Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
When do you consider stenting in patients with recurrent stroke with ICAD?
I agree with the answers mentioned above. Additionally, I ensure that the patient has made diligent efforts to address modifiable risk factors, with smoking cessation being of utmost importance, along with medication compliance. The specific area of stent placement and the type of stent used may var...
What is your approach to treatment in a patient with radiographic UIP but pathologic evidence of both fibrotic NSIP and UIP?
Depends on the underlying etiology and progression. I will most likely use antifibrotics, particularly for IPF or progressive fibrosis, but include immune suppression for autoimmune-related ILD.
Should methotrexate be stopped prior to radiation therapy if a patient has rheumatoid arthritis?
I have not stopped as dose of MTX for RA is low (7.5 mg) and there is data of CMF with RT for breast cancer with higher dose of MTX showing no significant increase in morbidity.
What antibiotics would you use for empiric treatment of a brain abscess in patients allergic to penicillin, metronidazole, and vancomycin?
Linezolid/Bactrim/Ceftaroline?
Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?
If the pulmonary coccidiomycosis was treated in the past, I would not necessarily prescribe prophylaxis, but that also depends on the meaning of "residual parenchymal changes.” If you’re referring to post-inflammatory fibrotic changes, then prophylaxis likely is unnecessary. If you’re referring to c...
Would you use sumatriptan in a patient with a history of cerebral aneurysm rupture?
Yes. There is no evidence that the use of triptan in patients with an unruptured cerebral aneurysm, or in those who have a history of ruptured aneurysm that have been coiled or clipped, increases the risk of serious adverse events. I would not use them in the setting of acute subarachnoid hemorrhage...
When do you consider the use of steroids in the management of acute exacerbations in patients with cystic fibrosis?
Steroids have been shown to improve FEV1 and decrease hospitalizations when used as a maintenance treatment regimen in Cystic fibrosis patients. But due to the long-term adverse effects, steroids are recommended for daily use (Mogayzel et al., PMID 23540878).Small Pilot projects showed no statistica...
Do you routinely recommend suppressive antibiotic therapy for patients with spinal hardware infections who have undergone surgical debridement with retention of hardware?
Executive Summary: "State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections" was published in Clinical Infectious Diseases, December 15, 2024 issue, by Tai and colleagues from the University of Minnesota, Mayo Clinic, Hospital for Special Surgery (New York) and the University ...
Would you consider the use of an anabolic agent to promote fracture healing?
While there are no drugs FDA that are approved to enhance fracture healing, there is considerable literature and experience using the PTH-based anabolic drugs to attempt to heal a fracture. They are sometimes used in the setting of delayed union or non-union. They have been used in elite athletes to...
How do you approach a patient with atrial fibrillation on apixaban who has a new cardioembolic stroke?
Assuming that the apixaban dose was 5 mg bid, I would switch to warfarin and aim for INR 2.5-3.5.