A patient complaining of abdominal pain has normal liver enzymes and a gallbladder wall polyp (but no stones) on ultrasound. What further intervention do you recommend?—Cynthia Lewin, ARNP, Sioux City, Iowa Gallbladder wall polyps can act similar to gallstones and have been associated with abdominal pain and dyspeptic symptoms. Polyps can also be potentially precancerous,…
A 44-year-old woman with a history of endometriosis who underwent total abdominal hysterectomy/bilateral salpingo-oophorectomy and appendectomy complains of intermittent right upper-quadrant pain of 3-4 on a 10-point scale for the past month. I suspect she has biliary dyskinesia, but she is able to sleep and has no nausea, vomiting, or diarrhea. A low-fat diet has…
Shortly after being placed on amiodarone tablets for one episode of ventricular fibrillation, an elderly patient began to experience paresthesias of the lower extremities. Even though he has been off the medication for a year, he continues to experience sensations in a socklike distribution below the knees, especially in the morning. Are these sensations likely…
How soon after starting a patient on an antihypertensive medication should its effects be reviewed and the dosage adjusted? —Bhavana Japi, MD, New Hyde Park, N.Y. The timing of dosage adjustment depends on three factors: the class of medication, the severity of the hypertension, and the ability of the patient to follow home BP and…
How do I distinguish between new-onset fungal eye infection vs. bacterial conjunctivitis in contact-lens wearers?—Felix N. Chien, DO, Newport Beach, Calif. Fungal disease presents as a corneal ulcer with white or creamy infiltrates. Stellate or feathery edges may be seen on slit-lamp examination. The pain and visual loss of fungal ulcers are not characteristic of…
As is common in many locales, there is a significant wait to see a pediatric psychiatrist in my area. What are the recommendations for starting patients on antidepressants or atypical agents? We conduct basic screening (Patient Health Questionnaire [PHQ] and Mood Disorder Questionnaire), but are there other tools that are more useful for adolescents?—Deanna Bridge,…
A diabetic patient with hemoglobin A1c 6.5%, total cholesterol 195 mg/dL, HDL 32 mg/dL, LDL 98 mg/dL, and triglycerides 195 mg/dL takes atorvastatin (Lipitor) 20 mg daily. Should I try to bring down the triglycerides to <150 while “raising” the HDL a bit? The patient is on seven medications for comorbid conditions. Are omega-3-acid ethyl…
Is it possible to feed or administer oral medications to nasotracheally intubated patients?—Mapara Qureshi, MD, Frederick, Md. Nasotracheal intubation is generally reserved for specific situations, such as head and neck surgery, or when there is a need to access the oral cavity, such as with trauma. While the oropharynx is not obstructed by a nasotracheal…
Why is diastasis recti not mentioned when referring to obesity and girth?—Kenneth R. Kaisch, MD, San Antonio Diastasis recti refers to thinning of the linea alba in the epigastric area, resulting in a midline vertical abdominal bulge that is frequently misperceived by patients to be a hernia. What is most significant about diastasis recti is…
