhD

Conditions

October 28, 2014

Before the Internet age, people with excessive and irrational worries about their health (we called them “hypochondriacs”) went to their doctors for reassurance. Today these patients still schedule appointment — often with exasperating frequency — with their primary care physicians when they’re concerned about an unusual lump or vague symptom. But most likely they’ll have first consulted WebMD or the Mayo Clinic website and come up with a differential diagnosis of their …

Why hysterectomy for many endometrial hyperplasias is often overkill

Roger Reichert, MD, PhD

Conditions

October 21, 2014

A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed …

Should we use antipsychotics to treat ADHD?

Claudia M. Gold, MD

Conditions

October 19, 2014

Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior.

When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range …

The Fault in Our Stars: Should thyroid cancer be renamed?

James Flory, MD

Conditions

October 18, 2014

Josh Green’s novel — and recent film — The Fault In Our Stars (TFIOS) is a new classic of young adult fiction, deservedly famous, and it’s easy to see why. The story is simultaneously deeply sad and really funny, mostly due to the narrator, Hazel. She is an intensely likable 16-year-old, who charms you even while she explains, stoically, that she is dying of thyroid cancer that has spread to …

Why are so many people opposed to epidurals?

Jennifer Gunter, MD

Conditions

October 10, 2014

To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger.

The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In …

MKSAP: 59-year-old woman with pain of the right foot

mksap

Conditions

October 4, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications …

When your child doesn’t poop: Solving the constipation death spiral

Roy Benaroch, MD

Conditions

September 27, 2014

Michelle wrote in: “We trained my 3-year-old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there …

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