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.

The Most Important Residency Interview Questions and How to Answer Them

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Introduction You will be asked many or most of the following prototypical questions during your residency interview. Practice these questions and your answers to them well, preferably with the help of a medical professional as a mock interviewer. The suggested answers won’t work for everyone. What might come across as genuine for one person could seem … Read more

Ataxia: The Physical Examination

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Ataxia

Ataxia is an extremely important clinical sign that has a broad and important differential diagnosis. Causes of ataxia include posterior circulation strokes and various toxic and metabolic insults to the cerebellum (and sometimes to the spinocerebellar tracts). Ataxia can be a very subtle physical finding, especially when you don’t know what to look for or … Read more

Purpura in Children

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Henoch–Schönlein purpura

The differential diagnosis of purpura in children is guided by two factors: the patient’s illness appearance and platelet count. Sick children with low platelet counts may have conditions like meningococcemia or leukemia, while well children could have Henoch–Schönlein purpura. Always consider meningococcemia in symptomatic cases.

Primary Pediatric Radiology

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Primary Pediatric Radiology

The formula for writing an exceptionally good radiology book is pretty straightforward: Well-organized chapters based on cardinal clinical scenarios Specific recommendations with regard to when and whom to image (or not to image!) Excellent images and annotations Primary Pediatric Radiology, by Susan Williamson, M.D., delivers on all of these points. It is a clinically oriented book, with … Read more

When to suspect an inherited metabolic disease

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Here are seven cardinal clues to the presence of an inherited metabolic disease (“inborn error of metabolism”): Normal pregnancy and birth, but the infant begins to deteriorate after an asymptomatic interval (usually after the first 24 hours of life) Symptoms are precipitated or exacerbated by changes in metabolic state or dietary habits: feeding, starvation, dietary changes, or exertion. … Read more

How to Manage Somatic Symptom Disorder in Medical Settings

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Introduction Somatic Symptom Disorder (previously known, roughly, as somatization disorder) is a maladaptive and counterproductive focus on physical symptoms or sensations, real or imagined. Patients with somatization disorders are really (and sometimes really, really!) suffering, it’s just that they have non-physical states and comorbidities that are making their symptoms worse. These include psychological determinants (e.g., anxiety, depression), social determinants … Read more

The Clinical Significance of the Various Descriptions of Vomitus

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Vomiting

Undigested food → esophageal issue (e.g., pharyngeal pouch or achalasia). Note: this is not really vomiting, but regurgitation, which is much less forceful and does not come from the stomach (and therefore not associated with nausea!) Non-bilious, with partially digested food → Gastric outlet obstruction (e.g., from peptic ulcer disease or malignancy, or from pyloric stenosis) GastroparesisVomiting … Read more