How do I do what is best for the patient if the patient cannot afford a higher level of treatment?
What is a good screening test for evaluation of closed head injury?
What constitutes a reasonable workup for neutropenia in an otherwise healthy young person?
Are there any studies that support eliminating foods like sugar, milk and wheat to improve Hashimoto disease symptoms?
How precisely must one follow the manufacturer's directions with regard to the amount of powder and water used in preparing infant formula?
Medication, ablation or rate control for a patient with first onset of atrial fibrillation?
Are there any guidelines for alternatives to cephalosporins in patients allergic to penicillin?
A patient returns after acyclovir fails to resolve a fever blister on the lip. What's the next step?
How can I avoid unnecessary antibiotic use while still satisfying my patients?
Does the concentration of hypertonic saline affect intracranial pressure reduction in patients with traumatic brain injury?
Would it be beneficial to give suprapharmacologic doses of vitamin D3 in cases of severe psoriasis?
A who takes acetaminophen for chronic neck and back pain awakens to a bloody nose and blood-soaked pillow. Could liver disease be to blame?
A girl with scoliosis returns to the clinic complaining of ankle pain.
What is the most sensitive test to use when trying to diagnose toenail fungus?
What is the recommended treatment for patients diagnosed with dementia who are suffering with paranoia and/or hallucinations?
Is there any danger of systemic effects from chronic use of OTC steroid creams and/or ointments?
Many patients take vitamins that are more than 100% the recommended daily allowance. When do they begin to pose risks to kidney function?
Many older patients take many medications, making contraindications a concern when trying to control hypertension.
When do patients benefit most from palliative care consults?
A young man presents with constant periumbilical pain, extreme weakness, anorexia, nausea, constipation, and orthostasis.
What are the next steps after ruling out Clostridium difficile?
A patient continues to have breakthrough bleeding while taking oral contraceptives, despite changing pills. What could be the cause?
Could vitamin D and calcium supplements be causing foul smelling urine?
Are dual-energy x ray absorptiometry scans safe for patients taking anti-seizure medication?
Does varicocele grade correlate with impotency level?
Can thyroid hormone replacement therapy affect bone density?
What considerations exist regarding the safety of using aripiprazole during pregnancy?
A patient has elevated creatine and fasciculations. Could an electrolyte imbalance be the cause?
What treatment regimen would have the least adverse effect on the fetus?
What treatment do you recommend for scrotal dermatitis?
Two clinicians disagree on a diagnosis after reviewing two-hour oral glucose tolerance test results. Who is correct?
What is an effective alternative to oral medications or topical ciclopirox (Penlac) for onychomycosis?
Is it common to see renal failure triggered by high doses of topical acyclovir?
A patient with newly diagnosed diabetes has a hemoglobin (Hb) A1c of 12.2% and glucose 350 mg/dL, despite increasing insulin (glargine [Lantus]) to 25 units. What else can be done to lower blood sugar?
How should patients whose Pap smear results show inflammation and no other abnormalities be managed?
Could a vegetarian diet be contributing to an older woman's alopecia?
Is there a window of opportunity when surgical intervention is most successful for patient's with Parkinson disease?
How should a primary care clinician follow-up after performing a lipid profile on an obese pediatric patient?
Could positive thyroid peroxidase adversely affect a mother's milk supply?
A patient with a tracheostomy for severe obstructive sleep apnea has not responded to several treatments to decrease secretions from the plastic tube. What's the next step?
Should testing for vitamin B12 deficiency be part of a standard geriatric workup?
Are there other treatment options for eating disorders after therapy, acupuncture, nutrition counseling and in-patient hospital stays have failed?
What are the current evidence-based recommendations for aspirin and clopidogrel (Plavix) use following coronary artery bypass graft (CABG) surgery (both on- and off-pump procedures)?
If follicle-stimulating hormone is >20 mIU/mL, most clinicians counsel patients against contraception, as the risk of pregnancy is virtually nil.
Advice for dealing with parent requests to drug test their teen without the child's knowledge or consent.
A 69-year-old man with multiple health conditions develops gynecomastia after hemodialysis. Are the two related?
What options are there for a patient with a continent urinary diversion, who is no longer able to self catheterize and has no reliable caregivers?
What is the best treatment option for a 50-year-old woman with major depression, alcoholism and general anxiety disorder.
Can vitamin D deficiency play a role in post-fracture pain?
What are the differences in side effects and responses to the available SSRIs?
What is the rationale behind the new combined oral contraceptive that adds folate to the estrogen and progestin?
Storing ophthalmic solutions in the refrigerator can result in even more soothing results.
What are the most effective therapies available to treat lymphedema?
Are certain oral contraceptive pills better for women with a family history of breast cancer?
A Native American man aged 40 years presents with a very tender right rib cage cystic formation that measures 2.0 x 2.0 x 0.5 cm.
Is there any relationship between calcium pyrophosphate dihydrate disease (pseudogout) and vitamin D deficiency?
How can a clinician determine whether it's appropriate to raise or lower bedtime insulin in a patient experiencing difficulty controlling morning glucose levels?
Can a patient with new-onset hypothyroidism be started on levothyroxine 50 µg/day without endocrine referral?
Are there any studies that confirm effective calcium absorption when the patient is taking long-term proton pump inhibitors (PPIs) along with oral calcium?
Should clinicians routinely check vitamin D levels in Hispanic patients as they do in others?
Is it safe to restart osteoporosis medications in patients with stage 5 chronic kidney disease?
How much of a workup do you recommend before ordering diagnostics with contrast (assuming kidney function tests are normal)?
What is the preferred thyroid management for a woman aged 34 years who presents with an enlarged thyroid, no nodules and irregular menstrual periods for the past six months?
Is there evidence showing that women taking statins saw little improvement in their lipid levels?
What treatment would you recommend for aborting a migraine in a patient with known coronary artery disease?
Are more clinicians performing auscultation through garments?
Which serologic measure of inflammation is the most cost-effective and reliable when monitoring inflammatory disease?
How reliable is a CT scan of the sinuses in a patient who does not respond to an initial extended course of antimicrobial treatment for sinusitis?
When is it appropriate to refer diabetic and hypertensive patients to a renal specialist?
Since 50% of patients admitted to the ED with deep vein thrombosis, should it be common practice to do a chest CT prior to discharge?
What is maturity onset diabetes of the young (MODY)? How does it differ from types 1 and 2 diabetes?
Nonalcoholic fatty liver disease (NAFLD) is rapidly emerging as one of the most common "incidental findings" identified with radiographic testing. One in four adults is found to have the condition when undergoing abdominal ultrasound.
Is there any indication that taking too much fish oil — particularly green-lipped mussel oil — can cause stomach problems in a person with a history of gastroesophageal reflux disease?
Could a liver infarct be the cause of a patient's dull, intermittent pain in the right-upper-quadrant? Or is something else to blame?
How would you proceed with a 64-year-old woman who has complex endometrial hyperplasia and secretory changes?
An elderly man complains of feeling cold all the time, even though the weather is warm.
Can substituting dietary corn oil with sesame oil reduce blood pressure?
Does an individual undergoing cataract surgery with standby or local anesthesia need a full workup if he or she has been stable on current medications, regardless of medical history?
What kind of steroid cream is safe for dermatitis of the eyelid and periorbital area, and how long can it be used?
Could a woman's nail dystrophy be related to a history of mild intermittent asthma?
If triglycerides are a more significant indicator of cardiovascular disease (CVD) risk in women than in men, is it appropriate to treat even if LDL is normal?
A patient taking terbinafine for onychogryphosis developed a fine pruritic rash over sun exposed body areas while on vacation. Could the drug be to blame?
What is the best choice for cardioprotection in a woman aged 75 years with episodic symptomatic angina, MI one year earlier and a sensitivity to nitroglycerin patches and spray?
Is it safe for a patient with chronic obstructive pulmonary disease to be on high doses (e.g., 100 mg b.i.d.) of metoprolol?
What treatment options are available for chronic esophageal reflux? Is surgery ever preferable to long-term treatment with a proton-pump inhibitor?
Esophagogastroduodenoscopy, colonoscopy, complement fixation, celiac, sonogram, gynecologic workup and routine labs have all been negative in a teen with a three-year history of recurrent chronic abdominal pain and diarrhea. What steps should be taken next?
A gastroenterologist and surgeon have recommended cholecystectomy for a patient with recurrent biliary colic and a 3% biliary ejection fraction on CCK-HIDA scan. Is this advisable?
What is the likelihood of acid-reflux rebound in a patient stopping a proton-pump inhibitor (PPI) (pantoprazole [Protonix]) after taking the medication for one month or more?
Which antidepressant would you recommend for a woman aged 47 years who presents with depressed mood, low energy, decreased motivation and hypersomnia?
How often should follow-up ECG be performed on a pregnant patient with atrial fibrillation (AF) that resolves with medication that is then discontinued?
How do I know which radiologic tests to choose when evaluating abdominal pain?
Many dentists, optometrists and other specialty providers are sending adult patients to our primary-care clinic for surgical or procedural clearance. Are there standards of practice for such patients?
An elderly patient presented with an acute reaction of shingles. How soon after treatment is it advisable to administer the zoster vaccine (Zostavax)?
What is the best way to differentiate tonsillopharyngitis from a peritonsillar abscess?
How often should blood tests be repeated to rule out systemic lupus erythematosus (SLE) in a patient positive for discoid lupus erythematosus (DLE)?
How does the ejection fraction (EF) calculated during the sestamibi imaging of a cardiac stress test correlate with an EF measured with a two-dimensional cardiogram?
Is there a connection between celiac disease (CD) and inflammation?
How can clinicians tell the difference between seborrheic dermatitis and scalp psoriasis?
A patient is suspected of having hepatic encephalopathy (HE) attributable to liver failure from alcoholism.
What is the significance of an isolated alkaline phosphatase (ALP) of 161 IU/L in the absence of gallbladder, pancreas or liver disease?