Internal Medicine Commons^™

Case Report: Thyrotoxic Pediodic Paralysis, Jesse Edwards, Md

The Medicine Forum

Introduction:

Thyrotoxic Periodic Paralysis (TPP) presents as a triad of acute attacks of muscle weakness, hypokalemia, and thyrotoxicosis. TPP was first described in East Asian countries, specifically Japan and China, where it was found to occur at an overall incidence of 2% and preferentially affected males.1,2 TPP also develops in other ethnicities, however, and given the growing ethnic heterogeneity of global society, it is becoming increasingly important for all physicians to be familiar with the diagnosis and management of TPP. The following case represents a typical presentation of TPP and serves as a valuable resource for informing our differential diagnoses …

Clinical Images: Sigmoid Volvulus, Divya Chalikonda, Md, Brian Lutman, Do, Alan Gandler, Md

The Medicine Forum

Case Presentation:

A 72-year-old male with a history of Parkinson's disease, Type 2 diabetes, hypertension, hyperlipidemia, and cerebral vascular accident presented to the emergency room for 10 minutes of unresponsiveness at his nursing home. A workup for the unresponsiveness was unrevealing. His hospital course was complicated by constipation, a condition that resulted in multiple hospitalizations in the prior 6 months. Abdominal exam was notable for mild distension, and an initial x-ray demonstrated an ileus. The severity of his distention acutely worsened two days after it was initially noted, and was associated with borborygmi and high-pitched bowel sounds. A repeat x-ray …

Clinical Images: Physical Diagnosis: When Blue Is A Clue, Matthew A. Murphy, Md

The Medicine Forum

Figure 1:

The classic blue sclera of a patient with type 1 osteogenesis imperfecta. Due to a defect in type 1 collagen, the overlying sclera is abnormally thin, resulting in increased visibility of the underlying choroidal veins and the blue color of the eyes. This patient also had a history of more than forty bone fractures throughout his life.

Table Of Contents: The Medicine Forum Volume 18, 2016-2017

The Medicine Forum

Table of Contents: The Medicine Forum Volume 18, 2016-2017

From The Editors, Neha Bansal Etherington, Md, Shuwei Wang, Md, Anita Modi, Md, Debbie Chen, Md, Jad Al Danaf, Md

The Medicine Forum

Dear Students, Residents, Faculty, and Friends of the Forum,

We are delighted to present you with the 18th annual edition of The Medicine Forum. Each year, we continue to be humbled by the dedication and passion of our students, mentors and colleagues and thankful for the opportunity to work with and among them.

At Jefferson, we are privileged to treat a diverse and complex panel of patients in the heart of Philadelphia, making this institution and this city a wonderful place to learn medicine. The backbone of The Medicine Forum has always been a place for Jefferson students, residents, and …

From The Desk Of The Residency Director, Emily Stewart, Md

The Medicine Forum

It has been another wonderful year in the Jefferson Internal Medicine Residency Program. Our program continues to train the best and brightest residents in the country. During the three years we are fortunate to have them at our program. It is my distinct pleasure to watch them grow into confident, dedicated, compassionate clinicians. The residents are not just outstanding clinicians but excel in all aspects of medicine including research, humanities and medical education.

Pembrolizumab-Associated Hypothyroidism: Case Report And Review Of Literature, Niranjan Tachamo, Saroj Lohani, Salik Nazir, Rishikesh Joshi, Mrunalini Deshmukh

Reading Hospital Internal Medicine Residency

Pembrolizumab is a Programmed Death 1 (PD-1) inhibitor used to treat advanced malignant melanoma and metastatic non-small cell lung cancer. It causes various endocrinological side effects including immune mediated thyroiditis. Thyroiditis caused by Pembrolizumab can mimic other immune mediated thyroiditis like Hashimoto thyroiditis and Grave’s disease.

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …

Hypersensitivity Pneumonitis: An Overlooked Cause Of Cough And Dyspnea., Ryan S. D'Souza, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Hypersensitivity pneumonitis (HP) is an immune-mediated pulmonary disorder involving inflammation of the lung interstitium, terminal bronchioles, and alveoli caused by the immune response to the inhalation of an offending environmental airborne agent. It can manifest as exertional dyspnea, fatigue, weight loss, and progressive respiratory failure if left untreated. Because of its protean features, it can be misdiagnosed as other common obstructive lung conditions such as asthma. If triggers are not avoided, it can progress to irreversible pulmonary fibrosis. In this article, we present the case of a 51-year-old male who presented to our hospital with recurrent bouts of dyspnea and …

Clara's Final Christmas Gift, Gus W Krucke

Faculty, Staff and Student Publications

No abstract provided.

Exploring Autonomy Support In Shared Decision Making And Patient Activation Of Diabetes Self-Care Behaviors, Carol Mahler Hamersky

Seton Hall University Dissertations and Theses (ETDs)

Introduction:

Chronic disease places a different set of demands on an individual and family. Self-care behaviors and daily decision making is an integral part of diabetes management. According to the CDC (2014), the prevalence of Diabetes is estimated at 29.1 million and an alarming 86 million Americans have Pre-diabetes. Despite a plethora of evidence on the importance of diabetes self-care behaviors on clinical outcomes, studies have highlighted the current disconnect of patients not able to follow self-care behavior recommendations and not asking for help from their health care providers. There is no literature on the impact of an autonomy supported …

Diagnostic Effectiveness Of High-Sensitivity Troponins, Sean R. Bodin, Jacqueline Ramirez

Physician Assistant Capstones, 2016 to 2019

Background: Acute myocardial infarctions (AMI) are a leading cause of death in the United States. The key to increasing survivability is early recognition to expedite the proper treatment modalities. In conjunction with the clinical presentation and electrocardiograms, the use of cardiac biomarkers is exponentially important in not only recognizing a cardiac event but also determining the extent of injury. Advancement in laboratory technology has led to the development of high-sensitive troponin (hs-troponin) assays which can detect smaller cardiac troponin serum levels compared to conventional troponin assays. This implies that the use of hs-troponin assays is more effective in the …

Demographics, Patterns Of Care, And Survival In Pediatric Medulloblastoma, Emily V. Dressler, Therese A. Dolecek, Meng Liu, John L. Villano

Internal Medicine Faculty Publications

We evaluated the American College of Surgeon’s National Cancer Data Base (NCDB) to describe current hospital-based epidemiologic frequency, survival, and patterns of care of pediatric medulloblastoma. We analyzed NCDB 1998–2011 data on medulloblastoma for children ages 0–19 years using logistic and poisson regression, Kaplan–Meier survival estimates, and Cox proportional hazards models. 3647 cases of medulloblastoma in those aged 0–19 years were identified. Chemotherapy was received by 79 and 74% received radiation, with 65% receiving both therapies. Those who received radiation were more likely to be older than four, while those who received chemotherapy were more likely to be age four …

Dislodging Anchored Diagnoses: An Unusual Presentation Of Acute Appendicitis, Talal Asif, Ravali Gummi, Zara Wadood, Kristy E. Steigerwalt, Rebecca R. Pauly

Marshall Journal of Medicine

Cognitive errors are the most common cause of diagnostic errors in the process of clinical decision making. Recently, there has been an immense focus on the new science of error prevention in health care. Anchored thinking or heuristics is a form of cognitive error that portrays shortcuts or abbreviated thinking in the light of diagnostic uncertainty. The risk is of comfort in a typical scenario and not being able to adapt to a new situation. Here we present an intriguing case of acute appendicitis in a patient who was initially admitted and treated for hypothermia and alcohol withdrawal. As the …

Image-Guided High-Dose Rate Intracavitary Brachytherapy In The Treatment Of Medically Inoperable Early-Stage Endometrioid Type Endometrial Adenocarcinoma, Scott E. Jordan, Md, Ida Micaily, Md, Enrique Hernandez, Md, J. Stuart Ferriss, Md, Curtis T. Miyamoto, Md, Facr, Shidong Li, Phd, Bizhan Micaily, Md

Division of Internal Medicine Faculty Papers & Presentations

To report the experience with high dose rate, image guided intracavitary brachytherapy in the treatment of medically inoperable, early stage endometrial cancer.

Poster presented at:

American Brachytherapy Society Annual Meeting April 20-22, 2017 in Boston MA.

Gastrointestinal Stromal Tumor Induced Hypercalcemia, Aram Barbaryan, Stefania Bailuc, Padma Poddutoori, Aida Richardson, Aibek E. Mirrakhimov

Internal Medicine Faculty Publications

Hypercalcemia in patients with cancer is a common laboratory finding affecting up to 44% of that patient population. 1,25-Dihydroxyvitamin D₃ mediated hypercalcemia is one of the rare mechanisms of this endocrine emergency in cancer patients. It is even rarer for solid organ neoplasms to present with hypercalcemia mediated through the production of 1,25-dihydroxyvitamin D₃. We report a case of a 77-year-old female who presented to the hospital with hypercalcemia and later was found to have metastatic gastrointestinal stromal tumor. There have been only 5 cases of gastrointestinal stromal tumor described in literature resulting in hypercalcemia. In our …

Removing Barriers To Care For The Underserved: Provider And Patient Perception Of Direct To Consumer Telemedicine, Robert M. Grell, Rachel Hatcliffe, Sean M. Gillen, Craig Sable, Vanessa Grant, Matthew Ledda, Mary Fuska, Shireen Atabaki

GW Research Days 2016 - 2020

Purpose of Study: Lack of access to pediatric subspecialty care is a major barrier to pediatric health for underserved populations in the Washington DC, Virginia and Maryland area. Lack of access to transportation, long office wait times, and missed school and work are barriers that prevent access to subspecialty care. Direct to consumer (DTC) telemedicine provides this service to our underserved population by bringing care into their own home through use of computers, tablets, and smart phones.

Methods Used: Structured interviews of parents and providers were performed prior to implementation of a subspecialty DTC telemedicine program for underserved children in …

The Significance Of So-Called Equivocal Immunohistochemical Staining For Cytomegalovirus In Colorectal Biopsies, David A Johnson, Philip O Katz, David Armstrong, Henry Cohen, Brendan C Delaney, Colin W Howden, Peter Katelaris, Radu I Tutuian, Donald O Castell

Faculty, Staff and Student Publications

The availability of over-the-counter (OTC) proton pump inhibitors (PPIs) for the short-term (2 weeks) management of frequent heartburn (≥2 days/week) has increased markedly, yet evidence-based recommendations have not been developed. A panel of nine international experts in gastroesophageal reflux disease developed consensus statements regarding the risks and benefits of OTC PPIs using a modified Delphi process. Consensus (based on ≥80% approval) was reached through multiple rounds of remote voting and a final round of live voting. To identify relevant data, the available literature was searched and summarized. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system terminology was used to …

Keberhasilan Pengobatan Antiretroviral (Arv), Teguh H. Karyadi

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Approach To Diagnosis And Treatment Of Drug Allergy, Roy Akur Pandapotan, Iris Rengganis

Jurnal Penyakit Dalam Indonesia

Drug allergy is a serious medical problem. Drug allergy can be defined as an adverse drug reaction involving immunological mechanism. However, it is not easy to decide whether an adverse drug reaction is an allergic reaction, and it requires a systematically diagnostic approach. Beside a thorough history taking and physical examination, there are general and specific laboratory examination to investigate drug allergy which can be done in vivo, in vitro, or biopsy. The management of drug allergy include the avoidance of the precipitating event, and specific methods to reduce the drug reaction which include threating through, dosing test, desensitization, and …