Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
How often would you repeat testing in a patient suspected of Cyclic Cushing's?
24-hour urine-free cortisol and MN saliva cortisol are preferred tests over ON dex suppression. The exact frequency depends on the severity of the symptoms, generally about every 3 months.
In patients with secondary osteoporosis due to primary hyperparathyroidism, should parathyroidectomy be recommended in the setting of recent prior bisphosphonate use?
I would recommend parathyroid surgery in a person with confirmed primary hyperparathyroidism and osteoporosis as the bone density will increase in most patients after surgery. Many of the patients with osteoporosis may have received bisphosphonates. In rare situations, a patient may have received a ...
How would you evaluate and treat a disabling tongue tremor?
This is a very interesting presentation. First, establishing phenomenology is needed. Is this a tremor or does it appear tremulous? Tremor is oscillatory and rhythmic. If these movements do not fit this pattern, consideration of neuromuscular disorders, like myorhythmia, or other movement disorders ...
What treatment options do you recommend in a patient with idiopathic granulomatous mastitis that has not improved on steroids and methotrexate?
I have multiple cases of IGM that I have treated successfully and have gone into remission or at least not needing any prednisone with azathioprine monotherapy and combo methotrexate and adalimumab.
Do you recommend monitoring IgG level in patients with AAV receiving rituximab?
Yes! At the OSU Vasculitis clinic, we check IgG before every rituximab infusion. At a minimum, it must be done yearly to ensure no impending CVID or to change rituximab.
How do you manage immunosuppressive medications in patients who develop a pneumonia?
For most bacterial pneumonia in transplant patients, I prefer to avoid changing immunosuppressives and simply administer appropriate antibiotic therapy. This approach is effective and minimizes the risk of triggering acute rejection. For viral etiologies, I will often reduce or hold cell cycle inhi...
How would you approach peri-operative immunosuppressive management of a patient with Behcet's, currently controlled on azathioprine, who needs genital surgery?
It might be helpful to know what kind of genital surgery is planned and why. Here are a few general thoughts: There are little data to guide a unified approach outside of BD patients who need vascular surgery. Standard rules of thumb are to 1) reduce surgeries to a necessary minimum and 2) regard mo...
Is SVC syndrome a medical emergency?
It is usually not an emergency but rather a medical urgency and all effort should be made to get a tissue diagnosis before treatment. The goal of treatment could be curative or palliative based on the histology, stage of disease, and performance status of patient
Do you routinely use tumor lysis prophylaxis when starting chemotherapy for germ cell tumors?
THere is not reason to use tumor lysis prophylaxis. Hydration of course is required for the cisplatin. I am not aware of anyone using allopurinol or other TLS approaches
What techniques do you use to treat patients who weigh more than the treatment table limit?
In our institutional experience, this weighty question arises more often than we would prefer and most commonly for cervical cancer patients. If the patient is only nominally beyond the limit, it is important to consider that the weight limits are consequent to the tolerance parameters of the motors...