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Hospital Medicine

Partial or partial complex seizures

I. What every physician needs to know. Partial seizures can also be known as focal seizures because by definition they start at a seizure focus, or at a certain part of the cerebral cortex that is irritated/injured. Partial seizures can generalize (generalized tonic-clonic seizure), and when they do, the actual generalized convulsion is indistinguishable from…
Features

Diagnosing diseases
 of the vulva

Vulvar biopsy is a helpful tool that should be utilized to diagnose 
and to guide the management of vulvar abnormalities.
Dermatology

Pilonidal Sinus Disease (Pilonidal Cyst)

Are You Confident of the Diagnosis? The development of a pilonidal cyst or pilonidal sinus disease (PSD) most commonly occurs along the upper portion of the gluteal cleft, especially when there is an extraneous congenital invagination or sinus tract near the apex of the natal crease (Figure 1 ). This epithelial invagination functions as a…
Endocrinology Metabolism

Hypophosphatemia

Hypophosphatemia and Refeeding Syndrome I. What every physician needs to know Acute hypophosphatemia is an iatrogenic development, caused by redistribution of phosphorus from the extracellular to intracellular compartments in patients with underlying depletion of phosphate stores. The classic example of this situation is the refeeding syndrome (RFS), of which hypophosphatemia is the cardinal manifestation; the…
Hospital Medicine

Alcoholic hepatitis

Alcoholic hepatitis is an acute reaction to prolonged excessive alcohol consumption. Mild forms of the syndrome improve without intervention, but when severe there is nearly a 50% 1 month mortality without treatment. Histologically, alcoholic hepatitis is characterized by swollen hepatocytes that contain Mallory bodies (alcoholic hyaline), a neutrophilic infiltrate, and fibrosis between the hepatocyte and…
Hospital Medicine

Amphetamine and methamphetamine toxicity

Amphetamine and methamphetamine toxicity I. Problem/Condition. Amphetamine and methamphetamine are both sympathomimetic amines that are classified as phenethylamines. These substances are best known for their central nervous system (CNS) stimulation, anorexiant and euphoric effects, with methamphetamines having both greater CNS activity and half-life to that of amphetamines. They elicit their effects by three neurochemical mechanisms:…
Hospital Medicine

Paracentesis

Paracentesis I. Problem/Challenge. Of the many rules of thumb that the Hospitalist lives by, the old saying “where there is fluid, there should be a needle” is perhaps the most compelling reason for doing a paracentesis whenever a patient with ascites is sick enough to seek care in the emergency department and/or be hospitalized. Complications…
Hospital Medicine

DVT prevention

I. Problem / Challenge. Pulmonary embolism (PE) resulting from deep venous thrombosis (DVT) is considered the most common preventable cause of hospital death. Without prophylaxis, estimated venous thromboembolism (VTE) incidence in hospitalized patients ranges from 10-26% in general medical patients, to 40-60% in those undergoing knee or hip surgery, to as much as 80% in…
Obstetrics and Gynecology

Menopause

Menopause 1. What every clinician should know Menopause matters. In the United States, approximately 37 million women are at or near menopause with some 45.5 million women beyond menopause. Menopause is the last menstrual period at the end of a woman’s normal reproductive life cycle. The diagnosis is retrospective because it is made one year…
Pediatrics

Hypopituitarism, congenital and acquired

OVERVIEW: What every practitioner needs to know Are you sure your patient has hypopituitarism? What are the typical findings for hypopituitarism? Hypopituitarism or pituitary hormone deficiency is a condition in which one or more of the pituitary hormones is are deficient. The pituitary, which plays an important role in regulation of growth, development, and metabolism,…
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