Mark Yoffe, MD

Mark Yoffe, MD, is a board-certified internist whose primary professional interest is clinical care. He also writes about medicine, media, and technology.

Myasthenia Gravis: The Workup

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Myathenia Gravis

Here’s a workup for suspected myasthenia gravis: Acetylcholine receptor antibody Muscle specific receptor tyrosine kinase (MuSK) antibody Chest CT (to look for thymoma) TSH (concomitant autoimmune thyroiditis is sometimes seen) Search for underlying infectious precipitants as guided by history (e.g., CBC, chest radiograph, urinalysis) Search for underlying concomitant metabolic derangements which may contribute to weakness … Read more

Inflammatory Bowel Disease: Crohn’s Versus Ulcerative Colitis

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Learning Radiology Lead Pipe

The best way to appreciate and remember the differences between Crohn’s disease and ulcerative colitis, both inflammatory bowel diseases, is to juxtapose them and compare them in a pairwise fashion: Transmural vs. Mucosal Only Transmural: This is the most important distinguishing feature of Crohn’s disease. The transmural nature of the disease is what leads to … Read more

Meningitis: How to Answer “Best Next Step” Questions

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If, on a  standardized test, you are asked what’s the “best next step” in the management of a patient with suspected meningitis, prioritize thusly: Droplet precautions if Neisseria meningitidis is suspected (this comes first for public health reasons) Administer acyclovir if HSV meningitis is suspected (there’s no reason to delay this) Draw blood cultures (because … Read more

Chronic Diarrhea: Laboratory Medicine Tips and Tricks

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Routine labs can tell you a great deal about your patient’s chronic diarrhea: Potassium: Potassium should, of course, be low in patients with chronic diarrhea. If it is high and the patient has normal kidney function, then your patient may have Addison’s disease, or primary adrenal insufficiency. Microcytic anemia: microcytic anemia suggests anemia of iron … Read more

Success with DRESS: What You Need to Know about Drug Reaction with Eosinophilia and Systemic Symptoms

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Introduction Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a potentially life-threatening medical emergency. Patients present with fever, rash and internal organ dysfunction or failure. Organs affected include liver (hepatitis, fulminant hepatic failure), lungs (pneumonitis), kidneys (renal failure, nephritis), brain (encephalopathy and/or aseptic meningitis), and heart (myocarditis, heart failure). Endocrine dysfunction such as hyperthyroidism, … Read more

Dr. Lander’s Eye Manual for Residents

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I would like to thank Jeffrey R. Lander, MD from the Leader Heights Eye Center for agreeing to share his awesome Eye Manual for Residents with the world. In Dr. Lander’s words: “If you are an internist or family practice doctor, you do need to know a few things about ophthalmology. Fortunately for you, you … Read more

Hand Infections You Don’t Want to Miss

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Here are some questions that you should ask (or at least think about!) when evaluating patients with hand infections to help make sure that you don’t miss anything big. Other than this pain, redness, swelling here (etc.), did you hurt your hand in any way? This is perhaps better than asking “Did you punch anyone?” … Read more