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Download Entire Issue-The Jefferson Medicine Forum, Volume 6, Winter 2004

The Medicine Forum

Download entire issue-The Jefferson Medicine Forum, Volume 6, Winter 2004.

The Use Of Non-Primed Peripheral And Central Iv Tubing For Nesiritide Infusion Is Reliable And Cost-Effective, Duygu Onat Phd, John Stathopoulos Md, Andrew B. Rose Md, Karel Newman Phd, Ulrich P. Jorde Md, Paolo C. Colombo Md

The Medicine Forum

Background

Prescribing information of nesiritide mandates priming

of intravenous tubing with 25 mL of nesiritide prior to

connecting the intravenous (IV) line to the patient, since

the drug may partially absorb to the line. Thus, 10% of

a reconstituted vial is wasted, with a cost of $40-50 per

line used. No study has quantified the binding effect of

nesiritide to intravenous tubing, tested binding

properties of different materials, or analyzed binding

effect of central lines, where priming cannot occur.

Furthermore, prescribing information states that

nesiritide must not be administered through a central

heparin-coated catheter, since it may bind to heparin. …

Resident And Faculty Feedback: The Student’S Perspective, Daniel J. Rubin Md, Pgy-2, Kyle E. Rarey Phd

The Medicine Forum

Background

Feedback from faculty members and residents is a critical component

of undergraduate medical education. Little is known about how

students assess the adequacy of feedback from faculty and residents.

Purpose

To report medical students’ evaluations of clinical teacher feedback

and to determine if students assess feedback given by residents

differently than they assess feedback given by faculty.

Methods

Data were retrospectively collected from medical students’ responses

to end-of-clerkship questionnaire items that evaluated feedback from

residents and attending physicians. The mean ratings of faculty

feedback in four clerkships were compared with the mean ratings of

resident feedback within each academic …

Effect Of Endogenous Noradenaline Release On Peak Exercise Heart Rate In Subjects With Chronic Heart Failure Receiving Carvedilol Versus Metoprolol, Timothy J. Vittorio, Duygu Onat, Paolo C. Colombo, John Stathopoulos, Cselaj Sulejman, Andrew B. Rose, Gillian Miller, Joshua Trufant, Rochelle Goldsmith, Ulrich P. Jorde

The Medicine Forum

Background

Dose equivalency of metoprolol and carvedilol for beta-

1 blockade remains subject of ongoing debate. The

degree of beta-1 blockade is best assessed in vivo by

blunting of the exercise induced heart rate. Accordingly,

we examined baseline and peak exercise heart rate in

subjects with chronic heart failure (CHF) treated with

carvedilol or metoprolol. To correct for possible

differences in norepinephrine (NE) release due to beta-2

blockade, we also measured NE levels at baseline and

peak exercise.

Pulse: Ekg-Man With Syncope, Emily Lai Md, Pgy-2, Anita Mehrotra Md, Pgy-1

The Medicine Forum

Mr. K, a 57 year-old Caucasian male with a history of

coronary artery disease, dilated ischemic cardiomyopathy,

ventricular fibrillation arrest status post

implantable cardioverter defibrillator (ICD) placement

was admitted to telemetry for two syncopal episodes. The

patient described multiple episodes of dizziness with

fatigue over the week prior to admission, the last two

episodes resulting in loss of consciousness with bladder

incontinence. He was home alone when these episodes

occurred and was unsure of how long he had been

unconscious. Mr. K was not aware of any recent firing of

his ICD. He denied any shortness of breath, chest pain, …

Images In Medicine-Clostridial Myonecrosis, Jaime Chin Md, Pgy-3

The Medicine Forum

A 48 year-old male with a past medical history of gout,

degenerative disc disease, and T cell lymphoma treated

with chemotherapy and autologous peripheral blood

stem cell transplant, currently in remission, presented

seven days status-post a non-myeloablative allogeneic

transplant with an acute onset of excruciating left hip

and groin pain and a low-grade fever. The physical exam

did not reveal any obvious cause of his extreme pain.

Pulse: Ekg-Ventricular Fibrillation Or Not?, Parmatma Parmatma Greeley Md, Pgy-3

The Medicine Forum

Mr. B is an 84 year-old African-American male veteran

with a history of type 2 diabetes and hypertension who was

admitted to the VA hospital for hypertensive urgency. In

the ICU, he became unresponsive and pulseless. Telemetry

showed “ventricular fibrillation” which spontaneously

converted to sinus rhythm. An echocardiogram showed an

ejection fraction of 60%. An ECG performed prior to the

ventricular arrhythmia is shown below.

Images In Medicine-Bronchiectasis, Jane Luu, 4th Year Medical Student

The Medicine Forum

A 43 year-old Chinese woman who

immigrated to the United States in

1994 was seen because of several years

of chronic, intermittent coughing

that was productive of voluminous,

thick, green sputum with occasional

blood streaking. The cough was

accompanied by right anterior

pleuritic chest pain. She had no

fevers, chills, or night sweats. Her

medical history included childhood

pneumonia at the age of 18 months,

a prior right pneumothorax that

required chest tube placement, and a

positive PPD. She was a nonsmoker.

Despite her symptoms, she was fully

functional with activities of daily

living but unable to tolerate exercise.

She …

Images In Medicine-Small Bowel Varices Without Esophago-Gastric Varices: A Cause Of Massive Gastrointestinal Hemorrhage, Sivakumar Srinivasan Md, Pgy-3, Kuntal Thaker Md, Pgy-6, Gastroenterology Fellow

The Medicine Forum

The following case demonstrates small bowel varices

without esophago-gastric varices as an unusual cause

of gastrointestinal bleeding in a patient with chronic

liver disease.

The patient is a 47 year-old man who presented to the

hospital with several days of back pain and weakness.

The work-up of his symptoms revealed a L3-L4

phlegmon on MRI of the lumbar spine. A biopsy of this

lesion yielded focal nonviable bone.

Images In Medicine-Pseudomyxoma Peritonei, Erev E. Tubb Md, Pgy-3

The Medicine Forum

The patient is a 78 year-old male with

a past medical history of

hypertension and duodenal ulcer

presenting with 2 months of

increasing abdominal girth. The

patient reports 1 month of loose

bowel movements and a 2 week

history of early satiety. He notes that

in the last week he has been nauseous

at the smell and thought of food. He

denies fevers, chills, excessive alcohol

intake, history of blood transfusions,

intravenous drug use, melena or

bright red blood per rectum. The

patient states he has never undergone

a colonoscopy and to his knowledge

there is no family history of …

What's Your Diagnosis? Hematology Slide Review, Jane Choi Md, Pgy-2

The Medicine Forum

A 23 year-old Caucasian female with no past medical

history presents with one week of easy bruising and

increasing “red spots” on her arms and chest. She does

not recall any history of trauma that may have lead to

the bruises. She denies any fever or chills. She has no

history of bleeding problems and underwent dental

procedures last year without any complications. On

review of systems, she had vague left abdominal pain over

the past week and 3 days of right ear pain that was

recently treated with cefuroxamine as directed by her

primary care doctor. Family history is …

What's Your Diagnosis? Lung Cavitary Lesion, Bassem Elgohary Md, Pgy-3, Betty Lim Md, Pgy-2

The Medicine Forum

A 35 year-old Caucasian woman with history of Systemic
Lupus Erythematous (SLE) complicated by Lupus
glomerulonephritis presented to the Emergency
Department complaining of worsening bilateral lower
extremity rash and leg pain. The rash had been present
for over a month and a recent biopsy of the lesion
revealed leukocytoclastic vasculitis. Her usual dose of
prednisone 120mg every other day had been increased
to 60mg daily over the past few weeks with the worsening
rash. In addition to the rash and leg pain, she also
reported some right-sided pleuritic chest pain.
Otherwise, the patient noted no shortness of breath,
cough, fevers, …

Weakness In A Young Man, Steve C. Tsai Md, Pgy-3

The Medicine Forum

A 39 year-old African-American male with past medical
history significant for uncontrolled hypertension presents
with a sudden onset of weakness and numbness on the
left side of his face, left arm, left leg, and right leg while
watching television twenty hours prior to presentation.
At that time, the patient did have a mild headache. The
patient initially thought that it was positional, but soon
realized that he could not move the affected extremities
at all. He also began to have some difficulty swallowing
and minor difficulties with speech as well.

Cambodian Monk With Malaise, Aditi Satti Md, Pgy-3

The Medicine Forum

A 26 year-old Cambodian monk presents with complaints
of a three week history of fatigue and malaise. The patient
reports that four days prior to presentation he developed
fevers to 103F, chills and a severe headache. The patient
reports that he had returned from Cambodia one week
prior to initiation of symptoms. He denies any sick
contacts and denies any neck stiffness, photophobia,
visual changes or abdominal pain. The patient does report
diarrhea for one week with approximately 8-10 bowel
movements per day. The patient denies any risk factors
for HIV. The patient had been seen in the Emergency
Department …

Woman With A Bleeding Diathesis, Bo Kim Md, Pgy-3

The Medicine Forum

61 year-old Indian female with history of hypercholesterolemia
presents to an outside hospital (OSH) with
worsening vaginal bleeding, hematochezia, nausea, and
vomiting starting three days prior to admission. Patient
also had a global persistent headache for approximately
24 hours at the time of admission. Otherwise, the patient
denied any fever, chills, abdominal pain, or trauma. The
patient noted no previous episodes of bleeding or easy
bruising in her past. She notes that her menstrual periods
were always regular and not subjectively heavy. Last
menstrual period was 10 years ago. Patient has had two
pregnancies in her obstetric history for which …

Woman With Post-Partum Kidney And Liver Failure, Joshua Gibbs Md, Pgy-3

The Medicine Forum

The patient is a 34 year-old G1P1 Caucasian female with
no medical history who was transferred from an outside
hospital after an emergent Cesarean section for increasing
jaundice with elevated liver enzymes, abnormal
coagulation times and acute renal failure. The patient
was healthy until 33 weeks gestation when she noted
dizziness, headache and visual changes. Blood pressure at
that time was elevated at 140/90 and she had trace lower
extremity edema. No proteinuria was detected. The
clinical picture was consistent with mild pre-eclampsia.
The patient was followed until 35 weeks gestation when
she developed vaginal bleeding and abdominal pain. At …

Woman With Mental Status Change, Vanita Treat Md, Pgy-3

The Medicine Forum

An 83 year-old African-American female with a history
of hypertension, frequent urinary tract infections, atrial
fibrillation, and a cerebrovascular accident (CVA) on
Coumadin presented two days after a fall. A family
member stated she was walking normally and tripped on
uneven concrete, hitting her chin on a fence. Two days
after the incident, the patient was found at home
slumped over in a chair with blood oozing from her chin
wound. The patient was brought to the emergency
department where she was lethargic but responsive. The
patient denied any chest pain, shortness of breath,
lightheadedness, dizziness, blurry vision, weakness or …