The Medical Media Review

Shock and Hypotension: An Expanded Differential Diagnosis

27 July, 201525 November, 2012 by Mark Yoffe, MD

The following is an expanded differential diagnosis of shock. Please let me know if you’d consider adding anything to the list! Cardiogenic Arrhythmias Impaired contractility (volume overload, ischemia, drugs, toxins, electrolyte disorders) Structural problems (valvular abnormalities, etc.) Obstructive Endovascular: pulmonary embolus, atrial myxoma or thrombus Exo-vascular: cardiac tamponade, hypertrophic cardiomyopathy, tension pneumothorax, tension mediastinum, breath … Read more

Hematuria: An Approach

26 July, 20158 November, 2012 by Mark Yoffe, MD

Etiology Traumatic: exercise, Foley catheterization, nephrolithiasis, coitus Infectious: urinary tract infections Malignant: bladder, kidney, prostate Vascular: renal infarct, renal vein thrombosis, sickle cell disease and trait Toxic: cyclophosphamide, antiplatelet agents, anticoagulants, NSAIDS Spurious: menses Workup Step 1: discontinue offenders Anticoagulants and antiplatelet agents Hemorrhagic cystitis: isophosphamide, cyclophosphamide, radiation therapy, methotrexate stone forming agents: loop diuretics, anticonvulsants, … Read more

Book Review: Symptom Based Radiology by Donald L. Renfrew MD (2011)

4 October, 20145 November, 2012 by Mark Yoffe, MD

Choosing the wrong imaging study leads to unnecessary costs, complications, and side effects (no citation needed!). Yet many seasoned clinicians sometimes have trouble with knowing what imaging study to order. I think the author was correct in stating: “I wrote Symptom Based Radiology to help primary care providers make better use of radiology services. The … Read more

Hematologic Emergencies

27 July, 20151 November, 2012 by Mark Yoffe, MD

White cell disorders Tumor lysis syndrome → allopurinol, hemodialysis Leukostasis (leukemia patient with very high white cell count and neurological changes) → leukophoresis Acute hyperviscosity syndrome (in Waldenström macroglobulinemia) → plasmapheresis Red blood cell disorders Methemoglobinemia → oxygen, methylene blue Sickle cell emergencies: Acute calculous cholecystitis → antibiotics, consider surgical intervention Acute splenic sequestration crisis (shock, LUQ pain, acute … Read more

Book Review: Brain CT Scans in Clinical Practice

12 July, 201531 October, 2012 by Mark Yoffe, MD

Brain CT Scans in Clinical Practice by Usiakimi Igbaseimokumo MD is concise, sharp, brilliantly written, practice changing, and full ofnumerous helpful clinical pearls. In places, the advice is extremely straightforward: blood clots or tumours in the brain deep to the pia mater are called intraaxial and those outside the pia are called extra axial. (P. 26-27) … Read more

Book Review: Atlas of Tropical Medicine and Parasitology (2007)

4 October, 201430 October, 2012 by Mark Yoffe, MD

Atlas of Tropical Medicine and Parasitology (2007) by Wallace Peters and Geoffrey Pasvol offers a bleak and sometimes depressing window into the state of health, or lack thereof, of underdeveloped countries, particularly those in Africa. The names of the diseases and symptoms are fearsome and sometimes curious: dengue, blackwater fever, rabies, leprosy, bubonic plague and more. The … Read more

Weakness: An Approach

15 September, 201429 October, 2012 by Mark Yoffe, MD

As a first step, neuromuscular weakness should be distinguished from its mimics, which are: Mental fatigue bradykinesia Decreased range of motion Depression Movement limited by pain. “Abnormal fatigability of striated muscle is the cardinal manifestation of disorders of the neuromuscular junction. Exercise-dependent weakness often affects the extraocular muscles first, causing ptosis or diplopia, as the … Read more