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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 …

Table Of Contents-The Medicine Forum, Volume 6, Winter 2004

The Medicine Forum

Table of Contents-The Medicine Forum, Volume 6, Winter 2004

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 …

Welcome To The 6th Edition Of The Jefferson Medicine Forum, Nicole Weinberg Md, Betty Lim Md

The Medicine Forum

We are very excited to bring you this
new and improved volume of the Forum
because it exhibits the talents of the
Internal Medicine Residents. This
edition showcases many of the residents’
strengths in writing scholarly projects,
creating research studies, and interpreting
modern diagnostic imaging.

From The Residency Program Director, Gregory C. Kane Md

The Medicine Forum

The goal of a Residency Program in Internal Medicine is
to strive to train the next generation of practitioners and
academicians in Medicine who will become physiciansscholars,
scientists, teachers, and humanists.

We are excited that many of our residents are pursuing
research opportunities in the laboratory or clinic. Such
participation is a requirement for training at Jefferson. In
addition, this journal serves as an outlet for scholarly
work of a variety of types. We are pleased to support
another issue of the Jefferson Forum to continue to
highlight this work. This represents the sixth installment
of the Jefferson Forum, which …

Download Entire Pdf: The Medicine Forum, Vol 5, Winter 2003

The Medicine Forum

Download entire PDF: The Medine Forum, (The Journal of Thomas Jefferson University Hospital, Department of Internal Medicine), Vol 5, Winter 2003.

Clinical Quiz

The Medicine Forum

5 question clinical quiz. Answers after case presentation: A Man with Dyspnea and Diffuse Abdominal Pain by Dominick Galluzzo MD.

Effect Of Intravenous Pulse Cyclophosphamtoe (Cyc) Therapy On Systemic Sclerosis (Ssc) Inflammatory Lung Disease, Nicole Weinberg, Md, Nora Sandorfi, Md, Sergio A. Jimenez, Md

The Medicine Forum

Deterioration of lung function is the most frequent cause
of death in SSc. Alveolitis is considered the initiating
event of SSc lung fibrosis. Effective therapy of SSc
alveolitis is, therefore, of paramount importance. Here
we assessed the use of intravenous CYC on pulmonary
function testing(PFT) and high resolution computerized
tomography (HRCT) abnormalities in 15 patients with
SSc and alveolitis.

Effects Of Walnut Consumption As Part Of Heart Healthy Diet On Atherogenic Lipoprotein Subclasses, Kimberly L. Dulaney, Md, John M. Morgan, Md, David M. Capuzzi, Md

The Medicine Forum

Nutritional therapy is fundamental in the treatment of
cardiovascular disease. Studies that utilized a low-fat diet
supplemented with 64 grams/day of walnuts have shown
a significant reduction in serum levels of total and LDL
cholesterol, and triglycerides. This study was designed to
see if lipoprotein subclasses varied in patients eating a
low-fat walnut supplemented diet.

A Man With Shortness Of Breath And An Abnormal Ecg: A Short Case, David Defeo, Md

The Medicine Forum

An 80 year-old Chinese male with a history of tobacco
use and asthma presented to the ER complaining of
shortness of breath that was unresponsive to
bronchodilator use. The patient’s ECG on admission was
sinus rhythm at 95 beats per minute with minimal ST
elevations in V2-V4. Laboratory results were significant
for a troponin of 7.7. The patient was started on anticoagulation
with heparin. A transthoracic echocardiogram
revealed an ejection fraction of 25%. The patient
underwent coronary catheterization, which revealed
luminal irregularities of his coronary arteries. Figures 1
and 2 show the end diastolic and end systolic left
ventriculograms from …

An Unresponsive Woman Found Down, Murliya Gowda, Md

The Medicine Forum

A middle-aged unidentified female presented by fire
rescue to the emergency department after being found
unconscious in the snow. Her identity, familiar contacts,
and medical history were not known, but the patient was
presumed to be homeless.

A Woman With Headache And Chest Pain, Theresa Pondok, Md

The Medicine Forum

A 34 y/o woman, with a past medical history significant
for asthma, newly diagnosed hypertension, and migraines,
presented to the emergency department with complaints
of sudden onset chest pain. She was an active young
woman, who up until the day of admission, had been able
to run several miles without chest pain or shortness of
breath. Symptoms began the morning of admission, when
the patient reported that she developed a migraine
heachache, with typical right-sided temporal pain. After
administering an injection of Sumatriptan, her headache
resolved. Soon thereafter, she noted 5/10 substernal chest
pressure occurring suddenly at rest, without radiation …

A Man With Shortness Of Breath And Bloating, Matthew E. Levy,Md

The Medicine Forum

The patient is a 61-year-old male with a past medical
history of hypertension and insulin-dependent diabetes
mellitus presented to the ED with new onset shortness
of breath. He reported a three week progression of
dyspnea after one flight of stairs, from a normal baseline.
The patient also noticed 2 pillow orthopnea and
increased urinary frequency and urgency. He denied
fevers, chills, chest pain, palpitations or productive
cough. Symptoms began when he ran out of his oral
medications three weeks prior to admission (furosemide,
enalapril, digoxin, metoprolol, spironolactone, aspirin).
Family history was positive for alcoholic cirrhosis. Social
history was positive for …

Training Residents In Acls/Code Response Using A Computerized Medical Simulator: Improving Resident Comfort And Preparedness, Elisabeth Dial, Md, Henry Schairer, Md, Steven Silver, Md, Jennifer Claves, Md, David Gardiner, Md, John Caruso Md, Salvatore Mangione, Md, Gregory C. Kane, Md

The Medicine Forum

Internal Medicine residents are responsible for leading the
code response team at most teaching hospitals, yet many
graduating interns (PGY1s) may feel unprepared to run
codes. Currently, the only formal training for house staff
is the two-day American Heart Association’s Advanced
Cardiac Life Support (ACLS) course, generally required at
the beginning of internship, with recertification necessary
every two years. This course does not address leadership
skills or a resident’s self-reported sense of comfort with
leading a code team within a teaching hospital. Prior
investigations have highlighted the deterioration in
knowledge of important ACLS protocols, with knowledge
levels at or near …

A Woman With Extreme Fatigue, Christopher Dimaio Md, Chief Medical Resident

The Medicine Forum

A 23 year old female presented to her primary care
provider’s office complaining of extreme fatigue over the
past few weeks.

Color Photos

The Medicine Forum

10 color photographs.

Isolated Abducens Nerve Palsy Secondary To Varicella Zoster In A Patient With Hiv, Ellen B. Lunenfeld, Md, John A. Walker, Md

The Medicine Forum

17
Varicella Zoster, the recrudescence of the dormant
varicella virus, occurs more often in older patients and
in those who are immunocompromised. Herpes Zoster
ophthalmicus (HZO) is the second most common
manifestation of the disease, second only to thoracic and
lumbar zoster.1 HZO is estimated to account for 10% to
25% of cases.2,3 HZO can lead to a number of ocular
complications, including proptosis, disciform keratitis,
internal ophthalmoplegia, bilateral retinal detachments,
Argyll-Robertson pupil, and progressive outer retinal
neuropathy (PORN).

A Man With Fevers And Chest Pain, Jigar Patel, Md

The Medicine Forum

A 42 y/o Hispanic man without significant medical
history presented to the ED with the complaint of
increasing left-sided chest pain. The patient reported that
symptoms began 4 days prior, when he developed a
severe headache. That night, he noted increasing chills
and sweats, with a fever measured at 103 degrees F. The
following morning, he developed left-sided chest pain
that he described as a pressure exacerbated by movement
and breathing. For the next several days, he reported
feeling worse with continuous chills and fever spikes up
to 105 degrees F, along with increased severity and
duration of his chest …

A Male With Chills And Arthralgias, Lo-Ku Chiang, Md, Ambrish Ojha, Md

The Medicine Forum

A 53-year old man presented to the ED with complaints
of fevers and chills for 5 days. Two days prior, he started
having generalized arthralgias and a painfully numb left
index finger. Similar symptoms had also begun on his
left great toe (See Figures D and E, Color Plates page
19). The patient denied recent trauma, although he was
unsure if he had sustained an insect bite on the dorsal
aspect of his left hand 8 hours prior to the onset of
symptoms. Three sets of blood cultures obtained prior
to admission were positive for methacillin-sensitive
Staphylococcus aureus. The patient …

A Man With Dyspnea And Diffuse Abdominal Pain, Dominick Galluzzo Md

The Medicine Forum

A 50 y/o male with a PMH significant for HIV/HCV
co-infection, and chronic renal insufficiency, presented
to the ED with a one week history of progressive dyspnea
and diffuse abdominal discomfort. He reported resting
shortness of breath without orthopnea, PND, or chest
pain. His abdominal pain was diffuse, and he denied
nausea, vomiting, increased abdominal girth or lower
extremity edema.

Prevention Of Central Venous Catheter-Related Infections, Raghuram Mallya, Md

The Medicine Forum

The central venous catheter is a valuable tool in inpatient
medicine. However, with its use comes the risk of local
and systemic infections. Kluger et al estimated that
250,000 cases of central line-associated blood stream
infections occur annually. Mortality rates range from 12-
25% per infection.1 Therefore, it is essential that health
care providers take all necessary precautionary measures
to avoid infection. Guidelines have been published by the
Centers for Disease Control and Prevention to provide
an evidence-based medicine (EBM) approach for
avoiding central venous catheter-related infections.
Recommendations include proper skin cleansing, the use
of maximal sterile barriers, selection of …

A Man With Diarrhea And Achalasia, Dan Valancius Md

The Medicine Forum

A 78 y/o male with an extensive history of CAD s/p
multiple MIs and CABG surgery, presents with two and
one half weeks of diarrhea. About 9 weeks prior, he had
been diagnosed with achalasia, and was treated with a
botulinum toxin injection, with resolution of his
symptoms of dysphagia. He was also hospitalized a month
ago after experiencing chest pain, and subsequently ruled
in for a small non-ST elevation MI. He underwent
coronary catheterization at that time, and was found to
have severe multivessel disease unamenable to PTCA or
bypass surgery. Now, he presents with progressively
frequent “brown watery” …

A Man With An Elevated Hemoglobin, Paula Sorokanich Md

The Medicine Forum

A 50-year-old male with history of severe gout and
degenerative joint disease presented to his PCP for a
physical. On routine blood work he was found to have
an elevated hemoglobin/hematocrit. This was confirmed
on repeat analysis and work-up was pursued.

A Man With A Soft Tissue Lesion Of The Hand, Susan Masonis Md

The Medicine Forum

A fifty year old male presents with a lesion on his right
hand. Approximately 2 months prior to presentation, the
patient, who is a dentist and avid boater, first noted the
lesion after hitting his hand when working in his boat’s
engine room. Initially he had a 1 cm erythematous
macular lesion on the dorsum of his right hand at the
5th metacarpal. He believed the lesion was present prior
to the time he struck his hand, and the injury brought it
to his attention.