Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
How do you determine if a pyoderma gangrenosum lesion is “burned out"?
The first sign is it becomes much less exudative.
Do you correct the synovial fluid white blood cell count for red blood cells, and if so, is there a rough approximation/equation you use?
In a rheumatology practice, under most circumstances, there is no need to make a correction of the synovial fluid white blood cell count. The fluid is either translucent, transparent, or opaque and the count will help to establish the presence or absence of an infectious or inflammatory process and ...
Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?
I only saw about 4 (non-HIV) patients with PJP before AIDS hit the US in 1981. Like others caring for AIDS patients in the 1980s, PJP was incredibly common I saw at least 200 cases over the years. Until AIDS, there were never enough non-HIV patients to do a RCT to look at steroids. Thanks to the wel...
Do you prefer cinacalcet or etelcalcetide for patients with hyperparathyroidism in the setting of kidney disease?
In a group of vintage ESKD patients, assuming compliance is not an issue and hypocalcemia handled and Parsabiv utilized when approved, PTH still not controlled often. Over few thousands. The main reason is that the parathyroid hyperplasia turns to be nodular and encapsulated. And it’s time for surgi...
Are adults with IDD at increased risk for adverse events like NMS or central anticholinergic syndrome?
Thanks so much for your question. There is no doubt that individuals with IDD may often exhibit aberrant behaviors including those with autism. The use of various psychopharmacologics is very prevalent. The risks of side effects and particular complications is certainly higher in this cohort. Check ...
How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?
Peri-adventitial inflammation seen in temporal artery biopsies is generally a non-specific finding. This was demonstrated nicely in a recent histopathological study from Mayo Clinic evaluating temporal artery samples from autopsy cases. Over 40% of temporal arteries from older individuals (with no h...
At what point is a skin biopsy indicated in patients with neuropathy?
Skin biopsy is indicated when small fiber neuropathy is suspected- that is, a patient with usually painful paresthesias- positive sensory symptoms, and less often negative sensory symptoms alone, and normal EMG/NCS. Clinical exam usually, but not always, will show some signs of small fiber involveme...
After corticosteroids, what second line agent do you select to treat drug induced hypersensitivity syndrome (also known as DRESS syndrome)?
see reference
How do you work up incidentally found papilledema in the emergency room?
The term "papilledema" should be reserved for optic disc swelling due to increased intracranial pressure - but I assume that this question is asking what to do if the fundus examination looks abnormal (blurred disc margins perhaps) when there are no visual symptoms or symptoms of increased intracran...
When do you consider nerve blocks for headache management in patients admitted to the neuro-intensive care unit with subarachnoid hemorrhage?
For aneurysmal SAH, I try different medication combinations for the first 5-7 days. After this time frame, if headache pain is still severe and/or the patient uses opioid meds too frequently, I request an occipital nerve block from our pain management team. In my experience, about two-thirds of pati...