To differentiate acute purulent tonsillitis from infectious mononucleosis, divide the total number of lymphocytes by the WBC count. If the ratio is >0.35, the diagnosis is mono. One of our biggest insurers will not pay for a rapid mono test, and this is much more efficient than waiting for an Epstein-Barr virus titer. I have…
The comments by Gail Koelker, MSN, RN-C, FNP (Item 115-3), reflect the need to avoid unnecessary expense in the workup of her patient with erectile dysfunction. In reply, David T. Noyes, MD, also suggests less expensive alternatives. Both these sentiments suggest a cause, as well as a remedy, for the spiraling costs of health care.…
Should elderly patients be given additional vaccines, or is one shot sufficient?
A 47-year-old asymptomatic woman has tested positive for hepatitis delta antigen (HDAg) (confirmed on repeat testing) and hepatitis Be antigen (HBeAg). The following test results are negative: hepatitis Be antibody, hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, hepatitis B core antibody (both immunoglobulin M and immunoglobulin G). Hepatitis B viral (HBV) DNA is…
A patient with subclinical hypothyroidism has a very high thyroid-stimulating hormone (TSH), but his other thyroid function tests (triiodothyronine, thyroxine, etc.) are normal. His insurer will not pay for testing more often than twice a year. Is retesting the TSH alone sufficient for adjusting levothyroxine doses?—Ferdinand M. Rivera, MD, Salinas, P.R. Subclinical hypothyroidism is a…
What are the recommended goals for nonfasting cholesterol levels? Since we spend most of our life in a nonfasting state, shouldn’t we be more concerned about nonfasting levels than we are about fasting ones?—Bradley Hope, MD, Santa Barbara, Calif. Since total serum cholesterol levels vary very little from the fasting to the nonfasting state, it…
Is there any new information available regarding the treatment of Henoch-Schönlein purpura (HSP)?—Norma L. Sneed, MD, Checotah, Okla. HSP is a form of systemic small-vessel vasculitis characterized by vascular and/or mesangial immunoglobulin A1 deposits. The main clinical manifestations are vascular purpura, predominating on the lower limbs, and articular, GI, and renal symptoms. Pulmonary, cardiac, genital,…
How frequently does angioedema develop in asthmatic patients who are just starting montelukast?
How would you manage a 31-year-old gravida 3 para 3 who is hypertensive (BP 130-160/90-110 mm Hg)? The woman is breastfeeding a 2-month-old infant and wants to continue until the baby’s first birthday because he has demonstrated intolerance to multiple formulas. The mother’s history includes a sulfa allergy and moderate persistent asthma that is currently…
Should women of childbearing age who require antibiotics be advised that such medications may decrease the effectiveness of oral contraceptives (OCs) and therefore, they should abstain or use a backup method? Also, am I correct to assume that a negative beta human chorionic gonadotropin (β-hCG) test is advised prior to starting isotretinoin (which is teratogenic)?—Dean…
