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.

Physical Examination of Muscles in Systemic Disease

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Muscles

How to examine patients and report findings in patients with suspected muscle diseases: Abnormal movements Fasciculation → peripheral nerve injury Tremor Resting → Parkinsonism (with bradykinesia and rigidity) Intention → cerebellar issue → look for additional signs of cerebellar problems (e.g., ataxia) Myoclonus (involuntary purposeless jerks of limbs) → toxic metabolic issues (e.g., hypoxia, uremia, … Read more

The 25 Best Medical Books of All Time

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Radiology Review Manual

Here is the Medical Media Review’s as-of-year-2015 list of the best medical books of all time: Dr. Gerald de Lacey, The Chest X-Ray: A Survival Guide by  (2008, reviewed here). Igbaseimokumo, Usiakimi, MD, Brain CT Scans in Clinical Practice (2009, reviewed here) Herring, William, MD, Learning Radiology, Recognizing the Basics, 3e (2015, previous edit reviewed here) Kurtz, Ira, MD, Acid Base Case Studies (2004, reviewed here) Desai, Samir P., MD, … Read more

Central vs. Peripheral Vertigo Simplified

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Vertigo

The first and most important step in evaluating a patient with vertigo is to attempt to distinguish vertigo of central origin from vertigo of peripheral origin because the management of central vertigo (brain imaging, hospital admission) is very different from the management of peripheral vertigo (symptomatic treatment, outpatient referral). Differences Between Central and Peripheral Vertigo Peripheral Vertigo … Read more

Stroke & TIA Mimics

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Here are the important stroke and TIA mimics: Systemic and metabolic insults: especially hypoglycemia, but also a very wide variety of other systemic insults such as infections (urinary tract infections, pneumonia) and toxins, all of which can cause re-expression of symptoms of old strokes. Peripheral neuropathies such as idiopathic seventh cranial nerve (Bell’s) palsy, peripheral … Read more

Headache: The Ominous Causes

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Introduction Most headaches are benign and do not require a specific workup. Here are the ominous ones that require a specific workup and management. From the Patient History Sudden, severe, and maximal at onset, especially in an older patient without a prior history of headaches → subarachnoid hemorrhage → get a head CT without contrast → CT angiogram or … Read more

Medical Question: Flank Pain

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A 60-year-old female presents to the emergency department complaining of intense left sided-flank pain radiating to the groin. Urinalysis is positive for gross hematuria, while a non-contrast CT of the abdomen and pelvis is negative for stones. The patient is sent for a contrast CT of the abdomen and pelvic, from which the following image is … Read more

How to Remember the Causes of Arrhythmias (the H’s and T’s)

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Causes of arrhythmias, including asystole, include: H‘s: think about what blood does: Volume (hypovolemia) Oxygen (hypoxemia) Glucose (hypoglycemia) Potassium (hypo- or hyperkalemia) Acid-base balance (H+ or acidosis) Temperature regulation (hypothermia) T‘s : imagine a (toxic) lead bullet piercing a chest. What can it cause? Trauma Toxins Tamponade Tension pneumothorax Thrombosis (PE or MI) Reference Dr. Christopher Gallagher’s … Read more