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1.   "13-year-old boy, very overweight, has gynecomastia. Mother said, 'I just read a magazine article about a treatment for gynecomastia.' Is there a pill for gynecomastia? I didn't know of any."
2.   "Are the Typhoid vaccine pills on the market?"
3.   "Are there any cardiac contraindications to Strattera?"
4.   "Are these Xopenex studies showing fewer side effects reliable?
5.   "Care of metacarpal fractures." Relates to a patient seen within the last month.
6.   "Colon cancer screening. I had sent one of my 43-year-old patients to gastroenterology for screening colonoscopy because her father had colon cancer in his 60's. They sent her back, saying we should start screening at age 50."
7.   "Dizziness, I don't know." Smoker, intermittent dizziness. I sent him to a neurologist with the question, "What's the cause of this dizziness?"
8.   "Does pregnancy induce or aggravate radicular pain from low back pain?"
9.   "Dr. X (study physician's partner) have you ever treated Mycobacterium gordonae?" "How do I treat this guy? Where do I go with this guy?"
10.   "Exposure to Stachybotrys? Diagnosis, treatment, prognosis?" 20-year-old man.
11.   "Followup for breast biopsy that shows hyperplasia. Not atypical hyperplasia. But what do you do about breast hyperplasia on biopsy?"
12.   "For a Monospot, I'm not sure what the window is."
13.   "Got any magical cures for nosebleeds? Maybe a legitimate question is when to send a nosebleed to an otolaryngologist."
14.   "Has anybody ever demonstrated that routine prenatal care in low risk patients improves outcomes?"
15.   "Have you ever prescribed Zantac 300 milligrams twice a day?"
16.   "Here's one. Incidence of secondary cellulitis with insect bites."
17.   "How do you workup a rectal prolapse?"
18.   "How would you classify uterine prolapse and when would you refer?"
19.   "Hypothyroid patient seen yesterday. I thought antithyroglobulin was for Graves and thyroid peroxidase was for Hashimoto's." I (investigator) prompted, "So the question was whether you were remembering this right?" And she said yes.
20.   "I can tell you one question I had. I had a patient with dry skin on both palms for years. Three years ago I did a culture and got Aspergillus and treated him with Sporanox for one week and he got better. He came in again with lots of scaling and redness. I cultured him again and got one colony of Aspergillus. I read all these references. Nothing!
21.   "I had a 66-year-old lady with an incidental adrenal mass. Her plasma normetanephrines came back twice the upper limit." "Then I had this question about which medications affect normetanephrine levels, because she's on theophylline and has diabetes.
22.   "I had this patient . . . has to do with dealing with families. 85-year-old woman was declining, dying. At the very end, her daughter would not let up. She wanted to be aggressive and it was completely inappropriate. I didn't look this up, but dealing with family members with difficult end-of-life issues. It was so beyond . . . .
23.   "I have a little question in the back of my mind. 34-year-old woman with sore throat and cough. Husband has a documented peritonsillar abscess. Are you more likely to have streptococcal pharyngitis if your spouse has an acute peritonsillar abscess?
24.   "I have a question. You know how some kids pop a lot when you pick them up? I (physician) said, 'Well, I don't know but it's probably normal.'" I (investigator) asked later to confirm that she (study physician) meant popping joints and she did.
25.   "I have another one for you. It's actually quite interesting. It's a hospital case. What is the followup if any for Type B aortic dissection (below the subclavians)?
26.   "I should look this up but . . . . I have a lady with terrible trigeminal, first division pain. I'm going to start Famvir, thinking that it's zoster. My question is, should we also give steroids?
27.   "I went over the list to see if I had any questions from this morning. A child came in for tonsillar problems. 8-year-old female. Wondered about indications for tonsillectomy.
28.   "Ideal treatment for peripheral edema from nonsteroidals other than stopping them?"
29.   "If people on statins, who have subjective muscle aching, if they are at higher risk for rhabdomyolysis. Is it the same type of process? And have normal creatine kinase of course."
30.   "If their high-density-lipoprotein cholesterol is 70 and the low-density-lipoprotein cholesterol is 160, who wins the battle?"
31.   "If you take iron, it makes the guaiac positive, right?"
32.   "In patients who have had a hysterectomy, is there any sense in doing pelvic exams?
33.   "Is Bextra better or worse than other COX-2 (cyclooxygenase-2) inhibitors?
34.   "Is it overkill . . . . I don't know if this is the kind of thing you want. Forty-four-year-old with change in bowel habits, diarrhea, constipation over the past couple of months. With that history in a 44-year-old would you refer for colonoscopy?"
35.   "Is there a familial high thyroid-stimulating hormone syndrome where the thyroxine and triiodothyronine are normal?"
36.   "Is there any interaction between atenolol and methyldopa?"
37.   "Is there any relation between iron deficiency and thrombocytopenia or could iron deficiency cause the low platelets? Or could the viral illness have caused the anemia and the low platelets?"
38.   "Is there any validity to "essential glyconutritionals"?
39.   "Is this herpes?" Refers to a 20 year-old woman with genital lesions.
40.   "It's just hearsay about . . .like the tuberculin skin test. It's not clear to me whether it's a requirement.
41.   "No big questions except I had the usual prostate-specific antigen conversation." The study physician and I (investigator) then had a long conversation in which it became clear that the question was whether to do routine prostate-specific antigen screening.
42.   "OK, do you have to wean Strattera? I don't know."
43.   "One other question I had today -- differential diagnosis of false positive RPR (rapid plasma reagin)."
44.   "One thing I did look up last week was the definitions for the New York Heart Association Heart Failure classification. I needed it to complete some paperwork for one of my patients."
45.   "Osteopenia in males. Do you treat it the same way as in women?"
46.   "Overweight woman having more hot flashes. All the specifics about that. For example, does it take longer to get over them if you are overweight? How long does it take to get over them when you stop hormones?"
47.   "PEG-interferon (pegylated interferon, polyethylene glycol) in Hepatitis C. There's some information out there about it but . . . ."
48.   "Pertussis. I had to look up whether or not we have to treat the people who are exposed and whether to use erythromycin.
49.   "Seven-year-old girl with grade II reflux and mild constipation. In attempting to treat the constipation, is olive oil or vegetable oil just as effective as, or an alternative to mineral oil?"
50.   "Should a patient who took too much amitriptyline get bicarbonate and if so what are the criteria for giving it? How bad does the overdose have to be before giving bicarbonate?"
51.   "That would be an interesting question. Whether there is any difference between a physician managing Coumadin and Coumadin clinics managing Coumadin."
52.   "The only thing I need to look up . . . 12-year-old girl with hepatitis C, for 6 months has been on interferon and ribavirin and in the last two months her enzymes have been essentially normal but on the last test, the enzymes jumped from about 40 to about 400. Now we have pegylated interferon. "Do I try pegylated interferon with ribavirin?"
53.   "The question is what is rhinomanometry and can we do it here. I've never heard of it."
54.   "This first patient (7-year-old male) had abdominal pain. There were no real questions except why . . . This kid is clearly atopic. He saw an allergist at age 5 and the allergist said we need to wait 2 or 3 years before doing a full evaluation. Do we really need to wait?"
55.   "This lady wanted to know if Centrum with Ginseng interacts with any of her medications."
56.   "Three-week old boy admitted with pyloric stenosis. Intravenous fluids." I (investigator) asked what the question was. She said, "He was still keeping some formula down, but if he did stop eating, I wanted to know what kind of intravenous fluids to give. I knew how to calculate the rate, I just wanted to know the kind of fluid."
57.   "Thyroid and weight fluctuations -- fact or fiction?" I think if you have Graves disease you can lose weight but I don't believe you gain weight with hypothyroidism. "What's the correlation?"
58.   "Von Willebrand's is autosomal dominant but what is the penetrance?"
59.   "We had a question." The study physician said this as he came out of the exam room with a resident. "The safety of lansoprazole in pregnancy."
60.   "What antihypertensives are OK in someone who wants to get pregnant?"
61.   "What are the chances of getting a viral gastroenteritis twice in one month?"
62.   "What do you do about . . . ? What about . . . ? One of my pet peeves . . . . Do I need to take magnesium for my osteoporosis?"
63.   "What do you do with hilar adenopathy in a kid with pneumonia? Is this a normal finding with pneumonia? Do you need to worry about a lymphoma?"
64.   "What does anagen mean? I haven't heard that word."
65.   "What is an alternate drug for otitis media for an adult who is allergic to penicillin?"
66.   "What is effect of magnesium on potassium?"
67.   "What is the best exercise for people with degenerative joint disease of the knee?" She meant aerobic exercise to lose weight.
68.   "What is the best radiologic test to order to rule out brain tumor? Computerized tomography or magnetic resonance imaging? Do you always want to do the computerized tomography with contrast?
69.   "What is the chance that aspirating a joint effusion that is not red or tender will yield anything diagnostically?"
70.   "What is the complete workup for a meconium plug in a newborn?"
71.   "What is the difference between gender identification disorder, gender dysphoria, and gender incongruent behaviors?"
72.   "What selective serotonin reuptake inhibitor has the highest incidence of serotonergic syndrome?"
73.   "When are you too old to have varicose vein surgery?"
74.   "When we do a sigmoidoscopy, when can we say it was a good one?" Certainly 60 centimeters is good and probably 45 or 50 but what about 30 or 35?
75.   "Where do I get growth charts for Downs babies?"
76.   "Who would you give primary prophylaxis with aspirin for vascular events?
77.   "Why does the American Academy of Pediatrics, American Academy of Family Physicians, and the Centers for Disease Control recommend five Diphtheria-Pertussis-Tetanus immunizations but the State of Iowa only requires three before school entry? And only three polios?"
78.   "Why is it difficult for postmenopausal women to lose weight?"
79.   "With chickenpox, when do you use Acyclovir?"
80.   "Would any further workup be needed in a patient who is having post traumatic headaches?"
81.   1-year-old boy got chickenpox vaccine a couple of weeks ago and now has a red reaction at the site with red bumps. So whether that was a reaction to the vaccine or what, I didn't know.
82.   10-month-old male. "Does the flu shot have Thimerosal?"
83.   10-year-old boy with attention-deficit-hyperactivity disorder. "Is there less appetite suppression with Adderall than Ritalin and Concerta?"
84.   10-year-old boy. What behavioral interventions are available and useful in treating this child who is currently skipping school, oppositional, with history of attention deficit disorder, fetal alcohol syndrome, oppositional defiant disorder, because whatever they're doing now is not working?
85.   10-year-old girl complaining of a buffalo hump on the back of her neck. What causes a buffalo hump besides Cushing Syndrome?
86.   10-year-old girl has prominent painful distal ulnas. We thought these were cysts (my partner and I).
87.   10-year-old girl with chronic urticaria. She had a positive antinuclear antibody test. The parents asked me what are the chances of getting lupus later.
88.   11 and 1/2-year-old male with intermittent testicular pain for the last 6 weeks. Episodic, exam within normal limits, no hernia, urinalysis negative. The question is, what is the etiology?
89.   11-year-old boy. Downs. My number 1 question is, do patients with Down Syndrome . . . Are they more sensitive to adverse effects of anticonvulsants?
90.   11-year-old girl with asthma. I want to wean her off the Serevent (she's using too much) and start her on a steroid inhaler, but I want to use the steroid that's in Advair in case I have to use both a steroid and Serevent (that is, add back the Serevent). So the question is, what is the steroid that's in Advair.
91.   11-year-old girl. If someone is sucking on a throat lozenge, does that affect the throat culture or the rapid streptococcal test?
92.   11-year-old with a wart on the hand. The question is "Is this a dermatology referral or we should do something else here or what?"
93.   12 year-old girl with chronic form of idiopathic thrombocytopenic purpura. She gets routine draws every month and today her platelets were down to about 9000. I know at around 8 to 10 you're supposed to treat but the question is, exactly at what level are you supposed to treat and what is the treatment?
94.   12-year-old boy fractures his metacarpal, came in 10 days later. In adults you would expect healing to have started by 10 days but what about a 12-year-old?
95.   12-year-old boy got his first Hepatitis B vaccine a year ago. Mother just spaced it off and never came back for the second in the series. Does he need to start over and if not, when should the second shot be given and when should the third be given?
96.   12-year-old boy on Ritalin has an elevated alkaline phosphatase (approximately 360 with normal 30 to 325) and phosphorus (approximately 6.0 with normal 2.3 to 4.6). I'm not sure if Ritalin can cause that or what can cause it.
97.   12-year-old boy with autism and attention-deficit-hyperactivity disorder. What would an appropriate sedative be for occasional procedures such as haircuts and dental appointments?
98.   12-year-old boy with posterior malleolar fracture. "What do I do with this?"
99.   12-year-old boy with urinary frequency for several weeks. When do you refer to a urologist? How much urinary frequency is normal and can just be chalked up to nerves, with a normal urinalysis? What's your threshhold for referring?
100.   12-year-old boy. I'm seeing a lot of patients with cough. When is it appropriate to investigate for pertussis and how do you do it?
101.   12-year-old girl. "How cold does it have to be to cancel recess?"
102.   13 and 11/12-year-old boy, lives in a group home, has had neck pain for two days. The question is, "Do you get an x-ray or not?"
103.   13-year-old boy complaining of gynecomastia. Obese, type 2 diabetic. I don't know what to do about the gynecomastia. I don't know whether hormonal treatments would be better or surgery.
104.   13-year-old boy with jaundice. I saw him one time and his eyes were yellow. We did a big workup and the bilirubin was 3 but everything else was normal. I asked a pediatric gastroenterologist what would give this picture and is there a test for Gilbert's disease.
105.   13-year-old boy with lymphoma had a 10-pound weight loss. Increased amylase was the only abnormal lab. He was still growing appropriately for his age (still within the appropriate percentile lines). The question was, "How aggressive should I get?"
106.   13-year-old boy with ventriculoperitoneal shunt, spina bifida, comes in with headaches. Always a question, is it a shunt malfunction or just a virus? The question is, "When does he really need a computerized tomography?"
107.   13-year-old boy. When you have joint custody, does that mean both parents have to agree to tests and treatment or can just one agree?
108.   13-year-old girl here for sports physical. Has a history of concussion (saw this when looking at chart before entering the room). "I often have to review the concussion rules. I have them in my file."
109.   13-year-old girl here for sports physical. The question is, "What is the differential diagnosis of an intermittent croupy cough?"
110.   13-year-old girl with abdominal pain and depression. I never put a 13-year-old on Xanax before, "so, I'll probably look it up later." But then she started looking it up. I (investigator) asked what the question was. Was it the dose or . . . . She (physician) said she's never used it in kids before. She looked at a reference. "Under 18 not recommended. Well fine, but if I do want to use it, how ...
111.   13-year-old girl with menorrhagia. She has a relative with von Willebrands and the mother asked me if this could be the cause of her menorrhagia. I said it could but the question was, "How exactly do I figure it out?"
112.   13-year-old male. Popping and cracking in TM joints for 6 months. No pain, no limitation of movement. Does anything need to be done?
113.   13-year-old premenarchal female with scoliosis and a 22 degree curvature at T5 to T10. "Should the patient be followed in a few months or referred to orthopedics?"
114.   13-year-old, former shaken baby with resultant spastic quadriplegia and cortically blind. The concern is that after a suppository he gets red in the face and squeezes out all these little pebbles. "Is an unprovoked stool every 3 days that bad?" Does it lead to perforation?
115.   14-year-old boy with mallet finger, the fracture fragment was pulled down away from the phalanx. I (investigator) said, "And the question was . . . ?" She said, "What do I do?"
116.   14-year-old boy with swelling over lower lumbar area. No pain, no injury. Horizontal area of swelling between the hips. Plain x-ray negative. I wasn't sure if any further workup was needed.
117.   14-year-old boy. Ketaconazole for tinea capitis. I (investigator) asked if the question was the dose. He said, "Dose and duration of therapy."
118.   14-year-old girl with a lump on her thigh. I looked in an anatomy book. I just wanted to be sure there was nothing else in there besides the rectus muscle and the quadriceps.
119.   14-year-old girl with rectal itching. Would like to check for pinworms, but to order that test, I need to know the name of it. I need to know what the test is called.
120.   14-year-old male with influenza. What is the dose of amantadine?
121.   14-year-old with asthma. Mom asked about Advair, saw it on TV. "I've never prescribed it before. I've not used it. This is more for prevention isn't it?"
122.   15 year-old girl had a portacath placed three weeks ago. Wound is draining, red, dehiscing, I can almost see the portacath. What to do with this?
123.   15-month-old born prematurely with Potter's syndrome. Now has poorly functioning kidneys. "I don't know if the failure to thrive is secondary to the foster mother or the renal problems."
124.   15-month-old boy with anemia and failure to thrive. I decided this was a viral thing. But, "how do I follow this up?"
125.   15-month-old girl. At age 12 months she had a microcytic anemia (hemoglobin about 11, mean corpuscular volume about 68 with normal over 75) and I put her on iron for 3 months, but after that she was still anemic (about 12) and the mean corpuscular volume was not back to normal (it was about 73). We did iron studies and a hemoglobin electrophoresis but these were normal. Now she has microcytosis...
126.   15-month-old had idiopathic thrombocytopenia purpura last spring with a platelet count of 2000. Initially had some blast forms. I (investigator) never got a clear idea of what the question was and asked the study physician if the question was "Could this infant have infantile leukemia?" He said, "Yes and the prognosis."
127.   15-month-old male had been cruising and just started walking. He has an unusual gait (the physician demonstrated it for me, the investigator). He walks normally with one foot but there is no swing-through phase of gait with the other, the other just stops when it is across from his planted leg (like a half-step). Is that from walking around furniture for so long? I wasn't sure.
128.   15-month-old well child exam but he has eczema not responding to hydrocortisone cream and moisturizing cream. If hydrocortisone cream doesn't work, what do I go to next? When do you go to tacrolimus cream?
129.   15-month-old. At what age should you give a child a pillow?
130.   15-month-old. Was he adequately vaccinated for polio or did he need another? He's had three polios so far.
131.   15-year-old boy with acne, tetracycline not working. What should I try next that is cost effective?
132.   15-year-old boy with history of tracheoesophageal fistula, often hospitalized when younger with respiratory illnesses. One time he had respiratory syncytial virus and was very sick and I called the tertiary center. "Should I give him Ribavirin?"
133.   15-year-old boy with vomiting and diarrhea. He has a gastroenteritis but is it from food poisoning or a virus?
134.   15-year-old girl I saw yesterday with vomiting and syncopal episode. Urinalysis showed 4+ glucose, blood sugar approximately 160. Today oral glucose tolerance test approximately 100, 230, 220, 190, 150. What action do we take now? Is this a kid you would start getting Glucometer readings on?
135.   15-year-old girl with chronic headaches. The question I have is, as we taper her off, can you use triptans to help taper someone who has chronic analgesic induced headache or how do you taper them off?
136.   15-year-old girl with post-influenza pneumonia. What should you treat with?
137.   15-year-old with an influenza-like illness, increased lactate dehydrogenase (LDH) and bilirubin. We had a recent death on the football field here (anomalous coronary artery). This patient is a football hero and the original question was whether to let him play. I did.
138.   16-month-old with intoeing. I had to look up intoeing before I went into the room. I (investigator) asked what the question was. He said, "How to distinguish whether the intoeing is just physiologic?"
139.   16-year-old girl got a tattoo from an unlicensed tattoo artist 3-4 months ago. Can a 16-year-old give consent for a human immunodeficiency virus test?
140.   16-year-old girl with chronic abdominal pain. She's lost 15 pounds in the last several months and they (parents) think she may have a problem with absorption. The question is, "What's the best way to look for those things?"
141.   16-year-old girl with primary pulmonary hypertension. "If she gets wheezing, can I give albuterol? What does albuterol do to pulmonary artery pressure?"
142.   16-year-old girl, mildly overweight with irregular periods. Is it worth working up?
143.   16-year-old with attention-deficit-hyperactivity disorder on Dexedrine SR. The question is whether it is OK to mix these two drugs (Dexedrine and Ritalin) to even out the effect over time. What are the potential problems with doing this?
144.   17-month-old male with pharyngitis, home from hospital and noted on Thanksgiving Day that 8 to 10 hours after starting steroids, he had noted an increased appetite. Question is do steroids increase appetite that quickly?
145.   17-year-old boy with "documented" micturition syncope. Heart rate 40 when seen. But I'm not sure I'm satisfied with that diagnosis. He had a normal thyroid stimulating hormone but I'm going to get a free thyroxine (Free T4). The question is, was this micturition syncope?
146.   17-year-old female with sore throat and mono-like syndrome had elevated bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. The question is, what is the etiology of this?
147.   17-year-old for a Reserve Officers' Training Corps physical. He has a Grade I to II systolic murmur. Should he get an echocardiogram?
148.   17-year-old girl complaining that her left lower quadrant is "hard." My question was what is the best way to evaluate this.
149.   17-year-old girl with Turner's syndrome and chest pain, thought to be secondary to anxiety, seen in emergency room. Parents say she sometimes has hallucinations. Should she be on antipsychotic medications?
150.   17-year-old girl with institutional colon. The question is how to treat her.
151.   17-year-old with institutional colon, rolling on the floor, screaming. They gave a soap suds enema but that was no help. The home was calling the physician for advice. The physician said, "What's the best treatment for institutional colon?"
152.   18-month-old male with cervical and supraclavicular adenopathy that persisted for 6 months. I get this a lot. Concerns from the mother. I (investigator) prompted, "What is the question?" He said, "I'm looking for more guidelines. Information in the books is meager."
153.   18-year-old female was vaccinated for chickenpox four years ago and again one month ago. She got a pruritic vesicular rash. How common is it to get chickenpox after the vaccine?
154.   18-year-old girl with low back pain for 18 months, ever since a motor vehicle accident. "I never know what to do with low back pain. Do you x-ray them? Or just have her seen by an orthopedic doctor? Or get a magnetic resonance imaging?"
155.   18-year-old male with a thyroid stimulating hormone of about 300, triglycerides 2000, low-density-lipoprotein cholesterol 450, high-density-lipoprotein cholesterol 20. My question was, "With that high a thyroid stimulating hormone, do we start with a higher than normal dose of Synthroid (0.1 milligrams)? And is any other evaluation indicated?"
156.   18-year-old male with hematuria. The question was how to interpret the antistreptolysin O (ASO) titer results. He was worried about acute glomerulonephritis in this patient. The antistreptolysin O titer on this patient was elevated.
157.   18-year-old woman had a positive Influenza A test. Her step father comes in 4 days later sicker than a dog. "Which one works to treat Influenza A?" "Would amantadine work because he didn't want to pay for Tamiflu."
158.   19-year-old coming in with "vitiligo." He said this before seeing the patient. He said, "Let's just look this up as he pulled a reference off his shelf. Before he had a chance to look anything up, I (investigator) said, "Before you look, what's the question?" He said, "Oh, just is there any treatment? And how to distinguish from that fungal infection?
159.   19-year-old female with severe cerebral palsy with history of cytomegalovirus (CMV) many years ago. Question is whether it is safe for others to care for her. Had note on his desk from phone call.
160.   19-year-old man from college, saw last week, had big lymph nodes and a rash and 13% eosinophils. What is the cause of the eosinophilia?
161.   19-year-old thin Type 1 diabetic inpatient with severe episodes of right upper quadrant pain. Normal ultrasound and upper endoscopy but her HIDA (hydroxyiminodiacetic acid) scan showed "barely visible gallbladder" and poor "ejection fraction." The question is what to do with this HIDA (hydroxyiminodiacetic acid) scan result. Could being NPO (nothing by mouth) affect the HIDA (hydroxyiminodiacet...
162.   2-month-old boy had a seizure versus apneic episode at age one week while I was making rounds. She said, I'm going to give his immunizations today. "I just want to make sure it's OK to give his DTaP (diphtheria-tetanus-acellular pertussis vaccine)."
163.   2-week-old female. Parents asked when is it appropriate to get ears pierced.
164.   2-year-old boy who has some autistic features. The main question was . . . mother says she tried a gluten-free diet. She didn't think it worked, he became more irritable because he likes pasta. She came right out and said, "What do you think about the diet, Doc?"
165.   2-year-old boy with fever and back pain. What is the normal range for the white blood count in a 26-month-old?
166.   2-year-old with otitis media. What is the dose of Augmentin? Then he remembered she was allergic to penicillin and the question became, "What is the dose of Biaxin?"
167.   2-year-old. "I didn't know if the otolaryngology associations have any succinct guidelines for myringotomy tubes for kids."
168.   20-year-old volleyball player with leg cramps. Coach said to try quinine. I've used quinine for night cramps with fair results, but I've never used it in the setting of young athletes.
169.   20-year-old woman wanted to know what her weight should be. I remember she was 20 pounds overweight and was 5 feet 9 inches tall.
170.   21-year-old female. Father had a coronary angioplasty at age 36. Do you screen her for coronary artery disease and if so when do you start screening?
171.   21-year-old female. I never know what to do with patients who complain of vaginal discharge and on exam there seems to be more discharge than usual, but all you see under the microscope are white cells, no clue cells or other apparent cause.
172.   21-year-old man with diabetes, I saw last Saturday when I was on "city call" (taking patients in the emergency room who had no personal physician). He had new-onset diabetes but the question was, "Was it Type 1 or Type 2?"
173.   21-year-old man. I looked up to see, in a guy I used Lamisil for toenail fungus, do you need to do liver function tests?
174.   21-year-old pregnant woman had a one-hour glucose of about 190. Her glucose tolerance test was about 90 (fasting), about 210 (one hour), about 160 (two hours), about 130 (three hours). Normals are less than 105, 190, 165, 145. "Do I need to be checking a random blood sugar every time?"
175.   21-year-old woman, has been on cholesterol medications, on massive doses of things, well not massive, but she's on Lipitor and Lopid and then Tricor. Triglycerides 415, cholesterol 157, high-density-lipoprotein cholesterol 26, low-density-lipoprotein cholesterol cannot calculate. I asked my partner, "What would you do with this girl?"
176.   21-year-old woman. "For people with recurrent bacterial vaginitis, do you do any suppressive treatment?"
177.   21-year-old. What to do about bacterial vaginitis in the first trimester of pregnancy?
178.   22 year-old man. Does Ritalin raise blood pressure?
179.   22-year-old first prenatal exam. There is a question on the form, "have you ever been tested for sickle cell trait?" But what if they haven't been tested? Is it a screening test that's recommended in pregnancy?
180.   22-year-old man on Ritalin for attention-deficit-hyperactivity disorder. After he takes his dose, he craves cigarettes. I (investigator) said, "I've never heard of that." She (physician) said, "I haven't either."
181.   22-year-old woman complains that her heart feels like it's jumping out of her chest, light headed, dizzy, suffocating feeling, mother said she had a hole in her heart. Sounds like anxiety. I got thyroid functions, but my question is, "Do you go as far as to get a Holter monitor on these patients?
182.   22-year-old woman. Group B streptococcus on urine culture in early pregnancy. Now 35 weeks. "Do you still do a culture at 35 weeks?"
183.   23-year-old man with tinea cruris and athlete's foot. He's a student so he doesn't have any money. I looked up to see if you could use Sporanox for tinea cruris.
184.   23-year-old woman with Graves disease. She developed an absolute neutrophil count of 30 on Tapazole (total white count 3000, 1% neutrophils). Is there any cross reactivity between Tapazole and propylthiouracil? Is it safe to start propylthiouracil?
185.   24-year-old woman with chronic hepatitis B and a seizure disorder and elevated alanine aminotransferase. Can Depakote cause an elevated alanine aminotransferase?
186.   24-year-old woman with chronic hepatitis B and a seizure disorder and elevated alanine aminotransferase. Does a patient with chronic hepatitis B need a liver biopsy? Would you do anything anyway? There is no treatment like there is with hepatitis C, is there?
187.   25-year-old male with severe headaches and constipation. Is Sansert causing the constipation?
188.   25-year-old woman in for a physical exam. Her mother and grandmother both have breast cancer. She asked me when her first screen should be. The question is when should you start doing mammograms in this situation.
189.   25-year-old woman with severe anxiety, on Xanax, and also vomiting because of gastroesophageal reflux disease. I know they make a topical Ativan gel. They use it for hospice patients with vomiting. So I was wondering about using it in her. I don't know how you'd switch to that exactly. It's kind of a question running through my mind.
190.   26-year-old man wants to stop smoking. One question I've always wanted to look up: Is the combined use of Zyban with nicotine replacement better than either one alone?
191.   27-year-old female. Patient called in and nurse discussed her with her doctor. He didn't see the patient. Today he ordered Levsin -- told nurse he didn't know the strength but give plain tablets and call in order to pharmacist.
192.   27-year-old homeless man, alcoholic, drug abuser, hepatitis C, hepatitis B. I'm just looking up with Klonopin, he's using so much alcohol, how safe is it to use Klonopin in someone who uses alcohol and has chronic hepatitis B and hepatitis C.
193.   27-year-old man with Type 1 diabetes. The magnetic resonance imaging showed a thalamic stroke. The erythrocyte sedimentation rate was 90. "That kept troubling me." I don't know what else to do. Is it from the diabetes? Is it from the anemia? Is that the reason for his erythrocyte sedimentation rate or should I work it up further and how to work it up?
194.   27-year-old woman had a miscarriage (actually at 4-5 months) and has anticardiolipin antibodies. My question was how to treat that.
195.   27-year-old woman with rash on her face. The rash almost had a butterfly pattern and my question was whether warfarin can cause a lupus-like reaction.
196.   27-year-old woman. "For someone on Ritalin for adult attention deficit disorder and depression, who has an elevated blood pressure and pulse, is there any alternative?
197.   28-year-old obstetric patient with a rash. What is the rash?
198.   28-year-old woman had a deep-vein thrombosis and pulmonary embolus with her first pregnancy. I diagnosed her with prothrombin mutation. I had a terrible time finding out how to treat her.
199.   28-year-old woman had a deep-vein thrombosis and pulmonary embolus with her first pregnancy. I diagnosed her with prothrombin mutation. Now she is on her second pregnancy. "What kind of anticoagulation does she need? Really the question was unfractionated heparin versus low molecular weight heparin."
200.   28-year-old woman with premature ovarian failure, diagnosed at a tertiary center. She's been on several types of hormone replacement and always gets migraine headaches from them. The question was what other preparations could we use that would be better for her migraines.
201.   29-year-old man. Can Paxil cause weight gain or alopecia?
202.   3-week-old with intussusception. Now seems to have a formula intolerance. Is there any association between formula intolerance and intussusception?
203.   3-year-old boy born at 24-weeks gestation. Has cerebral palsy. Mother is taking him for hyperbaric oxygen treatment. I (investigator) said, "This may not be a question for you but it is for me, whether hyperbaric oxygen treatment is effective for this." He (physician) said he didn't know either but he doesn't think so.
204.   3-year-old boy with dysuria. Urinalysis totally clear except for many calcium oxalate crystals. Can that cause dysuria?
205.   3-year-old boy. Alternating Tylenol and ibuprofen. Is it efficacious? Have there been any randomized controlled trials?
206.   3-year-old boy. Bullous myringitis. I'm curious to know if there is any need to give different treatment from the usual otitis media.
207.   3-year-old boy. Phone call from mother. The dentist says he's grinding his teeth a lot at night and the dentist is concerned, but he didn't tell her what to do. So the question is what to do. Psychological treatment? Medical treatment?
208.   3-year-old girl losing her hair and becoming mean, biting behavior. "Is there a specific reason for this? I'm not sure exactly what's causing this."
209.   30-year-old female exposed to influenza. Tamiflu versus Amantadine. Is there any difference in efficacy for prevention?
210.   30-year-old man with a rash on his abdomen and legs, quite extensive, never seen this kind of rash before. The question is, what is this rash?
211.   30-year-old man with alcoholic cardiomyopathy. Is it OK to drink at all?
212.   30-year-old woman had trichomonas on Pap smear. I had to look up the dose of Flagyl for Trichomonas.
213.   30-year-old woman with multiple sclerosis now has fever, nausea, vomiting, fatigue, and rash (confluent macular). "Are steroids appropriate in a multiple sclerosis exacerbation that may be due to a viral illness?"
214.   31-month old twin with developmental delay. I wonder if there have been twin studies on autism.
215.   31-year-old pregnant woman with a cough. I'm just double checking to see if Augmentin is safe during pregnancy and to see if guaifenesin is safe.
216.   31-year-old woman in for annual exam. Is Saint John's Wort helpful for premenstrual syndrome?
217.   31-year-old woman in for annual exam. Is St. John's Wort safe during pregnancy?
218.   31-year-old woman is breast feeding, complains of being tired and has a stomatitis with aphthous ulcers in her mouth. The question is whether tetracycline crosses into the breast milk.
219.   32-year-old exposed to chickenpox. She had the first immunization but not the second. Her question and mine: "Since she didn't get the second shot, will she get a mild case or full blown case or what?"
220.   32-year-old man chews tobacco. Does the patch help to get him off? Does the gum help?
221.   32-year-old man with shortness of breath on exertion, supposedly has Type 2 diabetes, has family history of cardiomyopathy. The question is how to address this issue. Is he having hypertensive cardiomyopathy? Is he having familial cardiomyopathy? And which antihypertensive would be best? Should I give a beta blocker because of the possible hypertensive cardiomyopathy? Should I give an angiotens...
222.   32-year-old nulliparous female. Amenorrhea (no galactorrhea) for 4 months. Pregnancy test negative, did workup, prolactin elevated to 90. (1) What is the recommended further evaluation of this elevated prolactin? (2) Leave it alone? Image? (3) If she doesn't want to get pregnant, can I use the elevated prolactin as a reliable form of birth control and tell the patient she doesn't need to use co...
223.   33-year-old female. The patient said, "I have been on inhaled steroids for 8 months and I am feeling aches in my arms. Can this medicine cause muscle aches and disease like the oral? I read about it over the Internet."
224.   33-year-old woman on birth control pills. She bleeds appropriately at the time of her periods but also bleeds at other times. If she was on a lower estrogen pill, like if I switched her from TriLevlen to Allesse, would that help? The whole issue of how to deal with abnormal vaginal bleeding pre- and post-menopausal is a question.
225.   33-year-old woman with vaginal bleeding had a positive pregnancy test. "After a miscarriage, how soon should the beta-human chorionic gonadotrophin levels fall?"
226.   33-year-old woman. Father and brother have Huntington's Chorea. "What are the warning signs of Huntington's Chorea? Is depression an early sign?
227.   34-year-old female, history of intermittent abdominal pain followed by diarrheal stool, followed by nausea, followed by vomiting. This occurs about 1 time per month or every other month but no menstrual pattern. Barium swallow, upper gastrointestinal series, gall bladder ultrasound all negative. What is causing these symptoms?
228.   34-year-old female. Mother had breast cancer at age 49. "When do you start screening?"
229.   35-year-old female with "throat feels funny" Possible allergies. She couldn't describe the feeling other than her throat feels funny. The question is what is going on? Could it be related to her beta blocker?
230.   35-year-old female with recurrent sinusitis despite steroid nasal spray, normal saline rinses, decongestants (Claritin D), and 3 surgeries for nasal polyps. Is there an antibiotic solution for rinsing the nose and sinuses?
231.   35-year-old man with obsessive compulsive disorder. The patient asked me, "What is the incidence of celiac disease?"
232.   35-year-old man, blood in the urine, very smelly urine, frequency and dysuria. I thought probably prostatitis. Got a urinalysis yesterday and started Levoquin because it was late in the day. But today his urinalysis came back negative and he has a dry cough, but his chest x-ray is also negative. "What am I gonna do? Treat that?"
233.   35-year-old man. Gynecomastia in males. My question is, is there any way of clinically knowing that it is benign, so that I would not have to refer?
234.   35-year-old man. My question is, "What is the incidence of sexual side effects with clomipramine?"
235.   35-year-old man. What are the long term complications for coarctation of the aorta repair in an adult who had the repair as a child?
236.   35-year-old woman came in with ankle injury. X-ray showed no fracture but there was a large lesion in the distal tibia. "I'm going to look up bone tumors because I don't know anything about bone tumors."
237.   35-year-old woman swallowed her tongue piercing. I called gastroenterology to ask if I should send her home of if they wanted to try to remove it.
238.   35-year-old woman with insomnia. I looked up dosages of Celexa and Ambien online in the exam room.
239.   35-year-old woman with multiple antibiotic allergies. There are only certain antibiotics she can take. Just a couple of quinolones. "But the question is, if she had been positive for streptococcus, I don't know if quinolones . . . what anti . . . ?"
240.   36-year-old woman. "I've asked this question . . . whether it's mandatory . . . blood pressure and birth control pills . . . I've had a couple of patients on it . . . ." I (investigator) said, "So the question is, "If you have hypertension, should you stop the birth control pill?" He said, "Right, right."
241.   36-year-old woman. The thyroid stimulating hormone is low but the free thyroxine is normal. What does it mean?
242.   37-year-old female inpatient with acute tubular necrosis and sepsis. She is anemic. The question is, "Does anything impair erythropoietin secretion other than chronic renal failure?"
243.   37-year-old female inpatient with acute tubular necrosis and sepsis. She was vomiting. "Can serosal implants (eg from metastases or endometriosis) cause vomiting without radiographic signs of bowel obstruction?"
244.   37-year-old man with a viral upper respiratory infection. Is it okay to give the influenza shot to someone with an upper respiratory infection?
245.   37-year-old man. I looked up the smallest dose of Prinivil in the exam room, online.
246.   37-year-old on Triphasil with 10 days of bleeding starting 5 days before the placebo pills. I'm just checking the dose of Provera for dysfunctional uterine bleeding.
247.   37-year-old on Triphasil with 10 days of bleeding starting 5 days before the placebo pills. The study physician asked me (investigator) how I would treat this patient.
248.   38-year-old female seen this morning. How to workup case of suspected infectious mononucleosis in someone with a history of infectious mononucleosis?
249.   38-year-old female with intertrigo. The question is, what is the current treatment for intertrigo?
250.   38-year-old female, chronic cocaine abuser. "A woman admitted with possible cocaine ingestion. In body stuffers, is it safe to use GoLYTELY?
251.   38-year-old female, health care worker, didn't get the flu shot. Daughter has influenza A. How long are you contagious when you have Influenza A?
252.   38-year-old man with sweaty feet and keratin build-up on heels. The physician started looking in a reference. I (investigator) asked her to phrase the question. She said she was just looking up keratolysis. I said, 'Could you say the question is "What are the characteristics of keratolysis?'" She said yes, you could say that.
253.   38-year-old man. Heel pain. I (investigator) asked what the question was -- was it "What is the best treatment for heel pain?" He said, "What is the best treatment that the literature has shown to be most effective and most cost effective."
254.   38-year-old man. What are the Ottawa criteria for ankle x-rays?
255.   38-year-old woman. "Does all axillary breast tissue have to be removed?"
256.   38-year-old woman. Why is the glycosylated hemoglobin good (6.5) even though the blood sugars are mostly high (150 fasting and 200's by the end of the day)?
257.   39-year-old woman on Paxil for depression and says she's 30% better. She's complaining of fatigue. I'm going to switch her to Zoloft, but I'm not sure what the differences in side effects are.
258.   39-year-old woman with complaints of vaginal discharge and clue cells on wet mount. I treated her with metronidazole. She has it back again. Why did she get it again so soon? What is the failure rate with metronidazole for bacterial vaginitis? What are the predisposing factors for bacterial vaginosis?
259.   4-day-old white male, newborn in the hospital, I delivered. He was just about to go home and the nurses said, by the way, he's been tachypneic for the last hour or two, with respiratory rates of 60 to 70. The question was, can tachypnea result from laryngomalacia.
260.   4-year-old girl with a rash. What is this rash?
261.   4-year-old girl with an ear infection last week, treated with Augmentin. Doctor X saw her yesterday and noted marked tenderness of the mastoid. He (study physician) started looking in the index of a reference and I (investigator) asked him what the question was. He said, "What imaging study would be indicated?"
262.   4-year-old girl with intermittent vomiting, two times per week for the last 5 weeks, always at night. The question is "What is it?"
263.   4-year-old girl. "What percent of bronchitis in pediatric patients is viral?" I think 90%.
264.   40-year-old female injured her left knee three months ago. Serial plane films were normal but we just repeated the magnetic resonance imaging because of persistent pain and it still shows the fracture without sign of healing but in good position. The question is whether to continue conservative treatment with the knee immobilizer or do something more.
265.   40-year-old female with diabetes and tinea pedis. Not resolved with Lamisil over the counter. What other broad spectrum cream should she use?
266.   40-year-old guy with an ileal conduit. What is an ileal conduit?
267.   40-year-old male. The patient asked me, "Do you think I will ever be able to get off hyperlipidemia medications? How will we know when to stop them?"
268.   40-year-old man drinks 12-15 beers per week. Has megaloblastic cells but is not anemic. Does he need any other laboratory work?
269.   40-year-old man with diabetes, wanted disability. They never teach this in medical school but it's so common in practice. How to do a disability evaluation (was my (investigator) sense of the question).
270.   40-year-old man with diabetes. He said, "I'm feeling dizzy and have a headache. Do you think it could be my medicine?" But it wasn't his medication. My (physician's) question was, "What is causing the dizziness?"
271.   40-year-old woman came to the emergency room with tetany and sensory changes in her back for 3 days and she had hypomagnesemia. She also had low potassium and low calcium and the emergency room doctor thought the low magnesium could be due to the low calcium, but I didn't think that was right. I decided to review the causes of low magnesium and the treatment and associated findings.
272.   40-year-old woman with Type 1 diabetes and depression. I (investigator) saw her (physician) looking in a reference. "I'm just thinking of this person with horrible depression -- what I could add in."
273.   40-year-old woman with diarrhea. Is there a certain duration of time you should let diarrhea go before doing stool studies like culture and ova and parasites?
274.   41-year-old female who said, "I am frustrated with the fact that I can't predict when my myasthenia gravis attack (or crisis) is coming. Is there a way to predict it? Like checking the peak flow for asthmatics?"
275.   41-year-old man with a lump in his neck. I don't know what it is. I think it's a muscle spasm but I really don't know.
276.   41-year-old with wrist pain for one month. X-ray showed avascular necrosis (didn't get which bone). We got a magnetic resonance imaging which showed "DRUJ effusion" and something about "TFCC." I had to ask an orthopedist to help me interpret the report.
277.   41-year-old woman with a family history of breast cancer. What is the appropriate screening for her?
278.   41-year-old woman with recurrent thrush. Can it just keep growing on her retainer or do we need to do some kind of workup?
279.   41-year-old woman with upper respiratory infection. She's pretty good size. The question is, "Should I give 500 milligrams or 250 milligrams of Amoxicillin?" I had to give that some thought.
280.   41-year-old woman. In women in their early 40's, still menstruating, having regular cycles, but having hot flashes, normal follicle stimulating hormone, do you really do hormone treatments with them? What do you do with these people? Hormone replacement? Should we do it?
281.   42-year-old man. Is he diabetic is the question. He has impaired fasting glucose (114). He had a 2-hour-glucose-tolerance test and his fasting was 109, one hour 212 (inadvertently done, I just wanted fasting and two hour), and 2 hour was 66. Glycosylated hemoglobin was about 5.
282.   42-year-old woman got 7 days of antibiotics for a cellulitis on her finger. Some use 7 days. Some use 10. Some use 14. I know it's been studied for streptococcal pharyngitis and urinary tract infections but cellulitis?
283.   42-year-old woman with upper respiratory infection. Wants to know when she should go back to work. That's always a question -- when you should let someone go back.
284.   42-year-old woman. Her tympanic membrane retracts with nasal inspiration. "What would cause that?"
285.   43 year-old female has had rash for approximately 1 year, has gotten worse. "What is the cause of this rash?" He said he knew what it was but needed to know the name of it - 3rd book he looked at finally had a good picture.
286.   43-year-old woman in for a physical exam. She's constipated. She's on Wellbutrin and I think that can do it but I don't know how common that is.
287.   43-year-old woman with bladder symptoms. The urinalysis showed "glitter cells." "I have no idea what that is."
288.   43-year-old woman. I don't know if she's neurotic or what, but she complains of environmental toxins. What to do in this situation?
289.   43-year-old woman. What do you do with premenopausal dysfunctional uterine bleeding?
290.   44 year-old woman. She has four siblings with adenomatous polyps. She was screened with a colonoscopy 3 years ago and does not have any. "When does she need her next colonoscopy?"
291.   44-year-old lady with a rash in the perineum. The question was whether it was bad yeast or herpes.
292.   44-year-old man has been seeing a chiropractor for neck pain. Then had motor vehicle accident and neck got worse. Orthopedist said nothing wrong with neck. Patient came to Dr. X at suggestion of his lawyer. Dr. X never saw him before and didn't want to see him now. He will go ahead and give his opinion but the question is what to do in a situation like this.
293.   44-year-old man here for immigration physical. Is it cheaper to give the measles-mumps-rubella vaccination or get the titers?
294.   44-year-old woman. No period since March (it is late June). So I asked Dr. X (family physician partner), "Is there a chance she could be pregnant and I asked about blood versus urine pregnancy test, whether either is better."
295.   44-year-old woman. What is the dose of Meridia?
296.   44-year-old woman. What is the generic name of Halcion? She was on a sleeper that began with a T. Wanted to see if she could get a refill.
297.   45-year-old man admitted today, now in hospital, seen by tertiary care center visiting cardiologist today. Do you use intravenous nitroglycerine on everybody, even if you only need low dose, or is paste okay?
298.   45-year-old man with hypertension on Tenex. Had questionable side effects including headache, fatigue, and lightheaded. Are these really side effects of Tenex?
299.   45-year-old man, overweight, snores at night, thick neck, falling asleep in daytime, told as a child he should have adenoids out. "Do you ever operate on folks like this without a sleep study?"
300.   45-year-old woman with diarrhea. "What is dosing on Lomotil?"
301.   45-year-old woman with dysfunctional uterine bleeding. What is the treatment? I already tried Provera 10 milligrams every day.
302.   45-year-old woman with systemic lupus erythematosus, blue toes due to vascular disease, history of reflex sympathetic dystrophy. The question is, "What is reflex sympathetic dystrophy?"
303.   45-year-old woman, she's active but not on her feet all day, complaining of edema. Pedal edema, mildly edematous, leg edema with no signs of venous insufficiency or other causes for edema. "What do you do with these people?"
304.   45-year-old woman. "I looked up the definition for malignant hypertension following a request from a patient. They emailed wanting to know if they had it.
305.   45-year-old woman. How should I follow up an elevated gamma glutamyltransferase and occasionally mildly elevate alanine aminotransferase in a Type 2 diabetic with hypercholesterolemia, well controlled on Lipitor?
306.   45-year-old woman. The question is regarding the use of Ultracet (Ultram plus acetaminophen) in a methadone user. Would it be bad to use in her?
307.   45-year-old woman. The study physician's partner called her in to see this patient's rash. The question is, "What is this rash?"
308.   45-year-old woman. With chronic lung disease, there have been studies indicating the need to give antibiotics if there is green or yellow phlegm. But I have not seen . . . . My question is what about the nonsmoker and non-chronic-lung-disease patient.
309.   46-year-old man. What is the dose of Prevacid and how do you spell it?
310.   46-year-old right-handed man seen this morning with clumsy left arm and leg without weakness. Where would you go to look into this; that is, how would you work him up?
311.   46-year-old woman complaining of excess sweating and fatigue for 5 days. The question is "Why is she sweating?"
312.   46-year-old woman with pituitary. There should be a book with all you need to know about prescribing steroids. It should have all types of steroids and a comparison scale with the concept of equivalent doses and the concept of physiologic levels and the concept of stress dosing, and how to bump up and taper down.
313.   46-year-old woman. "Look at this Papanicolaou smear. It shows atypical squamous cells of uncertain significance but the comment is 'cannot rule out high-grade squamous intraepithelial lesion.' Normally we just repeat in 4 months for atypical squamous cells of uncertain significance, but what do you do with this comment?
314.   46-year-old woman. One of her children said, "Mom, what's that lump in your neck?" I think she has a multinodular goiter. Thyroid stimulating hormone, free thyroxine (free T4), parathyroid hormone, calcitonin all normal. Would you skinny needle her?
315.   46-year-old woman. Two-year history of Raynaud's phenomenon (all 3 color changes). What is the recommended evaluation and therapy?
316.   46-year-old woman. What is the success rate in using phenol to prevent the nail from growing back after removing an ingrown toenail?
317.   47-year-old man with a gallbladder polyp on right-upper-quadrant ultrasound. I didn't know what to do. Do you follow it or what?
318.   47-year-old man. What evaluation should be done for erectile dysfunction?
319.   47-year-old man. What is the significance of a low free testosterone and normal gonadotrophins in a male with erectile dysfunction? Shouldn't you have high gonadotrophins if the free testosterone is low? Do these people all have pituitary insufficiency?
320.   47-year-old woman has had raised nevi on her face since childhood. The question was what is the best way to remove these without leaving a scar.
321.   47-year-old woman with rash, no better. The question is what is this rash from and how to treat it?
322.   48-year-old man. Another question is refractory hyperlipidemia (triglycerides 2000) and combinations of drugs, for example a statin with gemfibrozil. "Some people use a low dose statin with gemfibrozil, some use high-dose statin with gemfibrozil, and of course there are all the warnings, but in a practical sense, what do you do?"
323.   48-year-old man. How often is it recommended to check lipids in people being treated for hyperlipidemia?
324.   48-year-old noticed increasing prominence of his tibial tubercles. No pain. He noticed them becoming bigger one year ago after working on a roof.
325.   48-year-old woman with amyotrophic lateral sclerosis and thick sputum. I got her a suction device but I just wanted to know if any of the anticholinergic drugs, such as benztropine, would help with her oral secretions.
326.   48-year-old woman with cough, shortness of breath, chest pain, negative chest x-ray, normal pulse oximetry, now today has worse peak flows on prednisone, was 270, now 200. "What is causing this?"
327.   49-year-old female with burning metallic taste in mouth for two weeks. What is the etiology of this metallic taste?
328.   49-year-old man in for hepatitis recheck. All tests had been negative but today patient said frequent stools again and "getting yellow." Question is what is the cause of this hepatitis and where do I go from here with testing, et cetera?
329.   49-year-old man with diabetes, congestive heart failure, and steatohepatitis. "Can patients with steatohepatitis take statins?"
330.   49-year-old man with known diabetes had triglycerides above 7000. He never had pancreatitis. I hit the books to see how to treat that.
331.   49-year-old with obsessive-compulsive disorder. She's on Luvox 100 milligrams. I looked on an online resource to see if it can cause someone to be "buzzed or juiced up" because she seemed overly animated today.
332.   49-year-old woman asked the physician to fill out a disability form. "My question is what are the diagnostic criteria for fibromyalgia because that's what the form is asking for (which criteria does she have)."
333.   49-year-old woman in for a preoperative physical. She has a lump in the groin. What is this lump in the groin?
334.   49-year-old woman status post removal of in-situ malignant melanoma from her arm. What is the risk of metastases because now she has a new lump?
335.   49-year-old woman with hypertension, hypokalemia, not hirsutism. I (study physician) called the endocrinologist and basically said, "What do I do?" I (investigator) suggested at the same time she said this, "What was the question, was it 'What's the next step with the workup?' " She said, "Yes, that would be the way to phrase that."
336.   49-year-old woman. Single area of herpes zoster, less than 48 hours old. Since it's so small, should I treat her?
337.   5-week-old born at 32 weeks gestation, grunting at 4 weeks, asked pediatrician then, he said okay, not to worry. Now more tachypnea and tachycardia, less grunting. What is the cause?
338.   5-year-old boy with autism. The one thing I couldn't find much on . . . Dad was asking about chelation therapy such as with EDTA (ethylenediaminetetraacetic acid). "Has anyone used empiric EDTA?"
339.   5-year-old boy with cough, possibly pertussis. What is the dose of erythromycin for pertussis?
340.   5-year-old boy with intoeing. He examined the child and as he left the room he told the father he needed to check something. He told me (investigator) "I've just got to look at the normal angles. I forgot what they are."
341.   5-year-old boy. Luckily this kid can take pills but "which stimulants come in liquid form?
342.   5-year-old girl with tinea capitis. What is the dose of griseofulvin?
343.   5-year-old girl, inpatient, with possible achondroplasia. However, the pediatric radiologist didn't think it was achondroplasia so the question was, "What is the differential diagnosis of bony aplasia?"
344.   5-year-old with psychiatric issues (attention-deficit-hyperactivity disorder and lots of family history). The child has a sensitivity to light. He doesn't want to open his eyes. I looked in a reference and found nothing.
345.   5-year-old. At what frequency should you see kids back when they have attention-deficit-hyperactivity disorder?
346.   50-year-old chronic alcoholic man with markedly elevated alkaline phosphatase, 200 then 300 then 400 and now 1100. Why does he have this elevated alkaline phosphatase?
347.   50-year-old female with bug bites, bra and panties area. 1 cm papules, straight forward bug bites. What bug? Also had a cough. Is the cough related to the bug bites?
348.   50-year-old female with recurrent hot tub folliculitis. "Is there anything you can do to prevent that?"
349.   50-year-old male with nasal polyps and congestion. Allegra and Nasacort not working. Doesn't like steroids. Doesn't want surgery. Are there any other options?
350.   50-year-old man with Paget's disease. Should I treat medically?
351.   50-year-old man with hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia. The cholesterol is better but his triglycerides are still high. The question is should we put him on a triglyceride-specific drug along with Lipitor and risk muscle weakness? It's a style point.
352.   50-year-old man with psoriasis. "What size does Dovonex ointment come in and what is the dose?"
353.   50-year-old man with ulcerative colitis. He's been passing bright red blood for the past few days. He's on Asacol 400 milligrams three times a day. My question is, can I increase his Asacol?
354.   50-year-old man. High-density-lipoprotein cholesterol is high but low-density-lipoprotein cholesterol is also high. Which one wins?
355.   50-year-old white female. How concerning a risk factor is an elevated C-reactive protein?
356.   50-year-old woman here for a complete physical exam. What's the best way to taper someone off an estrogen/progesterone combination?
357.   50-year-old woman with Helicobacter pylori on biopsy at time of upper endoscopy. She had a good question. She asked me how long she should continue the Nexium after she finishes the 10-day course for treatment of the Helicobacter pylori. I (study physician) didn't know.
358.   50-year-old woman with Helicobacter pylori on biopsy at time of upper endoscopy. The question is how to treat this.
359.   50-year-old woman with an adrenal "incidentaloma" on computerized tomography scan. "Does positron-emission tomography (PET) scanning have a place in the evaluation of an adrenal incidentaloma?" When should you order it? What is the role of positron-emission tomography in this situation? Would a positron-emission tomography scan tell you if it was cancer?
360.   50-year-old woman with cataracts and high cholesterol. So the question is, can she continue to take Zocor since she has cataracts? The question is, are cataracts going to happen with EVERYBODY who takes them?
361.   50-year-old woman with elevated serum calcium. Our upper limit is about 10.1. A year ago her calcium was about 9.5. This year it was about 11 and a repeat was about 10.5. Her alkaline phosphatase was normal. The question is, "How aggressive do you get with people like that?"
362.   50-year-old woman with vertigo and then developed severe fat intolerance. An ultrasound showed a large solitary gallstone. "Do we yank every gallstone?" "Is this enough symptoms?" "It was only a single gallstone." I was also worried about a pancreatic disorder. Should I do computerized tomography on her?
363.   50-year-old woman. "Why does every woman over age 30 complain of trouble remembering things?"
364.   50-year-old woman. What are the indications for getting bone density scans?
365.   51-year-old female with sinusitis. What antibiotics can be used in a patient with myasthenia gravis?
366.   51-year-old woman with myasthenia gravis. Another question with her is sweats. Do you have to aim for something with her estrogen levels to control sweats and hot flashes?
367.   51-year-old woman with myasthenia gravis. Has this erythema multiforme like rash. She went to a dermatologist who said, no, it's more like some kind of drug reaction. So, "what skin disease does she really have?" "I don't know what to really have her on for this skin problem."
368.   51-year-old woman with myasthenia gravis. I've been having trouble finding out what drugs exacerbate myasthenia gravis.
369.   52-year-old female. Patient asked Dr. X why she has painful orgasms? "She feels that these may be like her uterus is contracting."
370.   52-year-old man. "In patients with chronic pancreatitis and pain, do enzyme supplements help with the pain or just the steatorrhea?"
371.   52-year-old man. People with knee pain and magnetic resonance imaging. Has somebody . . . ? "At 6 weeks if he's still not better and the x-ray is normal, is this cost effective at this time to do a magnetic resonance imaging?"
372.   52-year-old woman with right-lower-quadrant pain and a large fibroid (8 centimeters by 7 centimeters by 6 centimeters). When and when not to do a hysterectomy for a fibroid?
373.   53-year-old man. He has had a febrile illness, and, before the fever, he had arthralgias and neck stiffness. I can't remember the transient symptoms of the encephalitis virus going around New York City now (Eastern Equine Encephalitis).
374.   53-year-old man. What is causing his testicular pain?
375.   53-year-old woman. What would cause leg cramps that involve the entire leg and last one and a half hours?
376.   54-year-old man taking flax seed oil. "I have to think of what that's for. I'd have to look that up."
377.   54-year-old man taking saw palmetto. I can't think of the enzyme it blocks off the top of my head.
378.   54-year-old white female presents with respiratory failure, chronic obstructive pulmonary disease exacerbation. Also elevated creatine phosphokinase (greater than 600) with about 35% MB fraction (normal up to 9%), but negative electrocardiogram, negative Troponin-T and no chest pain. The question is whether this represents a myocardial infarction in addition to the chronic obstructive pulmonary...
379.   54-year-old woman complaining of feet burning. Normal blood sugar, heart and lungs. I can't find a single reason why her feet should be burning. She gets Vitamin B12 in her multivitamins.
380.   54-year-old woman had a cervical polyp removed, continues to bleed, referred to gynecologist. "Are cervical polyps ever malignant?"
381.   54-year-old woman with chest pain. What is the sensitivity and specificity of adenosine thallium and dobutamine echocardiogram in women compared to men?
382.   55-year-old man with dyshidrotic eczema. "What would be the best strength to use for triamcinolone cream? I'm looking for one with moderate potency."
383.   55-year-old woman has had breast cancer. Her question to me was, "What can I do to make sure I don't get ovarian cancer?" "So screening." I think there might be a risk of ovarian cancer in a woman with breast cancer. I'm not sure. Is there a role for ultrasound or CA 125 (cancer antigen 125) in this situation?
384.   55-year-old woman with blepharitis. Hydrocortisone cream was no help.
385.   55-year-old woman with diverticulosis. Five years ago she had an abscess and part of her colon removed. Fine. Then recently she is having exacerbations every 3 or 4 or 5 months. I sent her to the surgeon. She's concerned and doesn't know what she should do.
386.   55-year-old woman. This lady has epigastric pain and gallbladder symptoms. How do you assess her gallbladder function when you don't see stones on the ultrasound? Can a nonfunctioning gallbladder cause symptoms or do you only get symptoms if you have stones?
387.   55-year-old woman. What is the treatment for DeQuervain's tenosynovitis and should a splint be used?
388.   56 year-old female. Under what circumstances do you stop estrogen?
389.   57-year-old farm wife called and said veterinarian came and found rabies in a calf, brain sent to tertiary center X. Recommended that family be immunized against rabies. Do they really need rabies shots?
390.   57-year-old man with a chronic obstructive pulmonary disease exacerbation. At what duration of steroid treatment do you need to taper off instead of just stopping without tapering?
391.   57-year-old white female. Factor V Leiden? Does it increase the risk of coronary disease? Should you screen for it?
392.   57-year-old woman with irregular heart rhythm had been started on flecainide. I (investigator) saw her looking in a reference. I said, "I saw you looking in . . . " She said, "Tambocor. I didn't know what it was.
393.   57-year-old woman. "I'm just looking up olanzapine. I'm not sure whether I need to taper it. Because I want to switch her over to Paxil."
394.   58-year-old female. Do you need to give a trial of nonsteroidals before you inject a shoulder or is an injection a first line treatment?
395.   58-year-old white female has a family history of ovarian cancer and is requesting a hysterectomy. She said, "I'm not using this stuff, why not get rid of it?" The question is, "Is hysterectomy an option for her?" We do prophylactic mastectomies, so why not prophylactic hysterectomies?
396.   58-year-old woman, bilateral reduction mammoplasty, pathology was positive for ductal hyperplasia. Does that change breast cancer screening recommendations?
397.   59-year-old man with a generalized rash. No allergies, no virus infection. What is the best approach? Oral steroids? Skin biopsy? Send to dermatology?
398.   6 and 1/2-year-old girl. What's causing her ear pain? She has a normal ear on exam and normal tympanogram. Is it just eustachian tube dysfunction?
399.   6 and 11/12-year-old boy referred from a family physician with adrenarche. Wondering about precocious puberty. Did a bone age which was consistent with 8 years old, so I (study physician) said that's significant. But when I called the mother she said, well that's only one year, is that significant? So my question was, "What is a significant bone age discrepancy?"
400.   6-month-old boy involved in a motor vehicle accident where the air bag went off approximately three weeks ago. Could the cough be caused by the air bag deployment?
401.   6-month-old term delivery, developing normally except question of hypertonicity of lower extremities with some scissoring, which is now more definite. "Should I do any workup and if so should it be a magnetic resonance imaging or a computerized tomography or what?"
402.   6-month-old with prolonged diarrhea. We got stool cultures today. The question is, What do I start her on while I wait for the culture?
403.   6-month-old. When does a kid with an undescended testicle need to be referred? How long do you wait?
404.   6-week-old not tracking well. "I'm wondering about developmental delay. What is the differential diagnosis of developmental delay?"
405.   6-year-old boy with enuresis. Should you treat and if so what should you do?
406.   6-year-old boy with sinusitis and bronchopneumonia. What is the dose of Biaxin?
407.   6-year-old girl with encopresis. A question came to mind. "How long do we usually treat functional encopresis?"
408.   6-year-old here for attention-deficit-hyperactivity-disorder evaluation. The current thinking is that 95% is history and we don't do labs, but it's always nice to get a refresher on that. You always wonder, "Am I doing enough? Am I not doing enough?" (Meaning medical workup.)
409.   60-year-old man here for preoperative physical for cholecystectomy. "What percent of patients with porcelain gallbladder will develop cancer and is it really necessary to take it out?"
410.   60-year-old man with carcinoma of the prostate. He and his wife both complain that he has severe loss of memory. "It's very confusing. I'm really not sure what's going on. I don't know where to look for . . . . I need to think about him for a while before I can even formulate a question. I don't know what's going on here is my question."
411.   60-year-old man with total cholesterol 230, low-density lipoprotein cholesterol (LDL) 120, triglycerides 300. He's on Mevacor 20 milligrams twice a day. Should I switch to Lipitor since his triglycerides are high?
412.   60-year-old man. Low calcium on screening labs. History of thyroidectomy for hyperthyroidism. I followed up the low calcium with parathyroid hormone, phosphorus, and vitamin D levels which confirmed hypoparathyroidism. Patient was totally asymptomatic. Why do I need to treat? Can it be left alone until he develops symptomatic hypocalcemia?
413.   60-year-old white female. What are the eye manifestations of sarcoid?
414.   60-year-old woman just had a pulmonary embolus and deep vein thrombosis a few months back. She has Factor V Leiden, homozygous and she wanted me to give her more information for her children. I (investigator) said, "So the question is . . . " She said, "The question is prophylactic anticoagulation for them and information for their kids (grandchildren of the patient)."
415.   60-year-old woman presented yesterday with a perfect story for influenza, except there's no influenza around. (It's June.) Do you use anti-influenza medications?
416.   60-year-old woman with gastric outlet obstruction and probably gastric lymphoma. "I'm going to have to look that up."
417.   60-year-old woman with gastric outlet obstruction and probably gastric lymphoma. The endoscopist wrote "linitis plastica." I can't remember what that means.
418.   60-year-old woman with gastric outlet obstruction clinically and on computerized tomography scan. "Should she be admitted or should we get an EGD (esphogagogastroduodenoscopy) as an outpatient and work her up as an outpatient?"
419.   60-year-old woman with new atrial fibrillation being seen by the physician's assistant. Is she at high risk for stroke and so should she be on Coumadin? Which age group is it more important to anticoagulate? Her age group (60's)? 70's? 80's?
420.   61-year-old man with photodermatitis, taking Herbalife. Are any of the ingredients in Herbalife photosensitizers?
421.   61-year-old man with rash on face, thought to be secondary to photosensitivity from herbal medication, but now worse even after stopping this preparation. "How are we going to fix him?" "What else could be doing this?"
422.   61-year-old man. Are there any competitors to Androgel? I looked it up in a reference in the exam room.
423.   61-year-old woman. What is the best approach for elbow epicondylitis in terms of treatment -- steroid shot first or nonsteroidal anti-inflammatories first?
424.   62-year-old man with cheilitis. "What causes cheilitis and how do you treat it? I'm always puzzled by that.
425.   62-year-old man. He was healthy until 6 months ago when he moved to a new house and now he has asthma. He called today saying he is worse, just after getting off a course of Prednisone. "I don't know what should I do with him."
426.   62-year-old man. One question is the management of fasting hyperglycemia or impaired glucose tolerance, whatever you want to call it. "Nobody really talks about how often to check blood sugars." "And how aggressive to be with lipids in that setting." "So just sort of general management of impaired glucose tolerance."
427.   62-year-old woman with seborrheic keratosis on her leg, in for cryotherapy. "I don't know how to open this." She could not get the cryo bottle open to get to the liquid nitrogen.
428.   62-year-old woman, 2 years on Fosamax and has a declining bone mass (T-score now about -3.7). I (investigator) said, "So, the question is why?" She (study physician) said, "Why and what to do about it?"
429.   63 year-old woman got worse on Fosamax (decreased bone mass). "Would you do another bone density scan and if so when, knowing that there is not much else to do for her?"
430.   63-year-old female on tamoxifen to prevent breast cancer. So the question is whether this is justified to have her on the tamoxifen and if so, how long should she be on it. The other question is whether tamoxifen can cause low platelets.
431.   63-year-old man got hyponatremic (sodium 120, 121) so I had a question about the causes and treatment of that. He had a seizure. I was never convinced it was from the low sodium though, because usually it has to be 110 or 115. So I looked that up to see if that sodium level could cause a seizure.
432.   63-year-old man with the syndrome of inappropriate antidiuretic hormone. When you're on a diuretic, the diuretic messes up the serum osmolality and urine osmolality, so how do you work up hyponatremia when the patient is on a diuretic?
433.   63-year-old woman went to a vascular surgeon for varicosities and she did a Valsalva (I don't know what test this is) and the blood went down but not up. So the question is, "Can we just address the painful superficial veins and leave the deep venous system alone or is the problem with the deep system causing the painful superficial veins?
434.   63-year-old woman with a splenectomy years ago. Does she need the Pneumovax every 5 years?
435.   64-year-old man with polymyalgia rheumatica, erythrocyte sedimentation rate about 80, jaw claudication and thighs weak. "Should I start steroids even if no headache or blurred vision?"
436.   64-year-old woman complaining of trouble finding words. Magnetic resonance imaging showed multiple high signal intensity changes in the periventricular white matter with an orientation suggesting multiple sclerosis. I didn't know what to do.
437.   65-year-old man with chronic obstructive pulmonary disease, status post coronary artery bypass graft, chronic cough, congestive heart failure, rales at bases. Gave him Lasix, but that has not worked for the cough. Now what to do?
438.   65-year-old man. "What is the most readily available and best absorbed oral iron preparation?"
439.   65-year-old woman has not seen a physician in years. Has cancer of the cervix, extending into vagina and parametrium and has edema of her legs. Has back pain. Bone scan and x-rays did not show metastases. What is her prognosis?
440.   65-year-old woman with a blood pressure of 180/110. Her ambulatory readings are better than that. "White coat hypertension is not supposed to be a concern, but now you hear little things that maybe it is a concern. Well, is it or isn't it?"
441.   66-year-old man who says, "I have a sulfur smell out of the blue sometimes." "What's it mean?"
442.   66-year-old woman with a Baker's cyst. How many Baker's cysts are related to deep-vein thrombosis? How many people with Baker's cysts get deep vein thromboses?
443.   66-year-old woman. What to do about patient who is not taking prescribed Coumadin? She says she is taking it but lab work leads Dr. X to feel quite positively that she is not.
444.   67-year-old female with hypertension. Her question was, what do you do about widened pulse pressure. Should you treat it any differently from just systolic hypertension?
445.   67-year-old woman with a normal workup for microscopic hematuria. How often do they need follow up intravenous pyelogram and cystoscopy? I assume we'll get a urinalysis every year. Intravenous pyelogram and cystoscopy were recently normal.
446.   68-year-old female came in for Papanicolaou smear and physical examination. Her husband said, "Have you told the doctor about your sleep apnea?" What are those spells that her husband calls sleep apnea?
447.   68-year-old man with an isolated elevation of the alkaline phosphatase. "How far do you go with the workup?"
448.   68-year-old white female presented with abdominal pain for over two months. Eventually went to exploratory laparotomy where disseminated ovarian cancer was found. Question: What role, if any, would a CA-125 (cancer antigen 125) play in detecting this earlier?
449.   69-year-old man with gout, now has 3 days of swelling in wrist, I ordered an ANA (antinuclear antibody) since gout not typical in wrist. ANA (antinuclear antibody) is positive 1:40 mixed pattern. What does this mean and what should I do about it?
450.   69-year-old woman, diagnosis of temporal arteritis 10 years ago after a biopsy. Then got off prednisone after 8 years. Recently has been having headaches and blurred vision. Now, today she says she's seeing double (physician said this before going in to see her). "So I'm wondering what's going on with her. I'm wondering if we should get magnetic resonance imaging."
451.   7-year-old boy with attention-deficit-hyperactivity disorder. Does Metadate ER come in a lower dosage form than 20 milligrams?
452.   7-year-old boy with clinical gastro-esophageal reflux disease. What is appropriate to do first: ranitidine or omeprazole?"
453.   7-year-old boy with enuresis. Desmopressin. How long do you give it before switching to something else and what do you do? The books say to taper off, but if the enuresis starts again and you go back to desmopressin, how long do you keep trying?
454.   7-year-old girl from an orphanage in Eastern Europe, received the BCG (Bacillus Calmette-Guerin) vaccine. Had a 12-millimeter tuberculin skin test. Has had up to 17-millimeter reaction in the past, didn't know if she had been treated before. The question was "What will happen to the tuberculin skin test in a year when she gets tested again? Will it come down?
455.   70-year-old man developed a hard lesion at the inferior aspect of his left testicle over the last few days. What would cause that?
456.   70-year-old man here for complete physical examination. One of the things I struggle with is what screening tests to do. I don't know what we really should be doing.
457.   70-year-old man with a twelfth thoracic vertebra compression fracture. Is he a candidate for vertebroplasty (where they inject something in the vertebral body to increase the height)?
458.   70-year-old man with diabetes and transient ischemic attack-like symptoms. I don't know what's going on with him.
459.   70-year-old man with early Alzheimer's disease. When do you start Aricept and when do you stop it? What is the risk benefit ratio? How do you objectively measure whether it's helping?
460.   70-year-old woman with dyspepsia. I've gotten into the habit of checking for Helicobacter pylori and treating if I find it. Sometimes it works and sometimes not. You can't find anything about dyspepsia in the textbooks.
461.   70-year-old woman with herpetic disease of the eye. (1) How much and after how long will steroid use will cause immunosuppression, (2) Can steroid inhalers cause immunosuppression?
462.   70-year-old woman. A year after stopping Prempro she was still having hot flashes. She (the patient) asked, "Shouldn't a 70-year-old woman stop having hot flashes?"
463.   71-year-old lady with elevated potassium (5.3 with normal 3.5 to 5.0). No other laboratory abnormalities. "Do I check a phosphate?"
464.   72-year-old female seen last Thursday for swollen lip and side of face, treated with ice and Benadryl and it went away in 24 hours. Now returns - at noon today swelling recurred with tongue and gums now swollen. What is causing the swelling?
465.   72-year-old female with abdominal pain. What are the signs and symptoms of mesenteric artery occlusion and how do you test for it?
466.   72-year-old female. How do you figure out restrictive lung disease in a patient with a normal chest x-ray? What's the workup?
467.   72-year-old man seen this morning. Dr. X thinks he has genital herpes. The patient asked, "How long does herpes go on?"
468.   72-year-old man with hypertension. He is on Lotrel 5/20, Atenolol 100 milligrams, Cardura 4 milligrams and hydrochlorothiazide 12.5 milligrams. His blood pressure today is 166/72 by the nurse and I got 180 systolic. The question is where to go from here with his antihypertensives.
469.   72-year-old woman with chronic lymphocytic leukemia, white blood count>100,000. How should I treat her?
470.   73-year-old man with benign prostatic hypertrophy. I wanted to find a generic alpha 1 blocker.
471.   73-year-old woman, 13 years ago had colon cancer resected. Now she is itching. How common is itching as a paraneoplastic syndrome following treatment for colon cancer?
472.   73-year-old woman, 13 years ago had colon cancer resected. She had a colonoscopy and they found one hyperplastic polyp. The biopsy was negative, but you wonder . . . . Should she have had a computerized tomography scan to look for metastases?
473.   73-year-old woman. The radiologist said on the mammogram report, "increased density possibly related to hormone replacement therapy." "Can they say that? That seems like a clinical diagnosis."
474.   74-year-old female with memory loss and a negative workup. "What's the right dose of Ginko?
475.   74-year-old female with memory loss and a negative workup. What is the dose of Aricept?
476.   74-year-old man in for physical exam. He had some weight loss and a mild anemia (hemoglobin 11). Ferritin was 2000. I looked up the causes of a high ferritin.
477.   74-year-old man with dyspnea. Remote smoker. "I'm just wondering if there's anything else that could be causing it and if there's any treatment."
478.   75-year-old man with diabetes. What is the maximum dose of glyburide?
479.   75-year-old man. What ultrasound surveillance is necessary after carotid endarterectomy and is any ultrasound surveillance needed?
480.   75-year-old woman, hemoglobin approximately 12.0, mean corpuscular volume approximately 90, vitamin B12 level approximately 180 (200-650 is normal), and then approximately 150, intrinsic factor blocking antibody negative. "I'm just wondering what I should do?"
481.   76-year-old woman with Parkinson's Disease and hoarseness secondary to that. What do they do for hoarseness secondary to Parkinson's Disease?
482.   76-year-old woman with bladder cancer, last neoadjuvant chemotherapy was 6 weeks ago. Came in with a generalized rash, one-half to one centimeter red lesions, not itching, not painful. So the question is "What is this rash?"
483.   76-year-old woman with dyspnea for 3 to 4 days. History of congestive heart failure. On digoxin and Accupril. Lungs clear. Is there something else going on besides congestive heart failure?
484.   77-year-old female. On Norvasc, but insurance will only pay for verapamil, nifedipine, or Plendil. What is the dose of Plendil?
485.   77-year-old woman. Should I put her on a cholesterol lowering drug? What benefit would it be at her age, other than a financial burden?
486.   78-year-old man. Screening prostate-specific antigen about 9. Prostate biopsy shows Gleason 8 cancer in 1 lobe. What treatment is best?
487.   78-year-old woman with anemia, possibly caused by her angiotensin converting enzyme inhibitor. After we switch her to Cozaar, how soon would you expect her to correct?
488.   78-year-old woman with anemia, possibly caused by her angiotensin converting enzyme inhibitor. Is Cozaar an angiotensin converting enzyme inhibitor-2?
489.   78-year-old woman with blood pressure 210/110. She's on Univasc and Toprol XL 100. She has a history of an angiotensin-converting-enzyme-inhibitor (ACEI) cough and palpitations on Procardia. Is it still essential hypertension? My question is: I can still treat her with medication, but if it doesn't come down right away, when do I think about secondary hypertension?
490.   79-year-old female with atypical chest pain, status post coronary artery stent. "I don't think you could find such a thing, but you know what would be nice would be to have a comparison of the different types of stress tests. Sensitivity, specificity, ideal patient for each and the cost. Like a big table."
491.   79-year-old man in for followup of sciatica. My question is . . . Obviously with definite signs of spinal cord compression we get active and do further workup. The question is . . . Some patients come in with vague symptoms and soft signs. "How far do we go in working them up?"
492.   79-year-old man with facial palsy secondary to a stroke. He had mild wheezing on exam. How do you do pulmonary function testing on someone with facial palsy who is unable to make a tight seal with his lips?
493.   79-year-old man. Does one have to do any workup for coronary ischemia in elderly patients without any prior cardiac history that do have a lot of premature ventricular contractions?
494.   79-year-old man. In May 1999 his prostate-specific antigen was 3.8. Now, two and a half years later, it's about 7. So the question is what to do with this patient.
495.   79-year-old woman with irritation in the vaginal area, probably atrophic vaginitis. I tried an estrogen pessary and cream but they were no help. The question was "what other approaches can we take?"
496.   8-year-old boy with failure to thrive. The question would be, what endocrine tests to get. Do you get a growth hormone? Do you do cortisol levels? Thyroid function tests?
497.   8-year-old boy with perianal fistula, not healing, suspect inflammatory bowel disease. What is the incidence of inflammatory bowel disease in siblings?
498.   8-year-old boy. A question that sometimes comes up. Of how much worth is the rectal exam in planning therapy for a child with encopresis, if you feel stool on the abdominal exam and the history is compatible with overflow incontinence?
499.   8-year-old girl with angioneurotic edema. Mother said, "the only thing that works for her is Zithromax. "I said, don't you mean Zyrtec. She said, no Zithromax. I (investigator) asked how he would phrase the question. He said, "Has Zithromax ever been shown to be effective for angioneurotic edema and if so what's the mechanism or is this just a fluky thing?"
500.   8-year-old girl with elevated lead level (approximately 40). I (investigator) said, "So the question is treatment"? He said, "No, just etiology. I mean, is it supposed to be from iron deficiency or . . . ?
501.   8-year-old male patient. Question was the dose of erythromycin for a pediatric patient.
502.   8-year-old male with painful red bumps on his heel. Red painful subcutaneous, 3 to 4 millimeters in diameter. Couldn't find anything helpful in three references in my office.
503.   8-year-old was on Paxil, Adderall, Clonidine, and Trazadone. She stopped everything cold turkey and was started on Zyprexa. Two days later she came into the emergency room hypertensive (135/95) and tachycardic and tremulous. I called child psychiatry at a tertiary center and the question was, "What do I do?"
504.   80-year-old female. Why is she losing weight? Has well-controlled congestive heart failure. Patient says she isn't eating well and dentures don't fit well. Dr. X ordered thyroid stimulating hormone -- says he does it routinely. Dental appointment.
505.   80-year-old man with chronic obstructive pulmonary disease and pneumonia grew Moraxella catarrhalis in the sputum. I had to look up, what is Branhamella catarrhalis and how is it different from Moraxella. What is what and make sure I was treating with the right stuff.
506.   80-year-old man with shortness of breath, swollen leg, and history of pulmonary fibrosis. "This reminds me of a patient with a calf vein thrombosis and the question was, 'What do you do with a calf vein thrombosis?'"
507.   80-year-old man. I had to look up bacillus (gram positive rod) bacteremia. There I was just trying to find the etiology or anything that would be associated with bacillus bacteremia.
508.   80-year-old woman having total knee replacement in for preoperative physical exam. I had to look up the different stages of melanoma.
509.   80-year-old woman. I didn't look this up. Just kind of used common sense. "Is there any certain time you quit doing Papanicolaou smears? 80's or 70's?
510.   81-year-old female with atrial fibrillation and edema. She looked sick so I got a digoxin level and it was 3.0. She was on digoxin 0.25 milligrams once a day. "How is the dose to be adjusted?"
511.   81-year-old man here for prothrombin time and dyspnea on exertion. "What is the appropriate interval for doing prothrombin times once they're therapeutic?"
512.   81-year-old man with terrible kidneys (renal failure), colon cancer, iron infusion brought hemoglobin from approximately 7.0 to 8.0, yesterday reticulocyte count approximately 4.0%. Is this from blood loss or kidney failure?
513.   81-year-old man. When do you do a liver biopsy in a patient with slightly abnormal transaminases and normal liver ultrasound with risk factors for fatty liver and the rest of the workup is negative (for example, hepatitis studies, antibody studies)? And asymptomatic.
514.   81-year-old woman moved into a separate-structure retirement home and it had mold in the basement. "What degrees of mold exposure and what molds can cause these kinds of symptoms that they talk about in this magazine (hemoptysis, memory loss)?"
515.   82-year-old complaining of vertigo when up walking around, not when sitting. How can I make the world stop spinning for him? What is the source or cause of his vertigo?
516.   82-year-old female. "That would be an interesting question -- if we know what improves survival in patients with diastolic dysfunction."
517.   82-year-old female. "What's the evidence for using meclizine for dizziness?"
518.   82-year-old woman. Can Tamoxifen (being used for breast cancer) cause elevated blood pressure?
519.   83-year-old female in for physical exam. (1) When do you stop doing mammograms? (2) When do you stop getting DEXA (Dual Energy X-Ray Absorptiometry) scans? (3) When do you back off from aggressively treating cholesterol, Type 2 diabetes, coronary artery disease?
520.   83-year-old woman with chronic edema in her legs. She scraped it and got cellulitis. Now do I keep her on antibiotics until every bit of redness is gone, or can I stop now assuming the redness is consistent with resolving cellulitis?
521.   84-year-old female nursing home resident, diabetic, phone call from nursing home regarding blood sugars. Why are her blood sugars swinging so much?
522.   84-year-old female. Would you treat a pure culture of 40,000 Escherichia coli with a negative urinalysis?
523.   84-year-old woman with a leukemoid reaction. Persistent white blood counts in the 20,000's. No sign of infection. So the question was, what is the evaluation and causes of leukemoid reactions and what is the definition.
524.   85-year-old female with night sweats and tachycardia. Normal Holter and thyroid functions. What could be causing the night sweats and tachycardia?
525.   85-year-old female. This patient asked, if I have fecal occult blood testing every year for 20 years, do I need a flexible sigmoidoscopy? Wouldn't the occult blood testing be just as good?
526.   85-year-old man had left bundle branch block and had surgery and had a perioperative myocardial infarction. So the question was what further evaluation is needed in a patient with left bundle branch block who is undergoing noncardiac surgery?
527.   85-year-old woman admitted 2 weeks ago with syncope. Nonsmoker. Has a mass in her lung. The question was, would you just go to surgery, or try bronchoscopy and that kind of thing first. And the differential diagnosis too. No other primary cancers in her. The thought was, since she had the syncope and some palpitations, could this be a carcinoid?
528.   85-year-old woman. Hemoglobin has been about 11 for 5 years, normal iron studies. If you have someone with borderline anemia (hemoglobin 10 or 12), when are Procrit (erythropoietin) injections indicated?
529.   85-year-old woman. Is it smart to give the tetanus shot and the pneumonia shot at the same time?
530.   86-year-old with a femur fracture. Does deep-vein-thrombosis prophylaxis depend on the operative management, for example, pin versus prosthesis versus no surgery?
531.   86-year-old woman on Coumadin. What's the dose of Lovenox?
532.   87-year-old female with vertigo for two to three weeks. Possibly viral. How long should I expect the symptoms to last before referring or checking a magnetic resonance imaging?
533.   89-year-old man with end-stage renal disease, dyspnea, and fluid overload on chest film. On Lasix 200 milligrams twice a day. "I have a question. Why isn't he responding to oral . . . you know?
534.   9-month-old in for well-child exam. They know you're not supposed to give cow's milk because of gastrointestinal blood loss, but what about cheese and yogurt? Is that a problem?
535.   9-month-old whose sibling died of meningococcemia. The question is whether this child should get conjugated meningococcal vaccine and if so how do I get it for her.
536.   9-year-old boy with history of recurrent abdominal pain. So I guess it's more of a diagnostic question. Is the duodenitis causing the pain or the migraine? If it is migraine, what other drug treatment, abortive or prophylactic, could we use?
537.   9-year-old boy with self-injurious behaviors. The question is, "What would be an appropriate short acting sedative?"
538.   9-year-old girl with third urinary tract infection. I know I need a voiding cysto-urethrogram, but is an ultrasound enough or do I need an intravenous pyelogram?
539.   9-year-old with attention deficit disorder. On 18 milligrams of Concerta and 5 milligrams of Ritalin in the morning and at noon. I always thought you just give Concerta once a day. Why was it that he needed the extra Ritalin?
540.   A 2-year-old whose relatives had neuroblastoma. Mom asked if she needed to be screened for neuroblastoma. I didn't know so I called an oncologist. He said, "I don't know either. I'll have to look it up."
541.   A 20-year-old man had his first seizure and has an abnormal electroencephalogram (EEG), started on Dilantin, told not to drive for 6 months, but you find out he is driving one month later. Should you tell the department of transportation?
542.   A 20-year-old woman has a four-month history of diarrhea and cramps after she eats. She gets shaky before she eats. Could this be due to intestinal hormones or vasoactive intestinal peptide?
543.   A 34-year-old woman with endometriosis and on progesterone and with increased iron (approximately 230). Will this hurt her liver, heart, endocrine system?
544.   A 40 year-old woman with left chest pain, tender 4th rib, lungs clear, heart normal, psychiatric overlay, suspect intercostal neuritis. How far do you go with a workup for chest pain? Attempting to keep costs down.
545.   A 45-year-old female experienced dramatic worsening of Meniere's Disease when on alprazolam and wants to take Xanax instead. Is the worsening due to the generic form of the drug? Or is she only convinced that it is? Will Title XIX pay for it?
546.   A 45-year-old male came to office earlier (a few days ago) and said he wonders if dialysis could cause his headaches to get worse -- they seem worse after dialysis. Question is whether the dialysis procedure could accelerate the headaches?
547.   A 50-year-old woman asked me if she could be a surrogate mother.
548.   A 60-year-old woman uses a lot of Avon Care Deeply with Cocoa Butter skin cream. She asked if she could be absorbing enough of this through her skin to cause her elevated cholesterol.
549.   A 70-year-old woman with a total cholesterol of approximately 230, low-density lipoprotein (LDL-cholesterol) approximately 180. Should I worry about cholesterol in asymptomatic older patients?
550.   A 74-year-old woman with elevated cholesterol and history of myocardial infarction, on diet therapy. Her total cholesterol is approximately 290 down from approximately 340 and low-density lipoprotein (LDL-cholesterol) is approximately 210 down from approximately 240 on diet only. What to do? One wonders how aggressive one should be.
551.   A 9-year-old girl had been to Wacky Waters, now has clear vesicles on her hands, may be staphylococcal infection even though the vesicles are clear but I want to see what they have to say.
552.   A Henoch-Schoenlein-purpura patient. What's the source of the hemorrhage? Low platelets? Vasculitis?
553.   A boy with Ehlers-Danlos Syndrome I will be seeing this afternoon. I don't know which type. I need to read about it before I see him. I (investigator) tried to nail him down about what information he needed and never got a clear answer. But on the next visit, I asked him again what the question was and he said, "What is it?" meaning, "What is Ehlers-Danlos Syndrome?"
554.   A boy with attention-deficit-hyperactivity disorder. What is Spark? The mother asked me. I've never heard of it.
555.   A child had taken Claritin 6 months ago, had medicine left over. Is it OK to take the medication now? Is the dose the same?
556.   A child has vaginal discharge, positive for clue cells and whiff test, bacterial vaginosis. She has bruising which she says is from sledding. Has she been sexually abused?
557.   A child was admitted with glomerulonephritis. What is the association between Streptococcal infection and kidney disease?
558.   A child was scratched by a stray cat. Mom is concerned about rabies. What shots does she need and where on the body does she receive them?
559.   A child with rash and fever - what does she have?
560.   A couple of questions about her chronic obstructive pulmonary disease. "If there are any benefits between inhalers and nebulizers in terms of objective lung findings?
561.   A diabetic on insulin. Will these new medications (Glucophage, acarbose) allow me to get off insulin? Physician did not know answer.
562.   A family came in with a 5 or 6-year-old boy who had autistic features. They wanted to know if it was related to immunizations, especially the measles-mumps-rubella vaccine.
563.   A family physician called the study physician to ask about a 4-day-old with jaundice and a bilirubin of 20. "I was going to go over the guidelines. I think they say to transfuse if over 20 but I'm more conservative than that."
564.   A family physician had a newborn with a two-vessel cord. Her question was "What should I do with this?"
565.   A former 28-week-premature baby is now 15 months old and got Synagis last year. The question is whether he should get it again this year.
566.   A hospital nurse who never had chicken pox, negative titers, and frequently had to miss work, two years ago. I don't know if there are any recommendations about giving chicken pox vaccine to susceptible health care workers.
567.   A laboratory technician that works at the clinic is 38 weeks pregnant and had a positive group B streptococcal test. Question is do we know enough about this test to be using it in the way we do?
568.   A large-for-gestational-age baby was delivered by a family physician who consulted my partner because of a low calcium. My partner asked me why the calcium wasn't coming up even after we gave intravenous replacement. I said I didn't know.
569.   A less than 3-month-old male was seen earlier this week with chicken pox. The question was, "Should you treat or not?"
570.   A little girl with viral gastroenteritis and high fever. Had one metamyelocyte on her peripheral smear. What to do about it? Was it just a lab error?
571.   A little old lady Vitamin A user. She had some skin problems 3 months ago and self-medicated with Vitamin A, 2 tablets per day which is 8000 units per day. Is that enough to give you toxicity?
572.   A man had a tumor on his tongue. I did not know what it was so I referred him to an otolaryngologist. The question was "What is this tumor on the tongue?"
573.   A middle-aged man with impotence on Prozac and Atenolol had a low free testosterone and it was low two years ago. Follicle stimulating hormone and luteinizing hormone were normal. Would I need to do a magnetic resonance imaging of the sella?
574.   A mom is going to have an anencephalic baby. The question came up about donation of organs.
575.   A newborn was found to be hypoglycemic at birth on routine screen and despite treatment it persisted and was not responsive to treatment. The question was what to do about this.
576.   A newsletter says ibuprofen is linked to Reye's Syndrome. Is this misinformation?
577.   A nine-year-old came in this morning to follow up a recent hospitalization for pneumonia. Now he's much better. Chest x-ray is better. White count is 8,000 to 10,000. But about 900,000 platelets. What should I do? Should I repeat it and how soon? Should I worry about it? I said we will repeat it in 1 month. Do I need to do it sooner?
578.   A painful knee. Is it degenerative arthritis or might it be a stress fracture?
579.   A patient Dr. X saw the day before (7/30/96) said his friend told him that Plendil can react negatively if the patient is exposed to the sun. Is that true?
580.   A patient asked me a couple of days ago, "Should I take Vitamin B6 or Vitamin B12 for my neuropathy?"
581.   A patient called during the observation time to say she was worried about being on Baycol because she just heard on the radio that they were recalling it. The physician asked his nurse to tell the patient, "Just stop it and we will research that a little bit."
582.   A patient called the study physician. He and his kids are going to Asia and he wanted to know what to do for immunizations. Also he wanted to know if he should take any antibiotics with him.
583.   A patient from the nursing home (phone call) with a sore toe. History of gout. Uric acid normal. "It's hard to make a diagnosis of gout when the uric acid is normal."
584.   A patient had biopsy proven human papillomavirus on her cervix. How should you treat this? How do you know when someone is cured so it's okay to have intercourse without a condom?
585.   A patient had von Hippel-Lindau disease. "What is it? Is it cancer or a collection of blood vessels?"
586.   A patient has Duchenne's muscular dystrophy, urosepsis and is hypotensive despite many fluid boluses. What should I do?
587.   A patient has an abdominal mass. What kind of cancer is it?
588.   A patient has complex pulmonary and genetic abnormalities, fever, respiratory distress, desaturated. Is this more than usual asthma?
589.   A patient has fever and seizures. There's no source for the fever. Should I do a spinal tap?
590.   A patient has had a liver transplant. What antibiotics do I use for fever and liver failure symptoms?
591.   A patient has left lower quadrant pain and left flank pain. Urinalysis is negative. Significant pain during exam. Should I do a bimanual exam or an ultrasound to rule out ovarian problems?
592.   A patient has neonatal testicular torsion. How much damage is there to the other testicle?
593.   A patient has pyelonephritis. Does he/she need further evaluation?
594.   A patient has seizures, head bleed and coma. What kind of anti-seizure medication should I use?
595.   A patient heard that nicotine patches can cause myocardial infarction. Is this true? She heard it on the news.
596.   A patient of somebody else. Simple question. Came in with a huge international normalized ratio (prothrombin time). They decreased his Coumadin one week prior. He was getting too much thyroid. Free thyroxine was high. I don't know if that can affect the Coumadin.
597.   A patient phone call. She had 3 hives on her back but she gets hives from stress also. Is it safe to continue Bactrim?
598.   A patient various rashes which I can't diagnose. Family told her to switch care to my partner but he wouldn't take her. What should you do in this situation? I thought it was her decision.
599.   A patient with back pain, fever, abdominal pain, dysuria - should I do the complete blood count with differential before or after I get a urinalysis?
600.   A patient with pharyngitis. Is it streptococcus or not?
601.   A patient with pharyngitis. Is it streptococcus or not?
602.   A perpetual question. What to do with obesity?
603.   A phone call from mother of a 3-year-old with what she thinks is thrush. Has had it before. Physician looked up the dose of nystatin oral suspension in a reference.
604.   A phone message to one of the study physician's partners, quickly became a question for the whole group of physicians in the office that day. The phone message referred to an 8-year-old boy and read "Problem with gagging very easily with bad smells or gross things. Mom asks -- anything that can be done?"
605.   A physician's assistant asked the obstetrician (next to study physician) what would be a good antianxiety drug in this patient who is 4-months postpartum and breast feeding.
606.   A question came up yesterday . . . I don't even know how to say it . . . What is the relative risk or the incidence of streptococcal sore throat in tonsillectomized patients?
607.   A question the study physician wrote on the data form from a previous visit: "28-year-old white female notes increased acne after starting Ortho Tri-Cyclen. Is there a better choice?"
608.   A reference says you should monitor complete blood counts (CBCs) and liver functions when on Klonopin, but how often?
609.   A school-age child in for a physical exam has trace hematuria on the dipstick. "Where do you go from there?"
610.   A woman I saw last week has an abdominal aortic aneurysm (three and a half centimeters) and diverticulitis. She comes in with abdominal pain periodically. Is the abdominal pain her diverticulitis or her abdominal aortic aneurysm?
611.   A woman admitted with asthma. She said one of her children has a rare hemoglobinopathy. (The patient named the hemoglobinopathy.) I couldn't remember what that was so I looked it up in a reference in the hospital library.
612.   A woman complaining of halitosis. Had it a long time. Her (the patient's) question was, "Anything we can do about it?"
613.   A woman had Bell's Palsy as a young adolescent. When she gets a headache, her eye gets droopy on the same side. "I don't know if there's something like recurrent Bell's Palsy?"
614.   A woman with a pulmonary embolus status post pelvic surgery. She was started on heparin and then Coumadin and had a postoperative hemorrhage at her surgical site so she had an inferior vena cava filter placed and the heparin was stopped. Now she is 6 months post surgery and the question is whether she should be on anticoagulants in addition to having the filter.
615.   A woman with bad acne, status post bilateral tubal ligation is on Accutane. Dermatologist put her on oral contraceptive too. Why?
616.   A woman with fibrocystic breast disease. Why do I have to wait to get the mammogram before I send her to have the lump needled (aspirated)?
617.   A woman with lymphoma undergoing chemotherapy and wanted birth control. The question was what were the options in this patient with lymphoma, undergoing chemotherapy, and history of thromboembolic disease.
618.   A woman with mild hirsutism. "When do I need to do a dexamethasone suppression test?" "At what levels of dehydroepiandrosterone sulfate do you consider an adrenal tumor?"
619.   A woman with palpitations, good history for supraventricular tachycardia, heart rate up to about 200. The question is whether herbal supplements could be causing her tachycardia.
620.   A young guy in his late 30's had tinnitus and headaches. I did a computerized tomography scan and it showed a suprasellar mass pushing on the optic chiasm. I had to look up where the auditory nerve was in relation to the mass.
621.   A young guy with oro-genital ulcers. The question is what is this.
622.   A young woman was very concerned about whether she could have herpes. She asked, "How long does it take for herpes to show up after you have been exposed?"
623.   Adding Cytomel (T3) to augment Synthroid in patient's with depression and hypothyroidism. I can't find any good evidence for that. I (investigator) asked her what the question was and suggested, "Is that a legitimate thing to do?" She agreed that was the question.
624.   Adult woman, not seen today, but had nonulcer dyspepsia and Helicobacter pylori serology was positive. Should you treat them with antibiotics and Prilosec without imaging their stomach?
625.   After how many days can you stop using topical treatment for ringworm?
626.   After how many urinary tract infections in a child should you do a workup for anatomic defects in the urinary tract and what should the workup be? (recurrent urinary tract infection)
627.   After removing an adenomatous colonic polyp, how often should the patient have follow-up colonoscopy?
628.   After starting treatment for a step throat, how long does the patient need to stay out of work or school?
629.   Am I being too cautious in ordering a serum pregnancy test which I feel is more reliable than urine pregnancy screen? I've never found a source that says exactly when urine screens are reliable; that is, 7 days or 10 days, et cetera. I have found a range only.
630.   Am I using antibiotics appropriately to treat presumed sinusitis (versus viral upper respiratory infection)? That's my big dilemma that happens over and over. I usually use 7 days of upper respiratory infection symptoms as a reason to give antibiotics but is this appropriate?
631.   An 18-month old in for a well-child check. We always wait two days after a fever goes away before giving any vaccines. Is there any scientific data to support this?
632.   An adult diabetic with a fever for 4 days. I don't know what's causing the fever. I don't know if it's just viral or what.
633.   An adult female seen yesterday is going on a cruise and wanted to know if there was a shot for motion sickness that lasts two weeks. Is there a shot for motion sickness that lasts two weeks?
634.   An inpatient who needs blood. "If a family wants to donate blood, what is the turn around time?
635.   An old man went for eye surgery to have a cataract removed. I did a physical exam for this. I could not see the disk and could not test the ophthalmic nerve. Which cranial nerve number is the ophthalmic nerve so I can dictate that I could not test it.
636.   And then there is the 48-hour rule out. Some do 72 hours. What makes one baby a 48-hour rule out and another 72 hours?
637.   Another area we've had trouble with is Hepatitis C. I had a male patient I diagnosed with Hepatitis C, sent to a tertiary center where they did a recombinant DNA (deoxyribonucleic acid) and confirmed type C. But a different tertiary center tested twice and it was negative.
638.   Another one I always have is preventive care of people over 80 years old. Is there any consensus at all on lipid screening or colon cancer screening, for example?
639.   Another phone conversation with hospital pharmacist regarding providing enough dosage of typhoid capsules for Dr. X and his wife for out of country trip.
640.   Another question I've had. Singulair and Accolate. "Do these things work in allergic rhinitis?"
641.   Anxious patient. How much of her symptoms are organic and how much anxiety?
642.   Approximately 60-year-old man with two-month history of toe lesions. "What is causing these lesions on the ends of his toes?"
643.   Are Lotensin tablets scored and what doses does it come in?
644.   Are angiotensin converting enzyme inhibitors contraindicated in hypertensive patients with a creatinine over a certain level?
645.   Are antibiotics necessary to treat a boil (furuncle)?
646.   Are any streptococcal sore throats resistant to penicillin?
647.   Are beta blockers contraindicated in hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis, IHSS)?
648.   Are calcium channel blockers contraindicated after acute myocardial infarction?
649.   Are decongestants helpful for the common cold?
650.   Are either Entamoeba hartmanni or Blastocystis hominis pathogenic in a patient with diarrhea?
651.   Are green stools normal in infants?
652.   Are her headaches related to her elevated diastolic blood pressures? She has a booming headache today and her blood pressure is 180/96.
653.   Are her symptoms (sweating, feeling of being stimulated, nervous) due to Paxil?
654.   Are her symptoms due to dementia or depression, as often in early dementia there are symptoms of depression also?
655.   Are mexiletine levels commercially available or clinically useful?
656.   Are neck nodes helpful in diagnosing streptococcal sore throat?
657.   Are needle-like headaches described in the literature?
658.   Are nerve conduction studies or electromyograms (EMG's) helpful for purely sensory complaints (numbness)?
659.   Are nonsteroidal antiinflammatory drugs used for the inflammation of renal stones? Apparently urology clinic does that at Hospital X.
660.   Are oral decongestants contraindicated in patients with hypertension?
661.   Are patients who leave with something in their hand (sample or prescription) more likely to get better, than those who leave with nothing? Does that symbolize something, like the old witch doctor approach? I feel better when I give something but does it have anything to do with the outcome. Like in this case I gave a sample Proventil inhaler. Would it have been any benefit to give a sample of a...
662.   Are people with Fragile X syndrome sterile (male or female)? What kind of genetic counseling should they have?
663.   Are poison ivy extract injections helpful in preventing poison ivy?
664.   Are serum felbamate levels clinically available?
665.   Are skin tags associated with cancer?
666.   Are stories in the newspaper reporting an increased risk of myocardial infarction from calcium channel blockers accurate?
667.   Are subtle late decelerations just as bad as deep late decelerations?
668.   Are tear duct plugs (temporary or permanent) a legitimate treatment for dry eyes?
669.   Are the new birth control pills from Ortho (Ortho-Cept, Ortho Tri-cyclen, Ortho-cyclen) better than the usual minidose pills?
670.   Are the selective serotonin reuptake inhibitors (for example, Prozac) helpful for chronic pain? (Possible recent trial in New England Journal of Medicine)
671.   Are there any causes of a cervical hood besides fetal exposure to diethylstilbestrol?
672.   Are there any contraindications to changing a patient's Ativan to Xanax? Patient is also on Paxil.
673.   Are there any controlled trials on different ear drops for treatment of external otitis?
674.   Are there any data to support the claimed association between rapid labors and preeclampsia?
675.   Are there any diet pills on the market now that fen-phen is off the market (Meridia)?
676.   Are there any diseases where doing cardiopulmonary resuscitation (CPR) is futile and you would not have to offer it as an option?
677.   Are there any drug interactions with St. John's wort, specifically with selective-serotonin-reuptake inhibitors?
678.   Are there any drugs on this list that would interfere with general anesthetic agents? (Vasotec, Ultram, Prozac, Dicyclomine, Ambien, Tylenol)
679.   Are there any drugs that could cause a high erythrocyte sedimentation rate (ESR)?
680.   Are there any established diagnostic criteria for chronic fatigue syndrome?
681.   Are there any good review articles on the elbow fat pad sign?
682.   Are there any good reviews of management of rape in the emergency room?
683.   Are there any guidelines for when to order a head computerized tomography (CT) in a patient with a head injury?
684.   Are there any guidelines on indications for tonsillectomy in adults?
685.   Are there any immunizations a breast feeding mother should not get? Specifically is MMR (measles, mumps, rubella) okay?
686.   Are there any important differences among the three new oral contraceptives (Ortho-Cept, Ortho-Cyclen, Ortho-Tri-Cyclen)? What about safety?
687.   Are there any interactions between Biaxin and Depakote?
688.   Are there any interactions between Claritin and Midrin or between Zyrtec and Midrin?
689.   Are there any medications that can cause a tremor?
690.   Are there any new recommendations about infant feeding (nutrition) practices?
691.   Are there any new treatments for COPD (chronic obstructive pulmonary disease) exacerbation? What is the role of theophylline? Pulmocare?
692.   Are there any new treatments for hyperemesis gravidarum?
693.   Are there any new treatments or preventive treatments for influenza?
694.   Are there any nonsedating antihistamines that are safe in childhood?
695.   Are there any official recommendations about Hepatitis B vaccine in 3 - 5 year olds?
696.   Are there any published guidelines or expert opinions on what to do if you get no endocervical cells on the Papanicolaou smear?
697.   Are there any real differences among the nonsedating antihistamines?
698.   Are there any recent review articles on colposcopy and LEEP (loop electrosurgical excision procedure)?
699.   Are there any resources here so that we could get the hearing test here on this 2-month old?
700.   Are there any rules for when to get a chest x-ray to rule out pneumonia, like the Ottawa ankle rules? This patient has a cough and pleuritic pain, smoker, upper airway and bronchial sounds.
701.   Are there any studies looking at clonidine patches for nicotine withdrawal?
702.   Are there any tests or protocols to assess someone's ability to drive safely? (driving assessment)
703.   Are there appropriate accommodations for breast feeding in the workplace?
704.   Are there articles on definitions of fever?
705.   Are there better materials on natural family planning than what I have?
706.   Are there camps for attention-deficit-hyperactivity-disorder children in this area?
707.   Are there differences among the selective serotonin reuptake inhibitors (SSRI's) in terms of the degree of sedation they cause?
708.   Are there differences in blood levels between the generic and the brand name of Tegretol?
709.   Are there specific key indicators to use as a requirement for making a change in a patient's environment or living condition?
710.   Are there studies about the treatment of migraine headaches in children?
711.   Are there studies to show if passage of mucous plug in pregnancy is predictive of how soon the patient will deliver?
712.   Are there studies to show that the recommended weight gains for pregnant women are truly beneficial? He was referring to a patient whose starting weight was about 280 pounds.
713.   Are these mild gross motor delay and dysmorphic features Angelman or Prader-Willi syndromes?
714.   Are we supposed to check for Clostridium difficile if the patient is clinically better after treatment for Clostridium difficile, to be sure it's gone?
715.   Are you supposed to give the Hemophilus influenza B (HIB) vaccine at age 15 months or 18 months or just at age 2, 4, and 6 months?
716.   Are zinc lozenges any good for the common cold?
717.   As an expert witness, how should you respond when a lawyer asks long convoluted questions or questions with false preambles?
718.   At age 4 has had two simple bladder infections with no upper symptoms. Question is should I just treat or do more evaluation of the cause?
719.   At first I thought, do I focus on the groin pain or do I do these extraneous tests that he wants (like checking for diabetes) but then I thought "Is impotence a presenting sign of diabetes or a late sign?" "God do I have to look that up or am I going to wing it?" I decided to work him up now.
720.   At the age of 90, does the risk of bleeding from a daily aspirin outweigh the benefits?
721.   At what age do children need further tests after the urinary tract infection has been treated?
722.   At what age do growing pains occur and what are the typical symptoms?
723.   At what age do other doctors stop doing various screening tests? I had an 80-year-old man yesterday who wanted a prostate specific antigen and I couldn't convince him that he didn't need one. Also screening for high cholesterol and is there an age that you don't need to treat it anymore? Same with Pap smears.
724.   At what age does the risk for prophylaxis for a positive tuberculin skin test outweigh the risk of reactivation of tuberculosis (TB)?
725.   At what age should you expect a strawberry hemangioma to start to disappear?
726.   At what age should you recommend that a baby be weaned from a bottle to a cup?
727.   At what age should you refer an infant with strabismus? Does esotropia versus esophoria make a difference?
728.   At what age should you start giving influenza vaccine and pneumococcal vaccine (Pneumovax immunization)?
729.   At what age should you start screening adults for high cholesterol (hyperlipidemia)?
730.   At what age would you worry if there are no teeth. This was a 15-month-old.
731.   At what ages should you do a Denver Developmental Screening Test?
732.   At what angle of scoliosis do you not need to worry about progression in adolescents and what are the indications for referral and how do you follow them?
733.   At what dose of Premarin cream or other estrogen cream would you need to also give Provera (progesterone) to protect against endometrial hyperplasia?
734.   At what gestational age (how young) is it not very useful to do a fetal biophysical profile and nonstress test because gestational age is too low?
735.   At what hematocrit level should you worry about polycythemia vera in a smoker?
736.   At what level of anemia (what hematocrit or hemoglobin level) would you transfuse a patient postpartum?
737.   At what level of hypocalcemia should you treat with calcium? What level is dangerous for the heart?
738.   At what level of serum uric acid should you treat asymptomatic hyperuricemia?
739.   At what level on a vision screen should you refer a child with less than 20/20 vision?
740.   At what point do I start him on something prophylactic for his asthma, rather than just as-needed Proventil metered-dose inhaler?
741.   At what point in the development of a research idea should the study be submitted for institutional review board approval?
742.   Atypical presentations of sciatica. Patient has sciatic pain. Better when sitting (physician smiled indicating this was atypical). Better with lying down, which makes sense. I don't know what that is.
743.   Autopsy report (Dr. X is a medical examiner). How do you interpret a vitreous alcohol level as compared to a blood alcohol level (autopsy of motor vehicle accident victim)?
744.   Baby with brain abnormalities. What other things should we be looking for?
745.   Barotrauma -- how does it present in the ears? Forty-year old man who went scuba diving.
746.   Before I got the positive Monospot back, the thought went through my mind "What if these glands aren't from infectious mononucleosis? When do you do a lymph node biopsy so you aren't late with a lymphoma diagnosis? Can you wait 2 to 3 weeks?"
747.   Blood gas values are back. Should we change the ventilator settings?
748.   By what mechanism do angiotensin-converting enzyme (ACE) inhibitors cause renal failure in someone with renal artery stenosis? Does it matter if unilateral or bilateral stenosis?
749.   By what mechanism of action do thiazide diuretics impair glucose tolerance?
750.   Called in order for Antabuse to pharmacist. Double checked with pharmacist on dosage and frequency.
751.   Can COPD (chronic obstructive pulmonary disease) cause hyponatremia?
752.   Can Candida cause diarrhea? How do you test for it?
753.   Can Depo-Provera cause pelvic pain (pelvic cramping)?
754.   Can Group B streptococcus cause urinary tract infections in adults?
755.   Can I get a free supply of Viagra for this patient? Can I get the 100-milligram size?
756.   Can I order the nicotine patch on someone that is pregnant? She has cut down from 1/2 pack per day to 5 cigarettes and says she plans to quit completely.
757.   Can I use an MAO (monoamine oxidase) inhibitor such as Nardil in this patient who is on Risperdal and Synthroid and has been abusing Dalmane?
758.   Can Interferon cause a cough?
759.   Can Lorabid cause headaches?
760.   Can Marfan's syndrome cause joint pathology (knees, hips)?
761.   Can Neurontin (gabapentin) be used for chronic pain? Is it a legitimate treatment? Any side effects to worry about?
762.   Can Nizoral (ketoconazole) cream be used to treat seborrheic dermatitis?
763.   Can Premarin or Provera cause you to be extra sensitive to salt; that is, make foods taste saltier than they really are?
764.   Can RespiGam cause a fever?
765.   Can Seldane and Zithromax be used together? Patient phone in -- nurses discussed this with Dr. X -- he did not see patient today. Saw her earlier in the week. They did order Cefotan however -- he wasn't sure about Zithromax at first.
766.   Can Staphylococcus or Haemophilus influenza septicemia give the same clinical picture as streptococcal septicemia (fever, rash, joint pain, vomiting).
767.   Can Tegretol raise the gamma-glutamyl transferase?
768.   Can Ultram cause edema or constipation?
769.   Can Vitamin E be used as prophylaxis against coronary disease? Is 400 International Units of Vitamin E per day too much?
770.   Can Zoloft truly cause chest pain? She looked it up in a reference and it was listed as a side effect but can it truly do it?
771.   Can a blood transfusion cause an elevated white count (WBC)?
772.   Can a flare up of her pancreatitis cause relative sugar intolerance or do you think this could be the beginning of her needing insulin all the time (fasting blood sugar = approximately 240, two-hour post prandial = approximately 260)?
773.   Can a heart transplant patient have Sudafed?
774.   Can a large hematoma cause a fever?
775.   Can a low Vitamin B12 level cause dementia?
776.   Can a low serum ferritin be caused by anything besides iron deficiency?
777.   Can a mom who is breast feeding have Sudafed or another cold medication?
778.   Can a mother force her 17-year-old daughter to have a Depo-Provera shot for contraception? I should know the answer but I don't.
779.   Can a patient have pneumonia even though the chest x-ray is normal?
780.   Can a pulmonary embolus cause T-wave inversion and what electrocardiogram (ECG) changes would you expect?
781.   Can a ruptured ovarian follicle cyst cause a low grade fever and leukocytosis?
782.   Can acute infection (cellulitis, pneumonia) cause anemia the same way that chronic infection can?
783.   Can adults get bacterial laryngotracheitis?
784.   Can alcohol withdrawal affect pupillary size?
785.   Can alcoholic hepatitis cause a fever?
786.   Can amoxicillin or trimethoprim/sulfamethoxazole cause staining of a child's teeth?
787.   Can an acute pneumonia cause hypoalbuminemia?
788.   Can an acute pneumonia cause hypophosphatemia?
789.   Can an acute pneumonia cause the serum bilirubin to go up?
790.   Can an intracerebral hemorrhage cause a fever?
791.   Can anemia cause a low pulse oximetry?
792.   Can anemia make the PO2 or the oxygen saturation lower than it would otherwise be?
793.   Can anemia or acute gastrointestinal blood loss elevate the lactate dehydrogenase? (Patient also had a transfusion reaction. LDH1 (lactate dehydrogenase1) was normal so not heart)
794.   Can anorexia nervosa cause autonomic neuropathy?
795.   Can anorexia nervosa cause decreased small bowel motility, delayed gastric emptying, dysphagia?
796.   Can anserine bursitis occur in young adults (33 years old)?
797.   Can being on prednisone cause a high serum iron?
798.   Can blood substitutes be made immediately available for obstetric patients who are Jehovah's witnesses?
799.   Can burning incense bring lead into the environment of the home?
800.   Can cardioversion or an external pacemaker cause a fever?
801.   Can chronic alcoholism cause diarrhea? What is the treatment?
802.   Can colchicine be used as a diagnostic test for gout? If someone has a dramatic response to colchicine will this serve as a test with similar specificity to seeing crystals on joint aspiration?
803.   Can dapsone cause a drug fever?
804.   Can dapsone cause a rash?
805.   Can diabetes cause an elevated ALT (alanine aminotransferase)?
806.   Can diabetic neuropathy present as flank radicular pain? Would capsaicin help?
807.   Can dizziness and tingling be a side effect of Premarin vaginal cream? Patient called in with this question. Had presented earlier with these symptoms and today found the Premarin and remembered she had used it the night before these symptoms occurred.
808.   Can felbamate cause a feeling of being warm or hot or dizzy or thirsty?
809.   Can fever be a result of hives (urticaria)?
810.   Can hemochromatosis cause skin hyperpigmentation?
811.   Can hepatitis cause a pleural effusion or pneumonia?
812.   Can her walker which is an old one without wheels, have wheels put on it and will Medicare cover the cost?
813.   Can herpes zoster involve both sides of the head? Can a few other scattered lesions on the trunk occur normally?
814.   Can human immunodeficiency virus cause adrenal insufficiency?
815.   Can hyperlipidemia cause thickening of the Achilles tendon?
816.   Can imipramine be used for attention deficit disorder?
817.   Can imipramine cause leukopenia (white blood cell count 3.8)?
818.   Can inhalation of gasoline fumes cause vertigo?
819.   Can inhaled steroids cause glaucoma or cataracts?
820.   Can insurance companies pay for this pneumococcal vaccine?
821.   Can intravenous immunoglobulin cause oxygen desaturation of the blood?
822.   Can keratosis pilaris cause a generalized rash or is it always confined to the upper arms?
823.   Can lovastatin, niacin, diltiazem, or ranitidine cause myalgias or arthralgias?
824.   Can low serum testosterone cause fatigue?
825.   Can marijuana (cannabis) cause depression?
826.   Can metformin cause a mild acidosis that does not require stopping the drug?
827.   Can multiple sclerosis cause dysphagia?
828.   Can myoclonus during sleep be a result of multi-infarct dementia?
829.   Can old age alone cause weight loss? How should you work up weight loss?
830.   Can oral contraceptives cause a bone infarct (aseptic necrosis) in the tibia?
831.   Can oral iron cause a false positive Hemoccult (guaiac) test?
832.   Can pneumonia make a person's LDH (lactate dehydrogenase) and AST (aspartate aminotransferase) go up?
833.   Can pneumonia make the LDH (lactate dehydrogenase) go up?
834.   Can prednisone be used to treat alcoholic hepatitis?
835.   Can presence of the lupus anticoagulant predispose to pulmonary embolus? Does it cause a hypercoagulable state in the presence of an elevated partial thromboplastin time (PTT)?
836.   Can prolixin increase the serum prolactin level?
837.   Can prostatitis increase the prostate-specific antigen (PSA)? How much?
838.   Can sepsis cause an increase in the indirect bilirubin?
839.   Can she take Plavix is the question. I know it affects platelets. What lab work do you need before starting Plavix? It doesn't really say. Are there any interactions with the other medications she's on (she already takes 11 other medications).
840.   Can soft tissue trauma or hematomas cause elevated alanine aminotransferase (ALT) and lactate dehydrogenase (LDH)?
841.   Can steroids cause an elevated blood urea nitrogen (BUN)?
842.   Can stethoscopes act as fomites? Can they transmit infection from one patient to another?
843.   Can taking vitamin B12 predispose to gout?
844.   Can testes not being in the scrotum come from just being tense?
845.   Can the HDL (high-density-lipoprotein) cholesterol be low normally if the total cholesterol is low?
846.   Can the Zavanelli maneuver be used to replace a partially delivered breech?
847.   Can the family take this infant to high altitudes while traveling?
848.   Can the influenza vaccine cause paresthesias or peripheral neuropathy?
849.   Can this rash be a drug reaction to 1% hydrocortisone or some inert ingredient in the preparation?
850.   Can transient global amnesia have an aura similar to a migraine aura?
851.   Can upper gastrointestinal bleeding cause a leukocytosis?
852.   Can uterine fibroids cause constipation?
853.   Can vomiting cause hypokalemia? How?
854.   Can we do the PKU (phenylketonuria test) today on this 4-day-old baby? Amish, home delivery, breast feeding.
855.   Can we use Energix for all 5 doses of DPT (diphtheria-pertussis-tetanus vaccine)?
856.   Can we use Remicade in ulcerative colitis? Has anybody shown it to be effective?
857.   Can we use the QBC (automated complete blood count with automated differential) to differentiate viral from bacterial infection?
858.   Can wheezing occur in pulmonary edema?
859.   Can you breast feed when you have the stomach flu?
860.   Can you develop a tolerance to Tylenol (acetaminophen) if you take it chronically for arthritis?
861.   Can you get a fever from a resolving post-operative ileus?
862.   Can you get an ejection fraction from an echocardiogram?
863.   Can you get permanent brain damage or memory loss from electroconvulsive therapy (ECT)?
864.   Can you get rabies from a woodchuck?
865.   Can you give estrogen replacement therapy to someone with a history of deep-vein thrombosis (DVT)?
866.   Can you give omeprazole (Prilosec) for longer than 12 weeks if it's the only thing that works for a patient with reflux esophagitis? Do you need to follow the serum gastrin?
867.   Can you give the measles-mumps-rubella vaccine and chickenpox vaccine at the same time? She asked her nurse who said yes.
868.   Can you have a PO2 of 50 and an oxygen saturation of 99?
869.   Can you slow atrial fibrillation with Norvasc?
870.   Can you take Norvasc once a day?
871.   Can you tell the difference between wet rales and dry rales on physical examination?
872.   Can you treat onychomycosis with ketoconazole?
873.   Can you use Prozac along with lithium?
874.   Can you use a higher dose of Depo-Provera and use it every six months rather than every three? What dose?
875.   Can you use follicle-stimulating hormone (FSH) as an indicator of whether you are giving adequate estrogen (Premarin) as hormone replacement therapy (HRT) in menopause?
876.   Can you use ibuprofen in less than 6-month-old children?
877.   Can you use inhaled steroids for asthma below age 6 years? A reference says no. How do you administer them? How do you give oral steroids for asthma or to help diagnose cough in a child?
878.   Captopril has some side effect that other angiotensin converting enzyme inhibitors don't have that made me think I should be using enalapril more. What was the side effect? (Maybe it was just that enalapril has a longer duration of action.)
879.   Cephalexin did not work on his bronchitis. What antibiotic should I use now?
880.   Chief complaint: abdominal pain. Question: Does she have partially treated diverticulitis or is the pain related to refluxing and hiatal hernia?
881.   Child has pectus carinatum. Radiologist told Dr. X sometimes there are associated congenital heart problems. Dr. X wants to study up on this. Does the patient have these associated problems?
882.   Child just got started on sulfa today and rash developed two hours after first dose. How do you decide if this is a sulfa rash or a viral exanthem?
883.   Child seen in clinic with allergies. Prescribed hydroxyzine. Child is hyper. Is this a side effect?
884.   Child with croup. I treated with a single injection of Decadron 0.6 milligrams/kilogram/dose. But what is the total maximum single dose?
885.   Child with eczema. Is this specific procedure steroidal?
886.   Child with hyperactivity. A famous thing they put in books: Make sure you exclude other causes of hyperactivity. But no one tells you how to do that. Well, what exactly do you do? It's quite maddening.
887.   Child with unusual behavior. Kissing sister on neck. Touches father's girlfriend on breasts and babysitter on breasts. Is this a sign of sexual abuse?
888.   Clonus in a 2-month-old. Mother noticed it. Is this abnormal?
889.   College student. Suicide attempt by taking 50 Excedrin Migraine and 50 Ibuprofen. Excedrin migraine. Does it have Tylenol in it?
890.   College student. Suicide attempt by taking 50 Excedrin Migraine and 50 Ibuprofen. That amounts to 12 grams of Tylenol. Is that a toxic dose?
891.   Complains of fever 101, burns on inside or ears and throat, ears normal, throat red. What is it? I'm going to look up infectious mononucleosis symptoms.
892.   Congenital lung abnormality found in utero. What is the risk for the future?
893.   Consult from a family physician. 17-day-old girl with fever of 102. Blood culture showed alpha streptococcus. One question was whether this was most likely a pathogen or a contaminant.
894.   Conventional oral contraceptives are thrombogenic so I use Micronor for 3 months postpartum. I think that's right but I'm curious to know if that's how other people do it.
895.   Coronary angioplasty and stent placed last week. Started on Ticlid, looks like she's allergic to it. She's supposed to be on Ticlid one more week. Obviously we've got to stop it. Do they want her on something else or just stop it?
896.   Cough for one week, not getting better. 17-year-old girl. The question is, should she have antibiotics.
897.   Could I have used a low-dose birth control pill instead of doubling the dose of Premarin? I've heard you can do that. She's doing better on the higher dose of Premarin.
898.   Could I put this guy on ketoconazole? He had a four-fold rise in his liver function tests on Sporanox.
899.   Could Procardia or Mevacor cause tinnitus?
900.   Could an axillary mass in a pregnant woman at 31 weeks gestation be breast tissue?
901.   Could an osteoarthropathy associated with chronic lymphocytic leukemia (CLL) cause bilateral ankle pain?
902.   Could any of her medications cause her to be incontinent? She's on thioridazine, carbamazepine, Klonopin, theophylline, Premarin, trazodone.
903.   Could diphtheroids cause an abscess and should they be treated?
904.   Could mycoplasma present as hepatitis and pneumonia?
905.   Could phenol or xylene cause neurologic disease such as weakness on one side?
906.   Could skin lesions consistent with warfarin-induced skin necrosis be that if the patient has been on warfarin for "some time"?
907.   Could systemic lupus erythematosus cause left-sided weakness and how does systemic lupus erythematosus change cerebral spinal fluid?
908.   Could the cause of her weakness and dizziness be that she gets bradycardia at times from her medications? She's on Calan SR, a beta blocker and Lanoxin. Her pulse now is 88 but maybe it gets slow at times.
909.   Could the patient's prior medication (L-asparaginase) have caused deep venous thrombosis?
910.   Could the right-sided chest pain be the shingles (no rash now)?
911.   Could thirst, hypertension, and headaches, with the thirst and headaches improving on an angiotensin converting enzyme (ACE) inhibitor be related?
912.   Could this compression fracture of T12 (twelfth thoracic vertebra) be caused by cancer or what could be the cause? (Prostate cancer or Pagets or what)?
913.   Could this patient with pelvic inflammatory disease and generalized abdominal pain have Fitz-Hugh-Curtis syndrome?
914.   Daughter of 86-year-old woman called for Flexeril prescription for her mother's "contractures" and wanted it in liquid form. Doctor X said, "Flexeril doesn't come as a liquid does it?"
915.   Diabetic with orthostatic hypotension. Secondary to autonomic neuropathy? Was hypertensive but I've been gradually decreasing hypertensive medications. When do you start Florinef and how do you start it and how do you monitor it?
916.   Did I write the prescription correctly for Synalar lotion? I think there is just one strength, I think it's medium potency, I think it comes in 15 cc (cubic centimeter) bottles.
917.   Did X's study on malpractice and gender control for age?
918.   Did this patient have a seizure?
919.   Did we talk about whether crack smoking can precipitate sickle cell crisis?
920.   Do Asian patients have children who have more problems with jaundice?
921.   Do Coumadin and Augmentin interact?
922.   Do I gain anything with Bactrim over amoxicillin in terms of coverage? He was on amoxicillin a month ago and now has a second episode of otitis media. Should I be using a second line agent (for example, Augmentin) or does Bactrim have increased coverage over amoxicillin?
923.   Do I have to retreat this ear? Seen for otitis media 10 - 12 days ago, now returns for cough and sniffles but not really acute otitis. We all overtreat.
924.   Do I need to change the vent setting on this infant who has developed an abnormal blood gas?
925.   Do I need to prophylax my patient? Patient is on chemotherapy and mother developed a herpes cold sore on her lip overnight.
926.   Do I need to wait until the baby is a certain age before I do the renal ultrasound for single umbilical artery?
927.   Do I need to work this up right now with a full weight loss workup like a chest x-ray and something to look at the pancreas, or can I follow this for now?
928.   Do angiotensin II inhibitors work like regular angiotensin converting enzyme inhibitors to preserve kidney function in mild diabetes?
929.   Do angiotensin converting enzyme inhibitors aggravate glaucoma (for example, Plendil)?
930.   Do angiotensin converting enzyme inhibitors prolong survival if given routinely after a myocardial infarction?
931.   Do antibiotics help irritable bowel syndrome?
932.   Do any of Dr. X's studies challenge the Kansas City study which found an association between labor epidural anesthesia and cesarean section?
933.   Do brown recluse spiders live as far north as Red Oak, Iowa?
934.   Do fluctuations or abnormal levels of estrogen and progesterone (such as with menopause or cyclic changes) cause emotional upset?
935.   Do hot tubs cause urinary tract infections?
936.   Do kids need to be on multivitamins when they "eat fair" but likes noodles, does not like green vegetables?
937.   Do koilocytes on Papanicolaou smear or endocervical curettage (ECC) or colposcopy biopsy always come from human papilloma virus (HPV)?
938.   Do nonsteroidal anti-inflammatory drugs (NSAID's) cause hypertension? How commonly?
939.   Do opioids (narcotics) work for chronic pain?
940.   Do pilar cysts (sebaceous scalp cysts) ever turn hard (usually they're soft)?
941.   Do reticulocytes raise the mean corpuscular volume (MCV); that is, are reticulocytes bigger than normal red blood cells?
942.   Do salicylates cause the same concern about proteinuria as nonsteroidal anti-inflammatory drugs? She had proteinuria in the past which we traced back to nonsteroidal anti-inflammatory drugs.
943.   Do the same types of human papilloma virus that cause condylomata also cause cervical carcinoma?
944.   Do the side effects of Zocor include liver disease?
945.   Do these face films show a fracture?
946.   Do thiazide diuretics cause hyperlipidemia?
947.   Do ventilation tubes make tympanic thermometer readings even less accurate?
948.   Do we do a leukapheresis for a white count of 300,000?
949.   Do we have any patient information on idiopathic thrombocytopenic purpura (handout)?
950.   Do we have to do antiviral therapy until we receive the results back from the spinal tap?
951.   Do we immobilize pulmonary arteries at this institution? Do we do this procedure? (Resident mentioned sarcoma.)
952.   Do we need to do a spinal tap to rule out meningitis?
953.   Do we need to do a work-up on this patient with a pacemaker who is having severe chest pains?
954.   Do we need to work up a child who had a tracheostomy, has a runny nose, and is on a ventilator?
955.   Do we need to worry about thrombocytopenia or other side effects in someone on long term heparin?
956.   Do you always need to do a dilatation and curettage if you think someone has had a completed spontaneous abortion?
957.   Do you always need to treat a fractured fifth metatarsal with a cast, or is an ace wrap sometimes enough?
958.   Do you generally use antiinflammatory drugs for acute joint injuries before you inject?
959.   Do you have to avoid the sun when you take Lipitor?
960.   Do you know if Armour Thyroid suppresses the thyroid stimulating hormone but leaves the free thyroxine normal?
961.   Do you need antibiotics after a dog bite? Which antibiotics would you use?
962.   Do you need parental consent to insert a Norplant in someone under age 18?
963.   Do you need to be on a special diet before you get a 24-hour urine for vanillylmandelic acid (VMA), catecholamines, and metanephrines?
964.   Do you need to do a tuberculin skin test if you want to rule out tuberculosis in a patient with hemoptysis and the patient has a negative chest x-ray?
965.   Do you need to do anything else when somebody develops secondary enuresis, besides a urinalysis?
966.   Do you need to get a pregnancy test before giving the next Depo-Provera injection?
967.   Do you need to give subacute bacterial endocarditis prophylaxis before flexible sigmoidoscopy with biopsies?
968.   Do you need to monitor liver function tests with griseofulvin or terbinafine?
969.   Do you need to stop the valproate (Depakote) if the blood ammonia level is elevated?
970.   Do you need to use subacute bacterial endocarditis (SBE) prophylaxis for mild tricuspid regurgitation (TR)?
971.   Do you really need to do a liver biopsy in patients with a chronically but mildly elevated alanine aminotransferase (ALT) or elevated liver function tests (LFTs)?
972.   Do you treat a 50-year-old gentleman, recently returned from Africa with Blastocystis Hominis?
973.   Doctor A has 100 patient-days in March and Doctor B has 150 patient-days in March. Is there a significant difference?
974.   Doctor X saw a 73-year-old woman with a history of sarcoidosis in 1957. Patient wanted a follow-up chest x-ray. What is the recommended follow-up for sarcoidosis?
975.   Doctor X thinks he is probably just a normal 18 month old but would like to know if there are a certain number of respiratory infections that are considered normal for that age.
976.   Doctor X's question asked of Doctor Y. This hospitalized patient with bilateral pleural effusions of unknown etiology now has confusion and a pCO2 of 50. Is that pCO2 high enough to cause confusion? (pO2 = 74)
977.   Doctor would like a better way to introduce the subject of sexually transmitted disease -- open rather than closed question -- to get the information she needs. Now she asks "Are you careful about protecting yourself against sexually transmitted diseases?" Her question is whether there is a better way to ask this.
978.   Does Augmentin come in a chewable form?
979.   Does Benadryl come in a 50-milligram tablet?
980.   Does Biaxin raise theophylline levels?
981.   Does Celebrex (celecoxib) or Vioxx (rofecoxib) cause heart disease and myocardial infarction (MI)?
982.   Does Cipro come as a liquid?
983.   Does Claritin (loratadine) cause prolongation of the Q-T interval? Is it contraindicated with fluconazole or erythromycin?
984.   Does Cozaar bother renal function?
985.   Does Fiorinal make the birth control pill (oral contraceptive) less likely to work?
986.   Does Genora 35 really have exactly 35 micrograms of estrogen since it is a generic? If not does this affect efficacy?
987.   Does Glynase come in a 6-milligram strength?
988.   Does Griseofulvin come in a 375 milligram pill?
989.   Does Premphase work for birth control?
990.   Does Prozac cause cancer?
991.   Does Strattera really work?
992.   Does Synthroid come in 175 microgram pills? (His thyroid stimulating hormone was approximately 7.0.)
993.   Does Tetramune have acellular or regular pertussis vaccine? What is the current pediatric schedule?
994.   Does Vancenase AQ cause hypertension?
995.   Does Wegener's granulomatosis have neurological complications?
996.   Does Zantac (ranitidine) affect iron absorption?
997.   Does a child who cannot walk need to come back to the emergency room?
998.   Does a child with pneumonia on chest x-ray need a follow-up x-ray to document clearing?
999.   Does a family history of breast cancer alter screening mammogram recommendations?
1000.   Does a five-month-old with a ventricular septal defect meet criteria for respiratory syncytial virus vaccine (sic) (Synagis)?
1001.   Does amoxicillin come in 875-milligram tablets?
1002.   Does an LH:FSH (luteinizing hormone : follicle stimulating hormone) ratio of 3:1 or more indicate polycystic ovaries? (mentioned by Dr. X)
1003.   Does an obese postmenopausal woman need hormone replacement therapy?
1004.   Does any attending have experience with ingestion of glass ornament fragments?
1005.   Does bradycardia contribute to heart failure? Is it an indication for pacemaker or stopping digitalis?
1006.   Does breast cancer in an aunt increase the risk of breast cancer?
1007.   Does breast feeding affect diabetic control? Patient says her sugars are dropping and wonders if it is breast feeding that is influencing this. Also needing to use her glasses more.
1008.   Does bromocriptine cause hypertensive crisis and stroke? Is it no longer recommended for lactation suppression?
1009.   Does chronic use of Dulcolax tablets represent laxative abuse? Does the bowel become dependent on it the way it does on stimulant laxatives?
1010.   Does direct bilirubin elevation cause kernicterus?
1011.   Does diuretic use mess up the usefulness of the urine sodium in the diagnosis of hyponatremia?
1012.   Does ear taping work? (His partner asked him this and he didn't know.)
1013.   Does every person with bad esophagitis need endoscopy, looking for Barrett's?
1014.   Does every stroke patient need to be admitted to the hospital?
1015.   Does grand multiparity protect against ovarian and endometrial cancer the same way that oral contraceptives do?
1016.   Does having had a cone biopsy in the past affect the length of labor?
1017.   Does he have otitis media? Can't see his tympanic membrane's due to wax. Tried to get it out 4 days ago and couldn't.
1018.   Does he really have headaches or is he pulling my leg (to get drugs)?
1019.   Does her bulging fontanelle relate to her congestive heart failure? Would you do something more about the bulging fontanelle like an ultrasound or head computerized tomography (CT)?
1020.   Does hydrochlorothiazide cause gout or increased uric acid levels? Contraindicated in patients with gout?
1021.   Does imipramine come as a 25-milligram tablet?
1022.   Does intravenous erythromycin cause nausea?
1023.   Does it make any difference if you give Lipitor (atorvastatin) or other similar lipid lowering drugs with the evening meal or can you give anytime during the day?
1024.   Does it make any difference if you take the blood pressure again in the same arm after a few seconds of the first reading? Do you get an accurate reading the second time?
1025.   Does it make any difference whether someone has their shirt on with a rolled up sleeve when you take their blood pressure?
1026.   Does it make any difference whether the total daily dose of methylprednisolone you give for COPD (chronic obstructive pulmonary disease) exacerbation is given every 12 hours or every 6 hours?
1027.   Does it make any difference whether you draw the blood for a prostate specific antigen before or after the rectal exam?
1028.   Does it make sense to inject trigger points for chronic pelvic pain?
1029.   Does it matter if you do a rectal exam before you do a prostate specific antigen test? Does it affect the test?
1030.   Does meclizine come as a liquid?
1031.   Does menopause cause weight gain?
1032.   Does mild Eustachian tube dysfunction cause vertigo? And hearing loss? No otitis media, no aspirin.
1033.   Does obesity affect the efficacy of oral contraceptives?
1034.   Does omeprazole come in intravenous form?
1035.   Does oral iron therapy affect the guaiac card result?
1036.   Does palpable purpura have anything to do with thrombocytopenia or is it a different mechanism?
1037.   Does pregnancy cause a low albumin?
1038.   Does pregnancy exacerbate chronic fatigue syndrome?
1039.   Does pregnancy make acne worse?
1040.   Does progesterone (Depo-Provera) cause acne?
1041.   Does progesterone cause vasoconstriction, thereby causing hypertension?
1042.   Does psychosocial stress play a role in triggering enuresis?
1043.   Does saw palmetto work for benign prostatic hypertrophy (BPH)?
1044.   Does she have any underlying inflammation of her kidneys? Creatinine approximately 1.0, 3+ albumin on urinalysis, just over 500 milligrams protein/ 24 hrs, normal intravenous pyelogram.
1045.   Does she have appendicitis (white blood cell count = 16,000)?
1046.   Does she have osteoarthritis or rheumatoid arthritis (generalized but early stage)? He discussed and looked in textbook after patient left clinic.
1047.   Does she have pneumonia?
1048.   Does smoking increase the risk of breast cancer?
1049.   Does the c-reactive protein go up with temporal arteritis or polymyalgia rheumatica?
1050.   Does the length of symptoms help in diagnosing sinusitis?
1051.   Does the patient need to be fasting when you check the HDL (high-density-lipoprotein) and LDL (low-density-lipoprotein) cholesterol?
1052.   Does the serum cholesterol go down with acute illness? Is it worth getting on hospitalized patients?
1053.   Does theophylline cause fatigue?
1054.   Does this 9-month-old boy need any immunizations?
1055.   Does this baby have Cri du Chat Syndrome?
1056.   Does this child have hypospadias?
1057.   Does this child really need a morphine drip?
1058.   Does this child who's having an asthma attack need to come to the emergency room?
1059.   Does this child with physical anomalies have a syndrome or not?
1060.   Does this film show a fracture of the medial malleolus? Is this apparent avulsion fracture old or new?
1061.   Does this infant have a milk allergy? (explosive stools since put on cow's milk formula)
1062.   Does this patient need a lactation consult?
1063.   Does this patient need antibiotics? He came in expecting them but I think it's not streptococcus. No fever. I did not do a throat culture because he has no insurance and I did not want him to have that expense.
1064.   Does this patient who is vomiting need to be seen right away?
1065.   Does this patient with a 3-week-old fracture of the distal head of the fifth metatarsal need any treatment?
1066.   Does this patient with a plate in her hip, but no murmur, need subacute bacterial endocarditis prophylaxis before the dentist cleans her teeth?
1067.   Does this town have fluoride in the water?
1068.   Does this woman with moon face, hair growth and buffalo hump have Cushing's Syndrome? If cortisol levels are elevated, where do I go next?
1069.   Does treating versus not treating streptococcal sore throat prevent poststreptococcal glomerulonephritis?
1070.   Does vasectomy cause an increased chance of prostate cancer?
1071.   Does weight loss help obstructive sleep apnea?
1072.   Dose of Accupril increased from 20 to 40 and now she is coughing. Is this due to the medication?
1073.   Dose of Bactrim for a 52-pound child.
1074.   Dr. X knows that if a postmenopausal woman is on estrogen for only a few years, she gets a continued protective effect against osteoporosis. Is that protective effect also ongoing with only a few years of estrogen therapy in the case of heart disease?
1075.   Dr. X received consult report from neurologist at tertiary center X regarding patient's possible tendinitis but letter somewhat unclear so he telephoned this physician for an interpretation. Does she have tendinitis?
1076.   Dr. X received phone call from visiting nurse that his patient who had a leg amputation a long time ago (diabetic) now has an ulceration on her good leg, won't let them in the house to do dressing changes, et cetera. What to do?
1077.   Dr. X said Tagamet has been used successfully for treatment of warts--recommended by a dermatology professor. Question is, what is appropriate dosage?
1078.   Dr. X's nurse asked him about the dose of Valtrex when she was noting this visit on chart. Dr. X had to look up the dose.
1079.   Drug dosing question - Amphotericin - used a different formulation in past, now new formulation.
1080.   Drug representative visiting. I had a patient with hypertension, well-controlled. I started him on Celebrex and the blood pressure went to 200/110. "Can this happen?"
1081.   Drug representative was visiting. "I have a patient who is still having pain on Celebrex. What is the maximum dose?"
1082.   Earlier had been seen for vaginal bleeding. Ultrasound now shows 14-week viable fetus with adjacent blood clot the size of the fetus. Hemoglobin 10 so probably had a significant bleed. What is the most appropriate way to treat a pregnancy with a viable fetus?
1083.   Eight-year-old boy with recurrent abdominal pain. I called Doctor X (pediatric gastroenterologist) and said, "OK, what is this? I don't know what to do."
1084.   Elderly man status post deep vein thrombosis 2 years ago, on Coumadin. If the INR (international normalized ratio) and prothrombin time are a little over therapeutic, he feels good and has no swelling in his legs. If his prothrombin time gets down to 17 or 18 or INR (international normalized ratio) down to 1.9 or 1.8, he swells up and complains of pain. I don't know why this is so I keep him a ...
1085.   Elderly man with adenocarcinoma of the esophagus. "Just kind of knowing . . . ." "There's something called neoadjuvant chemotherapy." "Just trying to figure out the survival benefits with these regimens."
1086.   Elderly man with rheumatoid arthritis. What labs do you need to follow in a patient on methotrexate other than liver function tests and a complete blood count?
1087.   Elderly man. I had to look up hematospermia. How much of a workup you have to do?
1088.   Elderly patient in care center with cough and cold. Should you order complete blood count (CBC) and chest x-rays on patients like this or just treat?
1089.   Elderly woman came in this week with the odor of urine. Has diabetes and arthritis. Lives with grandson who is retarded. Is this elder abuse? What do you do about this?
1090.   Elderly woman with chin lesion. I thought this was a sebaceous cyst, but when I got in there it was more solid, ? granuloma. What is it?
1091.   Eleven-month-old twins with otitis media. A tympanocentesis came back Hemophilus influenzae sensitive to ampicillin/sulbactam but resistant to amoxicillin/clavulanate. So which oral antibiotic should we put them on?
1092.   Eleven-year-old boy with Down syndrome. Sleep apnea can increase the thyroid stimulating hormone but by how much and is that because night time growth hormone suppresses and overlaps somehow with the rest of the pituitary? "I wanted to know if there was a special antibody I should get."
1093.   Elidel. I wasn't sure if I could use it for cradle cap.
1094.   Email question from study physician: "A frail, thin, 82-year-old male presented to me with new onset of unilateral gynecomastia. Now the question is: Do I have to pursue any further workup? Mammogram? Is this similar to the adolescent male unilateral gynecomastia that we sometimes see, or is this more worrisome?
1095.   Email question from study physician: "A question we've had difficulty finding the right answer for: What is the normal alkaline phosphatase value for a 10-year-old girl?"
1096.   Employment physical, history of depression, doing well. Is there any sort of predictive data on an association between depression and safety and performance at work, on or off antidepressants?
1097.   Episodes of night time crying -- wakes up after she's been asleep awhile. Is she having night terrors? Doesn't want to play when she wakes up like when she was younger. Wakes at 10 PM or midnight.
1098.   Expressive language delay: what's normal, what age?
1099.   Fatty liver. What I don't know is whether biopsy is the standard of care. "Is that the standard of care?"
1100.   Female around age 40 with vascular headache. What is the dosage of Midrin? Said he has to look this up occasionally.
1101.   Female patient seen this morning. How long should you wait after delivering before starting oral contraceptives? I'm not sure if there are increased risks of blood clots.
1102.   Fever of unknown origin and seizure. Should I do a lumbar puncture right away or wait for blood work?
1103.   Five-week-old with colic who cries so hard she passes out. No seizure activity. How young do you see breath holding spells?
1104.   Five-year-old boy seen by my partner for kindergarten physical, mentioned he had been having some chest pain. Got an electrocardiogram which showed a QTc (corrected QT interval) of 440 milliseconds, otherwise normal electrocardiogram. "Any further workup needed?"
1105.   Five-year-old boy with "reactive airway disease." The question was, "What is the difference between asthma and reactive airway disease?"
1106.   Five-year-old boy with a distal radius fracture (buckle fracture). Should I use a long arm cast or short arm?
1107.   Five-year-old boy with severe mental retardation. Parents had lots of questions about "sensory diet." "The general question is does sensory integration therapy work and how does it work?"
1108.   Five-year-old girl with diffuse alopecia now improving. She was given the diagnosis of "loose antigen with hair disorder" by my former partner. Some kind of childhood associated alopecia. I've never heard of that. The question was, "What is it?"
1109.   Five-year-old twins. Dichorionic, diamnionic. Mom asked, "Can't that egg split in the fallopian tube and then be dichorionic, diamnionic?"
1110.   Five-year-old unable to swallow Adderall XR. "Can Adderall XR be crushed and mixed and still be extended release?"
1111.   For cost effectiveness will it be best to change patient to verapamil sustained release from Tiazac?
1112.   For diabetes insipidus, when do we use DDAVP (desmopressin) in regard to sodium levels?
1113.   For infants with colic and gastroesophageal reflux disease, what do the experts use as rough guidelines for when to treat with medications?
1114.   For long standing fluid behind the ear drum, should I order steroids? Patient says ears feel plugged up.
1115.   For osteoporosis, when do you use Evista versus when do you go to Fosamax? And when to do the intravenous bisphosphonate, Zometa?
1116.   For post viral cough, Dr. X usually prescribes a short term bronchodilator such as Proventil inhaler. Are there data to support this treatment?
1117.   For premature babies who get Synagis, we had one who tested positive for respiratory syncytial virus and the question was "Should we continue the Synagis for the rest of the respiratory syncytial virus season?"
1118.   For spotting in the first trimester, how often does ultrasound give a definitive answer as to the cause?
1119.   Four years ago was scoped and had chondromalacia of patella. Now having difficulty again, affecting mobility. What treatments would be beneficial?
1120.   Four-day-old male under bililights. The congenital adrenal hyperplasia test came back positive. How do I deal with this?
1121.   Four-month-old. "Positional plagiocephaly in infants. "Do you need to put that head banding thing on?" Do they need treatment?" Cranial banding. We're putting kids on their back now. Do they need that helmet?
1122.   Four-week old. What is the dose of Diflucan for tinea capitis in an infant?
1123.   Four-year-old boy with a fractured clavicle. How to treat a fractured clavicle?
1124.   Four-year-old with asthma, got respiratory syncytial virus. Do you give albuterol and steroids for respiratory syncytial virus?
1125.   Fourteen-month-old girl. We thought the girl had Fifth Disease. "Do you get hives with Fifth Disease?" was my question.
1126.   Fourteen-year-old with keratosis pilaris. I never know what to do with that.
1127.   General question that comes up -- what to do when a patient insists on a prescription for an antibiotic when it is probably a virus and will resolve on its own?
1128.   German exchange student. German physician said she needs another diphtheria-tetanus immunization. But I looked at her records from Germany and she was fully immunized, just had one 2 months ago. So what do you do?
1129.   Giardia test came back positive. What are the treatment options?
1130.   Had an out-of-town patient with kidney stone and blood in the urine. Typical drug abuse story. But microscopic exam showed red blood cells in all stages of crenation, suggesting on going rather than factitious bleed. True?
1131.   Had shortness of breath which is unusual for her. Doctor wishes she had access to a list of things that might cause shortness of breath in a normally healthy 28-year-old. Concerned about pulmonary embolism.
1132.   Had shoulder injury and after repaired was about to return to work but developed severe hives requiring steroids. What caused the hives? Was it angioedema due to being stressed about returning to work?
1133.   Has a Pseudomonas urinary tract infection sensitive to Cipro but no other oral drugs (in nursing home). Had a Foley catheter but now out. Should I add another antibiotic to the Cipro (use 2 drugs)?
1134.   Has a rash that is not getting better. How should I treat it? Would Cordran be appropriate?
1135.   Has an autonomic neuropathy caused decreased gastrointestinal motility and dysphagia similar to patient X been described?
1136.   Has anybody shown that well-child checks are helpful?
1137.   Has been on hormone replacement therapy for several years, menopausal for 10 years. Has breast tenderness and spotting a couple of times a year. What can I do to lessen her symptoms related to hormone replacement therapy?
1138.   Has cefaclor (Ceclor) been withdrawn from the market?
1139.   Has huge ganglion on right wrist. What is causing all the joint pain?
1140.   Has tetanus toxoid changed in the last 30 years? He had a febrile reaction at age 8 and has not had any tetanus shots since then. I suspect he got the (diphtheria-pertussis-tetanus vaccine) DPT.
1141.   Has the American Academy of Pediatrics set forth guidelines on sleep position in infants in order to prevent sudden infant death syndrome?
1142.   Has the use of prophylactic heparin been studied to prevent pulmonary embolus in patients with congestive heart failure?
1143.   Have there been any studies with low molecular weight heparin in pregnancy because I have an obstetric patient who had a deep vein thrombosis with her last pregnancy and I'm wondering if I can use it?
1144.   Have you ever dealt with an autistic child who urinates only once a day? 6-year-old.
1145.   Have you heard of the new rules for ordering lipids? I (investigator) said, "so the question is . . . what should I do with this?" She said, "Yeah. How do I follow therapy? Should I just order the whole panel and tell the patients they have to pay?"
1146.   Have you seen this? (Study physician handed me (investigator) a letter from an orthopedist which told about a new treatment for low back pain called the DRS (Decompression Reduction Stabilization)/Spina System. "I'd be interested to know what the orthopedic department at Iowa . . . ask them what they think of that."
1147.   He admitted this male patient to the hospital early this morning with pericarditis. The question is, "What is the current treatment for acute pericarditis?"
1148.   He brought up a concern about a 1-year-old female with cytomegalovirus who also has a younger brother. Not a current question but this came up with prior office visits because his nurse was pregnant at the time.
1149.   He had a direct fall on his shoulder. Is this a rotator cuff injury?
1150.   He has a history of getting hit in the head and neck and getting two "stingers" with numbness down his arm. Now in for a preparticipation physical. When do you do a neck x-ray?
1151.   He has a mole on his back. Is it a seborrheic keratosis or an intradermal nevus?
1152.   He has a rash on his forearms. Rashes are always a question to some extent in my experience.
1153.   He has decreased air entry on the left. Is he in more failure?
1154.   He has ear pain and I'm not sure of his diagnosis (temporomandibular joint syndrome versus external otitis).
1155.   He has had several ear infections and doesn't get over them completely -- (about 1 month duration). Is there a particular organism I should be after? Should I use another antibiotic than I use for an older child?
1156.   He has shown no improvement with three weeks of therapy for Bell's palsy -- still complete facial paralysis on the left side. When does he need more intervention? Dr. X usually sees improvement by now.
1157.   He has sleep apnea. They recommended using a continuous-positive-airway-pressure (CPAP) mask but before I noticed that, the question came to mind, how should I treat his sleep apnea? Continuous-positive-airway-pressure?
1158.   He is 5 feet 11 inches and weighs about 230 pounds. Is he obese?
1159.   He just started this patient with heart failure on a newly approved beta blocker (carvedilol). Is it really better than plain old propranolol for heart failure as it is probably about four times as expensive?
1160.   He noted that a lead level check had not been done yet so it was drawn today. How can we check every child for this? Do we try to do too much?
1161.   He states this is a frustration question. There is no answer. She is an exceptional patient that lives in a group home. Is having bleeding between periods, so scheduled for Papanicolaou smear. At the last visit she was having her period, so rescheduled for today and because of reluctance to have exam, was given Mellaril prior to coming into office. Again she refused to have the exam and so staf...
1162.   He wants the cream (Zovirax) which I never use so I've got to look that one up.
1163.   He's already on hydrocodone. I prescribed a Duragesic patch. The question is using narcotics for noncancer pain. How legitimate is that?
1164.   He's getting increasingly frequent herpes simplex virus of the lip. Is it related to his chewing tobacco?
1165.   He's got night sweats along with a lot of other symptoms. But the only concerning one is night sweats. I (investigator) prompted: "So what would you look up? What is the question?" He said, "Any other unusual causes that I might need to check for and any symptomatic treatment?"
1166.   He's on Hytrin 10 milligrams every day for benign prostatic hypertrophy. Still having benign prostatic hypertrophy symptoms. Do you push Hytrin higher? Do you add Proscar? Or do you just hold?
1167.   Hemoglobin approximately 4.0, white blood count 3000. History of dementia. What's causing her bone marrow to be knocked out? Is it related to her dementia? Also occult blood in stool. Should I put her through a gastrointestinal workup?
1168.   Her headaches don't fit a pattern. Are they migraines? (Complicated because there is so much going on socially.)
1169.   Her hip x-ray showed Paget's disease. What should I do with her Paget's disease? I've never had a patient with Paget's disease before.
1170.   Her prescription for Tegretol was filled in December, 1995 and she has not used them for a while. The trigeminal neuralgia has returned. Are the pills still good?
1171.   Her sodium is 133 and potassium 3.3. Why is she borderline low on sodium and potassium? Could her Dilacor do it? (also on Ventolin and Slobid) I didn't look up Dilacor.
1172.   Here is a nursing home patient (elderly female) (said this while going through his mail) with a pressure ulcer on her heel. I guess I'm supposed to know this -- which of the dozens of dressings available are best for this?
1173.   Here's a good question. DEXA (Dual-Energy X-Ray Absorptiometry) and computerized tomography bone density are different! I (investigator) asked her how she would phrase the question. She said, "Why is there such a discrepancy and which one should we be using?"
1174.   Here's a question that I looked up. Seven-year-old adopted patient from Russia, all records are in Russian, and they have not been translated, but parents thought he had had the BCG (Bacillus Calmette-Guerin) vaccine. We did a tuberculin skin test, and it was positive at 15 to 17 millimeters. "Do we treat it?"
1175.   Here's a question: Follicle stimulating hormone/luteinizing hormone ratios in the diagnosis of polycystic ovary syndrome. Recently I've been reading that it's not felt to be a useful test. Then why are the gynecologists ordering it all the time? Is it a useful test or not?
1176.   Here's a question: In someone with Addison's disease, is there any blood test you can do to check to see if they're on enough steroids, like an ACTH level or something?
1177.   Here's an ethical question: "Do you tell patients about medical mistakes?"
1178.   His lactate dehydrogenase (LDH) is low. What does a low lactate dehydrogenase (LDH) mean?
1179.   His last (and first) Hepatitis B vaccine was last August (6 months ago). I'm going to bunch the series in reverse; ie, give second injection today and 3rd in a month or two. Is that okay to bunch them in reverse?
1180.   His nurse's daughter had a tumor on her knee (distal femur). It was increasing in size but looked like a benign osteochondroma. Is it an osteochondroma even though increasing in size?
1181.   His nurse's grandmother called in for a prescription for Novahistine. What is Novahistine elixir and what is the dose?
1182.   His physician's assistant called about a patient with hidradenitis suppurativa asking how to treat her.
1183.   History of at least 2 urinary tract infection's which have responded to treatment, urine clear in between. Now she's having incontinence. What is causing her incontinence? She actually came in for osteopathic manipulation of her neck.
1184.   History of cancer of the colon 20 years ago at age 70 when cause of anemia was followed up. Her hemoglobin still falls but he doesn't think she has any more cancer. She takes iron supplements daily. Question is what causes hemoglobin to fall? Hemoglobin today 10.5 (lower).
1185.   History of coronary artery bypass graft, low-density lipoprotein (LDL) cholesterol approximately 140. He's going to Texas for 3 months. Should I continue lipid lowering diet or start medication now and ask him to find doctor in Texas?
1186.   History of dysequilibrium and treated for serous otitis three times, December, January, and now (June). Has responded to antibiotics each time but he is concerned, with this frequency, if there is a possibility of a neurologic problem (that is, brain tumor, et cetera). Offered neurology consult.
1187.   History of guaiac positive stools but flexible sigmoidoscopy clean this morning. Can beets cause guaiac positive stools?
1188.   History of past infection left deltoid which left small cyst. Now here with large 4" by 2 1/2" irregular red hot area L deltoid. Question is what is it?
1189.   How accurate are the rapid streptococcal test and throat culture if a patient is already on antibiotics?
1190.   How accurate is the rapid streptococcal test?
1191.   How are homocysteine and folic acid related to hyperlipidemia?
1192.   How are standard errors, standard deviations, and variances related to each other?
1193.   How are the newer medications for attention-deficit hyperactivity disorder (ADHD) being used?
1194.   How big does a pneumothorax have to be before you have to insert a chest tube? If you decide to treat expectantly, how fast does it resolve?
1195.   How big does the left atrium have to be before cardioversion for atrial fibrillation is unlikely to be successful (this patient was 5 centimeters)?
1196.   How can I get her to be compliant with exercise and a diabetic diet?
1197.   How can I keep up with all this paperwork?
1198.   How can I politely say "I don't have time to see your kids too" when a mother brings them along?
1199.   How can I understand past bronchopulmonary dysplasia spells in a patient with chronic lung disease?
1200.   How can you differentiate a common cold (viral upper respiratory infection) from one of the bacterial complications of a cold?
1201.   How can you do a screening motor exam of the hand?
1202.   How can you tell for a single patient if the before and after treatment scores on the American Urologic Association bladder-neck-obstruction questionnaire are significantly different?
1203.   How can you tell if a questionnaire or other survey instrument is reliable and valid (reliability, validity)?
1204.   How can you tell if someone has had an adverse drug reaction? What is the probability that the drug you think caused it really caused it?
1205.   How clinically important is the interaction between oral contraceptives and antibiotics? Does a patient on oral contraceptives with acne for whom you want to give tetracycline need to use an alternative method of contraception?
1206.   How common are the secondary bacterial infections you can get with chickenpox?
1207.   How could the mother of this 4 1/2-year-old drift along for so long without getting any immunizations?
1208.   How could you distinguish between withdrawal symptoms and recurrence of original symptoms if a patient were taken off lorazepam?
1209.   How do I adjust the ventilator based on blood gas values?
1210.   How do I approach treatment of stools with frank white/pink gastrointestinal mucosal sloughing with a lack of blood in a former gastroschisis patient?
1211.   How do I change the ventilator on this infant with high PCO2?
1212.   How do I combine antidepressant drugs in terms of dosage adjustment? This patient is on amitriptyline and Paxil. How high can I push the dose on each and is the usual upper limit of one affected by the other antidepressant?
1213.   How do I diagnosis congenital adrenal hyperplasia?
1214.   How do I diagnosis myelodysplastic syndrome?
1215.   How do I do a Ballard scoring exam on a newborn?
1216.   How do I do a paracentesis?
1217.   How do I do a vecuronium drip?
1218.   How do I dose gentamicin orally?
1219.   How do I find a journal article about failure to thrive?
1220.   How do I get American Academy of Pediatrics patient handouts off the computer?
1221.   How do I get a new obstetric patient to quit smoking other than brow beating?
1222.   How do I get my computer working again? I can't do any prescriptions, et cetera.
1223.   How do I handle the parents of a 9-month-old who is not gaining weight the way he should in the past month? Mom is breast feeding.
1224.   How do I heparinize this patient?
1225.   How do I load a patient with Dilantin who has a low Dilantin level?
1226.   How do I manage Stevens-Johnson Syndrome?
1227.   How do I manage a child who is having more apneic spells?
1228.   How do I manage a patient who had an abnormal lab value?
1229.   How do I manage atrial flutter?
1230.   How do I manage bacterial meningitis?
1231.   How do I manage chronic lung disease?
1232.   How do I manage fluids for kids with heart disease?
1233.   How do I manage newly diagnosed diabetes?
1234.   How do I manage respiratory distress in this cardiac patient?
1235.   How do I manage status asthmaticus?
1236.   How do I manage this acetaminophen overdose? What is the toxicity?
1237.   How do I manage this asthmatic?
1238.   How do I manage this genetic syndrome?
1239.   How do I manage this patient with respiratory syncytial virus?
1240.   How do I order prescriptions using the computer?
1241.   How do I take care of a circumcision that isn't healing properly?
1242.   How do I treat depression?
1243.   How do I treat head lice in a patient under 1 year?
1244.   How do I treat herpes zoster (shingles)?
1245.   How do I use terbutaline nebulizers for asthma?
1246.   How do associated symptoms such as cough help with the differential diagnosis of pharyngitis?
1247.   How do estrogen and progesterone affect serum lipid levels?
1248.   How do normal values for PO2 (on arterial blood gases) change with aging?
1249.   How do oral contraceptives work? What's the mechanism?
1250.   How do serum estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels vary during the menstrual cycle?
1251.   How do we best manage this brain injury which is increasing in pressure?
1252.   How do we bolus a patient (with Heparin) to get partial thromboplastin time levels up?
1253.   How do we diagnose Pneumocystis carinii pneumonia?
1254.   How do we do this vecuronium drip?
1255.   How do we do ventilatory management for this 8-month-old with respiratory distress?
1256.   How do we interpret this cerebrospinal fluid cell count?
1257.   How do we manage this patient's blood pressure?
1258.   How do we sedate this child when the normal way didn't work?
1259.   How do we start feeds on newborn infants? What rate do we feed them at?
1260.   How do we treat rhabdomyolysis?
1261.   How do we treat these hallucinations?
1262.   How do we treat this new presentation of leukemia?
1263.   How do we use the paralyzing agent in this intravenous infusion?
1264.   How do you administer the new meningococcal vaccine?
1265.   How do you analyze data with a dichotomous outcome variable and a continuous independent variable?
1266.   How do you analyze paired Likert scale data and ordered-scale outcome data?
1267.   How do you analyze paired count data?
1268.   How do you approach a nursing home patient who is incontinent? The nurses think there is a motivation issue with her. Elderly woman status post stroke. Residual 300 cubic centimeters in morning but 100 cubic centimeters at end of day, bed damp at times.
1269.   How do you approach serous otitis in terms of treatment?
1270.   How do you approach the asymptomatic patient with diffuse thyroid enlargement noted on routine exam? What is the work up?
1271.   How do you approach the situation of a pregnant woman's exposure to chicken pox?
1272.   How do you aspirate the hip joint?
1273.   How do you biopsy basal cell carcinomas?
1274.   How do you calculate Montevideo units?
1275.   How do you calculate the creatinine clearance?
1276.   How do you check for coronary artery spasm during cardiac catheterization? Inject ergonovine?
1277.   How do you classify pelvic fractures?
1278.   How do you convert (switch) someone from regular heparin to low molecular weight heparin (LMWH, enoxaparin)?
1279.   How do you convert grams to millimoles and milliequivalents?
1280.   How do you convert pounds to kilograms and inches to centimeters?
1281.   How do you correct for hypoalbuminemia when you have a low serum calcium?
1282.   How do you deal with a palpable thyroid nodule? What's the workup and treatment?
1283.   How do you deal with a patient who is going South next week for the winter and she needs a follow up thyroid function test in 6 weeks?
1284.   How do you deal with shoulder dystocia?
1285.   How do you decide who needs to be admitted to rule out myocardial infarction (MI) in patients who present to the emergency room with atypical chest pain?
1286.   How do you diagnose Herpes simplex conjunctivitis?
1287.   How do you diagnose Kaposi's sarcoma and how do you treat it?
1288.   How do you diagnose and treat IgA nephropathy?
1289.   How do you diagnose and treat a pediatric habit cough?
1290.   How do you diagnose and treat acute tubular necrosis (ATN)?
1291.   How do you diagnose and treat adult hyperactivity (attention deficit hyperactivity disorder, ADHD)?
1292.   How do you diagnose and treat chronic compartment syndrome?
1293.   How do you diagnose and treat hepatic encephalopathy?
1294.   How do you diagnose and treat post-streptococcal glomerulonephritis?
1295.   How do you diagnose carotidynia and how do you treat it?
1296.   How do you diagnose cor pulmonale and how do you treat it?
1297.   How do you diagnose diabetes just based on a random blood sugar or a fasting blood sugar (diagnostic criteria for diabetes, definition of diabetes)?
1298.   How do you diagnose gonorrhea pharyngitis?
1299.   How do you diagnose iritis and episcleritis (causes of red eye)?
1300.   How do you diagnose lactic acidosis in someone taking Glucophage (metformin)? What tests should you order and when should you suspect it?
1301.   How do you diagnose reactive hypoglycemia?
1302.   How do you diagnose rotator cuff tendinitis again? (Just went to a course on this)
1303.   How do you diagnose sinus infection? Does a green discharge mean sinus infection? When do you really have a sinus infection versus just a viral upper respiratory infection?
1304.   How do you diagnose sinusitis clinically?
1305.   How do you diagnose tracheomalacia? What is the differential diagnosis? What is the treatment?
1306.   How do you differentiate a basal cell carcinoma from sebaceous hyperplasia on inspection?
1307.   How do you differentiate prostatosis from prostatitis and how do you treat prostatosis?
1308.   How do you differentiate pseudoseizures from real seizures?
1309.   How do you differentiate ventricular tachycardia from supraventricular tachycardia with aberrancy?
1310.   How do you distinguish among the different kinds of headache? Are there diagnostic criteria?
1311.   How do you distinguish persistent pulmonary hypertension of the newborn (PPHN, persistent fetal circulation, PFC) from transient tachypnea of the newborn (TTN, TTNB)?
1312.   How do you do a Cortrosyn (cosyntropin, ACTH) stimulation test to diagnose Addison's disease?
1313.   How do you do a Tzanck prep and how do you interpret it?
1314.   How do you do a circumcision with a Gomco clamp?
1315.   How do you do a circumcision?
1316.   How do you do a modified Apt test for fetal hemoglobin where you put the sodium hydroxide directly on the bloody material on the diaper?
1317.   How do you do a paracentesis (for ascites)?
1318.   How do you do a sweat chloride test using pilocarpine iontophoresis?
1319.   How do you do a tilt table test to workup syncope?
1320.   How do you do a weighted average of Poisson data?
1321.   How do you do a weighted average of two proportions?
1322.   How do you do an intralesional injection for someone with pustular or cystic acne? How do you inject one nodule?
1323.   How do you do colposcopy of the vagina in a woman who had a hysterectomy and now has vaginal intraepithelial neoplasia on Papanicolaou smear?
1324.   How do you do no scalpel vasectomies (vasectomy) using Dr. X's method?
1325.   How do you dose Augmentin and amoxicillin when you give them twice a day (BID)?
1326.   How do you dose Glucophage XR (extended-release metformin)?
1327.   How do you dose heparin for a known or suspected pulmonary embolus or deep-vein thrombosis (DVT)?
1328.   How do you explain Bell's Palsy (peripheral) versus central facial nerve palsy in terms of the anatomy and cross innervation? There is cross innervation in the forehead and with Bell's there should be involvement of the forehead but how do you explain?
1329.   How do you explain and figure Kendall's tau?
1330.   How do you figure the mean blood sugar from the hemoglobin A1C (glycosylated hemoglobin)?
1331.   How do you fit a cervical cap?
1332.   How do you get a clean catch urine from an infant?
1333.   How do you get a stress view of the ankle if you are worried about ankle mortise widening?
1334.   How do you get cerumen out when it's plastered up against the tympanic membrane? I'm not sure what the ear nose and throat people would do.
1335.   How do you give Retin-A? How does it come? What strength? And how often?
1336.   How do you give Vitamin K if you want to reverse the effects of Coumadin if the prothrombin time is too long?
1337.   How do you give albuterol nebulizer treatments to infants and children? What's the dose?
1338.   How do you give an albumin infusion (such as for ascites)?
1339.   How do you give an amnioinfusion? What solution? How fast?
1340.   How do you give fresh frozen plasma to someone with a high prothrombin time (protime) (for example, from liver failure) before doing a procedure (for example, an abdominal tap for ascites)?
1341.   How do you give local anesthesia (nesicaine, xylocaine, lidocaine) for endometrial biopsy (Pipelle) or endocervical curettage (ECC)?
1342.   How do you give magnesium sulfate (MgSO4) for preeclampsia?
1343.   How do you give valproic acid (Depakote) for migraine headache prophylaxis?
1344.   How do you go about getting or prescribing an enuresis alarm?
1345.   How do you grade colposcopy results?
1346.   How do you grade spondylolisthesis and what are the treatments available and indications for surgery?
1347.   How do you help an overweight patient with degenerative joint disease to lose weight so his degenerative joint disease will get better?
1348.   How do you induce labor with prostaglandin gel? Do you need to stay in the hospital after you place Cervidil? How do you give Prepidil? How do you give Cytotec (misoprostol)?
1349.   How do you inject the bicipital tendon?
1350.   How do you inject the subacromial bursa (shoulder pain, rotator cuff)?
1351.   How do you instruct a patient on doing Kegel exercises?
1352.   How do you instruct someone to irrigate their nose for sinusitis?
1353.   How do you interpret Troponin levels?
1354.   How do you interpret a positive hepatitis B surface antigen (HBsAg) with a negative hepatitis B surface antibody (HBsAb), positive core antibody (HBcAb)? Should you check serologies or just enzymes and ultrasound? Should he get Hepatitis B immunization?
1355.   How do you interpret creatine kinase MB fraction? Is it the absolute value or the percent of total creatine kinase that you should look at?
1356.   How do you interpret different ankle/brachial blood pressure indices? What's bad, what's normal, is there a cutoff ratio for considering surgery?
1357.   How do you interpret hepatitis serologies and which ones should be ordered under what circumstances?
1358.   How do you interpret the draw-a-clock test after the patient draws it?
1359.   How do you interpret the international normalized ratio when adjusting the Coumadin dose?
1360.   How do you interpret these photoscreening pictures?
1361.   How do you interpret various levels of blood alcohol?
1362.   How do you know if ST elevation is abnormal on the electrocardiogram?
1363.   How do you know if ST segment elevation is real (that is, injury) or just J-point elevation?
1364.   How do you know when someone with heart failure should not receive digitalis because of diastolic dysfunction?
1365.   How do you know when you should induce someone with pregnancy induced hypertension (PIH) without preeclampsia?
1366.   How do you know where the outer extent of the transformation zone is?
1367.   How do you listen for a renal artery bruit (what technique)?
1368.   How do you make the Bonferroni correction?
1369.   How do you make the diagnosis of Marfan's Syndrome?
1370.   How do you make the diagnosis of Sjogren's Syndrome?
1371.   How do you make the diagnosis of asthma if a patient is reluctant to have the diagnosis for insurance reasons?
1372.   How do you make the diagnosis of diabetes insipidus?
1373.   How do you make the diagnosis of hemochromatosis?
1374.   How do you make the diagnosis of juvenile rheumatoid arthritis (JRA)?
1375.   How do you make the diagnosis of lichen planus if you suspect it?
1376.   How do you make the diagnosis of proctalgia fugax and how do you treat it?
1377.   How do you make the diagnosis of pseudotumor cerebri (benign intracranial hypertension) if you suspect it?
1378.   How do you manage a threatened abortion?
1379.   How do you manage neonatal abstinence syndrome?
1380.   How do you manage new onset diabetic ketoacidosis?
1381.   How do you manage this neuroblastoma?
1382.   How do you manage this patient with renal stones?
1383.   How do you manage tumor lysis syndrome?
1384.   How do you marsupialize a Bartholin cyst?
1385.   How do you mix up the saline nasal wash solution recommended by otolaryngology?
1386.   How do you motivate a diabetic patient to make positive life style changes; that is, dietary. Patient admits he isn't following recommended diet.
1387.   How do you prescribe Epi-Pen? Three episodes of itching, then hives, then short of breath. Two times following eating shrimp.
1388.   How do you prescribe sodium bicarbonate to alkanalize the urine in someone who needs to start probenecid?
1389.   How do you prescribe the fat-blocker orlistat (Xenical)?
1390.   How do you prescribe the new drug Propecia for baldness (and minoxidil)?
1391.   How do you prevent calcium containing kidney stones?
1392.   How do you remove endocervical polyps? What to do if there is bleeding?
1393.   How do you remove the memory from the Glucotrol Elite Glucometer?
1394.   How do you report a Bonferroni correction to the p-value?
1395.   How do you report the obstetric history (gravidity, parity) when there are twins or other multiple births?
1396.   How do you rule out or diagnose a patient who thinks they may have von Willebrands' disease?
1397.   How do you run a nitroglycerine drip?
1398.   How do you score the Beck Depression Inventory (Scale)? What is considered "positive"?
1399.   How do you score the Connors Teacher Rating Scale in a child with attention deficit hyperactivity disorder (ADHD)?
1400.   How do you score the geriatric depression scale?
1401.   How do you screen for homocysteinemia? Dr. X knows it is a risk factor for heart disease but treatment is probably folic acid which is pennies per day so should you spend the money to screen for it?
1402.   How do you sedate a child with Down Syndrome?
1403.   How do you set boundaries in a caring way with a manipulative patient? That's something I've been struggling with. I got where I didn't want to go into work because I knew her chart would be on my desk and I'd have to call her.
1404.   How do you switch someone from the oral contraceptive pill to Depo-Provera?
1405.   How do you take an influenza culture?
1406.   How do you tell if a distal fibular fracture is stable in which case you can just use a blue boot?
1407.   How do you tell if a patient is having a bronchospasm if they don't wheeze?
1408.   How do you tell if someone has acute tubular necrosis (ATN) versus just prerenal oliguria and azotemia?
1409.   How do you tell the difference between treating anxiety and treating benzodiazepine withdrawal symptoms when someone is trying to decrease their benzodiazepine intake?
1410.   How do you test (screen) for Cushing's disease? How do you do a dexamethasone suppression test?
1411.   How do you test reflexes?
1412.   How do you treat Barrett's esophagus? What is it? Should patients have endoscopic surveillance due to increased risk of cancer?
1413.   How do you treat Helicobacter pylori?
1414.   How do you treat Hepatitis A?
1415.   How do you treat a Tylenol overdose?
1416.   How do you treat a base of the 5th metatarsal fracture? Is a cast needed?
1417.   How do you treat a child with recurrent vomiting?
1418.   How do you treat a chronic (candida, monilia) paronychia?
1419.   How do you treat a chronic obstructive pulmonary disease (COPD) exacerbation?
1420.   How do you treat a few adhesions on the foreskin of a 2 year old?
1421.   How do you treat a nontoxic goiter?
1422.   How do you treat a quadriceps muscle contusion and what is the name of that disease that involves ectopic calcium deposits in the quadriceps?
1423.   How do you treat a ruptured Baker's cyst (pseudothrombophlebitis)?
1424.   How do you treat a tachycardia with a wandering atrial pacemaker (multifocal atrial tachycardia)?
1425.   How do you treat agitated depression?
1426.   How do you treat an Escherichia coli urinary tract infection?
1427.   How do you treat an acute myocardial infarction (MI) in the emergency room? What things should be done?
1428.   How do you treat an acute transfusion reaction characterized by shaking chills and dyspnea? Benadryl and hydrocortisone were used.
1429.   How do you treat an ankle sprain?
1430.   How do you treat and prevent and what causes urethral, prostatic, seminal vesicle stones (calculi)?
1431.   How do you treat bloody diarrhea due to E. coli 0157:H7?
1432.   How do you treat bronchiectasis?
1433.   How do you treat congestive heart failure when you also have chronic renal failure?
1434.   How do you treat daily headache (daily migraine or daily tension headache)?
1435.   How do you treat diastolic dysfunction when seen on echocardiogram?
1436.   How do you treat dyshidrotic eczema (also known as dyshidrosis or pompholyx)?
1437.   How do you treat emphysematous cystitis?
1438.   How do you treat gallstones in pregnancy or cholecystitis? Do you wait until after delivery? Is there such a thing as sluggish gallbladder during pregnancy that would cause symptoms?
1439.   How do you treat generalized anxiety disorder? Can you use a selective-serotonin-reuptake inhibitor (SSRI)?
1440.   How do you treat hemolytic uremic syndrome if you diagnose it?
1441.   How do you treat hemorrhoids and what are the indications for surgery?
1442.   How do you treat hidradenitis suppurativa?
1443.   How do you treat hyperkalemia (elevated potassium), and how do you look for the cause? How do you treat chronic hyperkalemia? (hyporenin-hypoaldosterone, Type 4 renal tubular acidosis)
1444.   How do you treat hypermagnesemia?
1445.   How do you treat hypomagnesemia?
1446.   How do you treat intrapartum suspected chorioamnionitis (fever in labor)?
1447.   How do you treat multifocal atrial tachycardia?
1448.   How do you treat myelodysplastic syndrome?
1449.   How do you treat neonatal acne?
1450.   How do you treat nephrotic syndrome?
1451.   How do you treat night cramps (leg cramps) and what causes them? Is gabapentin (Neurontin) effective? How do you workup muscle cramps?
1452.   How do you treat oral hairy leukoplakia?
1453.   How do you treat pancreatitis?
1454.   How do you treat pediculosis pubis in the eyelid? Asked of participant by different physician in group but it then became Dr. X's question.
1455.   How do you treat persistent yeast vaginitis?
1456.   How do you treat phantom limb pain?
1457.   How do you treat preterm labor? What tests should be done during speculum exam? What is the dose of Terbutaline for tocolysis in preterm labor (premature labor)?
1458.   How do you treat pulmonary hypertension?
1459.   How do you treat recurrent or persistent yeast (candida) vaginitis?
1460.   How do you treat refractory congestive heart failure?
1461.   How do you treat refractory heel pain syndrome?
1462.   How do you treat resistant Tinea versicolor?
1463.   How do you treat resistant head lice?
1464.   How do you treat scleroderma?
1465.   How do you treat someone with cervical spine arthritis with radicular pain and cervical spine series showing encroachment on neural foramina?
1466.   How do you treat someone with institutional colon (megacolon filled with air)?
1467.   How do you treat the diarrhea that can come from diabetic neuropathy?
1468.   How do you treat the four common kinds of headache?
1469.   How do you treat the newborn when the mother is Group B streptococcus positive?
1470.   How do you treat uric acid kidney stones?
1471.   How do you treat ventricular tachycardia?
1472.   How do you treat vitiligo?
1473.   How do you use Enoxaparin (low molecular weight heparin)? How do you dose it in an obese person?
1474.   How do you use Redux? What are the indications?
1475.   How do you use Tegaderm or Duoderm for bed sores (decubitus ulcers)?
1476.   How do you use Zofran for hyperemesis gravidarum?
1477.   How do you use Zyban (Wellbutrin, bupropion) to help with smoking cessation?
1478.   How do you use a 30 cubic centimeter (cc) Foley balloon to induce labor?
1479.   How do you use labetalol to acutely lower blood pressure?
1480.   How do you use the 24-hour total creatinine excretion to determine if you have an adequate 24-hour urine collection?
1481.   How do you use the 24-hour urine creatinine excretion to tell if you have had an adequate collection of urine?
1482.   How do you use the Bishop score for cervical ripening?
1483.   How do you work someone up for a hypercoagulable state? (Prompted by woman with two deep vein thromboses in the past)
1484.   How do you work up a high erythrocyte sedimentation rate (ESR) of unclear etiology?
1485.   How do you work up a jittery baby?
1486.   How do you work up a patient with asymptomatic proteinuria?
1487.   How do you work up a syncopal (syncope) episode in an adult?
1488.   How do you work up a woman complaining of generalized hair loss (alopecia)?
1489.   How do you work up an adult for chronic diarrhea?
1490.   How do you work up an elevated partial thromboplastin time?
1491.   How do you work up and treat fecal incontinence, fecal soiling, fecal leakage in an adult?
1492.   How do you work up and treat pruritus ani (perianal dermatitis)? What are the causes? (pruritis ani)
1493.   How do you work up hirsutism? Do you need to order all the androgens or can you screen with one?
1494.   How do you work up normocytic anemia?
1495.   How do you work up possible carcinoid syndrome?
1496.   How do you work up pseudocholinesterase deficiency?
1497.   How do you work up someone with a transient ischemic attack (TIA)?
1498.   How do you work up someone with hyponatremia?
1499.   How do you workup a kid with hematuria?
1500.   How do you workup a testicular mass (for example, ultrasound) and how do you know who does not need to be referred for biopsy?
1501.   How do you workup an adult for acute diarrhea?
1502.   How do you workup and treat priapism?
1503.   How do you workup galactorrhea? I think I should get at least a thyroid stimulating hormone and prolactin level.
1504.   How do you workup microscopic hematuria in an adult?
1505.   How do you workup someone who complains of loss of taste and smell (anosmia) over the past 9 months?
1506.   How do you workup someone with lytic lesions in their bones that could be multiple myeloma or metastatic lesions?
1507.   How do you write a prescription for cromolyn ophthalmic drops?
1508.   How do you write for Burrow's solution?
1509.   How do you write intravenous (IV) orders for maintenance and replacement fluids for kids?
1510.   How do you write patient controlled anesthesia (PCA) pump orders?
1511.   How does Legionnaires disease present and what is the best way to diagnose it? Does it involve the liver? Can it make the transaminases go into the thousands?
1512.   How does a possible cleft lip contribute to feeding problems?
1513.   How does allopurinol precipitate acute gout? What is the mechanism?
1514.   How does aspirin taken by the mother affect the baby?
1515.   How does hypokalemia affect the electrocardiogram?
1516.   How does lupus in the mother affect the baby?
1517.   How does mother's herpes simplex virus affect care of infant?
1518.   How does myotonic dystrophy present in newborns (general information)?
1519.   How does pregnancy affect serum cholesterol levels?
1520.   How does pulmonary artery banding work on tricuspid atresia?
1521.   How does sepsis change the values on a chemistry panel?
1522.   How does the IgG (immunoglobulin G) synthesis rate on cerebrospinal fluid help determine if systemic lupus erythematosus involves the central nervous system?
1523.   How does the computerized tomographic scan look for this child? (Child was seizing.)
1524.   How does the mnemonic Kentucky and Tennessee work with S3 and S4 gallops?
1525.   How effective is felbamate (new anticonvulsant)?
1526.   How far forward is it normal for a coccyx to be angulated forward? The patient's coccyx was acutely angled forward after a fall (< 90 degrees).
1527.   How fast should we give intravenous fluids to this leukemic patient?
1528.   How good is the evidence that Karo syrup causes infant botulism?
1529.   How good is the evidence that cimetidine (Tagamet) is effective for warts?
1530.   How good is the evidence that mitral valve prolapse causes chest pain and what are the characteristics of the pain?
1531.   How good is the evidence that topical anesthetics cause eye damage?
1532.   How good is the serum test (ELISA (enzyme-linked immunosorbent assay) or CIE (counterimmunoelectrophoresis)) for Giardia (as opposed to 3 stools for ova and parasites)?
1533.   How good is the triple screen at predicting Down syndrome?
1534.   How hard do you push to catch kids up on hepatitis B and varicella vaccine at their kindergarten physical? Do people still do tuberculin skin tests (PPD's) and that kind of stuff?
1535.   How high above normal is it safe to let transaminases go (liver function tests, LFT's, alanine aminotransferase, ALT) in a patient on a 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG co-A) inhibitor? How often to monitor? Same for creatine kinase (CPK)?
1536.   How high can I push the Elavil dose in someone who is also taking Prozac?
1537.   How high can you let the creatine phosphokinase (CPK) get in someone on Mevacor (lovastatin) before you have to stop the drug?
1538.   How high can you let the pCO2 go in someone with a chronic obstructive pulmonary disease (COPD) exacerbation before you need to use a respirator?
1539.   How high does the triiodothyronine (T3) have to be to consider T3 thyrotoxicosis? How high would Premarin make it go?
1540.   How high is it safe to let the liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) go up when someone is on isoniazid (INH)?
1541.   How high is too high for a fever that is not coming down? When do I send them to the ER?
1542.   How important is it to start this newly diagnosed diabetic on something right away, versus have him come back for patient education and do it then (4+ sugar in urine, random blood sugar 250)?
1543.   How important is it to use Gastroccult rather than Hemoccult (guaiac) to test for occult blood in gastric secretions?
1544.   How important is it to use an eye patch for a corneal abrasion (foreign body)? What ointment should be used?
1545.   How in depth do you go with a sports physical and lab work? I did not get a urinalysis. I heard at a meeting that only 1% of urinalyses on sports physicals show anything.
1546.   How infrequently is it reasonable for this kid to see a neurologist without pushing me into that uncomfortable corner that I'm not comfortable with (managing four seizure medications)?
1547.   How is Concerta like Ritalin?
1548.   How is a DEXA (dual energy x-ray absorptiometry) scan done to measure bone density (osteoporosis), and how do you interpret the results?
1549.   How is a heart transplant done? What are the risks for atrial arrhythmias? Ventricular arrhythmias?
1550.   How is it best to broach the withdrawing of treatment (best way to talk to the families, et cetera)?
1551.   How is preeclampsia defined and differentiated from just pregnancy induced hypertension?
1552.   How late is too late to use amantadine or rimantadine for influenza?
1553.   How likely is it that Zoloft or Valium versus all her stressors are causing her decreased sex drive?
1554.   How likely is it that a normal adult would get oral Candida (thrush)? How aggressively should they be worked up for immunosuppression?
1555.   How likely is it that someone with a high erythrocyte sedimentation rate but normal c-reactive protein would have polymyalgia rheumatica or temporal arteritis?
1556.   How likely is it to have no fever in an elderly debilitated person with pneumonia?
1557.   How little can I do in a patient like this who comes in so often? I can't blow things off too quickly even when they probably should be blown off.
1558.   How long after a myocardial infarction do you get Dressler's syndrome? (Patient X, 3 mos)
1559.   How long after menopause doesn't it do any good to start estrogen to prevent osteoporosis? Is there a time limit for preventing osteoporosis?
1560.   How long can you leave a throat culture for streptococcus sitting in the tube before you have to plate it?
1561.   How long do I administer antibiotics?
1562.   How long do I administer antibiotics?
1563.   How long do I let diarrhea go before doing a stool culture?
1564.   How long do subconjunctival hemorrhages last?
1565.   How long do we use the oral secretion medication for this seizure patient?
1566.   How long do you continue antidepressants or antianxiety medications after the patient is improved?
1567.   How long do you have to wait between chicken pox immunization and others?
1568.   How long do you need to wait after giving the Hepatitis B vaccine to check the Hepatitis B surface antibody to see if the vaccine worked and what to do if it didn't work?
1569.   How long does benign positional vertigo usually last?
1570.   How long does it take for a clinically unimportant coronary lesion to become clinically important; that is, how long before repeating a catheterization showing minimal disease if the patient has worse symptoms?
1571.   How long does it take the erythrocyte sedimentation rate to fall after the infection is getting better? Does the fall in sedimentation rate lag behind clinical improvement?
1572.   How long does it take to get frostbite at various temperatures and wind chill factors?
1573.   How long does labyrinthitis last?
1574.   How long does the troponin stay elevated after a myocardial infarction?
1575.   How long into the course of infectious mononucleosis is it before the Monospot turns positive?
1576.   How long is it acceptable to leave a kidney stone in the ureter with almost complete obstruction before trying to remove it? Or with minimal obstruction? When to check again?
1577.   How long is it before an infant diagnosed with respiratory syncytial virus (RSV) can go back to day care?
1578.   How long is it safe to be on phentermine alone?
1579.   How long is mononucleosis contagious?
1580.   How long should I treat a knee injury with conservative measures before referring to an orthopedic surgeon? (contusion of right patella)
1581.   How long should intravenous antibiotics be continued when they were not indicated?
1582.   How long should this patient be kept on Floxin? Has a history of two previous bouts of cystitis.
1583.   How long should you give isoniazid to a PPD (purified-protein derivative) converter?
1584.   How long should you give prophylactic colchicine once it is started after an acute attack of gout?
1585.   How long should you keep a patient with conjunctivitis out of school?
1586.   How long should you keep someone anticoagulated after a successful cardioversion if they were anticoagulated before for the purpose of doing an elective cardioversion from atrial fibrillation?
1587.   How long should you leave a patient on Coumadin AND heparin? Can I stop the heparin as soon as the protime is therapeutic?
1588.   How long should you treat someone with acute sinusitis?
1589.   How long should you wait after giving the digoxin dose before you get a digoxin level?
1590.   How long should you wait before getting an x-ray of a fracture to check for healing (callus) and when do you need to worry about nonunion?
1591.   How long should you wait before giving an epidural in a patient on oxytocin?
1592.   How long should you wait to try to get pregnant again after a spontaneous abortion?
1593.   How long will a Monospot test stay positive? This is an 18-year-old girl who had infectious mononucleosis a year ago with a sedimentation rate of approximately 50, now has a positive Monospot and sore throat and sedimentation rate of approximately 10.
1594.   How many adults get ear infections (otitis media), because I've had two this afternoon and usually you think of them in kids but not adults.
1595.   How many alcoholic drinks per day is too many? What is the definition of alcoholism?
1596.   How many cubic centimeters of Tylenol and Motrin do I give this child?
1597.   How many elevated blood pressures should you document before starting treatment for hypertension in adults?
1598.   How many family physicians are giving Hepatitis B vaccine to their teenagers?
1599.   How many months apart should the patient receive Prevnar shots (doses)?
1600.   How many nicotine patches are over-the-counter? Is it just Habitrol? or just Nicotrol? I didn't know if they were all over-the-counter or not?
1601.   How many people with a condition or exposure do you need before you can enter them into a logistic regression model?
1602.   How many red cells per high power field is considered abnormal on a urinalysis?
1603.   How many sprays are in the new Vancenase nasal inhaler -- the kind you use every day instead of twice a day. The patient asked me and I didn't know.
1604.   How many times do the real doctors at the U just treat with antibiotics rather than getting a streptococcal test?
1605.   How many weeks gestation does someone need to be before you would not try to stop preterm labor?
1606.   How meaningful are these fluctuations in cholesterol/triglycerides in this patient on Zocor (triglycerides approximately 170 increased to approximately 250 on the same dose of Zocor). How often do I have to follow the cholesterol?
1607.   How much Delsym cough syrup do I give?
1608.   How much Dilantin should he take? Dilantin level is approximately 2.5 and he started tapering it on his own against medical advice.
1609.   How much aspirin is in a baby aspirin?
1610.   How much bicarbonate should be added to Xylocaine to buffer it to make the injection less painful?
1611.   How much cholestyramine is in Questran tablets compared to a scoop of Questran powder?
1612.   How much codeine is in Tylenol with codeine elixir?
1613.   How much do you gain from hysteroscopy over fractional dilatation and curettage? Should I add this technique to my armamentarium?
1614.   How much does Hepatitis B vaccine cost?
1615.   How much does Hytrin cost? Is there a generic?
1616.   How much does a tetanus shot cost?
1617.   How much does cholestyramine (Questran Light) cost?
1618.   How much does lovastatin (Mevacor) and other lipid lowering agents (for example, Lipitor) cost?
1619.   How much does the chickenpox vaccine cost?
1620.   How much estrogen can a woman be on without being too much?
1621.   How much extra prednisone (steroids, corticosteroids) should you give someone under stress, or going to have major surgery, or trauma?
1622.   How much folic acid is in Zenate?
1623.   How much of a workup should I do in view of his age (84) particularly since he's eating well? He's lost approximately 10 pounds in the last 15 months.
1624.   How much of each kind of padding and casting material do you need for various kinds of casts?
1625.   How much potassium should you put in replacement intravenous (IV) fluid in a child or baby?
1626.   How much scoliosis is enough to pull the trigger and refer? He had a hair of lumbar scoliosis, no thoracic scoliosis. He was clearly under the line but where's the line?
1627.   How much should I be pushing hepatitis vaccine and chickenpox vaccine since they're optional?
1628.   How much vomiting is normal in an infant (for example, reflux) and how much should make you think of pyloric stenosis?
1629.   How much weight should a breast-fed baby gain in the first month? How little of a weight gain is safe before giving up and going to formula feedings?
1630.   How often can you safely inject steroids into someone's knee for osteoarthritis?
1631.   How often do ovarian cysts recur?
1632.   How often do women get auxiliary nipples?
1633.   How often do you need to check a patient's eyes if they are on lovastatin (Mevacor)?
1634.   How often do you need to check creatine phosphokinase (CPK) and liver enzymes in someone on 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG CoA) reductase inhibitors?
1635.   How often do you need to get complete blood counts (CBC's) when someone is on Ticlid (ticlopidine)?
1636.   How often does Henoch-Schoenlein Purpura occur and in what population?
1637.   How often does amoxicillin cause a rash in someone with infectious mononucleosis?
1638.   How often does an acute cholecystitis present with left-sided abdominal pain?
1639.   How often should I be seeing this patient with hypertension and hyperlipidemia?
1640.   How often should a carotid doppler be ordered for follow-up on this 76-year-old woman with hypertension and cardiovascular disease?
1641.   How often should a chest x-ray be done on a TB (tuberculin) reactor? He hasn't had an x-ray in 4 years.
1642.   How often should a patient have glucose screening if there is a history of gestational diabetes with a previous pregnancy?
1643.   How often should glucose be monitored in a baby born to a mother with gestational onset diabetes or other risk factor and how do you treat hypoglycemia in the newborn?
1644.   How often should he have an ultrasound or computerized tomography (CT) to follow his thoracic aortic aneurysm? Should I be doing one every time he has chest pain?
1645.   How often should she have a colonoscopy? Last one was one year ago and she has a history of colon cancer.
1646.   How often should someone have tonometry as a screen for glaucoma?
1647.   How often should this patient need a pneumonia vaccine? Her last one was in 1993.
1648.   How often should white blood cell counts be monitored in patients on carbamazepine?
1649.   How often should you check a Dilantin level in someone who's using it chronically? What's safe? What's wise? Not just what everybody does?
1650.   How often should you check lab work on a patient taking griseofulvin?
1651.   How often should you check liver function tests in patients on the "glitazones" like rosiglitazone (Avandia)?
1652.   How often should you do Papanicolaou smears on a patient following hysterectomy?
1653.   How often should you do screening blood work on a well adult or an adult with hypertension?
1654.   How often should you get LFT's (liver function tests) and CBC (complete blood count) on someone taking Antabuse (disulfiram) or should you at all?
1655.   How often should you get liver function studies on a PPD (purified-protein derivative) converter receiving isoniazid?
1656.   How old can you see mycoplasma as a common respiratory pathogen? Am I thinking appropriately when I say she might have mycoplasma?
1657.   How old do patients have to be in order to take Amantadine?
1658.   How old do you have to be before you don't need to aggressively workup hypertension (240-260/90)? This patient is 88.
1659.   How old is it still safe to give a woman birth control pills?
1660.   How old should a child be before they can switch from whole milk to 2% milk?
1661.   How old should a patient be before I quit doing prostate specific antigens (PSA's)?
1662.   How old should an adult male be before routine rectal exams should be done with physical examinations?
1663.   How representative is an oral prednisone challenge? Is that a decent way to diagnose cough variant asthma, realizing it's not a methacholine challenge test? How often do I really treat allergic rhinitis?
1664.   How safe is it to give Prilosec to a 3-year-old? Any studies?
1665.   How should I change the gentamicin levels?
1666.   How should I treat her traumatic alopecia? Nothing has worked. Does she have herpes zoster in her scalp?
1667.   How should I treat polymenorrhea in a 14-year-old girl?
1668.   How should I treat this fractured base of the fifth metatarsal? Would a splint be good enough?
1669.   How should I treat this patient with seizures?
1670.   How should I workup this baby with a single umbilical artery? Thirty percent of such babies have anomalies but where should I look if not obvious on physical exam?
1671.   How should a woman with known diethylstilbestrol exposure be followed? Iodine? Colposcopy?
1672.   How should medical students and doctors introduce themselves to patients? What form of address should they use?
1673.   How should the ventilator settings be changed?
1674.   How should this case of neonatal herpes be treated? With acyclovir?
1675.   How should this patient with respiratory distress and spina bifida be treated?
1676.   How should we be treating diabetes now that the Diabetes Control and Complications Trial is finished?
1677.   How should you adjust the birth control pill if someone has spotting on it?
1678.   How should you anticoagulate someone in atrial fibrillation before you cardiovert them?
1679.   How should you approach leukopenia and thrombocytopenia in a 27-year-old woman on nortriptyline for depression? (white blood count approximately 3.7, hemoglobin approximately 12, platelet count approximately 100, segmented neutrophils approximately 50, lymphocytes approximately 40)
1680.   How should you ask a sexual history?
1681.   How should you change the birth control pill (oral contraceptive) if someone gets amenorrhea on it?
1682.   How should you counsel a young man with no children who wants a vasectomy?
1683.   How should you dose Coumadin on someone you are just starting out on Coumadin (warfarin)?
1684.   How should you evaluate gynecomastia in an adolescent boy?
1685.   How should you examine for jugular venous distension and what is normal?
1686.   How should you interpret acetowhite epithelium that is in the columnar epithelium, clearly inside the squamocolumnar junction?
1687.   How should you interpret prostate specific antigen (PSA) levels when someone is taking finasteride (Propecia)?
1688.   How should you rule out a thoracic aortic aneurysm or abdominal aortic aneurysm (AAA) in someone with a family history of abdominal aortic aneurysm?
1689.   How should you suspend anticoagulant therapy (warfarin, Coumadin) for surgery? Should you use heparin, low-molecular weight heparin, or nothing and for how long?
1690.   How should you treat osteoporosis in a man, caused by chronic steroid use?
1691.   How should you work up a low Vitamin B12?
1692.   How should you work up and treat a 40 year-old woman with irregular vaginal bleeding?
1693.   How should you work up someone for an acoustic neuroma? Is there a characteristic audiogram? If tinnitus only, do workup? Cause of isolated 40 decibel loss at 500 hertz?
1694.   How should you work up someone who tried to give blood and has positive Hepatitis B core antibody?
1695.   How should you work up someone with unsuspected hepatomegaly?
1696.   How should you work up vulvar leukoplakia (colposcopy, acetic acid, methylene blue, iodine, biopsy)?
1697.   How soon after a vasectomy is it okay to have intercourse?
1698.   How soon after delivery can you start Depo-Provera?
1699.   How soon after exposure to someone who might have syphilis would you expect to have a positive VDRL (venereal disease research laboratory)?
1700.   How soon after exposure would you expect a test for HIV (human immunodeficiency virus) to be positive? What is the window period?
1701.   How soon can a child go back to school when he/she has conjunctivitis?
1702.   How soon following an acute deep-vein thrombosis (DVT) should the patient use a compression stocking?
1703.   How soon should you ambulate a patient with a deep vein thrombosis?
1704.   How soon will it be before transcutaneous glucose monitoring is available similar to pulse oximetry?
1705.   How specific is lid lag and exophthalmos for hyperthyroidism? Can anything else do it?
1706.   How strict should you be in preventing participation in sports if you have Osgood Schlatter's Disease?
1707.   How strong is the evidence for giving prednisone for Bells Palsy?
1708.   How to best treat a patient with the combination of atrial septal defect and bronchopulmonary dysplasia?
1709.   How to get this patient to follow through on needed colonoscopy (has had rectal bleeding and colonoscopy was recommended by gastroenterologist in 1995)?
1710.   How to regulate the protime on this patient? With Coumadin 5, it's too high and with 2 it's too low and there's no dosage in between (the patient isn't eating lettuce).
1711.   How to sort this out? Complaining of right arm pain and numbness - Is it the zoster scarring or is he developing carpal tunnel syndrome? Also he is diabetic and lipids are elevated so that could also be a factor.
1712.   How to stop somebody when she comes in with five problems, but her appointment time is only long enough for one?
1713.   How useful are bronchodilators (inhalers) for viral bronchitis?
1714.   How useful is it to use controls when doing tuberculin skin testing (testing for anergy)?
1715.   How well does biofeedback work for rectal incontinence?
1716.   How well established are Hemophilus influenza, Mycoplasma, and so on as causes of sore throat?
1717.   How well studied is the computer program that the University genetics people use to figure the risk of Down syndrome based on the triple screen?
1718.   How well-described is the "limbic flush" -- the rash that comes on a patient's neck when they are embarrassed about being examined?
1719.   How will cares change based on cares conference?
1720.   How would you counsel (genetic counselling) someone with beta thalassemia minor (trait)?
1721.   How would you desensitize someone or make sure it's safe to give someone an antibiotic with an iffy history of allergy and you really want to give that antibiotic (orally), in this case, azithromycin?
1722.   How would you treat a 49-year-old woman with suspected dysfunctional uterine bleeding (anovulatory bleeding)?
1723.   How would you treat a patient with a phobia for getting into cars or boats?
1724.   How would you treat heavy dysfunctional uterine bleeding (large clots, normal pelvic exam) in a 49 year-old woman acutely?
1725.   How young is it possible to have a seborrheic keratosis? (37 years old?)
1726.   Hypertension. Young woman, 28-years-old. "What all lab tests do I need to order?"
1727.   I (investigator) asked if he had to look up anything in a book in the last few days. He said, "I had a question about Hepatitis B. Recommendations for household contacts of carriers."
1728.   I (investigator) caught the physician looking in a reference and asked what she was looking up. She said, "I was just wondering how much I can go up on the Imodium?"
1729.   I (investigator) caught the physician looking in a reference. "I'm just looking up the dose of Zoloft." (Actually the maximum dose.)
1730.   I (investigator) caught the study physician looking at a reference. I asked what the question was and he said he was looking up the different concentrations of liquid ibuprofen.
1731.   I (investigator) caught the study physician's partner looking something up. "Oh it's just her anemia. What other things I need to add besides iron studies, reticulocyte count and having somebody look at the smear."
1732.   I (investigator) noted an open book on the physician's desk and asked if there was an associated question recently. "I was looking up to see what the standards are for hypertension in the newborn and the workup of hypertension if it continued."
1733.   I (investigator) saw her looking at her handheld computer and asked what the question was. She said, "Dosing for drops for otitis externa."
1734.   I (investigator) saw him looking in a book on his shelf and asked what the question was. He said, "Dose of penicillin for streptococcus . . . I always get confused on Bicillin . . ." I (investigator) said, "The issue is . . . ?" He said, "What type?
1735.   I (investigator) saw the study physician looking up something in a reference. I said, "This looks like a question." She said, "Dose of Zithromax for a 19-pound baby."
1736.   I (investigator) saw the study physician open a reference. I said, "What's the . . . ?" She said, "I'm just looking for doses for miglitol."
1737.   I always thought atrial fibrillation would lead to emboli in large vessels but this woman had a retinal artery occlusion. "Is there any predilection for the size of the vessel occluded by an embolus from atrial fibrillation? Can it be any size vessel?"
1738.   I am looking at growth. This is a kid with spastic quadriplegia and growth retardation. "I just wanted to make sure I'm getting the right lab work, just to make sure what lab work I should get."
1739.   I asked him what he was looking up. He said, "whether to give drops or elixir acetaminophen to a 1-year-old for their immunizations and what dose."
1740.   I asked the pathologist, "Is there any syndrome where you get hypersensitive to a normal hematocrit when you have chronic obstructive pulmonary disease and you need phlebotomies for that reason?"
1741.   I can feel a pounding aorta in this 58-year-old man. I'm not sure if it's normal. How often does an abdominal aortic aneurysm occur in patients under 60?
1742.   I can't remember the formula for converting hemoglobin A1C to average blood sugar.
1743.   I can't think of the name of that cream that's better than Retin-A for acne.
1744.   I caught her looking on her bulletin board and said this may be a question. She said, "No, I can never remember the potency of topical steroids." I said, "So the question is . . . ?" She said, "The question is what can I use that's fairly high potency?"
1745.   I checked to see if there were any interactions between iron and thyroxine.
1746.   I did a computerized tomography scan of the abdomen in a patient and it was because of some recurrent abdominal pain and one of the findings was that the proximal portion of the third part of the duodenum was somewhat dilated compared to the distal part, and then while they were, you know, saying that, I'm thinking what, you know, what does that mean?
1747.   I did have a question over the weekend, about a kid seen in the emergency room. Eight-year-old boy on Ritalin LA for attention-deficit-hyperactivity disorder, took 5 to 10 pills, so a moderate overdose, not a severe overdose. "Does anybody really know when it is not effective to induce vomiting anymore?
1748.   I do have to look something up later. Dyshidrosis. Four-year-old brother of the patient I'm seeing. Mother asked about him. I have to look up the management of this later.
1749.   I do not understand the significance of plain urinalyses looking for glucose and albumin. What is the usefulness of this if they have +1 albumin or +2 albumin, what are they going to do with them? What is the clinical usefulness of doing this? If I don't do it, what are the implications for the patient?
1750.   I don't have any questions about this patient other than the same question that any doctor would have about sinus disease. I try to practice scientific medicine and not treat viral disease with antibiotics. I do a lot of limited computerized tomography (CT) scans of the sinuses.
1751.   I don't know if there is a handy reference to ophthalmologic drugs because some are in this reference and some aren't.
1752.   I don't know if you're doing this, but any baby born breech gets a hip ultrasound here. I should look this up. "Is this really necessary?"
1753.   I don't know what antibiotics he can't take because he's on a nevirapine study (nonnucleoside protease inhibitor) (Viramune).
1754.   I don't know what is causing the numbness in his hand, doesn't seem like carpal tunnel syndrome.
1755.   I don't know what's causing her abdominal pain. She had a negative lower endoscopy without biopsy. If someone came up with a true way to diagnose irritable bowel I'd be happy with that. I hate irritable bowel. I recommended Citracel.
1756.   I don't know why she passed out but it's probably a combination of upper respiratory infection, taking two decongestant-antihistamine combinations, donating blood recently, et cetera.
1757.   I felt an elongated mass coming off the prostate and extending laterally, feels like a tight muscle. It's thin as a pencil lead and long, not sure what it is. One question is "Who should I punt to?" I'm not even sure what the question is.
1758.   I forgot the name of the antihistamine eye drop. 31-year-old woman with allergic conjunctivitis.
1759.   I get these day care physicals, four to five kids in the house, I asked her if she needs a tuberculin skin test, she said no and it's not on the form. I don't have a good source of information on state rules about who needs tuberculin skin testing.
1760.   I got an order to sign from the nursing home for a lady who wants Vicks VapoRub. Is Vicks VapoRub effective? Has research been done?
1761.   I had a 30-year-old male with a 7-day history of colon symptoms -- cramps and intermittent diarrhea and 2 days of mild urethritis. Urinalysis normal. Reiter's syndrome? What to do?
1762.   I had a 31-year-old woman with a mediastinal mass with dyspnea and dysphagia. She had a thoracoscopy and biopsy and this showed a noncaseating granuloma. So now the question was, did she have sarcoid or histoplasmosis?
1763.   I had a 41-year-old obstetric patient last week. "How many weeks along should you do an amniocentesis?"
1764.   I had a 70ish-year-old woman who had some sort of neurologic event when she was visiting someone in the nursing home. We got some labs and her free thyroxine was 0.7, normal is 0.8 to 1 and her thyroid stimulating hormone was 1.8 which is pretty low for that thyroxine. So we spent 30 to 40 minutes using an online reference.
1765.   I had a baby with a club foot and the question was, "What should I do?" The question was whether this can wait or needs to be referred soon.
1766.   I had a child with encopresis. The treatment of encopresis was the question.
1767.   I had a family physician call me from one of the outside clinics about a 23-year-old woman who had a viral illness with myalgias, and her creatine kinase was 8000. Basically, the question was if influenza or just a regular viral illness can cause a creatine kinase elevation.
1768.   I had a guy, 37-years-old who came in with bloody diarrhea, which changed to rectal bleeding so we admitted him. He was scoped and turned out to have Escherichia coli O157:H7. We started Cipro before the culture came back and I asked the gastroenterologist about whether we should stop the Cipro because of the increased risk of hemolytic uremic syndrome if you treat.
1769.   I had a guy, 68-year-old man, with subclavian steal syndrome. Had to look that up, the signs and symptoms.
1770.   I had a kid with congenital hypothyroidism and I tried to look up how often and when do you need to monitor his thyroid stimulating hormone and thyroxine.
1771.   I had a lady with rheumatoid arthritis. "What is the minimum dose of steroids for maintenance, that I don't have to worry about osteoporosis or gastrointestinal side effects, that I should shoot for?"
1772.   I had a man in the hospital a week ago. He had a superficial vein thrombosis. I know you're not supposed to anticoagulate if it's superficial but I repeated the ultrasound three or four days later and it showed "slight extension."
1773.   I had a man with neuropathy and cardiomyopathy. Could this be due to Agent Orange? He was at the Veterans Administration hospital and chronic renal failure and congestive heart failure were on the death certificate, but not Agent Orange.
1774.   I had a newborn referred to me yesterday with seizures. The question was whether to start anticonvulsants.
1775.   I had a pregnant patient on Synthroid and I called Dr. X (endocrinologist). He said to find out why she has hypothyroidism because it can make a difference to the baby. I (investigator) asked, "What was the question when you called Dr. X?" She said, "How do I manage thyroid replacement in pregnancy? What laboratory tests do I need to follow?
1776.   I had a question about enuresis in adults. I told them to get him up two to three times at night, and not give a lot of fluids before he goes to bed, and they tried that, but it didn't work.
1777.   I had a question with this man but to be honest I'm not going to look it up. He had a deep-vein thrombosis two weeks ago. I've been holding him off work. I'm going to let him go back now.
1778.   I had a trauma patient this morning and the question was, what is the dose of morphine for a 2-year-old.
1779.   I had a woman with perioral dermatitis. I didn't know what it was.
1780.   I had a woman. Celiac disease. Is there a specific test to check this disease?
1781.   I had an alcoholic in the hospital last week for treatment for withdrawal and the question was, "What day do the seizures usually come?"
1782.   I had an elderly patient with a cerebrovascular accident. New imaging studies. Which is better: computerized tomography or magnetic resonance imaging? When to use contrast and when not to use contrast?
1783.   I had another lady with a multinodular goiter, diagnosed on ultrasound. They recommended a repeat ultrasound in 6 months, which we did recently and now they are reporting a solid nodule in the lower left lobe, but they said it was smaller than it was previously, but they did not report it on the previous ultrasound, so, "now what do I do with her?"
1784.   I had her on Macrodantin for a urinary tract infection in December and she got a cough. Now has another urinary tract infection. Saw a urologist and was started on Macrodantin and was told that was the only thing that would work. Is her cough from Macrodantin? I switched her to Cipro.
1785.   I had this other gentleman (41-year-old man) with chronic inflammatory demyelinating polyneuropathy. I just wondered if there is any connection between the polyneuropathy and the monoclonal gammopathy of uncertain significance.
1786.   I had to look up the definition of Borderline Personality Disorder.
1787.   I had to look up the dose of azathioprine (Imuran) before I started her on it.
1788.   I have 2 kids with migraine, age 10 and 14. "What is a specific treatment for migraine in pediatrics?"
1789.   I have a 2-month-old with a varicocele and the question is, how long can I watch it?
1790.   I have a 30-year-old woman with Type 1 diabetes and when we started her on Lipitor, her sugars went up into the 300's. She asked me if Lipitor could cause this and I didn't know, so looked it up in a reference.
1791.   I have a 65-year-old woman with Type 2 diabetes who was new to me 7 months ago. The Food and Drug Administration recently said not to use glitazones with insulin because of the risk of congestive heart failure. But now her glycosylated hemoglobin is better and her insulin requirement is down to 40 in the morning and 32 at night. So what do you do with that information?
1792.   I have a dilemma. 9-year-old girl status post appendectomy last summer (one year ago). Two to three months afterward she started complaining of suprapubic abdominal pain at least two times per week. "I'm trying to now think how do you evaluate this type of pain. Is it adhesions? OK, how do I look at constipation, adhesions . . . how to do one thing to get the answer? Should she have an MRI (mag...
1793.   I have a frustrated woman who insists on having surgery for a normal gall bladder. Oral cholecystogram and ultrasound were normal. Complains of right-upper-quadrant pain and bloating. Surgeon did esophagogastroduodenoscopy which was normal and recommended cholecystectomy. Where do we go from here? Get second opinion?
1794.   I have a girl with facioscapulohumeral muscular dystrophy. I would like to know what the natural history is and if there's any way to treat it.
1795.   I have a lady with Graves disease (33 years old). She was trying to get pregnant when she was diagnosed with Graves. So the question is, what is the best treatment for Graves in someone who is trying to get pregnant, and, if we use radioactive iodine, how long does she need to wait?
1796.   I have a lot of questions about drug safety in pregnancy.
1797.   I have a patient with Graves disease. Ablation done. Still hyperthyroid. Every time I get her lab work back I have to rethink how to adjust her Tapazole.
1798.   I have a patient with a low hemoglobin 6 weeks ago. Yesterday I saw him for a viral illness and his total serum iron was worse (down to 10 from 16), but the total iron binding capacity was lower and now in the normal range. Am I missing something here? Or could it still be iron deficiency?
1799.   I have a patient with gout. Between Indocin prophylaxis and colchicine prophylaxis, what is better to prevent gout?
1800.   I have a patient with iron-deficiency anemia and heme positive stools (69-year-old man). He refuses a gastroenterology evaluation. It's more of a legal . . . "How much is enough informed consent?"
1801.   I have a patient. Her diastolic blood pressure is 20. Her systolic blood pressure is 160. She's already on three antihypertensives. I heard about the J-curve. What do I do?
1802.   I have a question on quinine. Cramps. I have not seen in the literature using quinine for cramps. "I'm not sure if it is still current practice or not." "Has it fallen out of favor?" "Do you need to check the electrocardiogram since it's related to quinidine?"
1803.   I have had two newborns recently with neonatal seizures at about 3 days of age. The question is, "Is acyclovir too aggressive?"
1804.   I have one more question but I haven't figured out what to do with this lady or even what the question is. She was an elderly woman referred by her dentist or ophthalmologist, I forget, but they said she didn't have much of a diastolic blood pressure. We got 150/0 here. So we were trying to figure out the differential diagnosis and what to do with that.
1805.   I have seen many people around here giving Advair and Singulair for people with chronic obstructive pulmonary disease but no asthma. Maybe they know something I don't about this, but I don't think so.
1806.   I have to look up thyroid nodules. So the question is how to work up thyroid nodules.
1807.   I haven't really seen a patient with congenital hip dysplasia. How soon do we need to refer them to orthopedics? Is it a matter of days or weeks?
1808.   I haven't treated mastitis in awhile -- is there anything new being used for treatment?
1809.   I just need to pull up the Centers for Disease Control . . . the Centers for Disease Control came out with immunization guidelines . . . having a runny nose is not a contraindication to immunization, having a fever less than a certain degree is not. This baby has a runny nose. I was trying to explain it to the mother but I just need to look that up again.
1810.   I just referred an 18-month-old boy with persistent cervical lymph node enlargement to a tertiary center. The question was, "Do these nodes need to be biopsied?"
1811.   I just saw a baby with a sacral dimple. What test do you do to check for a tethered cord? Magnetic resonance imaging or ultrasound?
1812.   I looked up in this reference the definition of tubular adenoma, I was pretty sure it was benign but wanted to double check.
1813.   I looked up penile rashes in one of my references. I saw a 40-year-old man with a purplish rash on the shaft of his penis.
1814.   I looked up the diagnosis and therapy of hyperthyroidism in this reference. The question was how to differentiate the different causes of hyperthyroidism.
1815.   I looked up the immunizations for an 18-month-old.
1816.   I looked up the maximum dose of Remeron, because someone wanted a refill for 45 milligrams twice a day.
1817.   I need a review of taxonomy of cells of the bone marrow. They rename them (the cells) and the diseases every 10 years. I'll admit I'm confused. I'm embarrassed to talk about it.
1818.   I need some information on Henoch-Schoenlein Purpura.
1819.   I normally give amoxicillin for tonsillitis. Mother said it didn't work last time. How far should I push it (the amoxicillin that I wanted to use)?
1820.   I once had this Department of Transportation physical and the guy was on dialysis. I refused to sign it. I called up the Department of Transportation first though and said what are the rules about driving if you're on dialysis. They just said, "It's up to you doc." Not very helpful.
1821.   I pushed on the aorta and it hurt in this young thin female. Should I do an ultrasound to rule out an abdominal aortic aneurysm? Must be very rare in young female but should I? Should you have pain when you push on the aorta?
1822.   I saw a 30-year-old man and admitted him with meningismus. I was sure he did not have meningitis but wanted to cover him with Claforan intravenously and ampicillin. Turned out to be a urinary tract infection. Don't know why he had meningismus. I had to look up dose of Claforan.
1823.   I saw a 40-year-old man with prostatitis. I had to look to see the duration of treatment.
1824.   I saw a 54-year-old woman a year ago with severe dyspnea (dying), skin like leather and she was hypothyroid (thyroid stimulating hormone 400, T4 0, T3 0). What happened to her thyroid, why did she get hypothyroid?
1825.   I saw a 57-year-old man this morning with non-specific abdominal pain. I couldn't feel his right testicle. So, my question was if an adult that has an undescended testicle that hasn't been recognized, does it have a malignant potential?
1826.   I saw a 6-month-old last week, and the mother asked if she should be on fluoride supplements. They live in the country and use well water. I didn't know.
1827.   I saw a girl with a seizure disorder. I had to look up Keppra and Topamax. Have you ever heard of those?
1828.   I saw a lady with a sore thumb. I thought it was gout. What is the sensitivity of joint aspiration in diagnosing gout?
1829.   I saw a lady with what looked like a squamous cell carcinoma. I excised it. The path report said in the plane of the section there was no malignancy but there was cellular atypia. I didn't know if I should excise further or what.
1830.   I saw a woman this morning with cancer of the breast. Now has a mass on the chest wall which was found to be carcinoma. The oncologist is seeing her and keeps saying we're going to do something (radiation, chemotherapy, et cetera). My question and her's is when? What are we waiting for?
1831.   I saw a woman this morning with chronic obstructive pulmonary disease and worsening dyspnea, still smoking, still oxygen dependent, recent 10 pound weight gain, oxygen saturation was fine. Why is she more short of breath? Is her cor pulmonale worse?
1832.   I saw a young boy. "What is the definition of conduct disorder?"
1833.   I saw an 8-year-old boy who had intermittent asymptomatic swelling of one knee. No trauma. It would just swell up out of the blue and then go down. The question is what would cause this.
1834.   I saw an 8-year-old girl who kept getting streptococcal sore throat so I cultured the whole family. What is the best antibiotic for the carrier state?
1835.   I saw an 8-year-old girl with a chronic vaginal discharge. I never referred her and I didn't know who I would refer her to anyway. I never found out what it was.
1836.   I saw an almost 3-year-old girl this morning. She had a ventricular-septal-defect murmur at birth, never had an echocardiogram, just went by the sound of it. She had a little murmur now in the pulmonic area, intermittent, I hear it with inspiration. The question was, well what is it exactly and where do I look it up exactly and I decided, well, I'm not going to find that anywhere, so I'm referr...
1837.   I saw an obese diabetic female yesterday who said she couldn't sleep while taking Glucotrol XL. She told me she wanted to go back on insulin in any case (moot point), but I wondered if Glucotrol is associated with insomnia.
1838.   I tend not to believe drug representatives, but are there real differences in the gastrointestinal side effects among various nonsteroidals? (Said this while pulling samples of Relafen off the shelf to give to patient.)
1839.   I think below age 60 you're not supposed to treat atrial fibrillation with Coumadin but I'm not sure that's right.
1840.   I think it's a basal cell carcinoma. If I treated her with liquid nitrogen, would I be just as far ahead as referring her to a dermatologist for excision?
1841.   I wanted to discontinue . . . Sometimes we place women on Depo-Provera shots who have heavy vaginal bleeding and anemia. This one is 49 years old and my question was "When do you stop the Depo-Provera?"
1842.   I wanted to prescribe Lotrimin 1%. The pharmacist said "Do you mean 2%," implying that's the only strength it came in. I thought it came in 1% but I had to look it up to be sure.
1843.   I was late this morning because I saw a child in the emergency room who had been there all night, while the emergency room staff took care of two trauma cases. The question is, "How do you get the emergency room staff to call us sooner so we could have seen this kid?"
1844.   I was recently on the Hospital X service and had 4 admissions in 14 days. They all came on the same day. What is the probability of that?
1845.   I wish I had more information about genetic testing for breast cancer. Should this patient have genetic testing?
1846.   I wish we had some sort of screening questionnaire for irritable bowel syndrome.
1847.   I wonder if there's any increase in the incidence of elevated liver function tests from the combination of statins and niacin as opposed to niacin alone?
1848.   I wonder if this patient could have a rotator cuff thing?
1849.   I would have had to look up mefloquine but he is staying in the city in Viet Nam so I don't need to look it up.
1850.   I would like him to stop working but he can't because he just started a new job. What to do?
1851.   I'd like to know what causes labyrinthitis and I'd like to know a good treatment for it too.
1852.   I'll have to look this up -- how to measure the voltage on an electrocardiogram. What do you add to what to diagnose ventricular hypertrophy?
1853.   I'll try this patient on Niacin and LoCholest (cholestyramine resine). I'm sure there are no contraindications or interactions -- I just don't know if it will be effective.
1854.   I'm 95% sure this is carpal tunnel syndrome but I'm not 100% sure.
1855.   I'm always uncomfortable with how quickly to move in terms of workup (patient had been having TIA (transient ischemic attack) symptoms for several weeks)
1856.   I'm going to ask you (investigator). Is that legal? Which antibiotic would you use for an infected toe with poor circulation?
1857.   I'm looking up Prevacid to see how long you can use it. It's like Prilosec which you can't use forever.
1858.   I'm not familiar with Serzone. How long does it take to start acting? What are the side effects? Because she's complaining of being tired.
1859.   I'm not sure what's going on with her. Thumping pain in ears and sore throat off and on for 2 weeks. Streptococcus test negative. History of ear problems for many years. They want antibiotics so will give amoxicillin and Cataflam. There may be an infection there, but I'm not sure so if not improved will refer to ENT (ear, nose, and throat physician).
1860.   I'm not sure when to intervene and get aggressive with patients like this. She has high blood sugars but 3 other endocrinologists haven't suggested anything different and I've quit looking at her sugars. Should I just let her be?
1861.   I'm uncertain about what to do with her knee problems. Has osteoarthritis, difficulty walking, x-rays don't look too bad.
1862.   I've got a guy with a goiter who is hypothyroid. I had the surgeon look at him after getting an ultrasound and the surgeon increased the dose of Synthroid even though the thyroid stimulating hormone was normal. He wanted to oversuppress her to make the goiter shrink and reduce the risk of cancer. But I didn't think you were supposed to do that.
1863.   I've got a woman with stage I breast cancer, 2 years status post mastectomy. "Am I considered a survivor?" That's what she asked me.
1864.   I've got one for you. Indications for oral versus topical therapy for impetigo.
1865.   I've got one for you. Most common antibiotic associated with Stevens Johnson Syndrome.
1866.   I've got to look this up. Mother mentioned there is a new growth chart for breast fed infants. I was not aware of that.
1867.   I've had two patients with squamous cell carcinomas of the skin recently. Is there anything else I should do other than a total body skin exam? And what kind of followup should they have?
1868.   If a 60-year-old man has a positive purified protein derivative ("quarter-sized"), negative chest x-ray, and received Bacille Calmette-Guerin vaccine (BCG) as a child, should he have further workup or treatment?
1869.   If a child receives his/her pneumococcal vaccine when over a year old, how many more doses are needed?
1870.   If a child throws up their medication, how long since the medication was given before you can assume it was absorbed and you don't need to repeat the dose?
1871.   If a kid has a nondescript rash, would you ever treat for scabies and see if they get better?
1872.   If a mother has von Willebrand disease, do you need to take any precautions with the baby?
1873.   If a normal risk patient has ruptured membranes in labor how long can you wait before giving Group B streptococcus prophylaxis?
1874.   If a patient delivers past term with one pregnancy, is she more likely to deliver past term with subsequent pregnancies?
1875.   If a patient has a definite breast mass, should you refer to a surgeon first or get mammogram first, or aspirate first or what?
1876.   If a patient has a low-density-lipoprotein-cholesterol of 199 but lipid risk ratios in the desirable range, is that acceptable?
1877.   If a patient has a pilonidal cyst that gets infected once and is drained, do they eventually need to have a definitive procedure to remove the cyst?
1878.   If a patient has a sulfa allergy, which drugs should they not take?
1879.   If a patient has genital warts (condylomata), do you do anything different in labor or delivery?
1880.   If a patient is referred by an optometrist because of small retinal hemorrhages, what workup should be done for systemic disease?
1881.   If a patient screens positive for possible alcohol abuse, what should you do next?
1882.   If a patient tries to give blood and tests positive for human immunodeficiency virus (HIV), will the blood bank notify the patient?
1883.   If a patient with a subarachnoid-hemorrhage-type headache has a negative head computerized tomogram, should they still have a lumbar puncture to look for blood in cerebrospinal fluid?
1884.   If a patient's creatinine clearance goes from 100 to 90 to 80, is that a significant trend? Or can't you answer because only one patient?
1885.   If a patient's husband has a positive blood test for Hepatitis C and elevated liver function tests, should the couple use condoms?
1886.   If a pregnant woman gets hand foot and mouth disease, can this hurt the fetus?
1887.   If a woman has had a subtotal hysterectomy (still has a cervix) and needs hormone replacement therapy, does she need Provera?
1888.   If an adult with no history of chicken pox is exposed to a child with chicken pox or to a child who was exposed to chicken pox, should the adult get varicella immune globulin (VZIG) or vaccine?
1889.   If an asymptomatic baby was born to a mother whose intrapartum vaginal culture was positive for Group B streptococcus, what should you do?
1890.   If an elderly woman has a definite pulmonary embolus on ventilation-perfusion (VQ) scan with no clear source, do you need to search for a source?
1891.   If another child at this patient's daycare is in the pediatric intensive care unit with meningitis, what steps should be taken to prevent this patient from being infected? (Do they need prophylaxis?)
1892.   If evaluating a child for shunt malfunction should I refer him on or order a shunt series and head computerized tomogram?
1893.   If just a sprained finger, I've always wondered whether it would make any difference whether we splint or not. She is a gymnast and wants to perform next week--very important to her.
1894.   If just one of three stools is positive for occult blood, do you need to do a colonoscopy?
1895.   If mammograms are recommended every year after age 50, how come insurance only pays for one every other year?
1896.   If one child has streptococcal sore throat and the sibling gets sick, should you culture the sibling or just treat over the phone?
1897.   If someone continues with a pregnancy after first trimester bleeding, do they need any special surveillance?
1898.   If someone gets a rash more than 24 hours after the last dose of ampicillin, could the rash (allergic reaction) still be considered due to ampicillin?
1899.   If someone had x-rays for acne treatment, how should they be followed-up regarding thyroid cancer risk?
1900.   If someone has a cervical disk, is it legitimate to try traction first or should you go straight to surgery?
1901.   If someone has a family history of ovarian cancer, should they have any sort of screening done?
1902.   If someone has a history of preterm labor or preterm delivery, do they need any special monitoring or surveillance during the present pregnancy?
1903.   If someone has a normal total cholesterol and normal low density lipoprotein (LDL) cholesterol but a low high density lipoprotein (HDL) cholesterol, should they be treated with medication such as niacin?
1904.   If someone has a peak expiratory flow of 500 and the chart says they should have 600, what percent below 600 is still normal? Same question for values on full spirometry.
1905.   If someone has amenorrhea and is overweight with a male escutcheon, do they need to be evaluated for polycystic ovary syndrome? In whom should you suspect polycystic ovaries and how do you make the diagnosis?
1906.   If someone has an abnormal triple screen, indicating an increased risk for Down syndrome, do they need any special follow-up or fetal surveillance?
1907.   If someone has an artificial heart valve and their child has documented streptococcal sore throat, do they need to be treated with penicillin?
1908.   If someone has both mosaicism and punctation on colposcopy, which is the worst lesion; ie, which should be biopsied?
1909.   If someone has cervical intraepithelial neoplasia (CIN) I on cervical biopsy (coloposcopy) that involves the glands (glandular involvement, extends into glands), do they need a cone biopsy?
1910.   If someone has had head and neck radiation as a child (for example, for acne or hypertrophied adenoids) what surveillance do they need for thyroid cancer?
1911.   If someone has nonGroup A beta hemolytic streptococcus on throat culture, and they have a sore throat, should you treat them with antibiotics?
1912.   If someone has premature rupture of membranes at 2:00 AM or 3:00 AM and no labor, is it okay for them to stay at home and come in later that morning or should they come in right away to be checked?
1913.   If someone is allergic to cephalosporins, is it okay to give penicillin?
1914.   If someone is taking lovastatin and they get sore muscles but have a normal CPK (creatine phosphokinase), do you still need to worry about myositis from lovastatin?
1915.   If the C5-C6 disc is bulging, which nerve root does this affect and same for other discs?
1916.   If the Papanicolaou smear comes back low grade squamous intraepithelial lesion (SIL) should you do an immediate colposcopy or just repeat the smear in 4 months?
1917.   If the human immunodeficiency virus (HIV) test comes back positive and you are asked to give the results to the patient, what should you do?
1918.   If the initial human immunodeficiency virus (HIV) test is positive and the Western Blot is negative, does this have any significance and is any follow-up needed?
1919.   If the mother of a teenage girl says she's worried that her daughter may be on drugs because her pupils are dilated and she acts drugged and wants to know what to do, what should you tell her?
1920.   If the patient is already on an adequate dose of angiotensin converting enzyme (ACE) inhibitor for hypertension, and they then develop new microalbuminuria, is there anything further to do?
1921.   If the purified-protein-derivative (PPD) is positive, should purified-protein-derivatives ever be placed again if isoniazid is used?, if isoniazid is not used?
1922.   If the triglycerides are high, like 500, do you treat the low-density-lipoprotein cholesterol first with a statin even though you don't know what it is (cannot calculate if triglycerides over 400) or do you treat the triglycerides with Lopid?
1923.   If the triple screen or maternal serum alpha fetoprotein (MSAFP) is normal in a woman over age 35, and she refuses amniocentesis, should she have a fetal anomaly scan (ultrasound) at 18 to 20 weeks anyway or at least be offered one?
1924.   If urologists throw fluoroquinolones at every sort of urologic symptom, can family practitioners do it too?
1925.   If you are allergic to sulfa antibiotics, does that mean you are also allergic to sulfonylureas?
1926.   If you are on 3 medications for hypertension and you're not controlled, do you add a fourth medication or do you take away some of the others and change medications?
1927.   If you are treating someone for hypothyroidism and the TSH (thyroid stimulating hormone) is high (14) and the T4 (thyroxine) is normal, should you go up on the Synthroid?
1928.   If you are trying to rule out structural liver disease as a cause of abnormal liver function tests, should you get an ultrasound or a computerized tomographic scan?
1929.   If you decide to do prostate-specific-antigen (PSA) screening, when should you start and when should you stop and how often should you do them?
1930.   If you detect microalbuminuria on a random urine, should you just treat with captopril or should you get a 24-hour urine protein to document the level?
1931.   If you have a high thyroid stimulating hormone (TSH) and low free thyroxine (T4), do you need to do any workup like thyroid antibodies or can you just treat? Consider temporary condition like thyroiditis? Follow them up for regaining thyroid function?
1932.   If you have a left occipital cerebrovascular accident, which side homonymous hemianopsia will you have?
1933.   If you have a patient who had a coronary bypass or any heart surgery, say 10 years ago, when do you do a stress test to see how they are doing? This patient is doing fine but when should you follow up?
1934.   If you have a patient with bright red rectal bleeding from hemorrhoids or some benign cause or with a negative flexible sigmoidoscopy, and they continue to have the rectal bleeding, when do they need to have another flexible sigmoidoscopy?
1935.   If you have an adult with bright red rectal bleeding or a normal appearing stool that is guaiac positive, should you do a flexible sigmoidoscopy (with or without barium enema to follow) or should you just refer right off the bat for total colonoscopy?
1936.   If you have lactose intolerance, is it okay to drink yogurt or sweet acidophilus milk?
1937.   If you have mild dysplasia on Papanicolaou smear, and the patient is in early pregnancy, is it okay to wait until she delivers to do the colposcopy?
1938.   If you have seven investigators and seven sets of field notes, one from each investigator, how do you randomly allocate them so that each one gets a different set of field notes to review?
1939.   If you have someone with mild subclinical (chemical) hypothyroidism, should you start with a low dose of Synthroid (for example, 0.05 milligrams) and work up or just go straight to full replacement (0.1 to 0.15 milligrams) assuming a normal heart?
1940.   If you just have serous otitis, I have in my mind that this resolves faster with antibiotics. I couldn't cite an article. I believe that but is it true? Every time I say that to a patient, I say to myself I should go back and check.
1941.   If you see a breast cyst on mammography or breast ultrasound, do you always have to aspirate it or can you just assume it's benign?
1942.   If you stop smoking does your cough get worse?
1943.   If you think someone has gallbladder disease, is it better to get an oral cholecystogram or an ultrasound?
1944.   If you think someone has temporal arteritis, should you wait to start Prednisone until after the temporal artery biopsy is taken, thinking the Prednisone will mess up the biopsy results?
1945.   If you treat a laboring patient for known or suspected Group B streptococcus, what should you do with the newborn?
1946.   If you want to do a thyroid scan for hyperthyroidism, what kind of scan should you do (technetium, I-125, I-131, and so on)?
1947.   If you want to inject the knee with steroid, do you give it medially or laterally?
1948.   Immunocompromised woman with yeast vaginitis now at tertiary center. Phone call from allergy fellow. "Is itraconazole an oral tablet? How is that given?
1949.   Immunoglobulins were drawn in the past. The immunoglobulin A level is low. What should I do?
1950.   In 40 to 50-year-old men with chest wall pain, how much workup is needed? Is a treadmill necessary? He knows there are many false positives with treadmills in women, but is that also the case in men? This is a frequent question he has.
1951.   In a 47-year-old woman taking isoniazid (INH) as tuberculosis prophylaxis, should you get periodic liver enzymes?
1952.   In a child with a fever, can you have elevated neutrophil count in influenza?
1953.   In a clinical presentation how would influenza compare to other viruses?
1954.   In a diabetic, already on an adequate dose of angiotensin converting enzyme (ACE) inhibitor for high microalbuminuria or hypertension, is there any reason to continue to screen for microalbuminuria? Or should you just follow the creatinine?
1955.   In a diabetic, at what amount of urine protein per 24 hours should you treat with captopril?
1956.   In a patient at term with premature rupture of the membranes (PROM) and an unfavorable cervix, not in labor, should you use oxytocin or prostaglandin gel or observation?
1957.   In a patient on warfarin for some other condition such as a deep vein thrombosis, should they also be on aspirin to interfere with platelet function if they have arteriosclerotic heart disease?
1958.   In a patient using long term steroids for asthma, what screening tests, if any, should be done (for example, dual-energy x-ray absorptiometry (DEXA) scan, cataract check, diabetes screening, and so on)?
1959.   In a patient who had a transient ischemic attack (TIA), how narrow should the carotid be before you recommend carotid endarterectomy?
1960.   In a patient with a completed stroke, what should be used for long term anticoagulation to prevent another one?
1961.   In a patient with a history of rheumatic fever, do you need to use subacute bacterial endocarditis prophylaxis for pilonidal cyst excision?
1962.   In a patient with acute pancreatitis, after it has resolved, do you always need to x-ray the stomach? I always do both the gall bladder and the stomach but do you always need to x-ray the stomach?
1963.   In a patient with congestive heart failure, how can you tell whether they have systolic or diastolic dysfunction?
1964.   In a patient with fibrocystic breast disease, you can't just keep biopsying masses that appear every time they appear. How do you follow such patients?
1965.   In a patient with infectious mononucleosis, if the spleen is going to get enlarged, how long does it take to do that? That is, how long should they stay out of sports? And then the other question is, how long does it take to go back to normal. Also, how big is a 10-year-old's spleen supposed to be on ultrasound? Do you have to wait until it goes back to normal size to go back to sports or just ...
1966.   In a patient with intermittent hoarseness, how soon should you visualize the vocal cords?
1967.   In a premature infant (35-weeks gestation) should you use a preemie (premature) growth chart and if so, for how long? If you use a regular growth chart how do you correct for the prematurity?
1968.   In a small rural hospital, there are 100 admissions in March and 110 admissions in April. Is this a significant difference?
1969.   In an adult female teacher with a lapse in her Hepatitis B series, how long can you wait after the second shot before you have to start the whole series over?
1970.   In an anorexic, amenorrheic patient, now cycling on hormones, when or should you change or decrease her estrogen dose because she is perimenopausal and she shouldn't be on this dose of estrogen after menopause?
1971.   In an old person with an osteoporotic fracture does Fosamax speed or delay the healing process? Does Fosamax interfere with healing?
1972.   In failure to thrive cases, what is the difference between inadequate height and inadequate weight?
1973.   In general, what things should you think about when a patient is planning to travel to an undeveloped country?
1974.   In general, when checking gentamicin levels, should you get a peak and trough level, or just trough?
1975.   In geriatric patients, how long should you treat depression with medication? Are there other characteristics other than a reoccurrence that would make you put the patient on a maintenance dose or is there a way to avoid the reoccurrence in the first place?
1976.   In logistic regression, how to turn the coefficient of a continuous variable into a meaningful odds ratio? Have coefficient for age but associated odds ratio (OR) is based on a 1-year increase in age, how to change it to a 10-year increase in age?
1977.   In medical school we always used to do tuberculin skin tests with controls. "Why aren't we doing controls anymore?"
1978.   In patients with fatigue, you read about how to work them up and they say what to do for the various causes but "what do you do if the workup is negative?"
1979.   In patients with gastroesophageal reflux disease (GERD), should you check a Helicobacter pylori titer (and treat if positive)?
1980.   In people who have multiple somatic complaints, we're supposed to be suspicious that they're depressed. But if you give selective serotonin reuptake inhibitors are they just as likely to get better as patients with more traditional depression? Should every older person with more than three complaints get a selective serotonin reuptake inhibitor?
1981.   In people with colds and coughs and hemoptysis, in who should you workup the hemoptysis for cancer with a cytology and/or a chest x-ray? Just smokers or who?
1982.   In regards to perinatal asphyxiation, when is it acceptable for the parents to decide when to withdraw support? How do we talk with the parents?
1983.   In someone on thyroid replacement (or not on replacement), what does it mean to have a low thyroid stimulating hormone (TSH) with a normal free thyroxine (free T4)?
1984.   In someone with intermenstrual bleeding, what would cause a low serum progesterone (1.8 nanograms/milliliter) with secretory endometrium on biopsy on the same day?
1985.   In someone with ulcerative colitis, how often should you do screening colonoscopy or sigmoidoscopy?
1986.   In the context of Hispanic or Vietnamese non-English speakers, can you simply translate the Folstein Mini Mental State Exam or are there cultural differences that would also make a difference?
1987.   In this idiopathic-thrombocytopenia-purpura patient, when should we check the platelet count again (it's now about 40,000)? I don't know when the tertiary center wants to check it again.
1988.   In this patient who is not responding to nonsteroidal anti-inflammatory drugs for superficial thrombophlebitis, what is round two?
1989.   In this patient with TIAs (transient ischemic attacks) and no cardiac murmur, should I do an echocardiogram anyway?
1990.   In this patient with a pituitary adenoma, is estrogen safe to use?
1991.   In this patient with a pituitary adenoma, what antidepressant should be ordered?
1992.   In this patient with back pain, how do you make a diagnosis of arachnoiditis and how do you treat it?
1993.   In this patient with probable labyrinthitis, what else do I need to check to make sure it's not something more serious?
1994.   Indications for carotid endarterectomy. Woman with 70-80% stenosis so she's not quite there, but I don't know.
1995.   Infant had cradle-cap-type dermatitis and he wondered which shampoo to use because of concern for toxicity. Would it be better to use Selsun or ketoconazole?
1996.   Inhalation injury. At what level of carboxyhemoglobin do you use hyperbaric oxygen?
1997.   Insulin dependent diabetes, follow-up hospitalization for skin graft for necrotizing fasciitis of calf. Has areas on graft that "almost look like boils." I'm not sure what this recurrent skin problem is.
1998.   Interesting case he discussed with Dr. Y, his associate. 14-year-old girl had physical exam last Thursday and Dr. X noted node on left clavicle area. On x-ray it looks to him like a large cervical rib. Dr. Y agreed but they haven't had radiologist report. They are both awaiting the radiologists report. "Is this a cervical rib?" Dr. Y said she agreed it was a cervical rib but they are waiting th...
1999.   Interesting patient (29-year-old woman), saw her as a gestational onset diabetic but now, post partum, she has Type I diabetes. Her c-peptide was about 0.5 nanograms/milliliter (normal 1-5) and her serum insulin was about 2 (normal 6 to 27). "Is this definite Type I diabetes?"
2000.   Iron ingestion - borderline. Needed to know more about how to treat?
2001.   Irregular menstrual bleeding is such a big problem. For example, women on Depo-Provera with spotting or women on oral contraceptives with amenorrhea or irregular bleeding.
2002.   Is 70% sorbitol a good treatment for constipation?
2003.   Is Aeromonas caviae pathogenic?
2004.   Is Amaryl (glimepiride) better than other sulfonylureas for diabetes?
2005.   Is Avandia safe to use in a patient with chronic obstructive pulmonary disease and severe coronary artery disease?
2006.   Is Clomid the best initial treatment for a short luteal phase?
2007.   Is Cognex (Tacrine) helpful for Alzheimer's disease?
2008.   Is Danocrine (danazol) helpful for the pain of fibrocystic breast disease?
2009.   Is Entamoeba hartmanni in the stool pathogenic?
2010.   Is Famvir (famciclovir) better than acyclovir for Herpes zoster?
2011.   Is Keflex the drug of choice for this patient with a positive streptococcus screen (allergic to penicillin and sulfa)?
2012.   Is Lipitor cheaper than Pravachol? More generally, do you stick with drugs with proven efficacy, or do you go with similar but cheaper drugs?
2013.   Is Mucomyst worthwhile to loosen respiratory secretions?
2014.   Is Niferex (ferrous polysaccharide) any good? (Any advantage over ferrous sulfate (FeSO4)?)
2015.   Is Ortho-Tri-Cyclen approved by the Food and Drug Administration (FDA) for use in acne? Does it have the progesterone that has an increased incidence of deep-vein thrombosis (DVT)?
2016.   Is Parkinson's Disease hereditary?
2017.   Is Plavix (clopidogrel) any good to prevent transient ischemic attacks (TIA's)? What are the indications?
2018.   Is Polytrim better than sulfacetamide for conjunctivitis in children because of less burning?
2019.   Is Prevacid 30 milligrams twice a day too high a dose?
2020.   Is Prinivil the same thing as Zestril? We have Prinivil samples. She's on Zestril and doesn't have much money.
2021.   Is Rogaine okay to use for female pattern baldness? What pattern does female baldness take?
2022.   Is Serzone okay to give to someone with a partial gastrectomy, will it be absorbed?
2023.   Is Sudafed a problem with breast feeding?
2024.   Is Ticlid better than aspirin for stroke and transient ischemic attack (TIA) prevention?
2025.   Is Timoptic a beta blocker?
2026.   Is Valtrex appropriate and cost effective to treat this patient with chicken pox? Patient was seen in the emergency room earlier in the week by the physician on call for Dr. X.
2027.   Is Verelan 240 milligrams scored? Verelan is expensive and this would be a way to cut costs (split the larger pill in half).
2028.   Is Vitamin E useful for the treatment or prevention of Alzheimer's disease?
2029.   Is Zoloft 100 milligrams scored?
2030.   Is a Richard's screw the same thing as a compression screw?
2031.   Is a chest x-ray on this patient needed?
2032.   Is a family history of breast cancer a contraindication to hormone-replacement therapy with estrogen?
2033.   Is a high urine pH any indication of a urinary tract infection?
2034.   Is a history of carcinoma of the cervix a reason not to give postmenopausal hormone replacement therapy (estrogen, Premarin)? What are the contraindications to hormone replacement therapy?
2035.   Is a history of ovarian cancer a contraindication to estrogen therapy?
2036.   Is a history of pulmonary embolus a contraindication to hormone replacement therapy (postmenopausal estrogen)?
2037.   Is a history of superficial thrombophlebitis a contraindication to the use of replacement estrogen?
2038.   Is a magnesium level of 1.7 (normal 1.8 - 2.4) low enough to treat?
2039.   Is a neurilemmoma benign?
2040.   Is a pacemaker an indication for subacute bacterial endocarditis prophylaxis?
2041.   Is a positive Hallpike maneuver necessary to make the diagnosis of benign positional vertigo?
2042.   Is a single dose of Diflucan (fluconazole) accepted treatment for vaginal candidiasis (monilia vaginitis)?
2043.   Is a small rise in creatinine acceptable when starting or increasing an angiotensin-converting-enzyme inhibitor?
2044.   Is a uterine ultrasound enough for menometrorrhagia in a 44-year-old?
2045.   Is acyclovir ointment helpful to treat herpes labialis? (HSV-1)
2046.   Is amoxicillin/clavulanate the same thing as Augmentin? (He was looking at culture and sensitivity lab report.)
2047.   Is an absent right pectoralis major muscle described as a congenital anomaly?
2048.   Is an ascending aortic aneurysm a sign of syphilis?
2049.   Is an upset stomach a side effect of Glucotrol? Dr. X said she hadn't seen that before.
2050.   Is aspirin just as good as warfarin (Coumadin) for preventing strokes in patients with chronic atrial fibrillation?
2051.   Is benazepril (Lotensin) just as good as captopril and enalapril for congestive heart failure?
2052.   Is bethanechol cholinergic or anticholinergic and what does that mean?
2053.   Is casting adequate treatment for this 10-year-old girl with a fracture of the distal radius? X-ray showed it was slightly displaced.
2054.   Is chewing tobacco a risk factor for heart disease or cancer?
2055.   Is chronic use of cephalosporins, such as to treat a chronic infection or acne, associated with serious long-term side effects?
2056.   Is clindamycin just as likely to cause pseudomembranous colitis in children as it is in adults?
2057.   Is cow's milk a risk for mad cow disease? (moving to Lebanon)
2058.   Is ddC (zalcitabine) okay to use as monotherapy for HIV (human immunodeficiency virus) (JAMA, 3/10/94)?
2059.   Is diabetes a risk factor for carpal tunnel syndrome?
2060.   Is diarrhea a frequent side effect of Cleocin (pediatric)? Patient is a 17-month-old male with pharyngitis for 5 days, a week ago.
2061.   Is dietary protein restriction helpful in someone with chronic renal failure? How much protein should be eaten?
2062.   Is donepezil (Aricept) worth anything in Alzheimer's disease?
2063.   Is endometriosis in the mother causing abdominal pain in a 12-year-old girl who is premenstrual?
2064.   Is erythromycin adequate treatment for sinusitis?
2065.   Is fenfluramine (Pondimin) effective in treating obesity when given with an antidepressant?
2066.   Is fluoxetine (Prozac) or similar drugs the drug of choice for treatment of depression in the elderly?
2067.   Is follicular carcinoma of the thyroid hereditary? What is the hereditary one?
2068.   Is gentian violet toxic when given for oral thrush?
2069.   Is gestational diabetes treated the same as type 1 diabetes? (the question is for the treatment of the baby)
2070.   Is headache or abdominal pain more common with streptococcal sore throat?
2071.   Is her asthma cardiac asthma?
2072.   Is her fatigue from anemia?
2073.   Is her head size normal for her age (mother asked)?
2074.   Is her illness due to a virus or allergies?
2075.   Is her injury a rotator cuff injury?
2076.   Is herpes zoster contagious? Should a pregnant woman avoid someone with Herpes Zoster? Can you get a herpetic whitlow by touching someone with Herpes zoster?
2077.   Is his discomfort only due to a urinary infection and should he have x-rays? Could the diverticulitis be irritating the bladder? He has a history of diverticulitis also.
2078.   Is intramuscular ketorolac (Toradol) just as likely to cause gastrointestinal hemorrhage and ulcer as oral nonsteroidal antiinflammatory drugs? Is the nonsteroidal effect systemic or local?
2079.   Is is true that we should stop using sublingual nifedipine for acute treatment of high blood pressure (hypertension)?
2080.   Is it OK to breast feed when you're on propylthiouracil?
2081.   Is it abnormal for a two-month-old to make a fist with the thumb tucked inside the fingers?
2082.   Is it all right for children to take griseofulvin?
2083.   Is it all right to switch suddenly from one tricyclic antidepressant to an equal dose of another antidepressant?
2084.   Is it all right to use Norplant in obese women?
2085.   Is it all right to use Prozac (fluoxetine) (or other selective serotonin reuptake inhibitor) with imipramine (or other tricyclic antidepressant)?
2086.   Is it better to give Lasix (furosemide) all in one dose or to split it twice a day?
2087.   Is it better to use prescription or over-the-counter Antivert? Patient has a ten dollar co-pay.
2088.   Is it contraindicated to give a beta blocker along with a calcium channel blocker?
2089.   Is it ever helpful to alter the timing of when glipizide is taken (the way you would with insulin) to get the bedtime blood sugars down in diabetes?
2090.   Is it ever normal to have a full or bulging fontanelle in an infant?
2091.   Is it ever normal to have an S3 or S4 gallop in an otherwise young healthy normal person?
2092.   Is it ever okay to not repeat a vasectomy in a patient with a few persistent dead sperm after 6-12 months?
2093.   Is it ever recommended these days in a young man with recurrent peptic ulcer disease to have a vagotomy? Will his health maintenance organization pay for it?
2094.   Is it gall bladder or gastritis pain?
2095.   Is it legal to send prescriptions to Canada?
2096.   Is it legitimate to use fenfluramine and phentermine longer than 6 months to control obesity? Is it legal?
2097.   Is it necessary to do a bone marrow in someone with monoclonal gammopathy to rule out multiple myeloma? How often should serum protein electrophoresis be done in someone with monoclonal gammopathy of undetermined significance?
2098.   Is it necessary to give an amnioinfusion if there is only light meconium?
2099.   Is it normal for adults to lose height (stature) as they grow older?
2100.   Is it normal for an infant to have a diastasis recti (separation of the rectus muscles with protrusion of the abdomen)?
2101.   Is it normal for some laboratory values to look worse before they look better in someone with alcoholic liver disease and big spleen after you take them off alcohol?
2102.   Is it normal to have inverted T waves in Lead 3?
2103.   Is it okay to Baptize a human immunodeficiency virus positive (HIV-positive) person? Any special precautions for the one doing the Baptizing?
2104.   Is it okay to breast feed if you are getting Depo-Provera for contraception?
2105.   Is it okay to breast feed when pregnant with the next child?
2106.   Is it okay to breast feed while taking atenolol and propranolol?
2107.   Is it okay to give Benadryl to a patient with asthma?
2108.   Is it okay to give antibiotics with Phentermine?
2109.   Is it okay to give doxycycline to a breast feeding mother?
2110.   Is it okay to give oral thiamine in alcohol withdrawal instead of intramuscular thiamine?
2111.   Is it okay to give pain medication to a patient with acute undiagnosed abdominal pain?
2112.   Is it okay to give rubella vaccine to a breast feeding mother?
2113.   Is it okay to give the oral polio vaccine (OPV) and other live vaccines to a baby if the mother is pregnant?
2114.   Is it okay to give the rubella vaccine to a breast-feeding woman?
2115.   Is it okay to just prescribe Viagra (sildenafil) for erectile dysfunction? What are legitimate indications and what are the side effects? What is the dose? What are contraindications? How effective is it?
2116.   Is it okay to report someone to the Department of Transportation if you think they should not be driving?
2117.   Is it okay to say I completely don't know? I don't know what this rash is. We've tried changing detergents. Goes away with prednisone but comes right back. Comes with pressure but doesn't look like urticaria.
2118.   Is it okay to take cafergot if you are breast feeding?
2119.   Is it okay to use a beta blocker with clonidine?
2120.   Is it okay to use a cheap angiotensin converting enzyme inhibitor for congestive heart failure (eg, Mavik) or do you need to use one of the ones proven to help congestive heart failure?
2121.   Is it okay to use cervical traction in this woman with headaches and cervical arthritis and minimal instability on cervical spine films?
2122.   Is it okay to use the nicotine patch during pregnancy?
2123.   Is it okay to use the nicotine patch in someone with known coronary artery disease?
2124.   Is it okay to use tricyclic antidepressants along with benzodiazepines?
2125.   Is it possible for someone to get recurrent pelvic inflammatory disease without a new exposure? She had it one year ago from an intrauterine device.
2126.   Is it possible to get gout in the olecranon bursa?
2127.   Is it possible to give a sclerosing agent through a thoracentesis tube in a patient with recurrent malignant pleural effusions?
2128.   Is it really Benadryl that's in Tylenol PM? I just didn't want her taking that with all her muscle relaxants.
2129.   Is it really safe to use Paxil during the first trimester of pregnancy. I think it is but I want to confirm that it is.
2130.   Is it really true that treating streptococcal sore throat with antibiotics does not make the symptoms go away any quicker?
2131.   Is it really worth using hormone replacement therapy in this woman who now has spotting and will require an endometrial biopsy?
2132.   Is it reasonable to get periodic ultrasounds to rule out an abdominal aortic aneurysm in someone with a family history of abdominal aortic aneurysm?
2133.   Is it safe to give influenza vaccine to a patient on Coumadin?
2134.   Is it safe to take Midrin while breast feeding?
2135.   Is it standard of care to always get a follow-up chest film (x-ray) for an adult with pneumonia?
2136.   Is it still the current recommendation that breast-feeding infants get fluoride, iron, Vitamin C, and Vitamin D supplements?
2137.   Is it sufficient to just excise this lesion or does he need other follow-up or evaluation?
2138.   Is it the progesterone or the estrogen that varies with the triphasic pill? What's the rationale?
2139.   Is it true as Dr. X says that you need at least 10 patients who have the outcome of interest for each independent variable in the logistic regression model?
2140.   Is it true that men on captopril have a better quality of life than men on enalapril?
2141.   Is it true that you can't correct hypokalemia unless you first correct hypomagnesemia?
2142.   Is it true, as Dr. X says, that inhaled steroids should be used even in mild intermittent asthma to prevent loss of beta agonist reactivity? If so should they be used continuously or intermittently?
2143.   Is it worth it to get a cholesterol on an 82-year-old man? (Total cholesterol approximately 220, low-density lipoprotein (LDL-cholesterol) approximately 160.)
2144.   Is itraconazole safe and effective for onychomycosis?
2145.   Is keratoconus hereditary?
2146.   Is melatonin good for anything? I don't know anything about melatonin. I need to know the dose.
2147.   Is mint snuff better than chewing tobacco or tobacco snuff?
2148.   Is multiple sclerosis hereditary?
2149.   Is obsessive compulsive disorder hereditary (mother has the diagnosis)?
2150.   Is one shot of Rocephin adequate treatment for otitis media?
2151.   Is oral clindamycin just as likely to cause pseudomembranous colitis as parenteral clindamycin?
2152.   Is platelet function affected by nonsteroidal antiinflammatory drugs the same as by aspirin? For example, can you give them to someone with a lower gastrointestinal bleed?
2153.   Is prostate cancer hereditary?
2154.   Is ranitidine indicated routinely in stroke patients to prevent stress ulcers?
2155.   Is rupture of membranes a contraindication to prostaglandin gel (for example, Cervidil)?
2156.   Is serum progesterone better than human chorionic gonadotrophin to follow someone with first trimester bleeding to see if they will abort?
2157.   Is she not sleeping well due to sleep apnea?
2158.   Is smoking one pack per day a contraindication to hormone replacement therapy?
2159.   Is softening of the cervix helpful in diagnosing preterm labor (apart from effacement and dilatation)?
2160.   Is sweating a side effect of Zestril?
2161.   Is taste sensation carried in the 7th (facial) nerve (relevant to Bell's Palsy)?
2162.   Is the 40-milligram Lipitor tablet scored?
2163.   Is the Atkins diet any good? Is it safe?
2164.   Is the Gastroccult test necessary to test gastric contents for occult blood or can you just use the Hemoccult slide? Would you get a false positive or false negative with the Hemoccult slide?
2165.   Is the Helicobacter pylori antibody test a reasonable test to diagnose Helicobacter pylori?
2166.   Is the appearance of the tonsils helpful with diagnosing streptococcal sore throat?
2167.   Is the bleeding (spotting) that occurs at the time of ovulation described anywhere?
2168.   Is the blood in this patient's mouth coming from the stomach?
2169.   Is the chest pain from costochondritis or Herpes Zoster?
2170.   Is the coccyx fractured? This was the question as the physician was looking at the x-ray of a young girl (about 7 years old).
2171.   Is the contraceptive sponge just as effective as the diaphragm?
2172.   Is the ductus arteriosus closing on this cardiac patient?
2173.   Is the estrogen patch less likely than oral estrogen replacement therapy to cause hypertension?
2174.   Is the faint trace of a vertical line on the rapid streptococcal test really positive? The manufacturer says yes but I'm not sure.
2175.   Is the maximum dose of Atarax 25 or 50 milligrams?
2176.   Is the meningococcal vaccine recommended for college students?
2177.   Is the mini-pill (progesterone only oral contraceptive) safe to use while breast feeding?
2178.   Is the most common organism causing the syndrome of otitis media and conjunctivitis Haemophilus?
2179.   Is the new blood sugar monitoring device (AtLast) that diabetics use on the forearm legitimate?
2180.   Is the new diet pill dexfenfluramine any good?
2181.   Is the pain in her legs from intermittent claudication or is it from diabetic neuropathy?
2182.   Is the patient getting nutrition through this intravenous line? What liver tests do I do to find out?
2183.   Is the rash on this child viral?
2184.   Is the shortness of breath physiologic or due to anxiety? (history of chronic obstructive pulmonary disease, congestive heart failure)
2185.   Is the silver stain of sputum the best way to diagnose pneumocystis pneumonia?
2186.   Is there a bursa under the first metatarsal phalangeal joint?
2187.   Is there a cure for interstitial cystitis? I have a friend who has tried everything.
2188.   Is there a danger of asymmetric growth in a 9-year-old girl with a nondisplaced Salter II fracture of the distal humerus?
2189.   Is there a depo form of intramuscular Haldol? Patient is getting 25 milligrams every 3 weeks. Could it cause edema?
2190.   Is there a dietary change or herbal medication that would prevent prostate cancer (patient asked him to help his son)?
2191.   Is there a drug for chlamydia if the patient cannot swallow pills?
2192.   Is there a drug interaction between indomethacin and captopril?
2193.   Is there a generic form of Glynase? He wanted samples because he has no insurance.
2194.   Is there a generic form of Zantac?
2195.   Is there a graph showing the cumulative chance of delivering based on gestational age (would go sharply up at 41 1/7, 41 2/7, and so on)?
2196.   Is there a hemoglobin A1C (glycosylated hemoglobin) criterion for diabetes?
2197.   Is there a new pill for stopping smoking besides Zyban?
2198.   Is there a particular age at which you would stop treating hypercholesterolemia or an age that you would not start treatment?
2199.   Is there a particular fever pattern from central nervous system (CNS) damage, like a stroke?
2200.   Is there a recommendation to put people on hormones (hormone replacement therapy) if they haven't been on them for 10-15 years? There are quite a few patients I don't see at menopause but they come in their 60's.
2201.   Is there a review or an answer to whether patients with osteoporosis should get bone densitometry, because now we have Fosamax?
2202.   Is there a short synopsis with pictures of how to do a vasectomy?
2203.   Is there a syndrome characterized by multiple lipomas? Does it have any significance if someone has multiple lipomas?
2204.   Is there a type of headache that gets worse with drinking alcohol?
2205.   Is there a way to give Augmentin so the child gets about 80 milligrams per kilogram per day of amoxicillin and about 10 milligrams per kilogram per day clavulanic acid?
2206.   Is there a way to improve the decreased libido (or sexual function) among females (or males) taking Prozac or other selective serotonin reuptake inhibitors (SSRI's)?
2207.   Is there an association between Crohn's disease and acute delusional psychosis?
2208.   Is there an association between HLA-B27 and iritis?
2209.   Is there an association between breast feeding and breast cancer?
2210.   Is there an association between high serum iron levels and coronary artery disease?
2211.   Is there an organized way to look at a fetal heart rate monitoring strip?
2212.   Is there another way to remove warts without scarring besides cryotherapy? This 3/4 cm wart on the knee was treated 6 weeks ago with cryotherapy, now red and raised and possible keloid forming.
2213.   Is there any association between Down syndrome and arthritis?
2214.   Is there any association between aerobic exercise and amount of bleeding with menstruation or menorrhagia?
2215.   Is there any association between restless legs syndrome and spinal stenosis?
2216.   Is there any association between smoking cessation and depression; that is, can quitting smoking cause depression?
2217.   Is there any association between thyroid function and urticaria? A patient's urticaria got better when she was hypothyroid and worse when given replacement therapy.
2218.   Is there any association between vitiligo and diabetes?
2219.   Is there any collagen vascular disease that can present as lung infiltrates and hepatitis?
2220.   Is there any contraindication to giving the influenza vaccine to someone with a history of Guillain Barre'?
2221.   Is there any difference among different types of estrogen in terms of adverse effects and benefits, such as vaginal atrophy, mood, and breast tenderness?
2222.   Is there any difference in how often you should wash the hair in black kids?
2223.   Is there any drug to decrease male sex-drive in a patient who requests it?
2224.   Is there any evidence that Atarax is better than other antihistamines for itching?
2225.   Is there any evidence that stool softeners like Colace (Docusate sodium) do anything?
2226.   Is there any good evidence for the use of simethicone drops for infants with colic? They use it "all the time" in Germany.
2227.   Is there any good reason for treating onychomycosis? It's a lot of money for a cosmetic problem.
2228.   Is there any information for parents regarding toileting refusal?
2229.   Is there any information on the use of Celebrex (celecoxib) in migraine?
2230.   Is there any interaction between terfenadine and desipramine?
2231.   Is there any interaction between warfarin (Coumadin) and the influenza immunization?
2232.   Is there any kind of legitimate arthritis cream you could prescribe for a patient?
2233.   Is there any problem with chronic steady use of Midrin such as tolerance or addiction?
2234.   Is there any reason to use captopril as opposed to other angiotensin-converting enzyme inhibitors in diabetics with microalbuminuria?
2235.   Is there any relationship between pseudocholinesterase deficiency and malignant hyperthermia? What are they?
2236.   Is there any sense giving Diflucan to a nursing home patient with suspected esophageal and oral candida without knowing for sure if that's what it is?
2237.   Is there any support group in this town for this patient who is going blind from macular degeneration?
2238.   Is there any treatment for daytime or nighttime bruxism (teeth grinding) or jaw clenching in an adult, especially if it may be causing temporomandibular joint (TMJ) syndrome?
2239.   Is there any treatment for geographic tongue?
2240.   Is there any treatment for jet lag?
2241.   Is there any treatment for vasomotor rhinitis?
2242.   Is there any way to correct for hyperglycemia (415) in someone with hyponatremia (130) to see what the sodium would really be?
2243.   Is there any way to get people to come to their appointments and monitor their blood pressure?
2244.   Is there any way to prevent Anthrax? How do you test for it?
2245.   Is there any way to prevent mucous (mucus) plugs in the airways?
2246.   Is there any way to stimulate appetite in cancer patients?
2247.   Is there anything besides antihistamines that can be used to treat physical urticaria (pressure urticaria)?
2248.   Is there anything in terms of clinical features that distinguishes the headache and blurred vision of preeclampsia from other causes of headache and blurred vision?
2249.   Is there anything in the literature about allergy testing or desensitization to acyclovir?
2250.   Is there anything in the literature about milk and molasses enemas?
2251.   Is there anything in the literature about the "spine sign" as a way to diagnose lower lobe pneumonia?
2252.   Is there anything in the literature on elbow fat pad signs?
2253.   Is there anything new in terms of nonsurgical treatment for spinal stenosis?
2254.   Is there anything that can be done one week out to prevent postherpetic neuralgia?
2255.   Is there anything to prevent sebaceous cysts from occurring? Is it a duct that gets blocked?
2256.   Is there more support we can provide to patients with macular degeneration?
2257.   Is there something like a screening test for diabetic neuropathy that's practical for family physicians? I'd probably lose those nylon things. I just touch their feet with my finger.
2258.   Is there such a drug as Lo-Estrin with iron?
2259.   Is there such a thing as bacterial bronchitis? Why can't there be? You can have bacterial infections everywhere else.
2260.   Is there such a thing as chronic compartment syndrome?
2261.   Is there such a thing as purulent rhinitis without sinusitis that requires antibiotics?
2262.   Is this Wiscott-Aldridge Syndrome?
2263.   Is this a bacterial or a viral infection?
2264.   Is this a drug rash from amoxicillin?
2265.   Is this a fracture or a growth plate at the base of the fifth metatarsal (looking at x-ray)?
2266.   Is this a fungal infection?
2267.   Is this a malignant melanoma or just a junctional nevus or seborrheic keratosis?
2268.   Is this a pyogenic granuloma?
2269.   Is this a seborrheic keratosis or an actinic keratosis or a basal cell carcinoma?
2270.   Is this a toenail fungus or just a thickened toenail?
2271.   Is this a viral or a bacterial infection?
2272.   Is this a viral or bacterial infection?
2273.   Is this abnormal? One kidney seems larger than the other on this newborn. Could this be associated with hypospadias?
2274.   Is this an accurate formula to calculate low-density-lipoprotein (LDL)-cholesterol? LDL = (total cholesterol - high-density-lipoprotein) - (0.2 * triglycerides)
2275.   Is this an avulsion fracture (ankle film)?
2276.   Is this anemia caused by iron deficiency? What tests do we do to find out?
2277.   Is this appendicitis or viral gastroenteritis?
2278.   Is this chest pain due to coronary disease? Electrocardiogram just shows an old myocardial infarction.
2279.   Is this eczema in the diaper area?
2280.   Is this girl normal early puberty or true precocious puberty?
2281.   Is this girl with synophrys (one continuous eyebrow) a childhood anomaly or Cornelia de Lange syndrome?
2282.   Is this level of Tylenol ingestion toxic?
2283.   Is this level of theophylline toxic?
2284.   Is this male child depressed? Child's counselor thinks Ritalin is stimulating him and suggested he shouldn't be on it. Dr. X thought he looked the best he has looked while on Ritalin but took him off and started him on Prozac.
2285.   Is this molluscum contagiosum a case of the chicken pox?
2286.   Is this oral herpes in the mouth or something else?
2287.   Is this patient allergic to Zofran?
2288.   Is this patient in danger of cardiac tamponade? They have an arrhythmia.
2289.   Is this rash eczema?
2290.   Is this redness on the penis and pain with urination balanitis or a urinary tract infection?
2291.   Is this respiratory plan for an extubated child okay?
2292.   Is this small lesion a case of nummular eczema?
2293.   Is this upper respiratory infection viral or bacterial?
2294.   Is transdermal estrogen less likely to cause breast pain (mastodynia) than oral estrogen replacement therapy?
2295.   Is treatment with chromium any good for diabetes?
2296.   Is varicella (chickenpox) vaccine available? What are the indications? Is it to be used routinely in children?
2297.   Is vitiligo associated with any systemic diseases that you should look for in someone with lots of vitiligo?
2298.   Is zinc oxide paste a reasonable treatment for generic diaper rash and how do you prescribe it?
2299.   Isn't there a stress test you can do for people who can't exert themselves?
2300.   It seems like an inflammatory thing but I'm not sure what's going on (patient with elbow pain, can't straighten elbow).
2301.   It's just the age old question, "How do you convince someone they are depressed when they don't want to accept it?"
2302.   It's not crystal clear what's going on with her. I may treat her for diverticulitis. I've seen diverticulitis in a patient as young as 19-year-old. (This patient is in her 20's.)
2303.   It's unlikely to get streptococcal sore throat in very young children. At what age would you do a step test? Would it make a difference if a family member has documented streptococcal sore throat? How young would you go if you do have a family member (sibling) with streptococcal sore throat? For example, would you do it in a one-year old?
2304.   Kindergarten physical, due for diphtheria-pertussis-tetanus vaccine (DPT) #5, but had only 3 previous diphtheria-pertussis-tetanus vaccines. Do I need to play catch up and give fourth and fifth or just fourth? Legally fourth is all she needs but medically what would be best?
2305.   Kindergarten physical. 7-8 red blood cells on urinalysis. No protein, no illness. How far do you pursue this?
2306.   Knee injury, slight swelling, no erythema, most likely a sprain, 2 days out from injury, 95% to 98% chance it will be normal but the question is . . . medicolegally you have to do it (x-ray) because it was an injury, but it's almost surely normal and you hate to have that expense.
2307.   Known cancer of the prostate. In 1994 his prostate specific antigen was approximately 20, now approximately 27. What to do?
2308.   Lady in her 70's with an ileostomy noted increased ileostomy output and wondered if she could have a fistula and if it was urine. The question was why her ileostomy output was increased. Was this just diarrhea or something else and then how to find out if it was a fistula.
2309.   Last Thursday a 52-year-old woman fell on an outstretched arm and she had some swelling. Her x-ray showed a chip fracture off the triquetrum or lunate. This was the first time I had a fracture like that and the question was how to treat this.
2310.   Last night I saw a 1-year-old with Turner's syndrome, has puffy feet. Mother asked me how long before the puffiness in feet goes away.
2311.   Last night I saw a newborn that was delivered after a Mity-Vac times three and forceps which never really got used. The question was how to evaluate this kid for a subgaleal hematoma. Head ultrasound? Computerized tomography?
2312.   Last week I had a 3-week-old boy with pyloric stenosis. I looked up pyloric stenosis to see if ultrasound is still the test of choice.
2313.   Last week I had a 37-year-old diabetic female and I wanted to convert her from regular insulin to Humalog and the question was, "What is the conversion factor, so I know how much Humalog to give?"
2314.   Last week I had a 72-year-old man with an elevated alkaline phosphatase of approximately 210 units per liter (normal 20 - 125). I broke it down, but each individual component was normal: bone approximately 40% (normal 23 to 62%), liver approximately 55% (normal 38 to 72%), and intestinal approximately 5% (normal less than 18%).
2315.   Last week I had a couple of patients with sinusitis whom my partner treated with Avalox and they didn't get better. I was always told if you overuse fluoroquinolones, you will get resistance. Our PharmD (Doctor of Pharmacy) in residency always said that. The drug representative said no, no that's not true and so he said he would send information on it.
2316.   Last week I had an adult woman seen in the emergency room with dyspnea and she had a mildly elevated D-dimer. My question was, "What do I do with this?"
2317.   Last week I saw a 2-week-old boy, whose sister has vesicoureteral reflux. Mother asked, "Does he need to be checked for reflux?"
2318.   Last week I saw a 4-year-old girl with shingles on the left leg. I didn't know what it was and I had the dermatologist take a look. He did a Tzanck preparation and it was positive. So the question was, "What is this rash?" and then the best way to treat it.
2319.   Last week I saw an 8-year-old girl with a bump in her groin. "What is this?" "I wasn't sure what that was or if I should refer."
2320.   Last week we had a 2-year-old with idiopathic thrombocytopenia purpura. So the question was "How many doses of immunoglobulin to give?"
2321.   Left posterior knee pain, history of Baker's cyst. Question is that Dr. X has "slight doubt" about whether the pain can all be attributed to the Baker's cyst.
2322.   Leg cramps and use of quinine. Two questions. Is there literature to support the use of quinine? Also why do leg cramps occur and how do you address them?
2323.   Let's find out more about T'ai Chi (said to nurse).
2324.   Let's give these immunizations. That's right isn't it?
2325.   Liver getting bigger and heart problems. Should we give him Lasix or not?
2326.   Liver getting bigger and heart problems. Was he in heart failure or not?
2327.   Low platelet count. Is this idiopathic thrombocytopenic purpura or something else?
2328.   Ludiomil. Patient came in to the emergency room on it. "What in the heck is that?"
2329.   Lyme disease. That always seems to raise its ugly head. Specifically what to tell patients who are concerned about Lyme disease.
2330.   Lymph nodes -- when do you refer and when do you just watch?
2331.   Male college student adopted from Korea. Tuberculin Tine negative at the time adopted, now has positive Mantoux on college physical examination. Could he have gotten BCG (bacille Calmette-Guerin) vaccine?
2332.   Man in his 90's with a change is bowel habits, and decreased caliber of stools. Do you (1) do a sigmoidoscopy, (2) do nothing, (3) compromise and use Hemoccult cards?
2333.   Man in his late 40's with bad Crohn's disease. Came in with pyoderma gangrenosum. We didn't know how to treat him.
2334.   Man seen 2 days ago for hypertension. Needs more medications for hypertension. Dr. X wants to add a diuretic. Asked his nurse to find out how much diuretic is in Hyzaar which he is already on.
2335.   Man with orogenital ulcers. Cultures from oral lesions and genital lesions were both negative. Referred to tertiary center who said he responded well to acyclovir and they thought he had herpes. "How sensitive is that test?" (meaning the herpes culture)
2336.   Man with partially avulsed finger nail from snowblower accident. "What would you use for antibiotics?"
2337.   Man with stomach ulcers. Can't take nonsteroidal anti-inflammatory drugs. Why can't I get the only thing that ever worked (Plegine)? What is it and how can I get it?
2338.   Mastodynia. I (investigator) prompted her for what the question was. I suggested, "What is the workup and treatment for mastodynia?" She (study physician) said, "Well, there really is no workup after you've eliminated caffeine. Once you've eliminated caffeine, what else is there?"
2339.   Metacarpal fracture in a 25-year-old man. I didn't know exactly what cast to put on and whether I needed a special cast to include the fingers.
2340.   Mom is breast feeding a 21-month-old up to 4 times a day and wants to wean. Is there anything she can eat to make her breast milk taste bad?
2341.   Mom's hepatitis B status is unknown. What do you do to the newborn?
2342.   Monday I admitted a 7-month-old boy with a reaction to peanuts. I called an allergist and asked him what he's seen in kids this age with a first exposure to peanuts. Do you get peanut exposure in utero was the question.
2343.   Morbidly obese (388 pounds). Eats a lot. Had a piece of pie before clinic visit so can't have blood work today. Is there something about the patient's sugar that makes him eat so much and is this (overeating) typical of other or all overweight people?
2344.   Mother died at age 55 of colon cancer. I will send her to the gastroenterologist for a colonoscopy ($1500). I sometimes wonder whether to do this because it's so expensive versus a flexible sigmoidoscopy and barium enema which is cheaper but not as good.
2345.   Mother has juvenile rheumatoid arthritis. "Is the baby at high risk for juvenile rheumatoid arthritis, and what would we be looking for in the baby?"
2346.   Mother is alcoholic and abuses tobacco. What are statistics regarding inheritance of tobacco abuse and relationship to social situation?
2347.   Mother of this child wanted to get a flu shot. She is breast feeding and wanted to know if it was safe.
2348.   Mother of this patient has tennis elbow (lateral epicondylitis). Which muscles insert into the lateral epicondyle?
2349.   Mother wanted to borrow the microwave to microwave the bottle of formula. The nurse and physician advised her to heat the bottle with warm water from the sink instead. Later the physician said, "You get hot spots don't you?"
2350.   Multiple small ulcers on ankles and buttocks. No history of bites. I sent him for a complete blood count (CBC) and blood sugar but I don't know what these are.
2351.   My last patient this morning is an 11-year-old boy. "Why would he be mildly anemic and have schistocytes?" "I'm not sure what causes schistocytes."
2352.   My partner had a 13-year-old boy with exudative tonsillitis. I (investigator) asked what the question was. She (physician) said, "What would be the differential?"
2353.   My patient is allergic to Ilosone. Is erythromycin the same thing?
2354.   My patient was convinced she had hypothyroidism. But her labs were normal. The thyroid stimulating hormone was normal but at the upper end of normal. I called Dr. X (endocrinologist) and said, "Now what do I do?"
2355.   My patient was convinced she had hypothyroidism. Her labs were normal in August and I even checked antithyroid antibodies and they were negative. She asked another physician to check her thyroid antibodies again and her thyroid peroxidase antibody was two times the upper limit of normal, so I called an endocrinologist and said, "Now what do I do with this?"
2356.   My question was, "Can we treat a four-week old with griseofulvin?"
2357.   Need to increase Ziac from 5 to 10 for better control. Is there a difference in price between the two doses?
2358.   Neonate with methamphetamine exposure. Potential adoptive parents wonder about long term outcomes of babies exposed to methamphetamine.
2359.   New PIXI (peripheral instantaneous x-ray imager) scan and DEXA (dual-energy x-ray absorptiometry) scan. "Is there any clinical evidence for how the PIXI scan correlates with the DEXA scan?"
2360.   New congenital cataracts in a child. When should you be able to pick that up?
2361.   New onset, unexpected thrombocytopenia -- What to do with it? Blood went to reference lab. I wonder if sitting in the tube in the courier's car would do that.
2362.   Newborn at 38-weeks gestation, term, Cesarean section for fetal distress, uncontrolled diabetic. Oximeter was 50, not tachypneic, no murmur. I (investigator) prompted, "So the question was, what's causing the low oxygen saturations"? The physician said, "Yes, my partner said, 'I didn't have any idea what was going on.'"
2363.   Newborn male. Why do they need to urinate after circumcision? In other words, why do hospitals have a rule that the baby has to urinate after circumcision before they can be discharged? What would you do if the baby didn't void and how long would you wait?
2364.   Newborn with hip click. Is this hip dislocated? Study physician's partner wondered if there are any indications for x-rays when suspecting a dislocated hip, or if we only do ultrasound now.
2365.   Newborn. Question from resident to study physician. Why are oral hypoglycemics contraindicated in diabetic mothers during pregnancy and why was this mother on glyburide and everyone thought that was OK?
2366.   Newborn. Thanatophoric dwarfism diagnosed by prenatal ultrasound and confirmed with amniocentesis. Almost always lethal (pulmonary hypoplasia). Question: How aggressively should we treat at birth?
2367.   Newborn. What are the latest immunization guidelines on hepatitis B virus? Specifically, do we have to give it in the newborn period before leaving the hospital?
2368.   Next is a huge question for me. Painful cracks in thick skin on the feet. How to treat this?
2369.   Nicorette gum. What is the dose?
2370.   Nine-month-old girl with excoriated diaper area due to diarrhea. This is a recurring question. "What else can you try?"
2371.   Nine-month-old girl with lipomeningomyelocele, not classic meningomyelocele. The question that arose was how soon will she retether her cord.
2372.   No known trauma to shoulder. The question is whether there is any kind of deformity or calcification.
2373.   No symptoms, previous prostate biopsy. Prostate specific antigen in 1994= approximately 4; 1995= approximately 4; 1996=approximately 6.5. What to do? Should you biopsy again?
2374.   Nonfasting blood sugar approximately 370, fasting blood sugar approximately 45. Drew glycosylated hemoglobin today. Dr. X thinks there is a condition with high postprandial blood sugars. Is there a better name for glucose intolerance?
2375.   Nonunion of Jones fracture. Should you operate?
2376.   Not my patient but mother is calling for head magnetic resonance imaging results. The results included an abnormal right cerebral hemisphere with neuronal migration disorder and changes of lissencephaly." After reading this, the physician said, "Neuronal migration disorder. I'd have to look that up to see what that means.
2377.   Now that intravenous hydralazine is not available, how should we treat hypertension in labor?
2378.   Now that we have the Women's Health Initiative results, in patients who have been on Premarin for 15 years and are now 70 years old, are you pulling them off?
2379.   Nurse practitioner asked the study physician about a 9-month old girl: "Is this unilateral laterothoracic exanthem?"
2380.   Nurse reported test results to Dr. X. Ova and parasites negative, no normal bowel flora. What does "no normal bowel flora" mean?
2381.   Nurse walked into his office to see what her laboratory work showed. She's on both Cytomel and Synthroid. Her thyroid stimulating hormone is slightly high. Is Cytomel T3 (triiodothyronine) or T4 (thyroxine)?
2382.   OK, here's one. 70-year-old woman. Had an episode of diverticulitis recently. Had a colonoscopy 2 years ago. Does she need it repeated?
2383.   Obese (360 pound) virginal female in for Papanicolaou smear. Can't get good look at cervix because speculum can't be inserted properly. What is the truly doing the right thing for her? (1) using anesthesia to insert speculum and visualize properly or (2) hope that manual exam where not feeling any abnormalities is adequate.
2384.   Obstetric patient at 39 weeks had little sore possible herpes. How long after the lesion heals is it safe to let her deliver vaginally?
2385.   Obstetric patient had an ultrasound and the estimated fetal weight on the ultrasound was in grams. I would have liked to know what is was in pounds so I could tell the mother.
2386.   Of all the immunizations we give, which are living and which are dead?
2387.   Of what value is it to know the A-a gradient (alveolar-arterial difference) on blood gases? How is it used clinically?
2388.   Oh, I know. (She was trying to remember the questions she's had recently). The workup for polycystic ovarian syndrome. And when to suspect it.
2389.   Old folks with otitis externa or other ear problems. Cipro or Floxin drops are preferred because of less damage to the auditory nerve than Cortisporin or Neomycin. Is that a marketing gimmick or is that real?
2390.   Old guy with fatigue and poor appetite, smoker, what's causing his fatigue?
2391.   On a treadmill, what is a normal rate-pressure product and what does the rate-pressure product mean? What does the FAI (functional aerobic impairment) mean?
2392.   One month ago I did a physical exam, his alkaline phosphatase was elevated. Had a questionable prostatic nodule, prostate specific antigen was normal. I discussed with my partner, bowlegged, question Pagets, fractionated alkaline phosphatase and both liver and bone were high, got x-rays of skull and pelvis, which were normal. Do I really want to go chasing after this elevated alkaline phosphata...
2393.   One of the strength coaches at the high school recommended oral supplements of creatine. What is it? I think it's just a protein supplement.
2394.   One question I always have is what criteria do I use to decide when to stop a chronic medication. We have lots of criteria for starting drugs but very few for stopping them.
2395.   One year and 10-month-old boy removed from his home because of parental neglect. Caretaker says he often cries like he's in pain, possibly abdominal pain. Not eating, just drinking liquids, not sleeping. The big question with him: "Is it something physical or all adjustment disorder?"
2396.   One-year-old ate racoon feces. Study physician's partner e-mailed infectious disease consult: "Do you have knowledge about the racoon ascarid Baylisascaris? Should we treat a one-year old who probably ingested racoon feces?"
2397.   One-year-old boy. "Are we going to be too late for the hepatitis vaccine?"
2398.   One-year-old boy. What immunizations does he need?
2399.   One-year-old boy. What is the difference between Hib (PRP-D) (Haemophilus influenza b conjugate vaccine (Diphtheria Protein Conjugate)) and Hib (PRP-OMP) (Haemophilus influenza b conjugate vaccine (Meningococcal Protein Conjugate)) and which one should I give?
2400.   One-year-old girl. Physiologic murmur. In what percent of healthy well-child checks is a physiologic murmur heard?
2401.   One-year-old with chronic renal insufficiency and failure to thrive. Workup and management. What specifically should I instruct the parents on in terms of meals and snacks and how much to offer at each meal?
2402.   One-year-old with previous Salmonella enteritis, now asymptomatic but followup stool culture positive for Salmonella. Should she be treated?
2403.   One-year-old. I have to look up head sizes, familial megancephaly. I (investigator) asked how he would phrase the question. He said, "What is the differential diagnosis of large head size?"
2404.   Only symptom is tenderness along lateral neck muscles. Temp 102 yesterday, none now. Ears, throat, et cetera normal. She must be coming down with something but I don't know what she has at this point.
2405.   Our clinic just instituted computer-assisted detection (CAD) for mammography. "Any better?" "Increased false positives?"
2406.   Ovarian stromal cyst removed by gynecologist. They found, at that time, a "streak" ovary. What is the etiology and embryonic development associated with this condition?
2407.   Over 90-year-old inpatient with severe congestive heart failure on Coumadin. She was having shortness of breath, and it was paroxysmal, so I got a ventilation-perfusion scan and this showed high probability for pulmonary embolus. The question is, should she get a filter. I didn't do her leg veins, but even if they were normal, should she get a filter?
2408.   Over 90-year-old with change in bowel habits (occasional diarrhea) and guaiac positive stool on exam today. The physician said, "What would you do?" asking me (investigator).
2409.   Parent asked: Is there a recommended amount of sugar I should allow my child to have? Dr. X told patient she did not know the answer but suggested offering a nutritious diet without a lot of added sweets.
2410.   Partner of study physician got a lab report that a urine culture was growing gram negative bacilli. She wanted to know if that was consistent with Escherichia coli.
2411.   Patient (parent) education: Is there a textbook I can show this patient's mother to help explain hand foot and mouth disease?
2412.   Patient at 38 weeks gestation, Gravida 1Para 0, blood pressure 140/80 (baseline 70), 2+ protein, swollen ankles, 9 pound weight gain in 1 week, unfavorable cervix. I think she has preeclampsia. Should I wait 24 hours? Is it really preeclampsia? How should I proceed? Should I induce or go straight to cesarean section due to unfavorable cervix. How much protein in urine are you looking for as a m...
2413.   Patient called in. He is going to Peru and needs malarial prophylaxis. Is malarial prophylaxis needed for Peru and if so what drug is needed?
2414.   Patient complaining of legs being weak and she fell. Could Diovan (valsartan) do this?
2415.   Patient complains she has been dizzy and can't lose weight for 3 months and she has a friend who has a thyroid problem and wonders if she also has a thyroid problem. Dr. X figures she has vertigo with labyrinthitis although he doesn't usually see labyrinthitis for 3 months. He says he is willing to order thyroid tests which came back slightly low but a repeat was normal. But neurologist suggest...
2416.   Patient didn't tell Dr. X she was breastfeeding and he ordered Tagamet -- when she went to pharmacy, pharmacist and patient decided best not to use it. Dr. X questioned whether it's okay to use Tagamet while breastfeeding.
2417.   Patient fell asleep while driving and woke up in a ditch. Did not feel sleepy before episode. Electroencephalogram normal. Should she be referred for a full sleep study to look for sleep apnea?
2418.   Patient fell to outstretched hands and complains of pain on dorsal side of both hands. X-ray showed chip fracture one of the carpal bones but he (Dr. X) couldn't find the name of the specific bone. Tried to consult radiology text but it wasn't in there, looked for anatomy text but none available, so will look up in an anatomy text at home tonight. Said it wouldn't affect outcome as they splinte...
2419.   Patient goals were no menopausal symptoms and no menses. Question is what is an acceptable way to achieve these goals? Currently on hormone replacement therapy - both estrogen and progesterone, cyclic, but she doesn't like having the periods.
2420.   Patient going to Cancun. Does he need Hepatitis A vaccine?
2421.   Patient going to Viet Nam. What immunizations are needed?
2422.   Patient had a hysterectomy in 1992 for benign disease. How often should a Papanicolaou smear be done on these patients?
2423.   Patient had a pleomorphic adenoma removed from her carotid artery. Question is whether this is a totally benign condition.
2424.   Patient had a tubal ligation and now her menstrual cramps are worse. Why would menstrual cramps be worse after a tubal ligation? She asked Dr. X this question.
2425.   Patient had synovitis of thumb (with stenosing). He questioned in his mind how to treat. He may refer to orthopedic physician later if symptoms persist.
2426.   Patient had taken an over-the-counter analgesic. It's supposed to help urinary tract infections. The urine is orange. What is the medication?
2427.   Patient has a node on her right thumb that doesn't really bother her but she wants it removed. Should it be removed or not?
2428.   Patient has a prolapsed uterus and is having problems which include urinary problems. Would removal of the uterus alone resolve her urinary symptoms or would she also need a cystocele repair, et cetera?
2429.   Patient has a small cervical os, next time I do a Papanicolaou smear, would it be best to use estrogen cream prior to the procedure? (Patient is currently on hormone replacement therapy, estrogen and progesterone.)
2430.   Patient has an ulcerated rash on his side. Has had the rash for many years. What is it?
2431.   Patient has been on Estraderm patch and cyclic Progesterone and was changed to PremPro today. Patient asked how long she will continue to have periods or spotting after the medication change. Dr. X wasn't sure -- told her maybe up to 6 months.
2432.   Patient has had a pacemaker for 5 years. Seen for preoperative physical (cataracts). Electrocardiogram showed atrial fibrillation. Should I put her on Coumadin?
2433.   Patient has large area on thigh that is red and warm. He thinks he was bitten by something but not sure. Is this an allergic reaction to a bite or a cellulitis?
2434.   Patient has nausea after meals. Does she have diabetic gastroparesis or gastritis?
2435.   Patient has sinusitis, mixed vaginitis and undesired fertility. How can I give all three medications together? Also got eye drops for conjunctivitis.
2436.   Patient has stomatitis (canker sores on roof of mouth) Will treat with Zovirax. The question is whether there is data to support this treatment.
2437.   Patient having employment physical to become a nurse's aide and there was a question about her mental health on the form. Is it appropriate or even legal to note her history of manic depression on this form as patient preferred it not be noted?
2438.   Patient having second episode of upper abdominal pain with vomiting (first episode 3 months ago). Also history of reflux at night. Dr. X thinks she is having biliary colic. Question is whether this is biliary colic or gastroesophageal reflux disease with spasm?
2439.   Patient having significant hot flashes. Are any of her medications causing her hot flashes? On Premarin, Provera, and Prozac. Elevated urinary metanephrines. You order these tests and then wonder what to do with them.
2440.   Patient here for preoperative physical for coronary artery bypass graft. Can I change her Synthroid dose a week before her cardiac surgery?
2441.   Patient here for temporal arteritis. Her sedimentation rate has not come down with the current dose of prednisone. Do I need to push the prednisone harder?
2442.   Patient in correctional institution (also alcohol treatment facility) with positive Mantoux and negative chest x-ray. Does he need isoniazid and what is the procedure to report this?
2443.   Patient in nursing home with Parkinson's. How to make him more alert at breakfast? His manner was much different this morning -- usually asking to go home, today just stiff and not talking. May be due to seeing him at different times.
2444.   Patient in the hospital with premature rupture of membranes and twins. I read the RADIUS (Routine Antenatal Diagnostic Imaging With Ultrasound) trial in the New England Journal of Medicine. I never used to do routine ultrasound but here everybody does it. I felt vindicated when RADIUS (Routine Antenatal Diagnostic Imaging With Ultrasound) was published. But I recently went to an OB talk and the...
2445.   Patient is hypertensive and is on Premarin. The question is, how can you tell if elevated blood pressure is exacerbated by the Premarin, other than by stopping the Premarin? If Premarin is contributing to the elevated blood pressure, should you try to control the blood pressure with medication and keep the patient on Premarin because of the many benefits of estrogen?
2446.   Patient is post pessary insertion yesterday for urinary incontinence and cystocele. Is her urinary tract infection associated with this procedure?
2447.   Patient is reluctant to take medications so I have been treating with smaller doses than I would with some other patients. How do I control her hypertension and still get her cooperation?
2448.   Patient noted 1.5 to 2.0 centimeter mass on left forearm that he picks at. Mom says it isn't as large as it was and no clear injury although child says he was bit by a snake (has an imagination). What is the etiology of this cystic lesion?
2449.   Patient on Estrace. What is the equivalent dose of Premarin?
2450.   Patient on angiotensin converting enzyme inhibitor with chronic cough. Is the cough due to her asthma or to the angiotensin converting enzyme inhibitor?
2451.   Patient wanted to know if she will make it worse by using the hand and what is causing this prolonged pain? Dr. X said the exam was normal and he couldn't answer these questions so a referral to an orthopedic hand specialist will be made.
2452.   Patient was on penicillin for 4 days for an infected pierced ear lobe. Now seen today for sore throat and streptococcal culture positive. The question is, why is the streptococcal culture still positive, what percent of streptococci are resistant to penicillin?
2453.   Patient was referred here by ENT (ear, nose, and throat physician) for pre-operative physical, for adenoidectomy tomorrow, has otitis media with effusion. Why is he having only adenoidectomy rather than tonsillectomy and adenoidectomy and/or myringotomy?
2454.   Patient was running and fell. The bones of the foot looked abnormal on x-ray. What is wrong?
2455.   Patient was seizing. How to appropriately correct low serum sodium (113) that was causing the seizing? Patient was on a stimulant.
2456.   Patient with a one-year history of infertility now has a miscarriage. Should an infertility workup be done?
2457.   Patient with amenorrhea for 6 months. Prolactin slightly high, testosterone slightly high. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) consistent with follicular phase. I just waited and she got her period spontaneously but I don't really have an answer as to the cause.
2458.   Patient with aortic valve replacement and triglycerides are over 2000. Had cerebrovascular accident (CVA) when her international normalized ratio (INR) was approximately 2.5. What should I do about the interaction between Coumadin and gemfibrozil?
2459.   Patient with atypical chest pain responded dramatically to "GI (gastrointestinal) cocktail" in emergency room. Now has only difficulty swallowing, no pain. Is it all right to keep treating with GI (gastrointestinal) cocktail or should he be scoped now?
2460.   Patient with balanitis. What is balanitis? What is the differential diagnosis?
2461.   Patient with chest wall pain. I think it is costochondritis, but am not positive, slight doubt.
2462.   Patient with chronic abdominal pain. I don't know what to do for it. What is the cause? He's had two negative computerized tomography (CT) scans.
2463.   Patient with chronic gastroesophageal reflux disease, thoroughly worked up. Responds well to Tagamet. He says oral vitamin B12 helps. He asked me why. I didn't know.
2464.   Patient with chronic lymphocytic leukemia had pneumonia. Why is she still short of breath now that her pneumonia is all better? Her hemoglobin is 10 and she is sick so that's probably part of it.
2465.   Patient with gluteus spasm from starting a lawn mower. Where are those bursae near the right hip?
2466.   Patient with history of 1 week of treatment for addiction. Patient says her counselor told her Buspar is not addictive. Is that correct?
2467.   Patient with hypertension and abdominal bruit. Should I order an intravenous pyelogram?
2468.   Patient with hypertension but history of adrenal insufficiency. Will I make her better or worse if I treat her hypertension?
2469.   Patient with ingrown toenail. What is Cutivate? (The chart said he was on this.)
2470.   Patient with knee pain -- was kicked in the knee. Knee has been injected and has been to physical therapy and seen specialist. Her complaints seem to outweigh the physical findings. There is workman's compensation involved here too. Question is why is she having so much discomfort in this knee and is she possibly depressed? Is there more going on here? Local orthopedist didn't find much either.
2471.   Patient with mild hypertension (150/80, 140/85). Should you go by their pressure in the office, or do you believe them if it's okay at home?
2472.   Patient with periodic hyperkalemic paralysis. Episodes every 2-3 weeks require her to come by ambulance, get admitted for albuterol, D50 (50 percent dextrose), insulin. Why can't we give her albuterol and insulin every day as prevention, not just treatment?
2473.   Patient with polycythemia vera seen this morning. Brought in because incoherent, lethargic, uncoordinated, headache. Could carbon monoxide poisoning do this? (Had history consistent with recent carbon monoxide poisoning.)
2474.   Patient with schizophrenia is shaky and can't remember things "on the line" at work, also short of breath, on thiothixene, nortriptyline, lorazepam. What is causing this exacerbation?
2475.   Patient with stiff man syndrome. Yesterday she vomited and then couldn't catch her breath. Sounded like a "tracheal spasm." Otolaryngologist said to drink cold water to relax trachea. She asked me how I can prevent these attacks in the future. I didn't know so I referred her to a pulmonologist. Also, what caused this episode?
2476.   Patient with threatened abortion, should I send tissue to pathology (she brought in)? Will it add anything?
2477.   Patient with torn cartilage. Can any of these medications cause her glucose to go up (blood sugar approximately 300 on preoperative laboratory tests)? (Vasotec, Ultram, Prozac, Dicyclomine, Ambien, Tylenol)
2478.   Patient's blood pressure is always elevated here in the office. She also sees a cardiologist and blood pressure seems to be fine there so question is what is her blood pressure really?
2479.   People with recurrent sinusitis. When I was in practice (he's now in urgicenter), I used to get nasal cultures and sometimes I would get interesting results like Staphylococcus aureus. What's the role of nasal cultures in patients with recurrent sinusitis?
2480.   Phone call from 39-year-old woman with depression, on Effexor 150 milligrams once a day. Still depressed. My question is how high can I go up on the Effexor.
2481.   Phone call from mother of one-year-old girl with fever of 102. "Can we mix Tylenol and ibuprofen in kids?" (Meaning, can you alternate acetaminophen and ibuprofen for fever?)
2482.   Phone call from mother to nurse regarding 2-year-old boy. "How big does a kid need to be to go into a hot tub with water approximately 104 degrees?"
2483.   Phone call from mother. Child receiving desmopressin nasal spray for enuresis. She paid $111 for 50-dose spray. Can that be the correct cost?
2484.   Phone call from nursing home about a pin-point rash. Several other patients there have a similar looking rash but patient is just finishing a course of Augmentin. Is it the environmental rash at the nursing home or is it the Augmentin?
2485.   Phone call from patient on Prempro which she stopped when she heard the news. But now she has severe hot flashes. "What's different about Ortho Pretest compared with Prempro?"
2486.   Phone call from patient. Does Zoloft cause stomach upset?
2487.   Phone call from radiologist. "Your 77-year-old patient has a category 5 mammogram. These old calcifications look like sclerosing adenosis." The physician said, "Isn't that premalignant?"
2488.   Phone call regarding one-year-old with fever of 102. What is the dose of ibuprofen for kids?
2489.   Phone call to nurse. The nurse asked the physician what the endocarditis prophylaxis was for a 48-year-old woman with a history of endocarditis getting dental work.
2490.   Phone call to office from parent of child who was bitten by a mouse (barely broke the skin). Parents thought mouse looked sick, probably ate rat poison. Question: Does anything need to be done to follow-up?
2491.   Phone call with otolaryngologist: "If you have a negative Dix-Hallpike maneuver, but you still think it's benign positional vertigo, will vestibular rehabilitation still help?"
2492.   Phone call with patient. She was on Procardia and blood pressure still elevated so he added Vasotec and blood pressure went higher. Question is why did blood pressure go up with addition of Vasotec?
2493.   Phone call, family of 81-year-old woman wants lab and x-ray results. Tell them "I'm still reviewing the results." 81-year-old new patient with heart burn, low abdominal pain, hip pain. Question of a uterine fibroid palpated on abdominal exam. Ultrasound showed "abnormal endometrium with irregular margins and a small fluid/blood collection. Why would an 81 year old have that? Wasn't sure what to...
2494.   Phone call. "Can you do a thin prep Papanicolaou smear when the patient is on her menses?"
2495.   Phone call. An elderly man lives at home with his wife. He's not eating, constipated, and has mobility problems. "Why won't she agree to let her husband go into the nursing home?"
2496.   Phone call. Patient wants a refill of Niaspan. Do I need to check a liver profile?
2497.   Phone call. This female child put her fingers in her mouth after holding an Iguana. Is she going to get anything from this? Mother wants to know.
2498.   Physician's assistant saw patient for preoperative physical (hernia) and he was on aspirin. Question: What is the appropriate time to stop aspirin prior to surgery?
2499.   Positive galactosemia screen, borderline positive. My question was, "OK, what followup test should I get?" "What are they testing when they do the newborn screen?" "OK, now where do we really go from here?"
2500.   Pregnancy test is negative today, but patient had sex recently. When should we check it again?
2501.   Pregnant female with hyperemesis. Dr. X was on the phone with hospital ordering intravenous fluids for this patient. Question is: Is Vitamin B6 by injection more effective than by the oral route? She told him she had it by injection in a previous pregnancy and thought it helped.
2502.   Preliminary amniocentesis back. Not normal. What does genotype mean?
2503.   Question asked of Dr. X by resident: Patient on birth control is having breakthrough bleeding. In her case is it best to increase the level of estrogen in her medication?
2504.   Question e-mailed to me by study physician between study visits: One of my patients stopped his Lipitor because it caused dry eyes. I still don't know if that was the cause.
2505.   Recent knee replacement. Still has abnormal labs: Calcium approximately 12, ionized calcium approximately 6, parathyroid hormone depressed, sodium approximately 130, sedimentation rate approximately 60. What is causing her malaise, sweats and abnormal labs?
2506.   Recommendation for treatment duration of uncomplicated cystitis?
2507.   Redness and lump right breast -- treated for mastitis with antibiotics and discharge sent to pathology and non malignant report. Question is, is there an underlying malignancy and how long do we wait after antibiotic treatment as this is a fairly large lump.
2508.   Referring to low-density-lipoprotein cholesterol in a 77 year-old woman, "How far do you push them down?" You know with the National Cholesterol Education Program Guidelines, all these patients had heart disease or diabetes, but what do you do with these patients who haven't had their heart attack yet and they don't have diabetes? She's on Zocor 20 milligrams a day and her low-density-lipoprote...
2509.   Referring to low-density-lipoprotein cholesterol in a 77 year-old woman, "How long do you push them down?" Meaning, at what age should you no longer treat elevated low-density-lipoprotein cholesterol?
2510.   Refractory vertigo. That's always a question. Most things talk about what to do, but in terms of refractory vertigo, that's always hard.
2511.   Regarding Phalen's test and Tinel's tests for carpal tunnel syndrome, Dr. X doesn't see these as useful and wonders if anyone knows the sensitivity of these tests.
2512.   Regarding a drug dosing schedule, how frequently should this drug be given?
2513.   Regarding a two-month-old I referred to a tertiary center with a positive blood culture, the spinal fluid had 4 cells in tube number 2 and 2 cells in tube number 3. "I think that's within acceptable limits, let's see."
2514.   Regarding doxycycline which was prescribed for patient, what are the limits on drinking milk products? (Must you abstain from milk products during the entire treatment period or just not take the medicine with milk products?)
2515.   Repeat Papanicolaou smear for past cervical inflammation. Question: If Papanicolaou smear comes back a second time with inflammation, should you do a colposcopy?
2516.   Rhabdomyolysis. 53-year-old farmer. On exam, had mildly tender thighs. I just got a creatinine kinase almost on a lark and it was 676. "What do I do now?"
2517.   Same immunocompromised woman had pulmonary embolus, smoker, on oral contraceptives. If her chest pain progresses and she comes in, would another VQ (ventilation-perfusion) scan be helpful or is that always going to be abnormal for her?
2518.   Saw a male patient this morning with a chemical conjunctivitis from household ammonia, incident occurred at 1 AM. I put him on an antibiotic steroid drop. I think that's appropriate but is it necessary?
2519.   Saw patient last week. 43-year-old obese male with growths (skin tags) on inside of thighs -- has had for some years but have become more uncomfortable. Dr. X removed a couple of them. What is the best way to remove these fibroepithelial skin tags?
2520.   Saw this patient earlier. I overheard his telephone conversation with hospital pharmacist (I believe patient is in hospital). Question he had was whether they make a one gram pill of Glucophage.
2521.   Saw this patient last week with headache and tender temporal artery. Referred to ophthalmologist. Sedimentation rate "elevated." History of daughter having Bell's Palsy. Is there an association between Bell's Palsy and headache and temporal artery tenderness? Does Bell's Palsy cause an increased sedimentation rate? Is Bell's Palsy familial?
2522.   Second infectious-mononucleosis test today negative. Question is are we all using the same mononucleosis test (Private lab X, hospital lab, this office)? He feels there about 25% false positives (sic, meant negatives) with this test.
2523.   Seen this morning for breast and pelvic exam. Had carcinoid tumor removed this spring. Question is what urine exam should be done to follow up a carcinoid tumor?
2524.   Seven-month old boy with bronchiolitis. "How much methylprednisolone can I give him?"
2525.   Seven-month old had a second occurrence of an abscess next to the rectum, grape sized. I (investigator) prompted the physician for what the question was. He said, "What treatment is appropriate?"
2526.   Seven-month-old born prematurely. Mother accused of Munchausen's by proxy, followed at a tertiary center, upset with their care, wanted a second opinion. I never know what to do with those. "How can we not accept them?" I guess would be the question.
2527.   Seven-year-old boy with possible attention deficit disorder. I (investigator) asked him what the question was and he said, "Well, I think 5 milligrams of Ritalin twice a day should be high enough to have some effect with a seven-year-old, but the question was, do you increase the dose or do you just put him on it or what?"
2528.   Seven-year-old girl with eczema, no better on hydrocortisone cream. The physician asked me (investigator), "Do you know if they (meaning physicians at the university) are using Elidel?" "Is there any concern with using it in terms of toxicity? Is there any immune suppression with long term use?"
2529.   Seven-year-old male on Pepcid and I wanted to start Ritalin. The question was, "Are there any interactions?"
2530.   Seventeen-year-old girl going to Haiti. At what age can you use oral typhoid vaccine?
2531.   Seventeen-year-old girl going to Haiti. The question is whether she should get Hepatitis A immunoglobulin versus Hepatitis A vaccine. How long is Hepatitis A good for?
2532.   She (study physician) asked me (investigator), "You can use Questran for cholestatic pruritus, right?"
2533.   She discussed patient with her nurse. Patient is losing weight. Question is whether this is a side effect of antidepressants (didn't get which antidepressant she's on).
2534.   She dropped a tractor weight on her toes. 4th toe red and infected. She is pregnant. Is it safe to use Ceftin during pregnancy?
2535.   She gets tachycardia with exertion but it's worse during her period. Is it something to do with her hormones?
2536.   She had Clomid the first time and had twins. Is there an increased incidence of twins in the second pregnancy without Clomid in someone who had twins the first time on Clomid?
2537.   She had a hyperextension injury to her hand. Is there a fracture?
2538.   She has a 2-month-old tibial plateau fracture and is overweight. The question is whether to let her start bearing weight on it.
2539.   She has a bronchitis. The question is whether it is viral or bacterial. It's been going on for a month, so the way I'm going to answer it is to put her on some erythromycin and see how she does.
2540.   She has a guaiac positive stool. Do I ignore it or not?
2541.   She has a history of mitral valve prolapse but I can't hear a murmur or a click. Do you really need to give subacute bacterial endocarditis prophylaxis in this case? The podiatrist has taken the decision away and said he will give intravenous antibiotics before the procedure.
2542.   She has an upper respiratory infection. Is it viral or bacterial?
2543.   She has chronic nonspecific pain in her legs. I think it's arthritis but I wonder if it could be something else. Vascular or other cause?
2544.   She has no endocervical cells on Papanicolaou smears for two years in a row. She has a family history of some type of female cancer and a history of abnormal Papanicolaou smears. Her cervix is "agglutinated." What should I do?
2545.   She is a fall risk and she has atrial fibrillation. Do I really want her on Coumadin? Probably not due to fall risk.
2546.   She is behind size-wise, always 4 cm behind. She refuses ultrasound due to her religion (Amish). When do I get worried? When do I start doing nonstress tests? When do I consider induction?
2547.   She is having irregular bleeding. Which birth control pill should I switch to?
2548.   She is on the pill and has not had menses. She is 3 days into this pack. She wants Depo-Provera. When can you start Depo-Provera? The rule is to give Depo-Provera within 5 days of the period and she is not technically within 5 days of her period onset.
2549.   She lives by herself and her family wants her in a nursing home. Should she be in a nursing home?
2550.   She needs an antihistamine-decongestant. I'd like to give her a nonsedating antihistamine but Title XIX says you have to try a cheap sedating one first. Which one will they pay for?
2551.   She sees a psychologist to help with depression. She's on 40 of Paxil. She started to have sleep apnea symptoms. Is Paxil associated with sleep apnea?
2552.   She's a nurse and wanted to know the maximum dose of Celexa and the exact pregnancy category.
2553.   She's not talking at age 2 years. Is this a problem?
2554.   She's now here for a recheck but when she first came in I wondered whether the x-ray showed a fracture.
2555.   She's on high dose prednisone for temporal arteritis. Can prednisone cause heart fluttering?
2556.   Should I be switching patients from albuterol inhalers to salmeterol? What does the Medical Letter say?
2557.   Should I be using adapalene (Differin) instead of Retin-A for acne? What is the place of adapalene in treatment of acne?
2558.   Should I charge her child for an office visit (not scheduled just brought her in as an add on)?
2559.   Should I continue the Prilosec? Mentally retarded patient with peptic ulcer disease and Helicobacter pylori positive. Every time we stop Prilosec he quits eating and drops 20 pounds but Title XIX does not want to keep him on it. Should we try again to stop it?
2560.   Should I do a streptococcal screen or just call it a virus? I was real certain it was a virus. But there were other circumstances. The patient thought she had streptococcus so I got it.
2561.   Should I do streptococcal tests or am I wasting money to do them on a 3 1/2-year-old? There is time when children never get streptococcus and when is the cross over to when they are susceptible to streptococcus?
2562.   Should I give a pneumococcal conjugate vaccine to a 15-month-old who has had only one dose early on in life?
2563.   Should I put all diabetics on angiotensin converting enzyme (ACE) inhibitors to protect their kidneys, even if they don't have hypertension?
2564.   Should I treat minimal reflux with antacids or not?
2565.   Should I try and transfuse this baby?
2566.   Should I use Comvax for an older child who is behind in immunizations?
2567.   Should I use Serevent (long acting beta agonist) or an inhaled steroid? Which would be the more effective?
2568.   Should I use Serevent in association with her heart medications which include a beta blocker. Will her heart medications need to be adjusted? Dr. X aware of known concerns about Serevent in these patients.
2569.   Should I use cimetidine to treat warts? Are there studies that show efficacy?
2570.   Should I use subcutaneous epinephrine for this asthmatic 2-year-old with croup?
2571.   Should a 47-year-old purified-protein-derivative (PPD) reactor (not converter) have a chest x-ray?, take isoniazid?, for how long?
2572.   Should a 47-year-old woman with a positive PPD (purified protein derivative) (not definite recent converter, received BCG (Bacille Calmette-Guerin) vaccine as child) be treated with INH (isoniazid)?
2573.   Should a 6-week-old infant exposed to chicken pox in a sibling receive varicella-zoster immune globulin (VZIG) or acyclovir?
2574.   Should a 77-year-old woman with herpes zoster on the face be treated with steroids to prevent post herpetic neuralgia? How good is the evidence?
2575.   Should a gestational diabetic have any antenatal fetal well-being testing done?
2576.   Should a history of strokes be a contraindication for hormone replacement therapy or an indication?
2577.   Should a patient with Osgood Schlatter's disease stop all sports and exercise? Would would happen if they didn't stop?
2578.   Should a patient with an acute kidney stone get prophylactic antibiotics to prevent infection, pyelonephritis?
2579.   Should a woman have bone densitometry to decide if she needs to go on hormone replacement therapy?
2580.   Should a woman with an uncomplicated lower urinary tract infection have any follow-up after treatment?
2581.   Should adults with two or more cardiac risk factors take aspirin?
2582.   Should all pregnant women be tested for human immunodeficiency virus (HIV)?
2583.   Should an adult woman with osteogenesis imperfecta be treated with a bisphosphonate or calcium or vitamin D?
2584.   Should an incontinent nursing home patient with an otherwise asymptomatic urinary tract infection be treated with antibiotics?
2585.   Should aspirin be continued for cardiovascular protection if a patient has a history of gastrointestinal bleeding? If aspirin is continued, should I give something to prevent the side effects?
2586.   Should aspirin be given prophylactically in someone with pregnancy-induced hypertension (PIH) or a history of pregnancy-induced hypertension (PIH) to prevent preeclampsia?
2587.   Should asymptomatic urinary tract infections in the elderly be treated?
2588.   Should children with meningococcal disease get the vaccine for Neisseria meningitidis? I have a 2-year-old in the hospital now with meningococcal sepsis. He's doing well but does he need the meningococcal vaccine?
2589.   Should elderly people in the hospital get deep-vein thrombosis (DVT) prophylaxis with low-dose heparin even if they don't have a recognized indication?
2590.   Should everyone over age 50 take prophylactic aspirin regardless of whether they have risk factors for coronary artery disease?
2591.   Should gastric polyps be removed?
2592.   Should he be on his Dilantin for the rest of his life? Can he come off it now? How should I follow him if he comes off?
2593.   Should ibuprofen, used on an as-needed basis, be stopped if the patient is on aspirin?
2594.   Should moderate elevations (200 - 1000) in triglycerides be treated with drugs or diet? When and how should you treat isolated hypertriglyceridemia or high lipids but mainly hypertriglyceridemia?
2595.   Should or could tissue plasminogen activator (TPA) have been used to treat this patient immediately after his stroke in the emergency room?
2596.   Should patients who are status post myocardial infarction (MI) be placed on beta blockers, aspirin and angiotensin-converting-enzyme (ACE) inhibitors indefinitely?
2597.   Should she be started on hormone replacement? She's 71 so is it too late to benefit her? I'm doing it due to coronary disease risk factors. I've heard that after 75 it doesn't do much good but at least we'll get 4-5 years.
2598.   Should someone with a midsystolic click but no murmur be on antibiotic prophylaxis for SBE (subacute bacterial endocarditis)?
2599.   Should someone with a strong family history of colon cancer take aspirin to help prevent it?
2600.   Should the HDL (high-density-lipoprotein) cholesterol plus the LDL (low-density-lipoprotein) cholesterol equal the total cholesterol?
2601.   Should the influenza vaccine (flu shot) be given to human immunodeficiency virus (HIV) positive patients?
2602.   Should the male partner of someone with HPV (human papillomavirus) changes on cervical biopsy have androscopy?
2603.   Should there be a doll in the Denver Developmental Screening Test toy kit?
2604.   Should this 4-year-old have a computerized tomography (CT) or magnetic resonance imaging (MRI)? Headaches since before Christmas (over 2 months).
2605.   Should this lady be on Fosamax or Premarin? She has a family history of coronary artery disease so I'd like to put her on Premarin, but she also has a family history of breast cancer so she's afraid to take Premarin.
2606.   Should this patient with pneumonia be hospitalized?
2607.   Should we anticoagulate this elderly woman with a thoracic aortic aneurysm, atrial fibrillation, and recent retinal artery occlusion?
2608.   Should we be discontinuing the new oral contraceptives, the ones with the new progestins (desogestrel, desogen, and so on)?
2609.   Should we be doing triple screening (maternal serum alpha fetoprotein, human chorionic gonadotrophin, unconjugated estriol concentrations) on all prenatal patients?
2610.   Should we be getting umbilical cord gases on all deliveries?
2611.   Should we be giving Hepatitis B vaccine to newborns?
2612.   Should we be giving Rotavirus vaccine? Any side effects?
2613.   Should we be giving the pneumococcal vaccine to babies?
2614.   Should we be recommending tamoxifen or raloxifene to women with greater than a 1.67% chance of getting breast cancer in the next 5 years according to the Gail model, and what is the Gail model?
2615.   Should we be screening for prostate cancer routinely with the prostate specific antigen?
2616.   Should we be using Selsun shampoo or Nizoral (ketoconazole) shampoo as first line therapy for seborrhea (seborrheic dermatitis) of the scalp? Which is the drug of choice?
2617.   Should we be using a new injectable typhoid vaccine instead of the four-dose oral vaccine?
2618.   Should we be using low molecular weight heparin instead of regular heparin to treat deep-vein thrombosis (DVT) and pulmonary embolus?
2619.   Should we be using terconazole vaginal cream rather than miconazole since terconazole is effective against Candida tropicalis?
2620.   Should we close this dog bite wound?
2621.   Should we continue chemotherapy on this patient?
2622.   Should we do a CT (computerized tomography) with contrast tomorrow (Saturday) or wait until Monday to do an MRI (magnetic resonance imaging) (when the machine on truck comes)?
2623.   Should we get a chest x-ray because this is the third antibiotic I've tried for this persistent cough? But she has lots of stress due to interracial marriage et cetera.
2624.   Should we recommend colonoscopy earlier than usual if there is a family history of polyps?
2625.   Should we release this patient? Is he a danger to himself or others?
2626.   Should we restart prostaglandins on this infant? His ductus arteriosus is not closing.
2627.   Should we start this child on antibiotics?
2628.   Should we start this patient on steroids or not?
2629.   Should we switch now to just Ancef? Are you satisfied with the rate of improvement? (Orthopedist did not get culture, foot still red)
2630.   Should we treat this wheezing with albuterol?
2631.   Should we use captopril in Type 2 diabetics with microalbuminuria as well as Type 1 diabetics?
2632.   Should we use captopril in diabetic patients even if they have no microalbuminuria to prevent diabetic nephropathy?
2633.   Should you automatically order the free prostate-specific antigen (PSA) or wait to see if the total prostate-specific antigen (PSA) is high? What are normal values, cost of test, how to order?
2634.   Should you expect the microalbuminuria to go away with angiotensin converting enzyme (ACE) inhibitor treatment?
2635.   Should you get a C-reactive protein (CRP) to help rule out sepsis in the newborn?
2636.   Should you get periodic prostate specific antigens (PSA's) to follow someone after prostate surgery, especially a suprapubic prostatectomy?
2637.   Should you give a full series of tetanus shots to an adult who does not know their immunization history?
2638.   Should you give phenobarbital after a single febrile seizure?
2639.   Should you repeat the pneumococcal vaccine (Pneumovax)?
2640.   Should you screen someone for a berry aneurysm with magnetic resonance imaging (MRI) if they have a family history of subarachnoid hemorrhage or intracranial aneurysm?
2641.   Should you treat a 37-year-old with a positive PPD (purified protein derivative), negative chest x-ray, no history of previous PPD?
2642.   Should you treat an asymptomatic urinary tract infection in a 68-year-old woman?
2643.   Should you treat white coat hypertension (200/120) or should you go by the home blood pressures (150/80)?
2644.   Should you use prophylactic antibiotics for an open fracture of the distal phalanx of the finger? (which one, how long)
2645.   Should you use the first blood pressure or the second trimester nadir to compare later blood pressure elevations in pregnancy?
2646.   Should you work up rectal bleeding if there is an obvious source such as a hemorrhoid?
2647.   Similac Advance and Enfamil Lipil. Docosahexaenoic acid and arachidonic acid. I (investigator) prompted him for the question. He said, "Is it really needed or is there an added benefit?
2648.   Since epidural anesthesia can cause low-grade maternal fevers, do we need separate criteria for sepsis workup in infants whose mothers got an epidural? Separate laboratory and rupture of membrane criteria?
2649.   Since these boys' father has Marfan's Syndrome, do these boys need further evaluation?
2650.   Six-and-three-quarters-year-old in first grade. What do you do for selective mutism?
2651.   Six-month old boy with respiratory syncytial virus and herpes simplex virus-type 1 around his mouth. "When is it too late to treat an outbreak of chickenpox or oral herpes with acyclovir?
2652.   Six-month-old girl. That's one question that comes up. "When do you recheck ears after otitis media?"
2653.   Six-year-old girl. For anxiety disorder in kids, is Luvox indicated? "What do you use?"
2654.   Six-year-old male seen by physician's assistant earlier in week. Patient had diarrhea and test results showed Clostridium difficile, which is generally seen only in people on antibiotics and she hasn't seen it in a child before. Are there false positives for the Clostridium difficile blood test?
2655.   Sort out "e" to "a" changes, vocal fremitus, tactile fremitus, "99."
2656.   Statin-induced myopathy. 40-year-old man on Lipitor having muscle pain and aches but creatine phosphokinase was normal. So my question was, "Do you go more by the clinical symptoms versus an elevated creatine phosphokinase to be able to say this should be myopathy?"
2657.   Status post bone marrow transplant. Diagnosis of left lower lobe pneumonia by chest x-ray. Why hasn't he had any physical findings consistent with pneumonia? Is there some underlying problem?
2658.   Status post recent coronary angioplasty. If he can bring his lipids into order with diet alone, is that satisfactory or based on the evidence, should he be started right off on the lipid drugs?
2659.   Steroids in biliary atresia. This is an old question that I just wanted to revisit. Is there anything new on this?
2660.   Surgeons are reluctant to search for foreign bodies unless they see something on x-ray. Is this standard of care for family doctors to go digging around in people's feet searching for foreign bodies? I do this about twice a year.
2661.   Swelling in the body. Non-specific swelling, for example in the hands, not necessarily dependent edema. You do a workup and there's no proteinuria and no kidney problem. Is it even worthwhile working it up?
2662.   Systolic hypertension in the elderly. Stop at two medications? Stop at three medications? Always an issue.
2663.   Tachypneic baby that didn't get tachypneic until day-of-life one. Nobody knew what was wrong.
2664.   Teenage girl last week, following her for several months with recurrent blotchy rash. Got better with lotrisone and then hydrocortisone but keeps recurring. What is the differential diagnosis of this rash?
2665.   Ten-month-old with a buckle fracture of the proximal tibia. What is the treatment?
2666.   Ten-year-old male referred with developmental delay (age 4) and attention-deficit-hyperactivity disorder, on Strattera. "When do you use Strattera and why would you use that out of the gait (rather than a stimulant)?"
2667.   That would be a question. 75-year-old man with Paget's disease in his leg. "What effect does Paget's disease have on other bones?" Does it cause problems with metabolism because he has a dorsal kyphosis and question of compression fractures in the mid-thoracic spine but no obvious Pagets there. I wonder if the rapid turnover of bone could do this.
2668.   The Papanicolaou smear shows reactive cellular changes that include repair. Can't I get a Papanicolaou smear that says negative or no atypical cells? Do I need to do anything about this?
2669.   The big debate now . . . we were always taught that percutaneous endoscopic gastrostomies make reflux worse, but a recent study seemed to show that reflux is not a contraindication to putting them in.
2670.   The cardiologist said in his letter that the patient has a distinct fourth heart sound. Why aren't I hearing the fourth heart sound? I couldn't hear it -- I guess I need to review heart sounds.
2671.   The child received an injection of Phenergan for nausea and vomiting -- 25 milligrams. Question asked of Dr. X's nurse was what size and concentration do the vials come in? She just double checked this so she would know the amount (in cubic centimeter's) of the injection.
2672.   The current level of vancomycin is off, how do I adjust it?
2673.   The husband of this patient asked me how to treat premature ejaculation and if there was any way to increase her libido.
2674.   The infant's eyes are red but is it viral or bacterial and how important is it to know as it will probably run its course?
2675.   The local pharmacist had a malignant melanoma. When the pathology report came back I needed to look up the classification system for depth of involvement.
2676.   The maximum dose of estradiol valerate is 20 milligrams every 2 weeks. We use 25 milligrams every month which seems to control her hot flashes. But is that adequate for osteoporosis and cardiovascular disease prevention?
2677.   The mother of a patient wanted some information on eclampsia.
2678.   The mother of this 2-year-old boy says he is drinking 10 ounces of milk per day. "How much milk one should drink per day?"
2679.   The mother of this 9-month-old with lipomeningomyelocele wanted to know if she is at high risk for future pregnancies for meningomyelocele and if she should take mega-dose folic acid (4 milligrams per day).
2680.   The nevus on her toe has doubled in size over the last month. Do I need to treat this or can I just watch it?
2681.   The nurse came in and said he had to rewrite the prescription for cholestyramine light for 90 days because 4 cans was not enough. He called the pharmacist and told him she was getting two scoops twice a day and wanted to know how long one can would last.
2682.   The nurse came in and wanted to refill a prescription. She said she had never heard of etodolac and wanted to know the other name for it.
2683.   The other thing I thought of . . . We need somewhere . . . But maybe it's not available yet. It's so new. Alternative medicines that are not harmful.
2684.   The patient asked Dr X how you can keep from getting sinusitis. He answered that he didn't know but he told her to take Vitamin C -- it might help and it's something she can do.
2685.   The patient asked if there were any interaction between amantadine (takes for Parkinson's) and cephalexin because she has noted fatigue since starting the cephalexin. I didn't know so I need to look it up.
2686.   The patient has been symptomatic with shingles for 4 days -- Can I still give Zovirax?
2687.   The patient has started Brewer's yeast and sweet potatoes for post menopausal symptoms of fatigue and droopiness. She says she feels better. Is this a legitimate treatment to relieve some menopausal symptoms?
2688.   The patient says she can't use inhalers because they upset her stomach. I never heard of that. Why would an inhaler upset her stomach?
2689.   The patient's appointment was for "back hurt" but also has a history of chest pain, angina, diabetes, hypertension, coronary heart disease. Question is how much do I have to workup today? He has a nagging concern about this with this type of patient.
2690.   The physician called the local mental health clinic and said, "I have just kind of a generic question. I have an 18-year-old with attention-deficit-hyperactivity disorder who was on Adderall but her obstetrician recommended stopping it. Is there anything that your psychiatrists have that we could use during pregnancy?"
2691.   The physician came into her office and said 5 words and then walked out: "Vitiligo. Autoimmune disease, or not?"
2692.   The physician received a lab result from his nurse. Man over age 90. "So this will be another question. Just the evaluation of monoclonal gammopathy.
2693.   The physician said, "That's my question. If the glycosylated hemoglobin is good and the 3-day monitor shows wide swings, would it be even better if the monitor was a flat line rather than up and down? If the lows are averaged with the highs, is that just as good as having less wide swings?"
2694.   The physician showed me the lipid panel on a 60-year-old woman. Total cholesterol about 250, triglycerides about 600, high-density-lipoprotein cholesterol 36, low-density-lipoprotein cholesterol 89. "Which one to start with: Lipitor or gemfibrozil? But my main question is if there is any evidence that omega-3 fatty acids (fish oil) are helpful."
2695.   The podiatrist doesn't know what he's got on his foot either. It's either a wart or a corn. It's a hyperkeratotic lesion with scaling and desquamation around it.
2696.   The question (he said everyone asks) is should I put this patient with an upper respiratory infection and bronchitis on antibiotics?
2697.   The question is what antibiotics do you give for diverticulitis. I used to give Keflex and Flagyl. I think now you give Cipro and Flagyl. I always have to look it up.
2698.   The same man has a son with Gaucher's disease and he gets transfusions once a month. Is Gaucher's a form of anemia? I'd have to look it up.
2699.   The same patient got bullous pemphigoid but I didn't know what the rash was and I had to look it up.
2700.   The sedimentation rate is 42 in this woman with possible diverticulitis. The question is whether to have the surgeon see her or not.
2701.   The study physician asked me (investigator), "Have you ever used those depression scales? I'm not sure how I would use them. Give them to everyone in the waiting room?"
2702.   The study physician called a hematologist and while she was on hold I (investigator) asked what the question was. She said, a patient in the hospital with low platelets and "HIT" (heparin-induced thrombocytopenia) and a deep vein thrombosis. "I'm calling to see if we should put him on that special low-molecular-weight heparin and if there is anything else we should do."
2703.   The study physician mentioned this patient was a "puzzle." I (investigator) asked if there was a question there. She said the patient (46-year-old woman) had heel pain worse in the morning and on first standing to walk. So I'm sure there are questions in there. "What's causing her pain?"
2704.   The study physician received a phone call from a pediatric gastroenterologist in a different city regarding a 2-month-old she had referred with gastroesophageal reflux. She (study physician) said, "Can you tell me a little bit about how much you're using Prilosec for infants and kids?"
2705.   The study physician wrote this: "49-year-old man. (1) how best to diagnose fatty liver? (does this man's morbid obesity and isolated alanine aminotransferase elevation qualify) (2) how much workup is necessary? (3) any management available other than weight loss?
2706.   The study physician wrote this: "64-year-old female. How does grapefruit interact with Lipitor?
2707.   The study physician wrote this: "72-year-old female. What is the optimal initial medication strategy for Parkinson's? How high do you go on Sinemet before you add additional drugs?"
2708.   The study physician wrote this: "8-year-old male. How do you get a hemotympanum without trauma? Do you treat it? How do you treat it? Prognosis?
2709.   There are all sorts of rules about initiation of exercise programs in patients over X years of age. But, brass tacks, what should you do before you allow an older person to exercise and how should they start out?
2710.   There are these questions that parents bring up that you just say it's OK. She asked me if there are any problems with just getting over infectious mononucleosis and giving the influenza vaccine.
2711.   There is a company doing very well here that sells screening ultrasound for carotid artery stenosis, abdominal aortic aneurysm, and ankle-brachial reflexes, all three for one hundred dollars, or you can get just one for thirty-five dollars. I've sent a few people. My partners say, "What are you doing that for?" They have no symptoms. But sometimes they find things even without symptoms. So I do...
2712.   There is a publication saying that ibuprofen is linked to Reye's Syndrome. Is this misinformation?
2713.   There is a residential home for severely retarded adults here and he feels he would like more information on how to meet the needs of these people. Is there a group of doctors with better information on this? This was brought up because of this patient.
2714.   There is an old lady (80 years old) coming this afternoon that you won't be here for, but I always have a question with her. She complains of "excessive phlegm." I never know what to do with that complaint or how to work it up.
2715.   There seems to be a lot of inconsistency in nutritional calcium information and this bothers Dr. X. Why is this the case? He does recommend 800 to 1200 milligram supplements and has a handout to give his patients.
2716.   There was a patient (50-year-old man) with left bundle branch block (questionably new or old) who had chest pain. I set him up for a stress echocardiogram, but the cardiologist said he could not do the stress echocardiogram due to the left bundle branch block. He wanted to do a pharmacologic stress echocardiogram (rather than exercise). "Why is that?"
2717.   There was an article in JAMA or New England Journal of Medicine within the past 5 years on the futility of doing CPR (cardiopulmonary resuscitation) in the elderly. What was the reference and what did they recommend?
2718.   There was this maneuver mentioned at a continuing medical education course for vertigo, but I couldn't remember how to do it or the name of it.
2719.   Thirteen-year-old boy with recurrent epistaxis since age 3, always on one side. "I don't know what to make of that."
2720.   Thirty-eight-year-old woman with bloody diarrhea, worse over the past week. I treated her with Flagyl empirically. I saw her two days later and she was lots better. No more blood, no fever. Now her report comes back and the Clostridium difficile is negative but she's growing Salmonella. "Should I finish the Flagyl or discontinue it?"
2721.   Thirty-five-year-old woman. Two days ago she had some local anesthesia for minor surgery. Yesterday she had some fullness in her ankles and fingers and she says everything feels stiff. No arthralgias, just edema. She has a little lymphopenia so it may be viral but . . . . "What would cause this?"
2722.   Thirty-year-old female with psoriasis. What is the name of the drug for treatment? He says he always has trouble remembering the name of the drug.
2723.   This 2-month-old was delivered at 34 and 2/7 weeks gestation. For preterm infants, is it now routine to give them something to prevent respiratory syncytial virus during the winter months?
2724.   This 25-year-old woman wants to start a family. Her brother has spina bifida. I can't remember the recommendation for folic acid when you have a family history of spina bifida (1 milligram versus 4 milligrams every day).
2725.   This 38-year-old man came in complaining that he could feel his prostate and it felt full. "I wasn't sure what to do with him."
2726.   This 52-year-old woman had a sister who died at age 34 of breast cancer. This patient is now menopausal. Should she be on hormone replacement therapy?
2727.   This child had some flea bites. Question is - are children more susceptible to flea bites and what preventive measures could be used?
2728.   This child has a lead level of 11. What is the danger level of blood lead levels?
2729.   This child has been having frequent Group A streptococcal infections. What is the efficacy of culturing everyone in the family and how should you manage this situation?
2730.   This child is early for their scheduled immunization. Can they still receive it? Is it safe?
2731.   This child received most of their immunizations in Russia. Do they still need Haemophilus influenza b? Until what age do you give Haemophilus influenza b?
2732.   This child was admitted to the hospital for intravenous hydration. How much fluid replacement and at what rate should Dr. X order? (patient weighs 42 pounds, down from 45 pounds normally)
2733.   This elderly woman had a hemoglobin of 7.5 and a positive stool for occult blood. Is it okay to let her go home and work her up as an outpatient. She did not want to go to the hospital. She won't have any reserve if she's in a car accident or something.
2734.   This family was heating their house with an open stove because they didn't think the furnace was keeping the house warm enough. The 6-year-old boy came in with muscle aches, arthralgias, headaches, and cold symptoms. One question was whether the stove could cause carbon monoxide poisoning.
2735.   This female patient was treated with Bactrim for a urinary tract infection but her culture grew Escherichia coli resistant to Bactrim. She got better on 10 days of Cipro but still has trace hemoglobin, no red blood cells, occasional pressure, so I kept her on the Cipro. When should I discontinue the Cipro?
2736.   This guy doesn't want to take cimetidine at night because he doesn't want to take his pills with his beer (worried about interaction). "How to get through to him?"
2737.   This guy is dizzy when he's active but no other symptoms. What gives a doctor more uncertainty than dizziness and fatigue? How often is an etiology found?
2738.   This guy is getting dental work and has a canker sore (aphthous ulcer). There's a cream for canker sores, Kenalog in Orabase. "How often do you use it?"
2739.   This is a 10-year-old girl who was treated 9 days ago for streptococcal sore throat with azithromycin. The swab (rapid test) was positive for streptococcus. Now her dysphagia is better but still has a sore throat and the swab is again positive for streptococcus. So the question is, what to do if you have persistent streptococcal pharyngitis? And what to do if she is a carrier? And if her tonsil...
2740.   This is a 12 year-old girl with a repetitive nervous habit of twirling her hair. (Mother had the same habit as a child) How should I manage this problem?
2741.   This is a 12-year-old girl with rectal itching at night and her pinworm slide was positive. The question is how often to give Vermox.
2742.   This is a 2-month-old in for well-child check but when she was a newborn she had blood in her stools. I called the pediatric GI person at the university.
2743.   This is a 33-year-old woman with daily tension headaches for several months. The question is what treatment to try next.
2744.   This is a 45-year-old woman who noticed a lump under her cheek bone and there are some overlying skin changes. It's near the parotid. The question is, what would cause this lump on the cheek.
2745.   This is a 49-year-old patient with a viral illness. I recommended supportive measures but now she's back and says she's no better and wants antibiotics. I still think it's a virus. How long do you fight it before you just give antibiotics?
2746.   This is a 7-month-old girl who was bitten on the face and hand by an 18-month-old at the same day care center. "What do you do about the day care situation where this happened? How do you prevent it?"
2747.   This is a 7-year-old girl, mother calling regarding treatment for urinary tract infection, she weighs 57 pounds, what is the dose of Bactrim?
2748.   This is a 72-year-old man on Lotrel 5/20, Atenolol 100 milligrams, Cardura 4 milligrams and hydrochlorothiazide 12.5 milligrams. I read recently that alpha blockers increase the risk of myocardial infarction and if that is the sole medication, you should switch, but they never say what to do if the patient is on a combination of medicines or if the alpha blocker is being used for benign prostat...
2749.   This is a 72-year-old woman who needs an intravenous pyelogram. She had a normal blood urea nitrogen and creatinine done two months ago. Is that recent enough or do we need to repeat the creatinine now?
2750.   This is a dilemma. I'm seeing a lot of women who have an abnormal Papanicolaou smear (ASCUS -- Atypical Squamous Cells of Uncertain Significance) that I THINK is just due to lack of estrogen. I suspect this is the cause in many cases, but I have to follow up and tell the woman her Papanicolaou smear is abnormal and they get anxious.
2751.   This is a kid with reactive airway disease. That's a question. At what age are pulmonary function tests reliable for the diagnosis of asthma? How old do you have to be before pulmonary function tests can be done?
2752.   This is a little girl with chronic developmental problems and a seizure disorder. She's had an increase in her seizures. When we increase her medicine, she gets tired. When we decrease it, she gets more seizures. The question is what to do next.
2753.   This is a little old lady with diverticulitis and diarrhea, acutely ill. She had hirsutism as a teenager and they irradiated her adrenals. Do I need to cover her with steroids?
2754.   This is a recurring question. With streptococcal sore throat, what's the youngest age at which the diagnosis of streptococcal sore throat is reasonable?
2755.   This is a woman who I think has benign positional vertigo. "How would you prove that this is not a central problem?"
2756.   This is an ethical question. I have an elderly lady who is depressed. But she considers depression a "moral weakness" and says she's not depressed. So the question is, "Can I give her an antidepressant and say it's an energy pill?"
2757.   This is an old person with macrocytosis. I see a lot of people with macrocytosis and their vitamin B12 and folate levels are normal. What should you do to workup the macrocytosis?
2758.   This is another question. 65-year-old man, smoker, doesn't take care of himself. Pressured by his wife. This private screening service showed that he most probably has blockage of at least one of his vessels. (The screening service is a computerized tomography scan of the heart, marketed directly to patients.) "What should I do?" I didn't ask for this. Do you know how much work this is?
2759.   This is more of a legal question. 26-year-old woman with drug-seeking characteristics. Had to call our headquarters to see what protocol we have to follow to discharge her from our practice.
2760.   This is more of a psychosocial or medical-legal question. Nine-month-old boy in foster care with recurrent wheezing. Visits grandparents every 2 weeks for 1-2 hours. In two days they are going to court and want my recommendation. The wheezing is aggravated after a visit to the smoking grandparents. Most books don't say whether it's really passive smoking or if you just don't smoke when the chil...
2761.   This is one of our employees with low back pain. Is this a conflict of interest? I need her to lift records but I need her to stop to help her back. Should I really be seeing her?
2762.   This is probably in the Framingham study or something but I'm never sure how many blood pressures you need to make a diagnosis of hypertension.
2763.   This is probably unanswerable but I have a 72-year-old woman who 3 or 4 weeks ago had a subendocardial myocardial infarction. She had already had some trouble with dizziness, but now she dropped her systolic blood pressure on standing (50 points) and was rehospitalized with chest pain. "I just wonder about this orthostatic hypotension and coronary spasm. Then what do you do? What other testing?...
2764.   This is the 64-thousand-dollar question. When do you refer a patient with head trauma for a computerized tomography (CT)? 99 out of 100 will be okay but I remember a couple of horror stories.
2765.   This is the second patient she has seen recently with cervical spinal stenosis which is not as common as lumbar. How prevalent is this?
2766.   This isn't a major one but this patient has had a cough for over a year, nonproductive, no wheezing. One of her parents has asthma, aspirin sensitivity and nasal polyps. I was just wondering what the inheritance of that is. Autosomal dominant or what?
2767.   This isn't a question but when I looked at her rash, I asked myself is it shingles or possibly staphylococcal impetigo? It isn't worth the cost of a test to find out.
2768.   This lady had morbid obesity, had bariatric surgery, no nausea or vomiting, not on a diuretic and her potassium is 3.1. "Does bariatric surgery have anything to do with that?"
2769.   This lady has a pneumonia. She's already on erythromycin. She works in a nursing home. What antibiotic should we use?
2770.   This lady is kind of a puzzle. 44-year-old woman. She has fibrosing mediastinitis. She had a jugular-atrial bypass. But I really don't know how to follow that (the graft surgery).
2771.   This man had a frontal unilateral (left) headache. I thought he had frontal sinusitis but his computerized tomography (CT) was negative so now I don't know what he has.
2772.   This man had unprotected intercourse with a stranger 5 days before I saw him last week, complains of yellow urethral discharge. I got gonorrhea and Chlamydia cultures. The discharge resolved spontaneously 2 days later. What to do now?
2773.   This morning I asked my partner, who does treadmills, about a 58-year-old man who complained of typical chest pain and dyspnea. My question was how should we approach this chest pain. Should we send him to the cardiologist for further testing, or should we say the treadmill done three years ago was sufficient and work him up for gastroesophageal reflux disease or other causes.
2774.   This morning I saw a 13-year-old boy with "nonspecific urinary frequency." The question is, "How to treat it?"
2775.   This morning I saw a 65-year-old woman with diabetes, hypertension, elevated lipids, and coronary disease. She has chronic low back pain, two surgeries, can hardly move. I referred her to a neurosurgeon who talked about implanting some sort of nerve stimulator. Not a transcutaneous nerve stimulator, but something implanted. I (investigator) asked him what the question is. He said, "What is that...
2776.   This morning I saw a 7-year-old girl with enuresis. I asked my partner "What's hot on enuresis?"
2777.   This morning I saw a 70-year-old man with left-sided shoulder pain and numbness. His biceps and triceps were weak and he had atrophy of his triceps. Got cortisone injection by orthopedist 2 weeks ago with no improvement, normal x-rays. High dose nonsteroidal anti-inflammatory drug no help. I didn't know what to make of it. Neuropathy? I called a neurologist and ended up referring him.
2778.   This morning I saw a premature infant born at 27-weeks gestation, 3 months ago. The discharge instructions said continue oral iron until the hemoglobin is "nice." What hemoglobin should we use to decide when to stop iron? How to consider this 3-month-old who is just now at his due date? Not directly answered but a reference said 12 grams normal for 3 month old so I used that. I almost called so...
2779.   This morning I saw an 8-month-old girl with erythema multiforme. My question was whether to use steroids.
2780.   This morning we looked up Lisch nodules. I (investigator) asked him what the question was. He said he wanted to check to see what other stigmata of neurofibromatosis we should check for.
2781.   This mother and son are both sick, probably with the same bug. Why is one coughing and the other has a runny nose?
2782.   This nursing home patient has hyponatremia. The Washington Manual is no help. Need to be off diuretics to use their algorithm, but what if they need the diuretic? Do you put up with a sodium of 128 if they are on a diuretic and they need the diuretic?
2783.   This obstetric patient needs to go back on her antidepressant but which one is safe?
2784.   This patient complains that normal sounds sound too loud. What should I do about that?
2785.   This patient found out about a drug called "coumarin" for chronic lymphedema on the World Wide Web (New England Journal of Medicine, Oct 14, 1993) and wants to know if it is safe. Dr. X said she didn't know but would look into it.
2786.   This patient got influenza even though she had the influenza shot. But she got one of the bad lot numbers (too weak). What should we do about that? Reimbursement? Should we repeat the vaccine in all patients who got that lot number?
2787.   This patient had a congested feeling in his ears. His exam was normal. What was causing the congested feeling?
2788.   This patient had a nonstress test one week ago and at the end of every acceleration there was a brief sharp spike not very deep deceleration. Is this important?
2789.   This patient had a shoulder deformity that is congenital and patient did not know the name of it, neither did Dr. X. What is the name of this deformity?
2790.   This patient had a spontaneous abortion 6 weeks previously and no one ever gave her Rhogam. How soon after a miscarriage do you have to give Rhogam?
2791.   This patient had well-documented Crohn's Disease in 1979. He's had no flare up for the past nine years and he's only been on Metamucil. How was he able to go so long without a flare up?
2792.   This patient has a blue lesion on her abdomen and I'm not sure what it is, so the question is, what is it?
2793.   This patient has a cervical polyp. Can we just watch these? How do we know if it's cancer? I'm always afraid of bleeding if I take it off.
2794.   This patient has a cervical radiculopathy with numbness of all four fingers (not the thumb). X-rays show foraminal narrowing at cervical spine level 5-6 (C5-6). What fingers are innervated by C5-6?
2795.   This patient has a history of bleeding ulcer, can we give him heparin for his suspected acute myocardial infarction?
2796.   This patient has a history of irregular heart beat, bigeminy and trigeminy. He's having a few brief runs occasionally now. On Quinidine in the past. Should I treat these?
2797.   This patient has a history of rectal cancer, status post surgery. Her carcinoembryonic antigen (CEA) was approximately 60 a year ago. When should I do another carcinoembryonic antigen?
2798.   This patient has a raised scaly patch about 2.5 centimeters on her cheek of 1 month to 5 weeks duration. No history of eczema. Has been using moisturizing cream on it. No make up. What is the cause of this erythematous patch on this patient's cheek?
2799.   This patient has abdominal distension with a huge left shift. Is it because of a urinary, blood, or some other infection?
2800.   This patient has an ulcer on his foot from peripheral vascular disease, no diabetes. We have a podiatrist in town who wants to do surgery on this ulcer. The physician called the vascular surgeon who already knows the patient and said, "With her circulation, do you think that's reasonable?"
2801.   This patient has atrial fibrillation and takes aspirin. Should I put her on coumadin or should I stay with aspirin? The studies on coumadin vs. aspirin are variable. I'm not a strong one for coumadin because of drug interactions and if they fall they'll bleed. Do I do an echocardiogram and see how dilated her chambers are to make this decision?
2802.   This patient has back and pelvic pain without a fall. Is there a stress fracture? Patient also has some confusion so admitted for outpatient observation.
2803.   This patient has been on long term prophylaxis. How long should he remain? How do I get him off?
2804.   This patient has chronic obstructive pulmonary disease and essential tremor. He wants a pulmonary consult but he's still smoking. I am referring him at his request. I have him on Inderal which helps his essential tremor a lot. Should I keep him on this or take him off because of his chronic obstructive pulmonary disease?
2805.   This patient has clinical signs of pneumonia (rales, et cetera). Should I do further tests such as a chest x-ray?
2806.   This patient is 22 weeks by dates but today measures about 26 weeks. Why the discrepancy? Could it be polyhydramnios? I guess it could be physician error.
2807.   This patient is almost 34 years old and her mother was diagnosed with breast cancer in her early 50's. Her mother's sister also has breast cancer and her maternal grandmother died of breast cancer in her 50's. The question is, does she need to do anything earlier? Genetic testing or what?
2808.   This patient is from a foreign country with a high prevalence of tuberculosis. What measurement is considered positive for this person's tuberculin skin test? When she phoned in she said her test looked the size of a nickel.
2809.   This patient is on a ketogenic diet. What do we do for an intravenous infusion when she goes in for surgery?
2810.   This patient is overweight and has been for years and won't do anything to lose weight. She is on so many medications which I try to get her off of. What can you do?
2811.   This patient needs to make life style changes and has the information. How do you motivate someone to make these changes? She comes in and cries but doesn't follow through on getting blood tests done, et cetera.
2812.   This patient still has a cervical strain that is flared up. Muscle spasm? What to do next? I'll probably refer to a neurologist if still no better at the next visit.
2813.   This patient was hospitalized and found to have rectal carcinoid. The question was treatment and how often do they metastasize.
2814.   This patient was in the hospital with third-degree heart block documented in the clinic but never occurred in the hospital. Discharged after stopping digoxin. Had another episode of similar symptoms 2 days ago. Does she need a pacemaker?
2815.   This patient with a gastrostomy tube is bleeding in the mouth. How should we treat this?
2816.   This patient with acne is on Retin-A 0.025% cream and is only moderately controlled. What would be the best thing to add?
2817.   This patient's blood sugar is fine, but her father has Type 2 diabetes and several nieces and nephews have Type 1 diabetes. The patient has one daughter. The question is, how frequently should she (the daughter) be screened for diabetes.
2818.   This pharmaceutical representative is trying to promote the 5 in 1 vaccine, Pediarix. "What is the position of the American Academy of Pediatrics on that?"
2819.   This question relates to a phone message which said this man wants me to see his wife who has somatization disorder. What is the difference between somatization disorder and somatoform disorder?
2820.   This was Dr. X's partner's patient seen yesterday so he doesn't know name, age, et cetera, but he helped look up information. What is the reason for the inverted p waves on electrocardiogram?
2821.   This was Dr. X's partner's patient yesterday so he doesn't know name, age, et cetera, but he helped look up information. They looked up the American Diabetes Association's definition of Type 2 diabetes. Patient with elevated blood sugar. Does he have diabetes?
2822.   This was discussed with patient today but relates to question from a few months ago. Patient had been on regular prednisone (not a burst) and he wondered how to wean her off the prednisone. She is now on inhaled steroids and doing well.
2823.   This woman called about her husband who was seen in the emergency room because of confusion and dementia. Should I get a head computerized tomography (CT) now since he is improving, or wait and run the risk of missing a brain tumor?
2824.   This woman has Herpes zoster on her chest. Which dermatome is it?
2825.   This woman takes Premarin 0.625 milligrams for osteoporosis prophylaxis but she got sore breasts. Is there a smaller size Premarin like 0.3 milligrams?
2826.   This woman was seen yesterday in the emergency room. She had numbness in her left hand and foot. Her CT scan showed a lacunar infarct, age indeterminate, at the genu of the internal capsule. I guess my question is, if it is a new stroke clinically, do I admit her at this point?
2827.   This woman with a burn wants a refill of SSD. What does SSD stand for? (Turned out to be silver sulfadiazine.)
2828.   This young man has attention-deficit-hyperactivity disorder (ADHD) and is describing what sounds like depersonalization episodes. I wonder if these could be a seizure equivalent?
2829.   This young woman has atypical chest pain. Can you ignore it? She has a strong family history of coronary disease. Our young police chief just had a coronary artery bypass graft.
2830.   Three-and-a-half-month-old boy with the worst case of infected eczema I've ever seen. "My question is, did the Elidel cause or perpetuate the infection?"
2831.   Three-and-a-half-week-old with persistent indirect hyperbilirubinemia (up to 24). What is the workup?
2832.   Three-month-old. "What is the spontaneous resolution rate of oral thrush?"
2833.   Three-week-old girl. I just wanted to be sure I wrote the right dose of Zantac.
2834.   Three-year-old girl possibly sexually abused by adolescent boy. Physician to Department of Human Services worker: "With him being an adolescent, is this a Department of Human Services case or do I go to the police to report it?"
2835.   Today a patient called who wants to get pregnant. 22-year-old woman on nortriptylene. So just managing depression in pregnancy.
2836.   Treatment of streptococcal pharyngitis. A nurse practitioner was looking at a reference and mentioned using once daily dosing for amoxicillin. I (investigator) said, "So the question is 'Is this a legitimate treatment?'" He said, "Yes."
2837.   Tuberculin skin test on someone who's had a BCG (bacille Calmette-Guerin) vaccine, adopted from India, thinks she had the BCG (bacille Calmette-Guerin). This reference is better than it used to be. "But it would be nice if there were clear guidelines on this: If the vaccine was given more than five years previously and the skin test is positive, do this." How long does the skin test stay positi...
2838.   Twelve-year-old boy with proximal humerus fracture. I (investigator) asked if the question was, "What's the treatment for this?" He said yes. "I was pretty sure he didn't need surgery. I just wondered if he needed anything more than a sling."
2839.   Twenty-six-month-old boy. Serum sickness. This kid came in first with hives on amoxicillin, no mucus membrane involvement. Then his ankles were swollen and tender and he wouldn't walk and he had a fever. "The question was, what caused this? Was it a serum sickness? Was it . . . ? It wasn't Stevens Johnson Syndrome."
2840.   Two days ago she had unprotected sex. She is 6 weeks postpartum. Is it okay to give Provera?
2841.   Two kids going to India near Bombay. What is the alternative to mefloquine if they are going to a chloroquin-resistant area?
2842.   Two months ago I had a 40 year-old woman who was just the picture of health, but she had an amazingly high very-low-density-lipoprotein (VLDL) cholesterol. I went to a reference, but they didn't even address at what level to treat or what the preferred treatment was. And I wasn't even sure why this lady would have it. I wonder if she had abnormal metabolism.
2843.   Two months ago I saw a patient and all her aunts (5 or 6 of them) had ovarian cancer. The question is, is there a study going on someplace I should refer her to?
2844.   Two nights ago I had a newborn with a congenital nevus, 4 millimeter diameter on the forehead. "What to do?"
2845.   Two patients with the same question regarding asymptomatic femoral bruits. "Why does she have this bruit? Do I need to look for peripheral vascular disease?"
2846.   Two weeks ago I was deposed on a patient who was in a motor vehicle accident and had heart disease. One of the questions the attorney asked was "Is there a source you can go to to see if someone with heart disease should be driving?"
2847.   Two year and 10-month-old boy weighs about 65 pounds and is about 42 inches tall. We did a bone age and the bone age was between 4 and 4 1/2 years old. The question is, is that significantly different from what it should be for this age and what should we do about it?
2848.   Two-and-a-half-year-old girl with a neuroblastoma. Yesterday, mom delivered another baby. Is it worth checking a chromosome study?
2849.   Two-day-old. Why are infants of diabetic mothers more likely to have polycythemia?
2850.   Two-month-old female, sleeping in bed with mother. Mother rolled over onto her side onto baby's right arm, today she is not moving the right arm and is fussy if it is touched. I just requested an x-ray. "If it's normal, what do I do?"
2851.   Two-month-old male presented to the emergency room two nights ago. One question was the hemoglobin. Don't know if I could explain this through the physiologic nadir or if it was related to autoimmune anemia with transfer of antibodies through the placenta of if it was the anemia of his illness.
2852.   Two-week old. Do you stop breast feeding for mastitis?
2853.   Two-week-old girl with bilateral preauricular pits and briefly a white discharge from them. So I looked at the books. I (investigator) said, "What was the question." He said, "What do I do with those? Do I just leave them alone? Do I refer? Do I need to do anything?"
2854.   Two-year old girl with Kawasaki's diagnosed about 7 days into her illness. Put on high-dose aspirin. "I'm not familiar with aspirin toxicity. The kid is a little tachycardic." The question was whether aspirin toxicity could cause tachycardia.
2855.   Two-year old girl with Kawasaki's diagnosed about 7 days into her illness. There is a recommended aspirin blood level for kids with rheumatoid arthritis but not that I could find for Kawasaki's disease. "Is there any utility in shooting for that blood level in a patient with Kawasaki's disease or should you just go with the recommended dose?"
2856.   Two-year-old girl going on a trip to Brazil with her mother. Mother said, "Does she really need the hepatitis A vaccine?" The question for me was, how important is it really.
2857.   Two-year-old girl with intermittent screaming due to back pain (she reaches around and grabs her back) going on for the last month. "I have no idea what's wrong with her."
2858.   Two-year-old girl with paroxysmal supraventricular tachycardia controlled on propranolol, broke through over the weekend. What should we do with her medications?
2859.   Two-year-old with constipation and overflow diarrhea, now having explosive stools on Miralax. "How to know if he's cleaned out and we're giving too much Miralax versus still having overflow diarrhea?"
2860.   Two-year-old with iron deficiency anemia. Do they still make Feosol spansules?
2861.   Ultraviolet keratitis. Like welder burns. Do you need to use antibiotic drops?
2862.   Unusual presentation - patient has swelling (lymphoid tissue at base of tongue). Is this normal or should I be concerned about a tumor, et cetera?
2863.   Was her dizzy episode a transient ischemic attack or from her atrial fibrillation or what?
2864.   Was the diagnosis pneumonia, atelectasis, or viral pneumonia?
2865.   We get these young girls with periods every two weeks for a year. "When do you get concerned? When do you regulate them? When do you refer?"
2866.   We had a baby who's mother broke out with Zoster a couple of days after she was born and the baby had a couple of skin lesions too. The question was what to do with the baby.
2867.   We had a case of rickets. 12-month-old boy. I (investigator) asked what the question was. He said, "Why is he failing to thrive?" Part of the question was how do you work up possible rickets.
2868.   We had a kid, 5-year-old, with a fever of 104, headache, dizziness, hallucinations. We thought it was the flu, but did a lumbar puncture, and the fluid was clear, looked good. But had some trouble getting the fluid. The next night he wouldn't walk, wouldn't lay down, crying with pain, would not bear weight. So I called my partner and said, "What do you think?" "All right, what is this?"
2869.   We had a patient with Dandy Walker syndrome. Mother said he had it. We used various references to look up an answer. I (investigator) said, "What is the question?" He said, "What is it?" meaning what is Dandy Walker syndrome.
2870.   We had an 8-year-old girl with joint pain and a positive antistreptolysin O titer but no other symptoms to go with rheumatic fever. "Is that mild rheumatic fever?"
2871.   We had this girl with a latex allergy and wanted to give her a flu shot, but she has a latex allergy. The stopper in the flu vaccine vial has latex in it so the question was how to deal with that.
2872.   We had to do some research yesterday. Hypercoagulation workup. First of all, "should we work her up? And what all labs should we do?"
2873.   We have an allergist that swears that generic prednisone is not as good as Deltasone. I'd like to know if there is any science behind that.
2874.   We have this home for "problem children." One of the kids bit one of the employees. I called one of the infectious disease nurses at the hospital here to see what their protocol is for human immunodeficiency virus, hepatitis B, hepatitis C.
2875.   We looked up tinea capitis and griseofulvin.
2876.   We saw this lady with a history of renal stones and hypercalcemia. The parathyroid hormone was 5 (normal 10 to 65), the calcium was about 9 (normal) and the phosphorus was about 2.0 (should be greater than 2.5). "So it's like, OK, what do we do with this now?"
2877.   We see a lot of people with depression. Many of them see psychiatrists. They put the patient on lithium. They may fail to check a lithium level. As a primary care provider, how often do you check the lithium level?
2878.   We usually make a diagnosis of mycoplasma bronchitis by clinical findings. How good am I at making a diagnosis of mycoplasma with clinical findings and should I use laboratory methods more often?
2879.   We're starting this patient on Klonopin (clonazepam). Patient has intractable seizures. What dose do we need/ how should we start?
2880.   Were the immunizations complete?
2881.   What I'm looking up is if there is any association between iron overload and HIV (human-immunodeficiency virus).
2882.   What about labile hypertension -- when do you treat it and when don't you?
2883.   What activities should be avoided in the immediate post cardiac catheterization period?
2884.   What agent should I use next in this hypertensive patient? 78-year-old woman with blood pressure 210/110. She's on Univasc and Toprol XL 100. She has a history of an angiotensin-converting-enzyme-inhibitor (ACEI) cough and palpitations on Procardia.
2885.   What am I doing wrong with this?" He said this to another physician as he was trying to get the cryosurgery unit to work to treat a wart.
2886.   What anti-inflammatory can I give this patient? She can't swallow pills. She needs to crush and dissolve it and put milk on it. Can I use Naprosyn EC (enteric coated)?
2887.   What antibiotic do I use for this infection?
2888.   What antibiotic prophylaxis should be used on this patient with cardiac asplenia syndrome?
2889.   What antibiotic regimens and doses are available for prophylaxis of otitis media?
2890.   What antibiotic should I use for this diabetic patient's infected foot ulcer?
2891.   What antibiotic should be given for this ear infection and sepsis?
2892.   What antibiotic should be used for a child with pneumonia (pediatric pneumonia)?
2893.   What antibiotic should you use in someone with a COPD (chronic obstructive pulmonary disease) exacerbation who requires admission?
2894.   What antibiotics and doses should be used to treat streptococcal sore throat?
2895.   What antibiotics can you use for prophylaxis of recurrent urinary tract infection (UTI) in someone who is allergic to sulfa?
2896.   What anticoagulation should patients get after a fractured hip? What does that official guideline publication say?
2897.   What antidepressant is best to avoid sexual dysfunction?
2898.   What antihypertensives are least likely to cause erectile dysfunction (impotence)?
2899.   What antihypertensives are safe while breast feeding?
2900.   What antihypertensives do not cause impotence?
2901.   What antihypertensives should be used according to what comorbid conditions are present?
2902.   What are "poppers"?
2903.   What are Acular ophthalmic drops? (good for allergic conjunctivitis?)
2904.   What are Alomide ophthalmic drops? (good for allergic conjunctivitis?)
2905.   What are Bleuler's A's of schizophrenia?
2906.   What are Dr. X's vulvar hygiene recommendations?
2907.   What are Hawkins and Neer impingement signs (for shoulder pain, rotator cuff injury)?
2908.   What are Lewy bodies?
2909.   What are Michaelis-Menton kinetics? May explain why small increases in Dilantin dose cause large increase in level.
2910.   What are and how common are the risks from first trimester bleeding if the patient goes on to complete the pregnancy?
2911.   What are antithyroid microsomal antibodies and when should you order them and how do you interpret the results?
2912.   What are common adjectives to describe someone's affect?
2913.   What are criteria for admission for respiratory syncytial virus in a 2-week old? How do they differ from criteria for older infants (ie, one to two months)?
2914.   What are current recommendations for getting digoxin levels?
2915.   What are current recommendations for polio vaccine?
2916.   What are current recommended weights for adults?
2917.   What are diencephalic seizures?
2918.   What are endomysial antibodies? Diagnostic test for celiac disease (nontropical sprue)?
2919.   What are good drugs to treat hypertension in the elderly?
2920.   What are guidelines for care of asthma in children?
2921.   What are guidelines for prophylactic antibiotics in a patient with orthopedic hardware especially regarding flexible sigmoidoscopy?
2922.   What are likelihood ratios?
2923.   What are methods to improve fluid excretion with patient on peritoneal dialysis?
2924.   What are normal adult head circumferences?
2925.   What are normal heel stick blood gases in a newborn?
2926.   What are normal peak expiratory flow rates in children?
2927.   What are normal pressures on a cardiac catheterization?
2928.   What are outcomes of a patient with ectopia cordis?
2929.   What are pineal brain tumors?
2930.   What are practical clinical techniques for measuring bronchospasm in the office without doing spirometry?
2931.   What are preeclampsia labs (laboratory studies)?
2932.   What are recommendations for subacute bacterial endocarditis prophylaxis for hysteroscopy?
2933.   What are recommendations for treatment of the influenza virus?
2934.   What are references and a description of intestinal pseudoobstruction mentioned by Dr. X?
2935.   What are some checklists for admission orders for common diseases such as pneumonia and urosepsis in elderly patients?
2936.   What are some commonly encountered patterns on audiometry besides high-frequency loss, and what does the audiogram of someone with acoustic neuroma and otosclerosis look like?
2937.   What are some general facts on inflammatory bowel disease?
2938.   What are some nonestrogen treatments for hot flushes in menopause?
2939.   What are some of the common street names of drugs used illicitly?
2940.   What are some of the nitty gritty details about treating preeclampsia in labor?
2941.   What are some of the psychodynamics? This is the first time I've seen her. She's seen my colleagues but I can't get everything from the records. I'm sure there's more because her complaint is fatigue. There's more to it than just adjusting her asthma medications.
2942.   What are some of the recent changes in pediatric immunizations?
2943.   What are some of the specific points about the technique of colposcopy?
2944.   What are some practical solutions to decreasing stress in one's life besides exercise -- not medications -- more along the line of relaxation type things?
2945.   What are some references to Ulysses syndrome?
2946.   What are some tricks and things to remember when doing flexible sigmoidoscopies?
2947.   What are some ways to treat congenital adrenal hyperplasia?
2948.   What are sources of vitamin B12 requirement in vegetarian children?
2949.   What are survival rates of premature babies according to gestational age?
2950.   What are symptoms of brown recluse and black widow spider bites versus stings from other bugs?
2951.   What are the 5 P's of acute arterial occlusion?
2952.   What are the ABCD's of malignant melanoma recognition?
2953.   What are the Agency for Healthcare Policy and Research (ACHPR) guidelines for getting plain x-rays in patients with low back pain?
2954.   What are the American Academy of Pediatrics guidelines about early discharge of healthy newborns especially as related to hyperbilirubinemia?
2955.   What are the American Academy of Pediatrics guidelines on treating hyperbilirubinemia in the neonate?
2956.   What are the CAGE (cut-down, annoyed, guilt, eye-opener) questions?
2957.   What are the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) criteria differences between borderline personality disorder and post-traumatic stress disorder?
2958.   What are the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for obsessive compulsive disorder?
2959.   What are the New York Heart Association classes I - IV? Where is an explanation of these?
2960.   What are the Occupational Safety and Health Administration (OSHA) criteria for using liquid nitrogen (that is, protection by gloves, et cetera)?
2961.   What are the Ottawa ankle rules for taking x-rays of injured ankles?
2962.   What are the Ottawa knee rules?
2963.   What are the Ranson criteria for acute pancreatitis?
2964.   What are the Supplemental Security Income (SSI) criteria for disability?
2965.   What are the Waddell incongruency signs for nonorganic low back pain?
2966.   What are the adult doses of antibiotics?
2967.   What are the advantages of plaster versus fiberglass casting material?
2968.   What are the alkaline phosphatase serum levels for different ages?
2969.   What are the appropriate immunizations for these 7-month-old twins?
2970.   What are the basic principles of chiropractic? I know I've never seen this in a textbook and I have so many patients that go to chiropractors, it would be good to know more about this subject.
2971.   What are the benefits and risks of treating subclinical hypothyroidism?
2972.   What are the best exercises for rotator cuff?
2973.   What are the causes of Erb's Palsy?
2974.   What are the causes of a dry mouth (xerostomia) in an adult?
2975.   What are the causes of a paradoxically split second heart sound?
2976.   What are the causes of a patient with Streptococcal sore throat who refuses to move his neck?
2977.   What are the causes of a pleural effusion?
2978.   What are the causes of a spontaneous pneumothorax in a 25-year-old female smoker?
2979.   What are the causes of a white cell count of 100,000?
2980.   What are the causes of an elevated creatine phosphokinase (CK, CPK) and how do you work it up?
2981.   What are the causes of an elevated white blood count (WBC, leukocytosis, neutrophilia)?
2982.   What are the causes of and how do you work up a 50-year-old man (or 43-year-old woman) with chronic generalized lymphadenopathy?
2983.   What are the causes of and how do you work up a chronic cough in a 50-year-old obese woman? (yellow sputum, one pack per month, possibly Pickwickian)
2984.   What are the causes of chronic perianal dermatitis in kids? What is in Mycolog II cream?
2985.   What are the causes of delirium and what is the workup?
2986.   What are the causes of ear pain (otalgia) other than ear disease?
2987.   What are the causes of facial palsy?
2988.   What are the causes of fixed and dilated pupils?
2989.   What are the causes of hydramnios?
2990.   What are the causes of hypermagnesemia?
2991.   What are the causes of hypomagnesemia?
2992.   What are the causes of isolated hypophosphatemia? Can nonsteroidal antiinflammatory drugs cause hypophosphatemia?
2993.   What are the causes of low voltage on the electrocardiogram?
2994.   What are the causes of metabolic acidosis in newborns?
2995.   What are the causes of rhabdomyolysis?
2996.   What are the causes of sinus tachycardia?
2997.   What are the causes of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
2998.   What are the causes of tinnitus?
2999.   What are the chances of having an ectopic pregnancy if the urine pregnancy test is negative (negative predictive value; false negative rate)?
3000.   What are the chances of reversing a vasectomy? He asked me and I didn't know. Specifically, does the technique of doing a vasectomy affect the chance of reversal?
3001.   What are the chances that a brain tumor would present with only a headache and no other neurologic symptoms or signs (deficits) on history or physical exam?
3002.   What are the clinical and electroencephalographic (EEG) features of absence seizures and the sensitivity of the electroencephalograph (EEG)?
3003.   What are the clinical features and prognosis of post-concussion syndrome?
3004.   What are the clinical features and treatment of floating rib or overlapping rib syndrome? (Slipping rib syndrome)
3005.   What are the clinical features of Wernicke's encephalopathy and Korsakoff's psychosis?
3006.   What are the clinical features of scleroderma?
3007.   What are the clinical signs of neonatal myasthenia gravis?
3008.   What are the comparative sensitivity and specificity of oxytocin contraction test and nonstress test? If the oxytocin contraction test is more sensitive as Dr. X says, why do the nonstress test first and if nonreactive, do oxytocin contraction test?
3009.   What are the complications of nasal fractures?
3010.   What are the components of Larson's Syndrome?
3011.   What are the components of a fetal biophysical profile?
3012.   What are the concentrations of all the iron preparations?
3013.   What are the contraindications and risks of using Imitrex?
3014.   What are the criteria for Briquet's syndrome?
3015.   What are the criteria for a head computerized tomogram?
3016.   What are the criteria for a normal (reactive) nonstress test (NST)?
3017.   What are the criteria for an abnormal pregnancy oral glucose tolerance test (OGTT, gestational diabetes)?
3018.   What are the criteria for borderline personality disorder and what is the best way to deal with a patient with borderline personality disorder?
3019.   What are the criteria for obsessive compulsive disorder in a male teenager (he's been doing a lot of handwashing and so on)?
3020.   What are the criteria that should be met before you decide to screen for a disease?
3021.   What are the current cholesterol (National Cholesterol Education Program) guidelines? When to start diet? Drug?
3022.   What are the current recommendations for pediatric immunizations?
3023.   What are the current recommendations for screening mammography?
3024.   What are the current recommendations for treatment of serous otitis media? Antibiotics? Steroids? Tubes?
3025.   What are the differences between iodine and Technetium thyroid scans?
3026.   What are the different Tanner Stages?
3027.   What are the different drug possibilities for treatment of depression?
3028.   What are the different forms of chronic hepatitis B and how do you treat them? What do the various serologies mean?
3029.   What are the different kinds of von Willebrand disease and how are they inherited? (this patient had Type 2A)
3030.   What are the dosage forms available for Lipitor?
3031.   What are the dosage forms of Effexor?
3032.   What are the dosage forms of Percocet?
3033.   What are the dose and side effects of rimantadine (Flumadine)?
3034.   What are the doses for these medications (half a dozen) that I need to give this leukemia patient?
3035.   What are the doses of Solumedrol and Claforan for an 8-year-old female?
3036.   What are the doses of long acting verapamil? I know the short acting but the long acting is something like 80 or 120.
3037.   What are the effects of hypercarbia on cardiovascular function?
3038.   What are the effects of methamphetamine exposure in the prenatal period?
3039.   What are the fetal effects of maternal von Willebrand disease?
3040.   What are the findings for herpes infection in the newborn?
3041.   What are the five diseases that Fifth disease is a part of?
3042.   What are the glucose protocols for this infant?
3043.   What are the guidelines for phototherapy in premature babies?
3044.   What are the guidelines for tuberculin skin test interpretation?
3045.   What are the head exercises you can do for treatment of benign positional vertigo? What is the treatment?
3046.   What are the heat injury syndromes?
3047.   What are the immunizations required by the State of Iowa?
3048.   What are the implications for the newborn when the mother has von Willebrand's disease?
3049.   What are the implications of Cortisporin otic suspension versus solution when prescribing for otitis externa with perforation?
3050.   What are the important clinical differences between Prozac, Zoloft, and Paxil?
3051.   What are the indications and contraindications for glucophage (Metformin)?
3052.   What are the indications and contraindications to thrombolytics and what is the dose?
3053.   What are the indications and schedule and dose for Hepatitis A vaccine?
3054.   What are the indications for Digibind (digoxin immune fab)?
3055.   What are the indications for Sandostatin (somatostatin)?
3056.   What are the indications for a 24-hour blood pressure monitor?
3057.   What are the indications for a ventilation-perfusion (VQ) lung scan in someone with a chronic obstructive pulmonary disease (COPD) exacerbation that might also have a pulmonary embolus?
3058.   What are the indications for adenoidectomy in children? snoring? chronic nasal obstruction?
3059.   What are the indications for admitting a patient with a community-acquired pneumonia (hospital admission)?
3060.   What are the indications for and dose for ticlopidine (Ticlid), Plavix (clopidogrel) and aspirin for prevention of transient ischemic attack and stroke?
3061.   What are the indications for biphosphonates such as Fosamax in the treatment or prevention of osteoporosis? Can you give it to someone already on estrogen?
3062.   What are the indications for breast ultrasound as opposed to mammogram? When should you get an ultrasound instead of a mammogram? If it shows cysts, is it okay to do nothing further? How many cysts should be aspirated? If keep recurring, what then?
3063.   What are the indications for doing a thrombectomy or using thrombolytics for a patient with a deep-vein thrombosis (DVT)?
3064.   What are the indications for estrogen cream versus testosterone cream versus steroid creams for vulvar skin diseases and what is the classification of vulvar disease?
3065.   What are the indications for fine needle aspiration versus regular biopsy of breast masses?
3066.   What are the indications for getting a C-peptide (C peptide) and islet cell antibodies? Is it useful to differentiate Type 1 from Type 2 diabetes?
3067.   What are the indications for getting a digoxin level?
3068.   What are the indications for getting a nortriptyline level?
3069.   What are the indications for getting an alpha fetoprotein (AFP)? Is it helpful for chronic hepatitis?
3070.   What are the indications for growth hormone in a small child?
3071.   What are the indications for induction of labor for postdates pregnancy?
3072.   What are the indications for insulin in a type 2 diabetic not controlled on oral agents? What is a reasonable goal for degree of control in Type 2 diabetes?
3073.   What are the indications for ketoconazole (Nizoral) cream? Is it better for tinea manis than miconazole?
3074.   What are the indications for plain x-rays or magnetic resonance imaging in patients with low back pain?
3075.   What are the indications for removing kidney stones that are still in the kidney, and, if there are no indications to remove them, how should they be followed?
3076.   What are the indications for ribavirin in RSV (respiratory syncytial virus, bronchiolitis)?
3077.   What are the indications for tapping a pleural effusion or empyema associated with a pneumonia?
3078.   What are the indications for the Lyme disease vaccine and how do you give it?
3079.   What are the indications for trying to diagnose and/or treat Helicobacter pylori in patients with peptic disease and nonulcer dyspepsia? What are the indications for testing for Helicobacter pylori, especially by serology?
3080.   What are the indications for tympanostomy tubes (ventilation tubes, pe tubes)?
3081.   What are the indications for urology referral in someone with an acute kidney (ureteral) stone?
3082.   What are the indications for vertical banded gastroplasty?
3083.   What are the indications for working up a patient for a hypercoagulable state? Should a patient be worked up after a single deep-vein thrombosis (DVT)?
3084.   What are the indications for working up possible secondary causes of hypertension?
3085.   What are the interactions of the new antidepressant Remeron with other gastrointestinal and migraine drugs patient is taking for Crohn's and migraine (Midrin, Fiorinal, Zantac)?
3086.   What are the latest recommendations about using prophylactic antibiotics for otitis media?
3087.   What are the laws regarding a 13-year-old who is pregnant?
3088.   What are the long term effects of Dilantin use?
3089.   What are the long term effects of allergy injections? Patient asked me and I didn't know the answer.
3090.   What are the long term effects of sleep apnea if it's not treated?
3091.   What are the long-term options for treatment of hemorrhagic gastritis beyond H-2 blockers and antacids?
3092.   What are the manifestations of polyarteritis nodosa and Wegener's granulomatosis and how do you tell them apart? (This patient had pleural and pericardial effusions and peripheral neuropathy secondary to vasculitis.)
3093.   What are the manifestations of tyrosinemia syndrome?
3094.   What are the mnemonics to help remember what to ask about in depression?
3095.   What are the most likely causes for a parapneumonic effusion?
3096.   What are the most likely side effects of lithium?
3097.   What are the names and locations of the bursae around the knee?
3098.   What are the names of the three bones that are supposed to line up on the lateral wrist film?
3099.   What are the names of the three lateral ankle ligaments?
3100.   What are the new recommendations for unexplained infertility?
3101.   What are the normal limits for age of menopause so you can say this is within normal limits (age 36) and you don't have to worry about it?
3102.   What are the normal procedures for low birth weight? Just general information wanted.
3103.   What are the optimal number of calories for an obstetric patient? She says she eats all the time.
3104.   What are the options for ruling out renal artery stenosis in a patient with refractory hypertension?
3105.   What are the options for treating a streptococcal pharyngitis if you also want to cover a urinary tract infection?
3106.   What are the options for treating an elderly man, already taking Thorazine, who has insomnia and daytime agitation?
3107.   What are the perils of scuba diving?
3108.   What are the possible causes of an acute inflammatory scrotal mass?
3109.   What are the possible causes of pleural effusion?
3110.   What are the possible causes of this child's leg pain and limp?
3111.   What are the practice parameters for this patient with elevated bilirubin?
3112.   What are the presenting symptoms and treatment of Kawasaki's Disease?
3113.   What are the presenting symptoms of Behcet's disease?
3114.   What are the procedures for single ventricle heart in a baby? What kind of heart surgery?
3115.   What are the questions in the American Urological Association's (AUA) score for prostate symptoms (bladder neck obstruction symptoms, benign prostatic hypertrophy)? (Also called American Urological Association (AUA) Symptom Index.)
3116.   What are the recent JAMA (Sackett) and Journal of Family Practice (Slawson) articles on critical review of the literature and information management?
3117.   What are the recommended immunizations for travel in Mexico?
3118.   What are the recommended laboratory tests when using griseofulvin?
3119.   What are the relative costs of various diet pill regimens with fenfluramine (Pondimin), Phentermine (Fastin, Adipex-P) and dexfenfluramine (Redux)?
3120.   What are the relative frequencies of side effects for the different tricyclic antidepressants?
3121.   What are the relative potencies (equivalent doses) of various estrogens in hormone replacement therapy versus oral contraceptives versus endogenous production? What is the estrogen that is normally in the blood?
3122.   What are the respiratory complications of Prader-Willi syndrome?
3123.   What are the risks of recurrent seizures if you stop seizure medications after a prolonged seizure-free period?
3124.   What are the risks when you take out umbilical lines?
3125.   What are the seven levels of evidence (quality of evidence) when evaluating a medical research study?
3126.   What are the side effects of Depo-Provera when used for contraception? How long is it normal to have irregular bleeding with Depo-Provera?
3127.   What are the side effects of Florinef? Could it cause headaches?
3128.   What are the side effects of Reglan?
3129.   What are the side effects of Zoloft?
3130.   What are the side effects of amiodarone?
3131.   What are the side effects of doxycycline?
3132.   What are the side effects of ondansetron?
3133.   What are the side effects of the chemotherapy drugs they are using for this neuroblastoma patient?
3134.   What are the side effects of the chicken pox vaccine?
3135.   What are the side effects of the measles-mumps-rubella (MMR) vaccine?
3136.   What are the side effects on the liver of a sedative I want to give? The child has ingested Tylenol and is combative.
3137.   What are the side effects, contraindications, and dose of Antabuse? What symptoms result from drinking alcohol while on Antabuse?
3138.   What are the signs and symptoms of adrenal insufficiency?
3139.   What are the signs and symptoms of hyperthyroidism?
3140.   What are the signs, symptoms and course of Guillain-Barre syndrome?
3141.   What are the simple tests for urinary incontinence in the elderly ("poor man's cystometry")?
3142.   What are the skin lines under the eyes in people with allergies called?
3143.   What are the sources of hypertension? Is post-streptococcal one?
3144.   What are the specifics for treatment of Bacille Calmette-Guerin tuberculosis?
3145.   What are the speech development milestones at 12, 18, and 24 months?
3146.   What are the standard orders for alcohol withdrawal?
3147.   What are the structure and physiology of heart malformations?
3148.   What are the symptoms of Alport's Syndrome?
3149.   What are the symptoms of interstitial cystitis and how do you make the diagnosis?
3150.   What are the three kinds of memory and how do you test them?
3151.   What are the toxic effects and treatment of Tegretol overdosing?
3152.   What are the transfusion guidelines?
3153.   What are the transfusion guidelines?
3154.   What are the typical abnormalities for trisomy 18?
3155.   What are the various strengths of Synthroid and what is appropriate for this patient?
3156.   What are the weight loss criteria for deciding if someone needs an extensive work up for weight loss?
3157.   What are these brown dots on this 16-day-old's scalp? The physician's partner asked him to look at the baby.
3158.   What are these cells that I am seeing under the microscope on this urine sediment?
3159.   What are these pills she got in Mexico?
3160.   What are these two rashes, one on the face and one on the trunk?
3161.   What are those four principles of medical ethics mentioned by Dr. X?
3162.   What are traits and more specifics of Williams syndrome?
3163.   What are various methods of bracing for various injuries? This woman has had back pain radiating to her leg. Physical therapist thought that favoring one leg aggravated the other.
3164.   What are we going to do for this child with cellulitis?
3165.   What asthma inhaler is blue and white?
3166.   What besides Coumadin and liver disease can prolong the prothrombin time?
3167.   What besides drug interactions would cause a patient to be resistant to Coumadin and have a subtherapeutic prothrombin time in spite of increasing Coumadin doses?
3168.   What blood sugars should you try to achieve when treating a gestational diabetic?
3169.   What bolus dose of propranolol does this infant need?
3170.   What can I find out about hemolytic uremic syndrome?
3171.   What can cause a positive Monospot other than infectious mononucleosis?
3172.   What can we mix octreotide in? How well can we concentrate it?
3173.   What can you do to optimize renal function, prevent worsening renal failure, and be sure you are not missing a treatable cause?
3174.   What can you give someone to make their periods (menses) stop (cause amenorrhea) if they want to stop them for convenience? (for example, paraplegic woman) Also how to delay period for honeymoon, et cetera?
3175.   What can you use besides cryotherapy for plantar warts or warts in kids?
3176.   What can you use to prevent a transfusion reaction in someone with a history of febrile transfusion reactions in the past?
3177.   What caused her periorbital swelling?
3178.   What causes Cheyne-Stokes respirations?
3179.   What causes Chinese Restaurant Syndrome?
3180.   What causes Torsades de Pointes and how do you treat it? Overdrive with external pacemaker?
3181.   What causes a "small population of reactive lymphocytes"?
3182.   What causes a high ferritin with normal iron and TIBC (total iron binding capacity)?
3183.   What causes a low serum phosphorus (hypophosphatemia)?
3184.   What causes a monocytosis?
3185.   What causes adrenal calcifications on plain x-ray film of the abdomen?
3186.   What causes and how do you treat uric acid bladder stones?
3187.   What causes bad breath?
3188.   What causes delayed gastric emptying (gastroparesis) besides diabetes?
3189.   What causes dermatofibromas?
3190.   What causes dysequilibrium? (not vertigo or near syncope)
3191.   What causes fibroids and what would cause them to enlarge rapidly (patient asked Dr. X and she didn't know)?
3192.   What causes hand and foot paresthesias? Can captopril do it?
3193.   What causes high magnesium levels?
3194.   What causes hypercalcemia (elevated serum calcium) and how do you work it up?
3195.   What causes hyperhidrosis (excess sweating)?
3196.   What causes hyperphosphatemia?
3197.   What causes hypoalbuminemia and how do you treat it?
3198.   What causes intractable hiccups?
3199.   What causes jugular venous distension besides congestive heart failure?
3200.   What causes loss of libido in males and is there any treatment?
3201.   What causes loss of the suprasternal notch? She has no borders or definition to her suprasternal notch. She noticed this 9 months ago.
3202.   What causes low serum calcium?
3203.   What causes marathon runner's amenorrhea? Should it be worked up or treated?
3204.   What causes mild disseminated intravascular coagulation?
3205.   What causes nonpalpable purpura?
3206.   What causes orange breast milk?
3207.   What causes pain and tenderness on the xyphoid process?
3208.   What causes pain on movement of the eyes and photophobia?
3209.   What causes peeling fingernails where the ends of the nails flake off? What is this called?
3210.   What causes portal vein thrombosis and how do you treat it?
3211.   What causes premenstrual spotting? How do you treat it?
3212.   What causes reactive arthritis?
3213.   What causes small unexpected pleural effusions on chest x-ray?
3214.   What causes swimmer's itch?
3215.   What causes unilateral nosebleeds?
3216.   What causes urinary frequency and dysuria in a child with a normal urinalysis?
3217.   What causes uvulitis and how do you treat it?
3218.   What class of antihypertensives have the least effect on male sexual function?
3219.   What concentration of sodium chloride does a tablet contain?
3220.   What congenital syndrome would cause decreased hip mobility and a wide-based gait?
3221.   What cough suppressant contains dextromethorphan but is prescription and is covered by Title XIX?
3222.   What could cause acute massive swelling of the tongue?
3223.   What could cause decreased libido in a 41-year-old woman? Can diabetes cause it? What is the treatment?
3224.   What could cause fasciculations in the calf?
3225.   What could cause opisthotonus (hyperextension of the neck) in an infant?
3226.   What cranial nerve is responsible for upward gaze?
3227.   What criteria do we need to meet in order to get human-leukocyte-antigen (HLA) matched platelets for this patient?
3228.   What crystal causes pseudogout? Is meniscal calcification pathognomic of pseudogout?
3229.   What did Dr. X's summary of toxicology say about antidepressant overdose?
3230.   What did that article in the New England Journal of Medicine say about how to diagnose acute myocardial infarction in the presence of left bundle branch block (LBBB)?
3231.   What did that recent New England Journal of Medicine article say about what types of fat are good for preventing coronary disease?
3232.   What did the article in JAMA (Williams) say about diagnosis of sinusitis and the value of pain and tenderness in the maxillary sinuses?
3233.   What diet should someone follow if they complain of flatulence? What treatments are available for excess passage of bowel gas (flatulence)?
3234.   What difference in arm blood pressures is concerning for coarctation or aortic dissection?
3235.   What different strengths does Accupril come in? Patient currently takes two 20-milligram tabs.
3236.   What do I do with this chronic-back-pain patient? What do I do with this drug seeker? I send them to the pain clinic and they send them back and it's not solved at all.
3237.   What do I need to be doing to workup this patient with apparent acute hepatitis? How aggressive do I get with painless jaundice, thinking about pancreatic cancer, et cetera.
3238.   What do I need to know about allergic colitis?
3239.   What do I need to know about cytomegalovirus infections?
3240.   What do I need to know about cytomegalovirus infections?
3241.   What do I need to know about heart lesions and other heart conditions?
3242.   What do I need to know about hypoplastic left heart?
3243.   What do I need to know about neurogenic bowel?
3244.   What do I need to know about neurogenic pulmonary edema?
3245.   What do I need to know about the syndrome of inappropriate antidiuretic hormone?
3246.   What do I need to know about thrombocytopenia?
3247.   What do I treat contact dermatitis with? (implied drug treatment)
3248.   What do actinic keratoses look like?
3249.   What do elevated ST segments mean on an exercise tolerance test?
3250.   What do flattened T waves in all precordial leads mean in a 54-year-old woman with hypertension and potassium of 3.3 milliequivalents/liter?
3251.   What do hyperacute (symmetric tall peaked) T waves look like on an electrocardiogram and what is their significance?
3252.   What do lichen sclerosis and atrophicus look like?
3253.   What do practitioners do in cases of pharyngitis? Streptococcal screens, or wait, or hit them with antibiotics?
3254.   What do pyogenic granulomas look like?
3255.   What do the new American College of Physicians guidelines say about treating a 60-year-old woman with a low density lipoprotein cholesterol of 170?
3256.   What do the tall peaked T waves of an acute myocardial infarction look like? What else causes tall peaked T waves?
3257.   What do we do with mammogram, cholesterol, and pap smear screening in women over 70? What is a good source that is both scientific and yet has common sense about what is cost effective and what Medicare will pay for?
3258.   What do we monitor in respiratory-syncytial-virus patients?
3259.   What do you do about snoring? Anything to do besides refer to sleep laboratory to work up sleep apnea?
3260.   What do you do for a painful bump on the heel where the Achilles tendon inserts ("pump bump")?
3261.   What do you do for mild vesicoureteral reflux? What kind of followup do you do and how often? Do you repeat it (the voiding cystourethrogram)?
3262.   What do you do for the PSA (prostate-specific antigen)?
3263.   What do you do if a prenatal patient tests positive for hepatitis B surface antigen (HBsAg)?
3264.   What do you do if someone is late for their Depo-Provera shot? How late can they be and still not get a pregnancy test?
3265.   What do you do if you treat a pneumonia and it doesn't get better?
3266.   What do you do when someone has no insurance and has almost no money to buy Chemstrips?
3267.   What do you do when the patient complains of vaginal discharge, lots of white cells seen on wet mount and Papanicolaou smear (inflammatory pap smear), cervix red, pH normal, negative wet mount (no clue cells), negative KOH (potassium hydroxide)?
3268.   What do you do with a 39-year-old woman with dizziness, tingling in her chest and right arm, and shortness of breath?
3269.   What do you do with a Papanicolaou smear that has no endocervical cells? I usually repeat it but what if the second one shows no endocervical cells?
3270.   What do you do with a child in a vegetative state, who was DNR (do-not-resuscitate status), but now mother changed her mind and wants a full code?
3271.   What do you do with a lead level of 10 in an 11 month old which is borderline high? What is the management besides getting them out of the spot?
3272.   What do you do with a patient who refuses investigation or treatment but has pain?
3273.   What do you do with an angiotensin-converting-enzyme-inhibitor-induced cough?
3274.   What do you do with dysuria with a negative urinalysis and negative vaginal wet prep (preparation)?
3275.   What do you do with heparin anticoagulation in pregnancy?
3276.   What do you do with isolated hypertriglyceridemia (triglycerides = 271)? Not high enough to cause pancreatitis but high.
3277.   What do you do with serous otitis? Long term antibiotics? Nose spray? Decongestants? I do nothing usually and then if it's persistent, when do you refer and what do you do about it?
3278.   What do you do with someone who has 7 days of heavy bleeding with Norplant in for one year?
3279.   What do you do with someone who has unexpected mild elevations of AST (aspartate aminotransferase) and/or ALT (alanine aminotransferase) on chemistry panel?
3280.   What do you say the risk of a heart attack is from calcium channel blockers to a man who is perfectly well controlled on verapamil and his mother wants him to change?
3281.   What do you watch for with a gastroschisis patient?
3282.   What does "FA" mean for a hemoglobinopathy screen?
3283.   What does "oropharyngeal swallow on lateral view shows penetration aspiration on liquid swallow" mean on an esophagram report?
3284.   What does "proximal escape of the primary peristalsis" mean on an esophagram report?
3285.   What does Axis I, Axis II, and so on mean in a psychiatric impression, (psychiatric diagnosis)?
3286.   What does Bumex do?
3287.   What does Consumer's Union say about blood pressure cuffs?
3288.   What does Dr. X say about treatment of hyperlipidemia?
3289.   What does MSG stand for (regarding Chinese restaurant syndrome)?
3290.   What does Nipride do?
3291.   What does OSCE stand for and what is an OSCE?
3292.   What does PPHN stand for? What does PFC stand for?
3293.   What does T.A. stand for on an immunization card from New Guinea?
3294.   What does VVIR stand for in terms of pacemakers?
3295.   What does a classic growth curve look like for constitutional low weight and height in a child? Can it start normally in infancy and then fall off?
3296.   What does a high mean platelet volume mean?
3297.   What does a right ventricle or right-sided myocardial infarction look like on the electrocardiogram?
3298.   What does a short run of ventricular tachycardia mean on treadmill testing (GXT)? What do premature ventricular contractions (PVCs) mean?
3299.   What does a slightly low free thyroxine (free T4) with a normal thyroid stimulating hormone (TSH) mean in a patient on thyroid replacement or not on replacement?
3300.   What does an antinuclear antibody (ANA) of 1:40 mean in someone with a low probability of lupus? What are the criteria for systemic lupus erythematosus (SLE)? How should you work up someone with a positive titer?
3301.   What does antimitochondrial antibody test for? Primary biliary cirrhosis?
3302.   What does aortic stenosis do to the blood pressure?
3303.   What does depression look like?
3304.   What does ethnography mean?
3305.   What does exercise induced left bundle branch block (LBBB) mean on a treadmill (GXT)?
3306.   What does increased variability (saltatory pattern) mean on a fetal heart rate tracing?
3307.   What does it mean if you have upsloping ST depression on an exercise tolerance test (GXT)? What are the criteria for a positive test?
3308.   What does it mean to have "shoulders" on a variable deceleration?
3309.   What does it mean to have a positive hepatitis B core antibody and a negative hepatitis B surface antigen?
3310.   What does it mean to have tertiary contractions on a barium swallow? Are they normal? How do you treat them?
3311.   What does it mean to have yeast cells in the stool of a patient with chronic diarrhea?
3312.   What does it mean to say something is growing or declining at an exponential rate? (Medical student's learning issue: there is an exponential decline in lung function of 2 - 3% per year.)
3313.   What does it mean when the laboratory report says "low level rubella immunity"? Should the patient get rubella vaccine or not?
3314.   What does medical informatics mean?
3315.   What does nicotine stomatitis look like? Would a white hard palate with red dots be consistent?
3316.   What does paraneoplastic syndrome mean and what does it do?
3317.   What does squinting and eye rubbing mean in an infant or child?
3318.   What does the American Academy of Pediatrics recommend concerning frequency of well-baby exams, laboratory work to get (lead, complete blood count, urinalysis), Tuberculin testing, checking developmental milestones, and so on?
3319.   What does the American College of Obstetricians and Gynecologists (ACOG) recommend for frequency of prenatal visits according to trimester?
3320.   What does the American College of Obstetrics and Gynecology (ACOG) say we should do about toxoplasmosis? A reference seems to indicate that the American College said all women should be screened for toxoplasmosis.
3321.   What does the JNC (Joint National Commission) say about which antihypertensive to start first (and what to add) in someone with no other illnesses or mitigating circumstances?
3322.   What does the Medical Letter say about Lozol (indapamide)?
3323.   What does the United States Preventive Services Task Force say about skin cancer screening?
3324.   What does the United States Public Health Service Task Force say about doing rectal exams for prostate cancer?
3325.   What does the discharge of atrophic vaginitis look like? She has a brown discharge.
3326.   What does the ferritin level do in anemia of chronic disease?
3327.   What does the health maintenance organization (HMO) formulary say I can use for this patient's nasal condition?
3328.   What does the prenatal care checklist include?
3329.   What does the psychiatry service like to use instead of Haldol for sedation for sun downing?
3330.   What does the workup for secondary causes of hypertension consist of?
3331.   What dosage and frequency does the hepatitis A vaccine require?
3332.   What dosage does this child need for gentamicin and Flagyl?
3333.   What dosage of Amicar is needed?
3334.   What dosage of Biaxin do I give this child?
3335.   What dosage of Flagyl is needed?
3336.   What dosage of Lotensin does this two-year-old need?
3337.   What dosage of Miralax does this patient need?
3338.   What dosage of Miralax does this patient need? They are constipated
3339.   What dosage of Timentin does this child need?
3340.   What dosage of antibiotic is needed?
3341.   What dosage of antibiotic is needed?
3342.   What dosage of aqueous vasopressin is needed?
3343.   What dosage of ceftriaxone does this child need?
3344.   What dosage of eutectic mixture of local anesthetics (EMLA) cream does this patient need?
3345.   What dosage of famotidine does this patient need?
3346.   What dosage of gentamicin and Benadryl does this patient need?
3347.   What dosage of gentamicin is needed?
3348.   What dosage of gentamicin is needed?
3349.   What dosage of medication should I give the mother of my patient who has a herpes cold sore on her lip?
3350.   What dosage of oral Celestone is needed?
3351.   What dosage of phenobarbital is needed?
3352.   What dosage of piperacillin is needed?
3353.   What dosage of this antibiotic does this patient need?
3354.   What dose of Adderall does this large 12-year-old need?
3355.   What dose of Ancef does this patient need?
3356.   What dose of Augmentin does this patient need?
3357.   What dose of Benadryl and Phenergan does this patient need?
3358.   What dose of Carafate is needed?
3359.   What dose of Dextran does this child need?
3360.   What dose of Famvir to treat a primary (not recurrent) herpes genital infection?
3361.   What dose of Fer-in-sol should this patient have?
3362.   What dose of Gentamicin should this baby have?
3363.   What dose of Keflex does this patient need?
3364.   What dose of Periactin and Atarax does this patient need?
3365.   What dose of Polytrim (frequency and number of drops) does this patient need?
3366.   What dose of Robitussin should I give?
3367.   What dose of Versed (for sedation) does this patient need?
3368.   What dose of acyclovir does this patient need?
3369.   What dose of antibiotic does this child need for otitis media?
3370.   What dose of antibiotic does this patient need?
3371.   What dose of bicarbonate does this patient need?
3372.   What dose of captopril should you push for in congestive heart failure?
3373.   What dose of captopril should you use in a diabetic with microalbuminuria?
3374.   What dose of cefazolin does this patient need?
3375.   What dose of ceftriaxone does this patient need?
3376.   What dose of cimetidine does this patient need?
3377.   What dose of cryoprecipitate is needed?
3378.   What dose of epinephrine drip does this patient need?
3379.   What dose of famotidine does this child need?
3380.   What dose of folic acid should be taken when a patient is trying to get pregnant?
3381.   What dose of granulocyte colony stimulating factor (GCSF) does this patient need?
3382.   What dose of heparin does this patient need?
3383.   What dose of multivitamin (ADEK) does this patient need?
3384.   What dose of ranitidine should this patient receive?
3385.   What dose of ursodiol does this patient need?
3386.   What dose of vancomycin does this patient need?
3387.   What dose of vitamin E does this patient need?
3388.   What drug can best treat a certain bacterial infection?
3389.   What drug for mastitis can be used safely while breast feeding for penicillin-sensitive patient?
3390.   What drug should be used for chemical cardioversion of atrial fibrillation?
3391.   What drug should you give to prevent a patient from going back into atrial fibrillation once they convert to sinus rhythm? Diltiazem? No drug?
3392.   What drugs and what dose can you use for otitis media prophylaxis?
3393.   What drugs are contraindicated in the treatment of congestive heart failure in the face of aortic stenosis?
3394.   What drugs are folic acid antagonists?
3395.   What drugs does Fosamax interact with?
3396.   What drugs should patients with heart failure be on unless contraindicated, besides diuretics?
3397.   What effect does wine intake have on lipids?
3398.   What effect would hemolysis have on the serum cholesterol level?
3399.   What evaluation should diabetics have at every clinic visit or other periodic evaluation?
3400.   What fetal surveillance should be done in a post-term pregnancy and how should you manage it?
3401.   What foods contain Vitamin B6 (pyridoxine)?
3402.   What general information do I need to know about methanol poisoning?
3403.   What general information do I need to know for newborn exams?
3404.   What general information should I know about cholestatic jaundice?
3405.   What harm does it do to have a low pO2 (for example, 50 or 48) if it's chronic and the patient is not uncomfortable?
3406.   What hepatitis serology do you get in international adopted child?
3407.   What immunizations are needed at one year old?
3408.   What immunizations does someone need if they have had or are going to have a splenectomy and how often should they be repeated?
3409.   What immunizations should this 45-year-old woman get before she goes to Viet Nam in two weeks?
3410.   What intravenous (IV) antibiotic should you give to an inpatient with a cat bite or dog bite?
3411.   What is "henox premer"? What is the name of that disease? This is the closest the patient could come to the pronunciation. (Turned out to be Henoch-Schoenlein Purpura.)
3412.   What is Ambien (zolpidem) and is it any good? Is it okay to prescribe it chronically?
3413.   What is BOOP (bronchiolitis obliterans and organizing pneumonia)?
3414.   What is Best's disease?
3415.   What is Betamol eye drops?
3416.   What is Carnett's sign? (Questionably, the patient raises leg and if the pain hurts worse, the pain is coming from the abdominal wall rather than the viscera)
3417.   What is Cetirizine (Reactin)?
3418.   What is Charcot Marie Tooth Disease?
3419.   What is Child's classification of cirrhosis?
3420.   What is Cozaar?
3421.   What is Cronbach's alpha and Cohen's kappa and how do you calculate them?
3422.   What is D-dimer and what is it used for?
3423.   What is DDAVP (1-desamino-8-D-arginine vasopressin) and how is it used to treat von Willebrand disease?
3424.   What is Dakin's solution?
3425.   What is Dipentum (olsalazine)? (questionably a better form of sulfasalazine)
3426.   What is Dr. X's method of dealing with cystocele and recurrent urinary tract infections?
3427.   What is Dr. X's method of reassurance in hypochondriacal patients?
3428.   What is Dr. X's treatment regimen for chronic vulvar pruritus (kraurosis vulvae, lichen simplex atrophicus)?
3429.   What is Dynabac (dirithromycin)? What bacteria does it cover? What are the indications for use? Should you take it with food? What is the dose?
3430.   What is Endolimax nana and should you treat it?
3431.   What is FISH (fluorescence in situ hybridization)?
3432.   What is Fanconi's Syndrome?
3433.   What is Fragile X syndrome? Related to 49 year-old patient of Dr. X with colitis and mental retardation.
3434.   What is Fragile-X syndrome? Should all mentally retarded adults be screened for it?
3435.   What is Genora (possible estrogen)?
3436.   What is Humate-P (used to treat von Willebrand disease at delivery)?
3437.   What is Hytrin?
3438.   What is Kenny syndrome?
3439.   What is Klippel Feil Syndrome? What are the manifestations?
3440.   What is Kussmaul breathing?
3441.   What is Lantus insulin (insulin glargine)?
3442.   What is Legatrin?
3443.   What is Lotrel?
3444.   What is Lunelle and what are the indications?
3445.   What is Maltsupex? (laxative for infants)
3446.   What is Mexitil (mexiletine)?
3447.   What is NARES (nonallergic rhinitis with eosinophilia syndrome), when should you suspect it, how do you diagnose it?
3448.   What is Noonan syndrome?
3449.   What is Norvasc (amlodipine)? Does it have any advantage over other calcium channel blockers?
3450.   What is Ogilvie's syndrome?
3451.   What is Osler's sign (Osler's maneuver) (still feel artery after cuff pumped over systolic BP) and what should you do if you have a patient with it (pseudohypertension)?
3452.   What is Peutz-Jegher's Syndrome?
3453.   What is Phoma species on a fungal culture report of a toenail?
3454.   What is Prader-Willi syndrome?
3455.   What is Proshield?
3456.   What is Resaid?
3457.   What is Rovsing's sign?
3458.   What is Rovsing's sign?
3459.   What is Sandifer syndrome? (head posturing, torticollis, related to gastroesophageal reflux disease (GERD), hiatus hernia)
3460.   What is Sansert?
3461.   What is Schober's test for diagnosing ankylosing spondylitis?
3462.   What is Serzone (nefazodone) and when is it indicated?
3463.   What is Sperling's sign (Sperling's maneuver)?
3464.   What is Stickler Syndrome? Does it affect a chronic ruptured tympanic membrane?
3465.   What is Still's disease?
3466.   What is TCA (tetracaine, cocaine, alcohol)? Is it effective and safe for topical anesthesia? (also known as TAC)
3467.   What is Tamiflu (oseltamivir)?
3468.   What is Terazol (terconazole)?
3469.   What is Type IV renal tubular acidosis and how do you treat it (hyporenin hypoaldosterone)?
3470.   What is Ultram (tramadol)?
3471.   What is Ultravate cream (Halobetasol)? Is there anything special about it for use on alopecia areata?
3472.   What is Urised?
3473.   What is Uristat (it's over the counter)? Is it the same thing as pyridium?
3474.   What is Vagisil?
3475.   What is Vanderwoude syndrome?
3476.   What is Walker-Warburg Syndrome?
3477.   What is Walker-Warburg syndrome?
3478.   What is Wegener's granulomatosis?
3479.   What is WestSoy formula?
3480.   What is Williams Syndrome?
3481.   What is Xalatan eye drops?
3482.   What is Zofran (ondansetron)?
3483.   What is Zoloft (sertraline)? It may be an antidepressant similar to Prozac.
3484.   What is Zyprexa?
3485.   What is a "high" ankle sprain?
3486.   What is a "low renin, low aldosterone state"? (hyporeninemic-hypoaldosteronism, Type 4 renal tubular acidosis)
3487.   What is a "nested case-control study"?
3488.   What is a GI (gastrointestinal) motor meal as opposed to just an upper gastrointestinal series?
3489.   What is a Hawkins II fracture of the talus?
3490.   What is a Hepatolite scan (questionably the same as a PAPIDA scan)?
3491.   What is a Lisfranc fracture?
3492.   What is a Roux-en-Y hepatoenterostomy?
3493.   What is a basic classification of lung cancer?
3494.   What is a basic workup for dementia to rule out other causes besides Alzheimer's?
3495.   What is a blue dome cyst? Mother had blue dome cysts on her breasts.
3496.   What is a good nonsteroid cream for psoriasis?
3497.   What is a good protocol for diagnosis and treatment of corneal foreign body?
3498.   What is a good source to use for teaching residents how to repair 4th degree lacerations?
3499.   What is a good steroid eye drop?
3500.   What is a good way to remember which kind of face presentation will deliver vaginally?
3501.   What is a good way to treat temper outbursts and anxiety in a mentally retarded adult?
3502.   What is a list of things that are easy to forget to do in obstetric care and when admitting a patient in labor?
3503.   What is a meaningful difference between two receiver operating characteristic (ROC) curves when you are doing a sample size calculation?
3504.   What is a nerve sparing prostatectomy?
3505.   What is a normal amnionic fluid index (AFI)?
3506.   What is a normal amount of fluid and calories for a newborn to take by mouth?
3507.   What is a normal body mass index (BMI)?
3508.   What is a normal body mass index?
3509.   What is a normal calcium level in a baby?
3510.   What is a normal heart rate for a newborn?
3511.   What is a normal hemoglobin and hematocrit for an infant and young child?
3512.   What is a normal kick count (fetal movement count), 10 per hour, 4 per hour, 10 per two hours?
3513.   What is a normal left ventricular ejection fraction?
3514.   What is a normal opening and closing cerebrospinal fluid (CSF) pressure for a lumbar puncture?
3515.   What is a normal partial thromboplastin time for a 3-day-old?
3516.   What is a normal prostate-specific antigen (PSA) velocity?
3517.   What is a normal prothrombin time value for a 3-day-old?
3518.   What is a normal respiratory rate for a newborn?
3519.   What is a normal scalp pH?
3520.   What is a normal temperature for a newborn?
3521.   What is a normal white blood count for a baby (for various ages in an infant)?
3522.   What is a normal white count and band count for a newborn?
3523.   What is a reasonable heart rate to achieve for aerobic exercise?
3524.   What is a reasonable workup for fatigue in terms of history, physical, and laboratory work?
3525.   What is a reference to n-of-one trials?
3526.   What is a sliding hiatus hernia?
3527.   What is a test to diagnose Wegener's granulomatosis (?antineutrophilic cytoplasmic antibody)?
3528.   What is a tethered spinal cord? Can it cause urinary incontinence? When should you be suspicious clinically?
3529.   What is amantadine dosing?
3530.   What is an "adequate dose" of benazepril for microalbuminuria (assuming no problems with hypotension). The original studies were done with captopril, but now we use benazepril or some other angiotensin converting enzyme ACE inhibitor.
3531.   What is an Adie's pupil?
3532.   What is an appendix epididymis and how would you know that's what it is by palpation?
3533.   What is an eccrine spiradenoma?
3534.   What is an exact conversion between grams and pounds?
3535.   What is an incidence rate ratio?
3536.   What is associated with greater toxicity/morbidity: to increase pressures on the ventilators or to settle for a higher fraction of inspired oxygen (FiO2)?
3537.   What is biliary gastritis (bile gastritis) and how do you treat it?
3538.   What is bronchiolitis?
3539.   What is causing her abdominal pain? Stress versus ulcer disease?
3540.   What is causing her anemia?
3541.   What is causing her ankle pain? No history of injury. X-rays negative.
3542.   What is causing her back pain?
3543.   What is causing her dysuria (urinalysis negative)?
3544.   What is causing her dysuria? (UA is negative.)
3545.   What is causing her dysuria? She's on an antibiotic for a urinary tract infection, her urinalysis is negative and her wet mount is negative.
3546.   What is causing her fatigue? A young healthy woman with normal lab work complaining of fatigue. Denies depression, but has had 2 recent miscarriages.
3547.   What is causing her fatigue? Thyroid studies are normal.
3548.   What is causing her hives? Has had two courses (burst and taper) of prednisone and rash returns when she stops prednisone. Also complains of fatigue.
3549.   What is causing her intermittent dysuria?
3550.   What is causing her recurrent hives?
3551.   What is causing her right-lower-quadrant pain (severe sharp pain)?
3552.   What is causing her to be nauseated? (Persistent nausea and some diarrhea.) Could her anesthesia have caused this? (Had total knee replacement 4 to 6 weeks ago).
3553.   What is causing his abdominal pain and dark stools? Is it gastritis or a tiny ulcer resulting from his ibuprofen? He's feeling better now and has a stable hematocrit.
3554.   What is causing his chest pain? Is it cardiac or gastrointestinal?
3555.   What is causing his dizzy spells?
3556.   What is causing his fatigue? I think it's viral but I'm not sure. Will get complete blood count (CBC) and Monospot.
3557.   What is causing his fatigue? Long lasting viral entity? Not sure of diagnosis. Differential diagnosis includes viral illness, arthritis.
3558.   What is causing his hip pain?
3559.   What is causing his insomnia? He went to the tertiary center and was told he had restless legs but he didn't respond at all to clonazepam. All his life he is awake from 12 midnight to 4 AM. Sleeps from 10 to 12 and 4 to 6 and takes 30 min nap in the daytime.
3560.   What is causing his testicular pain (orchialgia)? His exam is normal, his prostatic fluid is normal, he's been of Septra without help.
3561.   What is causing the chronic itching?
3562.   What is causing the elevated liver function tests?
3563.   What is causing the groin pain? Dr. X said it was hard to get the information he needed from this patient.
3564.   What is causing the heel pain?
3565.   What is causing this child's shakiness which only presents in the morning?
3566.   What is causing this chronic cough? Could this be cystic fibrosis? Should we get a sweat chloride? Should he go to a pulmonologist?
3567.   What is causing this groin pain? Adductor tendinitis? Is it a defined entity and what to do about it?
3568.   What is causing this patient's rapidly progressing memory loss?
3569.   What is causing this rash?
3570.   What is ceftazidime?
3571.   What is central pontine myelinosis? We gave hypertonic saline to a patient with hyponatremia and Dr. X warned about this.
3572.   What is cerebral palsy? How do you diagnose and treat it? What is the etiology? What is the pathogenesis?
3573.   What is cilostazol (Pletal) (for intermittent claudication)?
3574.   What is clonazepam (Klonopin)?
3575.   What is considered a normal baseline fetal heart rate?
3576.   What is considered abnormal for an orthostatic (postural) blood pressure drop?
3577.   What is considered normal for systolic blood pressure in the elderly in view of recent findings of benefit in treating systolic hypertension?
3578.   What is corpora conduplicato (conduplicato corpore)?
3579.   What is cyclandelate and has it been shown to be effective for Meniere's disease?
3580.   What is cysticercosis?
3581.   What is discriminant analysis (for example, D'Angelo LJ. Obstet Gynecol. 1980;55:319-323)?
3582.   What is dissociative disorder? What are the Diagnostic and Statistical Manual (DSM IV) criteria?
3583.   What is dose of Dilaudid, a narcotic?
3584.   What is droperidol (Inapsine)?
3585.   What is dysdiadokokinesis?
3586.   What is dysfibrinogenemia?
3587.   What is dyskinesia?
3588.   What is egophony? What are the definitions of the other lung sounds like pectoriloquy, ronchi, rales, crackles, and so on?
3589.   What is euthyroid sick syndrome? Is it an abnormal-lab problem only or a physiologic problem? Is it a triiodothyronine (T3) problem?
3590.   What is fetor hepaticus and what does it smell like?
3591.   What is flumazenil? It's supposed to be a benzodiazepine reverser.
3592.   What is fluvoxamine (Luvox) and can it be used for depression as well as obsessive compulsive disorder?
3593.   What is focal sclerosing adenosis on mammogram and can it cause breast pain?
3594.   What is gemfibrozil and what is it good for (being used in a patient with high triglycerides)?
3595.   What is general information about DiGeorge Syndrome, for the family?
3596.   What is general information about Guillain-Barre, including diagnosis and management?
3597.   What is general information about bilateral optic neuritis?
3598.   What is general information about brain tumors in children?
3599.   What is general information about evaluation of an international adopted child (China)?
3600.   What is general information about extreme hypoxic injury?
3601.   What is general information about meningomyelocele, including outcome and what to watch for with the patient?
3602.   What is general information about neonatal seizures?
3603.   What is general information about peritoneal dialysis?
3604.   What is general information about sickle cell disease?
3605.   What is general information about sickle cell disease?
3606.   What is general information about varicella (chicken pox)?
3607.   What is glatiramer (Copaxone)? A treatment for multiple sclerosis.
3608.   What is good treatment for aphthous ulcers in the mouth?
3609.   What is happening on a physiologic level with this cardiac patient whose ductus arteriosus is not closing?
3610.   What is heel pain syndrome?
3611.   What is hemoglobin Ao? Patient was not seen today but Dr. X was looking at lab report and had this question.
3612.   What is hemolytic uremic syndrome?
3613.   What is herpes gladiatorum? How do you treat it?
3614.   What is in Midol and can it be taken with ibuprofen?
3615.   What is in Ortho Novum 1/35?
3616.   What is involved in this experimental treatment of a gastrointestinal disease?
3617.   What is lipoprotein A, and what are low-density lipoprotein (LDL) patterns A and B, and are they used clinically?
3618.   What is melanosis coli and what causes it and how should you treat it?
3619.   What is mepron (Atovaquone) (antibiotic for pneumocystis)?
3620.   What is midodrine? How do you use it for diabetic autonomic neuropathy with postural (orthostatic) hypotension?
3621.   What is nabumetone?
3622.   What is nasal ipratropium (Atrovent) and what are the indications?
3623.   What is nedocromil sodium (Tilade)? (Possibly similar to cromolyn sodium)
3624.   What is negative binomial regression and how do you use it?
3625.   What is nephrocalcinosis?
3626.   What is neutral fat and split fat on a stool sample stained with Sudan stain?
3627.   What is new and different about Dyazide (not formulated the same as it was according to patient)?
3628.   What is nimodipine (Nimotop)?
3629.   What is occipital neuralgia? How do you diagnose and treat it?
3630.   What is octreotide (Sandostatin) and somatostatin?
3631.   What is paregoric?
3632.   What is patient's specialist seeing on her neck cyst?
3633.   What is perichondritis and relapsing perichondritis of the ear?
3634.   What is pityriasis lichenoides?
3635.   What is prealbumin and why would you order a serum prealbumin?
3636.   What is propafenone and how do you use it to treat atrial fibrillation?
3637.   What is pseudonormalization mentioned by Doctor X on Patient X's electrocardiogram (ECG)? (T-wave change)
3638.   What is regression to the mean?
3639.   What is risperidone (Risperdal)?
3640.   What is schizoaffective disorder?
3641.   What is senile tremor? Is it the same as benign familial tremor?
3642.   What is seronegative spondyloarthropathy?
3643.   What is serum sickness and what are the causes?
3644.   What is some general information about methadone?
3645.   What is sotalol?
3646.   What is tenesmus? What does the word mean?
3647.   What is terbinafine (Lamisil) and what does the Medical Letter say about it?
3648.   What is the "dawn" phenomenon and how do you know if someone has it?
3649.   What is the Advanced Cardiac Life Support (ACLS) mnemonic to help remember causes of PEA (pulseless electrical activity) or EMD (electrical mechanical dissociation)?
3650.   What is the Augmentin dose for this 16-kilogram girl with otitis media? Actually I know that, but what I really need to know is what concentrations Augmentin syrup comes in.
3651.   What is the Delphi technique and how do you do it?
3652.   What is the Jendrassik maneuver?
3653.   What is the Marsh score (having to do with Rh sensitization)?
3654.   What is the Poland anomaly?
3655.   What is the University protocol for lid hygiene for blepharitis?
3656.   What is the Westermark sign on chest radiographs (pulmonary embolus)?
3657.   What is the absorption rate of clonidine patch over time?
3658.   What is the accuracy of non-finger-stick blood sugar checkers?
3659.   What is the acoustic reflex good for (helpful for)?
3660.   What is the adenosine-thallium exercise tolerance test?
3661.   What is the angiotensin converting enzyme (ACE) inhibitor of choice?
3662.   What is the antibiotic coverage for Staphylococcus aureus lung abscess?
3663.   What is the antibiotic dose?
3664.   What is the antibiotic dosing for a patient with fever and neutropenia?
3665.   What is the antibiotic of choice for acute and chronic sinusitis?
3666.   What is the antibiotic of choice for acute sinusitis?
3667.   What is the antibiotic of choice for an elderly patient in the nursing home with pneumonia?
3668.   What is the antibiotic of choice for otitis media?
3669.   What is the antibiotic of choice for postpartum endometritis?
3670.   What is the approach to genital ulcers, diagnostically?
3671.   What is the appropriate dose for Stimate for patient with von Willebrand disease?
3672.   What is the appropriate dose of Pediapred for this patient?
3673.   What is the appropriate dose of Zithromax?
3674.   What is the association between alcoholism and diabetes? Does alcoholism cause diabetes?
3675.   What is the average length of time between quitting breast feeding and when lactation should stop? Is there any correlation between this time and development of fibrocystic breast disease? That is, if long time, more likely to develop it. This patient has a cyst.
3676.   What is the average length of time between the Kasai procedure and liver transplant in a patient with biliary atresia?
3677.   What is the best GI (gastrointestinal) cocktail to give and the necessary proportions and dosage?
3678.   What is the best and most cost effective way to diagnose sinusitis (acute vs. chronic)? I don't want to do a CT.
3679.   What is the best antibiotic for a severe corneal abrasion?
3680.   What is the best antidepressant for an elderly patient with chronic obstructive pulmonary disease and lung cancer?
3681.   What is the best approach in a 60-year-old woman with complaints of loss of libido?
3682.   What is the best approach to functional abdominal pain in children?
3683.   What is the best dressing for a leg ulcer? Saline? Wet to dry? Acetic acid?
3684.   What is the best interval to repeat thyroid tests on someone who is on thyroid replacement and how soon after I change the dose should I check the level?
3685.   What is the best kind of glucose monitoring machine (like Accucheck) for monitoring type 2 diabetics?
3686.   What is the best medication for this guy with depression but who gets sleepy on Prozac? He sometimes ruminates on things. What's the right medication for his symptom complex? The psychiatrists always seem to know right away.
3687.   What is the best method for removing a sebaceous (intradermal, epidermoid) cyst?
3688.   What is the best obesity surgery? Vertical banded gastroplasty, Roux en Y? And what are the indications for surgery?
3689.   What is the best shoe for walkers who have a lot of calluses?
3690.   What is the best test for Lyme disease? How should you approach the patient who thinks they may have Lyme disease? How to work up? Just treat if any doubt due to poor tests that are available?
3691.   What is the best test for bone mineral density?
3692.   What is the best time to draw anticonvulsant serum levels?
3693.   What is the best treatment for a callus? What should be the frequency of paring? I put on a donut pad, will that help prevent it?
3694.   What is the best treatment for a needlestick injury after a human immunodeficiency virus exposure?
3695.   What is the best treatment for an excess amount of foreskin left after circumcision? Also skin bridging to the glans. What should be done with that?
3696.   What is the best treatment for dry mouth (xerostomia)? Artificial saliva?
3697.   What is the best treatment for external otitis?
3698.   What is the best treatment for fungal external otitis?
3699.   What is the best treatment for gastroesophageal reflux disease (frequent spitting) in a 3 1/2-month-old?
3700.   What is the best treatment for gout in someone with a normal uric acid level and normal 24-hour urine uric acid?
3701.   What is the best treatment for menorrhagia in a 32-year-old with periods getting steadily heavier but normal pelvic exam?
3702.   What is the best treatment for poison ivy?
3703.   What is the best treatment for restless legs syndrome?
3704.   What is the best treatment for the common cold?
3705.   What is the best treatment for vaginal dryness after childbirth?
3706.   What is the best treatment of hypercholesterolemia? The patient is already on two drugs.
3707.   What is the best way to avoid pain with cervical biopsies during colposcopy? How to do endocervical curettage?
3708.   What is the best way to change pills in someone with irregular bleeding on oral contraceptives? What is the underlying rationale?
3709.   What is the best way to dose gentamicin?
3710.   What is the best way to enter a continuous variable like age into a logistic regression model?
3711.   What is the best way to give the Centers-for-Disease-Control-recommended folic acid 0.4 milligrams to women of child-bearing age?
3712.   What is the best way to go about delivering a 29-week fetal demise (prostaglandin, Cytotec, et cetera)?
3713.   What is the best way to instruct about fetal kick counts (fetal movement)? Is it 10 kicks per day or 4 kicks per hour? What evidence is the use of kick counts based on?
3714.   What is the best way to make an elbow splint for an acute fracture?
3715.   What is the best way to prevent recurrent bacterial vaginosis?
3716.   What is the best way to remove seborrheic keratoses?
3717.   What is the best way to sedate someone on a respirator?
3718.   What is the best way to treat a pleural effusion in this 3-year-old with pneumonia?
3719.   What is the best way to treat a sinus infection in a patient allergic to Ceftin, penicillin and sulfa? Also has insulin-dependent diabetes.
3720.   What is the best way to treat acute respiratory distress in this child?
3721.   What is the best way to treat ingrown toenail? How do you destroy the nail matrix (bed)? What are the indications for destroying the nail matrix?
3722.   What is the best way to treat multiple plantar warts?
3723.   What is the best way to treat the vomiting and diarrhea associated with dysmenorrhea?
3724.   What is the best way to treat this perianal dermatitis with probably both a yeast and bacterial component? Already on medications for yeast.
3725.   What is the binomial distribution?
3726.   What is the bivariate normal distribution?
3727.   What is the bolused dose of morphine for a child who was on a drip?
3728.   What is the bottom line in terms of estrogen hormone replacement therapy since that New England Journal of Medicine article came out (Colditz, et al N Engl J Med. 332:1589)
3729.   What is the bulletin for patients with Crohn's disease and how do you get a patient on the mailing list for this?
3730.   What is the caffeine dose for spinal headache?
3731.   What is the captopril DTPA (diethylenetriamine pentaacetic acid) study and how is it done? Hospital X does not know what DTPA stands for even after looking at the package insert. DTPA is the isotope.
3732.   What is the cause and treatment of this old man's stomatitis?
3733.   What is the cause of her chest pain? What tests does she need?
3734.   What is the cause of her intermittent light headedness?
3735.   What is the cause of her sciatic nerve damage? Inflammatory? Mechanical? (Rheumatologist didn't really check mechanical.)
3736.   What is the cause of her symptoms (muscle spasms left leg, left foot pain, body feels twitchy and jaw feels like it's being pulled to one side)? Two days ago had febrile illness. Patient very symptomatic and upset.
3737.   What is the cause of this child's fever? Has been worked up recently at tertiary center and all was negative (virus). Mom came with record of fevers.
3738.   What is the cause of this long term memory loss?
3739.   What is the cause of this man's weight loss, hemoptysis, shoulder pain, night sweats? Can I find 2 or 3 things to put all this together?
3740.   What is the cause of this patient's tremor? What is a benign tremor?
3741.   What is the cause of this rash?
3742.   What is the cause of this rash?
3743.   What is the cause of this recurrent rash? This patient wants a "cure" for it.
3744.   What is the cause of this woman's long term head shaking (tremor)?
3745.   What is the cheapest anticholesterol agent (lipid-lowering agent)? Is there any reason not to always use it instead of the others?
3746.   What is the clinical significance of distant heart sounds? Can it be a sign of congestive heart failure (CHF)?
3747.   What is the clinical significance of mucous retention cysts in the sinuses? Could that cause a bad taste in the mouth when a patient yawns?
3748.   What is the common serum marker for ovarian cancer? I want to say carcinoembryonic antigen (CEA) but that's for colon cancer. I just don't remember.
3749.   What is the concentration of Tylenol #3 in liquid preparation?
3750.   What is the conservative treatment of tarsal tunnel syndrome?
3751.   What is the continuity correction for sample size determinations? (?Yates continuity correction)
3752.   What is the conversion for methadone? I want to stop using morphine and use methadone instead.
3753.   What is the conversion formula for potassium chloride (KCL) between milligrams and milliequivalents?
3754.   What is the correct dosage form of Retin-A cream?
3755.   What is the cost of Losartan?
3756.   What is the cubital tunnel syndrome?
3757.   What is the current protocol for management of abnormal Papanicolaou smears and colposcopy?
3758.   What is the current recommended immunization schedule for well babies? Specifically, should children get a total of three Hemophilus immunizations or four?
3759.   What is the currently recommended best treatment for bedwetting (enuresis)?
3760.   What is the currently recommended treatment for vaginal candidiasis?
3761.   What is the definition of alcoholism?
3762.   What is the diagnosis and treatment for multiple sclerosis?
3763.   What is the diagnosis for this rash that looks like impetigo, comes every April and May?
3764.   What is the diagnostic meaning of various tattoos? Specifically, a tear drop on the cheek and a cross in the web space between the thumb and index finger?
3765.   What is the diameter of a normal aortic root? This patient's aortic root was 45 millimeters on echocardiogram (ECHO).
3766.   What is the difference between a chalazion and a hordeolum?
3767.   What is the difference between a chalazion and a hordeolum?
3768.   What is the difference between a partial complex seizure and a major motor seizure?
3769.   What is the difference between a pingueculum and a pterygium?
3770.   What is the difference between antibiotic tolerance and resistance?
3771.   What is the difference between direct and indirect Coombs test and which is done in pregnancy and why?
3772.   What is the difference between ischemia, injury, and infarction on the electrocardiogram (ECG)?
3773.   What is the difference between lichen sclerosis and lichen simplex?
3774.   What is the difference between osteoporosis, osteopenia, and osteomalacia?
3775.   What is the difference between restless legs syndrome and nocturnal myoclonus?
3776.   What is the difference between short and long-term fetal heart rate variability and what is normal long-term variability?
3777.   What is the difference between the Denver II and the regular Denver Developmental Screening Test?
3778.   What is the difference between the Spearman and the Pearson correlation coefficient?
3779.   What is the difference between the glycohemoglobin (total) and the glycohemoglobin A1C on the Laboratory X report compared to the "glycosylated hemoglobin" we used to get from Laboratory Y?
3780.   What is the difference in price and otherwise between Cardizem, Cardizem CD and Cardizem SR?
3781.   What is the differential diagnosis and general information for chronic granulomatous disease?
3782.   What is the differential diagnosis and how do you treat gynecomastia?
3783.   What is the differential diagnosis and treatment for this child with encephalopathy and hepatitis?
3784.   What is the differential diagnosis for acidosis?
3785.   What is the differential diagnosis for elevated direct bilirubin?
3786.   What is the differential diagnosis for lymphocytosis in a new liver transplant patient?
3787.   What is the differential diagnosis for this rash?
3788.   What is the differential diagnosis of a lupus-like butterfly rash on the face?
3789.   What is the differential diagnosis of a patient with acute generalized rash and arthralgias?
3790.   What is the differential diagnosis of a patient with constant wetting and pyelonephritis?
3791.   What is the differential diagnosis of annular skin lesions?
3792.   What is the differential diagnosis of aphthous stomatitis (mouth ulcers) in a child?
3793.   What is the differential diagnosis of cyanosis?
3794.   What is the differential diagnosis of delirium and how do you work it up?
3795.   What is the differential diagnosis of fatigue?
3796.   What is the differential diagnosis of folliculitis?
3797.   What is the differential diagnosis of gynecomastia?
3798.   What is the differential diagnosis of left axis deviation?
3799.   What is the differential diagnosis of leg and ankle edema and how do you workup someone with edema?
3800.   What is the differential diagnosis of microcytic hypochromic anemia and is it related to sickle cell anemia?
3801.   What is the differential diagnosis of neonatal seizures and how do you tell them apart?
3802.   What is the differential diagnosis of night sweats and hyperhidrosis (excessive sweating) and how do you treat it?
3803.   What is the differential diagnosis of otalgia in someone with a normal ear exam?
3804.   What is the differential diagnosis of peripheral neuropathy and how would you work-up someone with a peripheral neuropathy, looking for the etiology?
3805.   What is the differential diagnosis of poison ivy? (lichenified single patch on neck)
3806.   What is the differential diagnosis of postauricular fold dermatitis?
3807.   What is the differential diagnosis of raised red papules on the posterior scalp in a 48-year-old man?
3808.   What is the differential diagnosis of sialorrhea?
3809.   What is the differential diagnosis of sinus tachycardia in a 10-year-old?
3810.   What is the differential diagnosis of someone with hypoxia, not dyspneic, normal chest x-ray, status post fractured hip, pH normal, pCO2 normal, PO2 56, nonsmoker?
3811.   What is the differential diagnosis, treatment, et cetera for Chediak-Higashi Syndrome?
3812.   What is the dosage for Fer-In-Sol (iron)?
3813.   What is the dosage for Questran? He wants to treat the bile gastritis. The drug is not FDA (Federal Drug Administration) approved for bile gastritis but the patient also has an elevated cholesterol so it should help that too as patient doesn't watch dietary intake (lots of fried chicken).
3814.   What is the dosage of Famvir for treatment of herpes simplex?
3815.   What is the dosage of Lodine?
3816.   What is the dosage of ursodiol?
3817.   What is the dose for this bacterial endocarditis prophylactic antibiotic?
3818.   What is the dose for this drip?
3819.   What is the dose of Acular (ketorolac) eye drops?
3820.   What is the dose of Amaryl?
3821.   What is the dose of Ancef?
3822.   What is the dose of Augmentin XR?
3823.   What is the dose of Azmacort?
3824.   What is the dose of Bactrim for this 40-pound child?
3825.   What is the dose of Ceftin?
3826.   What is the dose of Cefzil (cefprozil) for an 18-pound girl with otitis media?
3827.   What is the dose of Cipro for traveler's diarrhea?
3828.   What is the dose of Claritin?
3829.   What is the dose of Cotrim?
3830.   What is the dose of Dexedrine SR? What size do they come in?
3831.   What is the dose of Dilantin?
3832.   What is the dose of Famvir?
3833.   What is the dose of Famvir?
3834.   What is the dose of Famvir? I thought it was 500 milligrams three times a day but a recent New England Journal of Medicine article says 750 milligrams.
3835.   What is the dose of Flagyl for Gardnerella vaginitis?
3836.   What is the dose of Imodium?
3837.   What is the dose of Klonopin?
3838.   What is the dose of Lamisil?
3839.   What is the dose of Lasix?
3840.   What is the dose of Lasix?
3841.   What is the dose of Levsin drops for a 30-pound child?
3842.   What is the dose of Levsin?
3843.   What is the dose of Neurontin?
3844.   What is the dose of Pediacare in a 19-pound, 5-month old? It always says call your doctor below a certain age but what am I supposed to say? There's no information on it.
3845.   What is the dose of Pediazole for this child? It has been taken out of a reference.
3846.   What is the dose of Pediazole?
3847.   What is the dose of PremPro?
3848.   What is the dose of Premarin vaginal cream?
3849.   What is the dose of Reglan?
3850.   What is the dose of Sporanox?
3851.   What is the dose of Tamiflu (new medication, liquid form)?
3852.   What is the dose of Tamiflu?
3853.   What is the dose of Tapazole? This patient has a history of hyperthyroidism with Graves disease and hadn't taken anything for awhile. Thyroid level is elevated.
3854.   What is the dose of Tigan suppositories?
3855.   What is the dose of Toradol?
3856.   What is the dose of Trilisate?
3857.   What is the dose of Valtrex for cold sores?
3858.   What is the dose of Vanceril inhaler?
3859.   What is the dose of Vantin? (patient with a dog bite)
3860.   What is the dose of Vi-Daylin F/ADC + Fe (vitamin drops) for infants?
3861.   What is the dose of Zithromax for this 35-kilogram kid?
3862.   What is the dose of Zovirax for oral herpes?
3863.   What is the dose of Zyrtec for a 3-year-old?
3864.   What is the dose of acyclovir (for chicken pox)?
3865.   What is the dose of acyclovir?
3866.   What is the dose of amoxicillin in this 5-month-old who weighs 14lbs, 12oz?
3867.   What is the dose of aspirin needed to prevent TIAs (transient ischemic attacks)?
3868.   What is the dose of bromocriptine (Parlodel)?
3869.   What is the dose of captopril?
3870.   What is the dose of cholestyramine for diarrhea?
3871.   What is the dose of clindamycin for a 6-year-old with recurrent positive streptococcal sore throats?
3872.   What is the dose of compazine spansules?
3873.   What is the dose of erythromycin?
3874.   What is the dose of fentanyl?
3875.   What is the dose of fluoride?
3876.   What is the dose of glucophage (Metformin)?
3877.   What is the dose of griseofulvin?
3878.   What is the dose of imipramine for a 10-year-old boy?
3879.   What is the dose of iron in Poly-Vi-Sol?
3880.   What is the dose of medication for a child with asthma?
3881.   What is the dose of nasal ipratropium?
3882.   What is the dose of octreotide?
3883.   What is the dose of oral Lamisil?
3884.   What is the dose of penicillin for streptococcal sore throat?
3885.   What is the dose of propranolol?
3886.   What is the dose of propranolol?
3887.   What is the dose of propranolol?
3888.   What is the dose of steroids for a 2-year-old who is wheezing?
3889.   What is the dose of theophylline?
3890.   What is the dose range of Klonopin? Her chart says she's on 0.5. Is that good or bad?
3891.   What is the dose range of indapamide (Lozol)?
3892.   What is the drug Zyprexa? The patient brought it in with him and said his psychiatrist had put him on it (not in a prescription bottle, but a sample drug bottle).
3893.   What is the drug dosage for amoxicillin?
3894.   What is the drug dose of cefuroxime?
3895.   What is the drug dosing for amoxicillin?
3896.   What is the drug dosing for phenobarbital?
3897.   What is the drug dosing of this respiratory medication?
3898.   What is the drug of choice for enterococcus infections (not vancomycin-resistant Enterococcus faecium)?
3899.   What is the drug of choice for epididymitis?
3900.   What is the drug of choice for inpatient treatment of pelvic inflammatory disease? Is cefotetan and oral doxycycline adequate treatment?
3901.   What is the drug of choice for onychomycosis and would griseofulvin work since it is less expensive?
3902.   What is the drug of choice to start with in Type 2 diabetics (advantages and disadvantages of each)? Should they start with a sulfonylurea or some other drug for their diabetes? What combination of oral agents are okay to use?
3903.   What is the drug of choice to treat hypertension in someone with chronic renal failure?
3904.   What is the duration of breast feeding?
3905.   What is the duration of hemangiomas?
3906.   What is the earliest gestational age you can do a nonstress test?
3907.   What is the earliest gestational age you would use tocolysis for preterm labor?
3908.   What is the effect of Relafen on this patient who is on Coumadin for atrial fibrillation (also has congestive heart failure, arthritis)?
3909.   What is the effect of in-utero exposure to diethylstilbestrol (DES) on the male fetus?
3910.   What is the effect of oxygen therapy on cluster headaches. Patient requested this therapy based on past history of this treatment relieving his headaches. Several years ago his doctor in town X prescribed it and it helped.
3911.   What is the efficacy of monitoring fetal heart rates? We always do it.
3912.   What is the efficacy of scheduling ear rechecks in kids with otitis media and what should be the timing of doing it? Is it really necessary to see them back? If they have persistent fluid at 3 weeks, do they need antibiotics again or just observe?
3913.   What is the equation for glucose per kilogram per minute for intravenous infusion?
3914.   What is the equivalent dose of Synthroid for someone on Armour Thyroid 180 milligrams per day?
3915.   What is the etiology and associated findings of gastroschisis?
3916.   What is the etiology for a child with a limp?
3917.   What is the etiology of Klebsiella pneumonia?
3918.   What is the etiology of Moyamoya disease?
3919.   What is the etiology of anion gap acidosis?
3920.   What is the etiology of herpangina?
3921.   What is the euthyroid sick syndrome?
3922.   What is the evidence that "developmental care" is useful in newborn nurseries?
3923.   What is the evidence that bupropion works for depression and what is the dose?
3924.   What is the evidence that micronized progesterone works for PMS (premenstrual syndrome)?
3925.   What is the follow-up needed for a small head circumference?
3926.   What is the formula for anion gap? What causes anion gap and nonanion gap acidosis?
3927.   What is the formula to calculate the relationship between pH and pCO2?
3928.   What is the fractional excretion of sodium (FENa)? How do you calculate it and what is it good for?
3929.   What is the frequency for Bactroban (topical antibiotic)?
3930.   What is the frequency of deviated septum, and if it is say 30%, how many of them have problems related to it? This patient has had frequent sinus infections and is scheduled for surgery.
3931.   What is the full reference for the uniform requirements for manuscripts in Annals of Internal Medicine?
3932.   What is the general approach to metabolic disorders?
3933.   What is the general treatment for an asthma exacerbation? If a patient is resistant to normal treatment, what are other options?
3934.   What is the generic name of Protonix?
3935.   What is the half-life of this drug I want to use on a post operative heart patient?
3936.   What is the highest recommended dose of Avapro?
3937.   What is the histology of the endometrium while on oral contraceptives?
3938.   What is the ideal body weight for a 5-foot, 8-inch, 26-year-old woman?
3939.   What is the importance of left-atrial pressure in post-cardiac surgery patients? How do you manage these patients?
3940.   What is the incidence of dyspareunia after a vaginal wall cyst? This was removed about a year ago by a gynecologist and for the past year she has had this problem.
3941.   What is the incidence of hypothyroidism in a 13-year-old girl? Should I check a thyroid level because of her fatigue or not?
3942.   What is the incidence of single umbilical artery (two-vessel umbilical cord)?
3943.   What is the incubation period for Hepatitis A?
3944.   What is the incubation period of influenza A?
3945.   What is the initial response to coma in the emergency room (ER)?
3946.   What is the initial treatment for community acquired pneumonia in the adult?
3947.   What is the interquartile range and is it better to use the median and interquartile range versus the mean and standard deviation when you have a skewed deviation?
3948.   What is the lab work-up for gynecomastia?
3949.   What is the latest information about the treatment of adolescent migraines?
3950.   What is the latest you can do an abortion in Iowa? At what stage do you switch from suction curettage to some other method?
3951.   What is the least expensive cholesterol lowering drug? Dr. X usually uses Pravachol and Mevacor but they are expensive so thought he'd try Lescol.
3952.   What is the least sedating muscle relaxant?
3953.   What is the lesion in her mouth, lower gum, just in front of last tooth? Will biopsy next week.
3954.   What is the lifetime incidence of breast cancer and how much is this increased if you have fibrocystic breast disease?
3955.   What is the likely cause of hematuria (microscopic) in a 5-year-old boy whose father had gross hematuria in high school and college when he ran?
3956.   What is the lowest possible maintenance dose of prednisone for chronic obstructive pulmonary disease that will do anything rather than just a placebo effect? Is it just physiologic to give 1 milligram twice a day?
3957.   What is the maneuver called where you pull your hands apart to accentuate deep tendon reflexes? Sounds like "jendresik."
3958.   What is the maximum dose of Dynacirc?
3959.   What is the maximum dose of Ritalin in an adult?
3960.   What is the maximum dose of Vasotec?
3961.   What is the maximum dose of Zoloft?
3962.   What is the maximum dose of atenolol?
3963.   What is the maximum dose of digoxin? (patient seen in emergency room had digoxin level less than 0.03)
3964.   What is the maximum dose of ibuprofen? Can you give 800 milligrams four times a day?
3965.   What is the meaning of thrombocytosis in a 2-month-old?
3966.   What is the mechanism of edema in myxedema?
3967.   What is the mechanism of hypertension in coarctation of the aorta?
3968.   What is the medical term for a groin muscle pull? Is it a described entity? How do you diagnose it and how is it treated?
3969.   What is the minimum dose of Provera (progesterone) that you should use if you are using it cyclically for hormone replacement therapy?
3970.   What is the mnemonic for anion gap metabolic acidosis?
3971.   What is the most common etiology of hypothyroidism in a teenager?
3972.   What is the most effective remedy for ear wax?
3973.   What is the most effective, but easiest (considering her busy life) thing to do with temporomandibular joint syndrome?
3974.   What is the name and concentration of pediatric liquid prednisone? Liquid Pred?
3975.   What is the name of that accessory ossicle behind the talus on lateral ankle films?
3976.   What is the name of that diet pill that decreases the absorption of fat?
3977.   What is the name of that dimple in the lower back in infants that can be a sign of spina bifida?
3978.   What is the name of that eye drop that just stops itching but doesn't do anything for the allergy?
3979.   What is the name of that new drug that is like Prilosec? It has "acid" at the end of the name.
3980.   What is the name of that rash that diabetics get? Ends in "diabeticorum."
3981.   What is the name of that skin disease on the feet that produces moist skin and little holes?
3982.   What is the name of the device that pulls the patella medially in chondromalacia or patellofemoral pain syndrome?
3983.   What is the name of the lethal virus in the four corners area of New Mexico?
3984.   What is the name of the new cream you can use to treat genital warts (venereal warts, condylomata)?
3985.   What is the name of the ophthalmic drop that has ciprofloxacin in it?
3986.   What is the name of the syndrome that causes a preauricular lymph node along with a viral syndrome?
3987.   What is the name of the syndrome where you get a lot of seborrheic keratoses as a sign of internal malignancy?
3988.   What is the name of the systemic disease that gives brown lesions on the lips?
3989.   What is the name of the tendon (not the biceps) that comes across the anterior aspect of the shoulder?
3990.   What is the name of those cysts that can occur inside the lower lip? (mucus or mucous retention cysts)
3991.   What is the needle stick protocol to prevent human immunodeficiency virus (HIV) and Hepatitis B?
3992.   What is the new (3 hydroxy-3-methylglutaryl-coenzyme A) HMG Co-A reductase inhibitor (Lipitor, atorvastatin) that's supposed to be so effective and what is the dose?
3993.   What is the new asthma drug advertised on television lately (montelukast, trade name: Singulair)?
3994.   What is the new recommended dose of metronidazole for bacterial vaginosis just reported in the New England Journal of Medicine?
3995.   What is the new test to diagnose Legionnaires disease?
3996.   What is the next step in the workup of a patient with a high free T4 (free thyroxine) and a low thyroid stimulating hormone (TSH)?
3997.   What is the next step in the workup of amenorrhea if the patient has no bleeding with Provera? How do you workup secondary amenorrhea?
3998.   What is the normal Q-T interval? (QT interval)
3999.   What is the normal cerebrospinal fluid?
4000.   What is the normal flora of a hamster's mouth?
4001.   What is the normal hemoglobin value?
4002.   What is the normal liver span by percussion on physical exam?
4003.   What is the normal number of white blood cells (WBC's) in the cerebrospinal fluid (CSF)?
4004.   What is the normal peak expiratory flow rate to tell her when she uses her peak flow meter at home?
4005.   What is the normal ratio between crown to pubis and pubis to floor, and what would be consistent with Marfan syndrome?
4006.   What is the normal respiratory rate for a two-month-old who was born at 34-weeks gestation and just normal vital signs for infants in general?
4007.   What is the normal value of thyroid stimulating hormone?
4008.   What is the optimal treatment for a parapneumonic effusion?
4009.   What is the optimal treatment for depression during pregnancy? (this patient was on Paxil)
4010.   What is the optimum dose of penicillin for streptococcal sore throat in a 5-year-old boy?
4011.   What is the other drug besides Famvir and acyclovir for Herpes Zoster?
4012.   What is the outcome and treatment of nephrotic syndrome in children?
4013.   What is the over-the-counter cream she is using for her intertrigo? Sounds like "Tofenate."
4014.   What is the oxygen dissociation curve?
4015.   What is the pathway of the enzymes that is making this congenital adrenal hyperplasia abnormal?
4016.   What is the percent of success with various methods of endometrial biopsy (that is, getting the instrument into the uterus); for example, Pipelle vs Novak curette? Are there any predictive factors other than age that would predict not being able to pass the sound or Pipelle?
4017.   What is the percent of time that an ultrasound can tell if a breast cyst is really a cyst? ?75%, ? 99%, et cetera.
4018.   What is the pharmacy number and the regimen for micronized progesterone in PMS (premenopausal syndrome)?
4019.   What is the pivot-shift test?
4020.   What is the policy for post-exposure needlestick injuries?
4021.   What is the postcholecystectomy syndrome? What are the symptoms? How are the symptoms different from dumping syndrome? (Patient with epigastric pain when stomach empty since cholecystectomy; another patient with diarrhea.)
4022.   What is the practical value of neurobehavioral testing in the dementia patient?
4023.   What is the practicality of freezing sperm before you do a vasectomy? We got some information from the University but how long can you freeze sperm and still have it be good?
4024.   What is the prep (preparation) for a gallbladder ultrasound?
4025.   What is the procedure of choice to diagnose gallbladder disease -- not just stones, but nonfunction too -- ultrasound, oral cholecystogram, CT (computed tomogram)?
4026.   What is the prognosis for endometrioid cancer?
4027.   What is the prognosis for this premature baby with cardiac disease?
4028.   What is the prognosis of necrotizing enterocolitis (NEC)?
4029.   What is the prognosis of osteosarcoma?
4030.   What is the proper dose of Zithromax for this child?
4031.   What is the proper method of doing peritoneal dialysis for this patient?
4032.   What is the proper role of magnetic resonance imaging in the evaluation of low back pain if there are no obvious neurologic deficits?
4033.   What is the proper treatment for a dog bite?
4034.   What is the proper treatment for gastroesophageal reflux disease (GERD)?
4035.   What is the protein you can test to see if someone has type 1 or type 2 diabetes?
4036.   What is the protocol for giving oxytocin (Pitocin) to augment or induce labor?
4037.   What is the protocol for this patient's health maintenance organization for when I should see her back to follow up her otitis media? Am I supposed to see her in one month like I used to or 6 weeks or what?
4038.   What is the purpose for getting an alpha-1-antitrypsin level in a patient with emphysema, since there's nothing you can do about it anyway?
4039.   What is the recipe for the gastrointestinal (GI) cocktail?
4040.   What is the recommended evaluation of hemospermia (hematospermia)?
4041.   What is the recommended treatment for a fungal nail infection and how should you make sure that's what it is?
4042.   What is the reference for the article on arthrocentesis technique?
4043.   What is the reference that said fatty infiltration of the liver is the most common cause of mildly elevated liver enzymes?
4044.   What is the reference to iterative hypothesis testing in New England Journal of Medicine or JAMA?
4045.   What is the reference to that algorithm for diagnosing a pulmonary embolus and what is the strategy?
4046.   What is the reference to that article about whether histamine-2 (H2) blockers help prevent stress ulcers in intensive-care-unit (ICU) patients on respirators and what did it say?
4047.   What is the reference to that article on standardized reporting of statistics in medical articles?
4048.   What is the reference to that article on the consensus statement about treatment and prevention of kidney stones (renal lithiasis)?
4049.   What is the reference to that article on the improper use of power analysis after the results are known?
4050.   What is the reference to that article on what to do with abnormal liver function tests in apparently normal people? How do you work them up?
4051.   What is the reference to that article showing that many people with colds have sinus disease?
4052.   What is the reference to that article that said compazine (prochlorperazine) was effective for migraine?
4053.   What is the reference to that article that said it was unnecessary to give one day of oral antibiotics before hospital discharge to a patient who had been receiving intravenous (IV) antibiotics for an infectious disease?
4054.   What is the reference to that article that said oral iron was not needed during pregnancy?
4055.   What is the reference to that article that said to use estrogen even if after 20 years of menopause?
4056.   What is the reference to that book that has a differential diagnosis of skin lesions according to location?
4057.   What is the reference to that patient education sheet on prostate specific antigen (PSA) screening?
4058.   What is the reference to the article from tertiary center X on patient Y's cutis aplasia?
4059.   What is the reference to the article that says dehydration and starvation in a comatose or demented patient does not cause suffering?
4060.   What is the reference to the article that says you should do a limited abdominal computerized tomography (CT) rather than an intravenous pyelogram to confirm an acute kidney stone?
4061.   What is the reference to the book or article that says you should not use words like "significant" except to refer to statistical significance?
4062.   What is the reference to the directions that a husband should use for a precipitous emergency home delivery (unplanned)?
4063.   What is the reference to the guidelines for treating children in the emergency room with fever of unknown source?
4064.   What is the reference to the symptom score sheet for benign prostatic hyperplasia (BPH)?
4065.   What is the reference to those articles by Dr. X on characteristics of an effective researcher?
4066.   What is the relationship between the Bernoulli distribution and the binomial distribution?
4067.   What is the reticulin stain used for on a bone marrow?
4068.   What is the return on lumbosacral spine films for a patient with sciatica?
4069.   What is the right interval for checking the thyroid stimulating hormone level on patients on thyroid replacement, and if you make a change in dose, when should you check the thyroid stimulating hormone?
4070.   What is the risk of Down syndrome at various maternal ages?
4071.   What is the risk of dying from an intravenous pyelogram (IVP) that you should quote to a patient?
4072.   What is the risk of stroke in a 74-year-old woman with atrial fibrillation, not on anticoagulants?
4073.   What is the role of the primary care physician in the care of the patient with human immunodeficiency virus (HIV) infection? What health maintenance issues should be addressed?
4074.   What is the schedule for pneumococcal vaccine for a high-risk patient who is 4?
4075.   What is the sensitivity and specificity of straight-leg raising and other physical exam findings for herniated disks?
4076.   What is the sensitivity and specificity of the latest rapid streptococcal tests?
4077.   What is the sensitivity of the gonorrhea and chlamydia tests we do (PCR or whatever it is)? Most of the ones I get are negative but can we trust that?
4078.   What is the sensitivity of the prostate specific antigen?
4079.   What is the significance of Haemophilus Aegypticus on an eye culture in a neonate with conjunctivitis?
4080.   What is the significance of a 1 centimeter anterior fontanelle in a 4-month old?
4081.   What is the significance of achlorhydria?
4082.   What is the significance of an asymptomatic abdominal bruit over the left renal artery in a 48 year-old woman?
4083.   What is the significance of cervical mucus ferning in a nonpregnant patient? Does it occur normally at the time of ovulation?
4084.   What is the significance of mucin clot and fibrin clot on synovial fluid analysis?
4085.   What is the significance of premature ventricular contractions (PVCs) during an exercise challenge test? This patient had the same number at rest though.
4086.   What is the significance of sterile pyuria in a 2-year-old?
4087.   What is the significance of temperature instability, especially low temperature, as a sign of neonatal sepsis?
4088.   What is the significance of the Lachmann test?
4089.   What is the significance of yeast in a trachea aspirate?
4090.   What is the source of this right knee pain?
4091.   What is the standard workup for infertility and how do you use Clomid if the problem is anovulation? Do you need to check urinary luteinizing hormone (LH) while using Clomid?
4092.   What is the steroid treatment for poison ivy?
4093.   What is the strain pattern on electrocardiogram? What does it mean? How do you differentiate it from ischemia?
4094.   What is the strength of Atrovent nasal spray and can you use it for allergy symptoms as well as the common cold?
4095.   What is the success rate for Nissen Fundoplication by laparoscopy for gastroesophageal reflux?
4096.   What is the success rate for drug treatment for onychomycosis?
4097.   What is the surfactant dose for this infant?
4098.   What is the topical antibiotic of choice for conjunctivitis?
4099.   What is the trade name of ceftazidime? What generation cephalosporin is it? Is it a good treatment for COPD (chronic obstructive pulmonary disease) exacerbation?
4100.   What is the treatment duration for bacteremia (urinary-tract-infection source, Escherichia coli)?
4101.   What is the treatment for Helicobacter pylori in a 70-year-old patient with dyspepsia?
4102.   What is the treatment for alopecia areata?
4103.   What is the treatment for anaphylaxis? Do you give the epinephrine intravenously or subcutaneously?
4104.   What is the treatment for and how do you diagnose a sterile abscess versus a real abscess following an immunization?
4105.   What is the treatment for chondrodysplasia punctata?
4106.   What is the treatment for cryptosporidium?
4107.   What is the treatment for esophageal spasm?
4108.   What is the treatment for exercise-induced asthma?
4109.   What is the treatment for hemangiomas?
4110.   What is the treatment for hyperthyroidism due to Graves' disease?
4111.   What is the treatment for this rash?
4112.   What is the treatment for tri-iodothyronine thyrotoxicosis?
4113.   What is the treatment of choice for Giardia lamblia?
4114.   What is the treatment of osteosarcoma?
4115.   What is the treatment of rheumatoid arthritis in 1992? What are the possibilities for acute flares and for disease altering medications?
4116.   What is the treatment of tyrosinemia syndrome?
4117.   What is the treatment, if any, for a middle-aged man with inflammatory myopathy (creatinine kinases up to 3000, chronically) without symptoms for many years?
4118.   What is the upper limit of normal for the QRS duration?
4119.   What is the upper limit of normal of small bowel diameter on flat plate of abdomen? A quarter (the coin) is 2.4 centimeters.
4120.   What is the urological surgery technique?
4121.   What is the usual classification of hip fractures?
4122.   What is the usual cut-off age for colic?
4123.   What is the usual presentation and epidemiology of corpus luteum cysts?
4124.   What is the usual presentation of Henoch-Schoenlein Purpura?
4125.   What is the usual presentation of rheumatic fever?
4126.   What is the usual presentation of types of vasculitis?
4127.   What is the variance of a binomial proportion and how do you calculate confidence intervals for a binomial proportion of zero; for example, 0/24 = 0?
4128.   What is the work-up for urinary tract infections?
4129.   What is the work-up of an adolescent female with abdominal pain?
4130.   What is the workup and treatment of an elevated white count and no other symptoms?
4131.   What is the workup of lower abdominal pain in a 20-year-old?
4132.   What is the workup of suspected urinary tract infection?
4133.   What is this duplication of chromosome Number 9?
4134.   What is this lump on the thigh of this woman?
4135.   What is this opacity in the left lower lobe on chest film?
4136.   What is this protein allergy in breast feeding?
4137.   What is this rash (tiny papules on face of 2 1/2-year-old)?
4138.   What is this rash and what is causing it?
4139.   What is this rash in the axilla? It is probably eczema but could also be fungal.
4140.   What is this rash on his upper arms and legs?
4141.   What is this rash?
4142.   What is this rash? (Physician's assistant asked him, and he didn't know either.)
4143.   What is this rash? It's probably Rhus. Could be cutaneous larva migrans but I don't think so.
4144.   What is this thumb nodule? Wart versus foreign body?
4145.   What is this unusual rash?
4146.   What is time series analysis and how do you use it?
4147.   What is transient neonatal pustular melanosis? What does it look like? What do you do about it? (newborn skin lesions, vesicles, pustules)
4148.   What is unusual about this section of the shoulder blade x-ray? Or is it normal?
4149.   What is vestibulitis? How do you diagnose it and how do you treat it?
4150.   What is zolmitriptan (Zomig)? (like Imitrex)
4151.   What it the best way to deal with these little capillary things that occur on the face (for example, spiders and other capillary lesions)?
4152.   What kind of asthma inhalers are okay to use in pregnancy?
4153.   What kind of cardiac evaluation can you do in someone like this status post coronary artery bypass graft with terrible lungs who cannot do a regular treadmill?
4154.   What kind of clavicle fracture should not be treated by a family physician and should be treated by orthopedist?
4155.   What kind of iron studies does a patient need who is receiving daily iron therapy?
4156.   What kind of parathyroid hormone should you order if you want to rule out hyperparathyroidism?
4157.   What kind of penicillin do they give here in clinic for intramuscular injection?
4158.   What kind of rash is this?
4159.   What kind of skin lesions can Coumadin (warfarin) cause?
4160.   What kind of splint should you use for a buckle (torus) fracture in a child?
4161.   What laboratory studies do we do to work up a new leukemia patient?
4162.   What laboratory tests do we need to do for rhabdomyolysis?
4163.   What laboratory work do I need for an infertility workup? Patient is anovulatory.
4164.   What labs should you get to monitor someone with congenital adrenal hyperplasia?
4165.   What level of antibiotic should I use for enterococcus bacteremia?
4166.   What liquid prednisone tastes better? Pediapred or Prelone?
4167.   What liver function tests should we do?
4168.   What makes serum amylase and lipase high besides pancreatitis?
4169.   What malignancies and gene defects are associated with neurofibromatosis?
4170.   What medical problems and health maintenance things should you be aware of with someone with Down syndrome both as an adult and as a child?
4171.   What medication (and dose) do you need for a Factor IX deficiency?
4172.   What medications should be taken for these migraines?
4173.   What medicines can cause ankle edema? Can nonsteroidal anti-inflammatory drugs (NSAIDS)? Can calcium channel blockers?
4174.   What medicines does the patient need to be off before getting a captopril renal scan?
4175.   What metabolic work-up should a patient have with recurrent kidney stones?
4176.   What muscles attach to the greater trochanter?
4177.   What neonatal screening tests are done in Iowa?
4178.   What oral contraceptives are best for acne?
4179.   What order should the various colposcopy procedures be done? What are the possible abnormal findings? What percent acetic acid? When cytobrush? Bethesda system translation? Transformation zone versus squamocolumnar junction?
4180.   What organisms can cause pelvic inflammatory disease if you don't think it's sexually transmitted?
4181.   What partial thromboplastin time (PTT) level should we be shooting for in someone on heparin?
4182.   What percent of migraines have loss of vision associated with them? Is that the cause of her loss of vision? She lost all the vision in her right eye. Computerized tomography (CT) and labs were fine.
4183.   What percent of pregnant women have first trimester spotting without regard to outcome? Dr. X says 50%.
4184.   What percent of women bleed with continuous estrogen (0.625 milligrams) and Provera (2.5 milligrams) replacement therapy for menopause? If bleeding occurs is an endometrial biopsy necessary? Should a bone density be done first?
4185.   What percent of women on Norplant get irregular bleeding, amenorrhea, and so on?
4186.   What percentage of 3-year-olds toe in? Family history in both parents, mother wore corrective shoes.
4187.   What percentage of doctors fail to check renal function one week after starting an ACE (angiotensin converting enzyme) inhibitor and are now in jail for malpractice?
4188.   What percentage of kids get fevers with teething and do the medical books agree with the mothers?
4189.   What percentage of patients gain a lot of weight on Depo-Provera?
4190.   What percentage of sebaceous nevi are associated with basal cell carcinoma?
4191.   What postpartum follow-up on the mother should you do if she had gestational diabetes (GODM)?
4192.   What precautions should be taken for children on long term aspirin treatment?
4193.   What precautions should you take in someone with an elevated creatinine (chronic renal failure) in whom you want to do an abdominal CT scan, using intravenous (IV) or oral contrast?
4194.   What screening should be done for a patient with a family history of colon cancer?
4195.   What screening tests and procedures should be done with otherwise healthy adults?
4196.   What shots do I need to go to Egypt?
4197.   What should I be doing every year for an annual physical exam in terms of testing?
4198.   What should I do about a demyelinating disease? The patient and parents are concerned about its progressing.
4199.   What should I do about this bullous lesion found on sinus films?
4200.   What should I do about this patient's husband? Husband is symptomatic and wife has bacterial vaginitis. Doctor did a microscopic exam.
4201.   What should I do now with this new atrial fibrillation?
4202.   What should I do with this abnormal distal femur on x-ray (from an old fracture complicated by osteomyelitis)?
4203.   What should I do with this antinuclear antibody test (ANA) of 1:40 (normal <1:40) that one of my colleagues ordered? What is the significance of an ANA of 1:40?
4204.   What should I do with this man who complained of left neck fullness and now has a possible thrombosis on magnetic resonance imaging (MRI)?
4205.   What should I do with this man who has had a negative extensive workup for palpitations and chest pain?
4206.   What should I do with this organic-personality-disorder patient with a subtherapeutic Depakote level but who is clinically stable?
4207.   What should I do with this patient whose biopsy report shows carcinoma in situ of the vulva?
4208.   What should I know about herpes in neonates?
4209.   What should I know about infantile spasms?
4210.   What should I know about neonatal sepsis?
4211.   What should I know about partial complex seizures?
4212.   What should I know about twin-twin transfusion?
4213.   What should I order for subacute bacterial endocarditis prophylaxis on patient with allergy to penicillin pre-operatively?
4214.   What should I use for atopic dermatitis?
4215.   What should be included in a "sexually transmitted disease (STD) workup"?
4216.   What should be included in a preoperative evaluation (pre-op physical)?
4217.   What should be monitored for this kid that swallowed crack cocaine?
4218.   What should be monitored for this kid that swallowed crack cocaine?
4219.   What should the urine sodium be in someone with Addison's disease? Is 22 consistent?
4220.   What should we be doing about Group B streptococcal prevention, screening, and treatment in pregnancy?
4221.   What should we be doing to screen for lead in infants and children? What are the current recommendations of American Academy of Pediatrics, American Academy of Family Physicians, Centers for Disease Control?
4222.   What should we be telling pregnant women about calcium intake?
4223.   What should we be using for menopause (osteoporosis, heart disease protection, breast cancer protection, hot flashes): raloxifene (Evista, selective estrogen receptor modulators, SERM) versus estrogen versus bisphosphonates (Fosamax, alendronate)?
4224.   What should we do with this chronic migraine-type headache? Doesn't have insurance so we can't do a million dollar workup. Antidepressants didn't work.
4225.   What should we do with this patient that is behind on his vaccine-dosing schedule?
4226.   What should you do about a Grade 1 or 2 systolic heart murmur in an otherwise healthy newborn?
4227.   What should you do about a borderline positive treadmill (GXT)?
4228.   What should you do about a low-frequency hearing loss?
4229.   What should you do about a small focus of metaplasia seen on a stomach biopsy?
4230.   What should you do about a thoracic aortic aneurysm in an elderly patient?
4231.   What should you do about an ovarian cyst (corpus luteum cyst) in a perimenopausal woman?
4232.   What should you do about asymptomatic gallstones?
4233.   What should you do about borderline elevated AST (aspartate aminotransferase -- 54 (0 - 41) and ALT (alanine aminotransferase) -- 48 (0 - 45)? (on a chemistry panel, unexpected)
4234.   What should you do about hyperplastic polyps?
4235.   What should you do about the pancytopenia that can occur with alcoholism besides just withdrawing alcohol?
4236.   What should you do at the time of delivery if the partner of a pregnant patient develops genital herpes?
4237.   What should you do for asymptomatic carotid bruits or bruits in general? Folic acid?, Vitamin B1? Aspirin?
4238.   What should you do if a 9-month-old infant has no teeth that have erupted?
4239.   What should you do if a biopsied skin tag comes back "neurofibroma" on the pathology report?
4240.   What should you do if a newborn baby fails to void within the first 24 hours?
4241.   What should you do if a patient comes after trying to give blood, saying they tested positive for Hepatitis C virus?
4242.   What should you do if a patient has heavy bleeding while on Depo-Provera?
4243.   What should you do if a patient reaches into a toilet with a hand with lacerations when feces from a Human-Immunodeficiency-Virus-positive patient are in the toilet?
4244.   What should you do if a small lung nodule is noted on computerized tomography (CT) scan?
4245.   What should you do if an obstetric patient at 27 and 5/7 weeks notices decreased fetal movement?
4246.   What should you do if an obstetric patient has a family history of sickle cell trait (mother and father both have trait, brother has the disease)?
4247.   What should you do if an obstetric patient is exposed to Fifth disease (parvovirus, erythema infectiosum)?
4248.   What should you do if several members of a family get recurrent streptococcal sore throat?
4249.   What should you do if someone has dysfunctional uterine bleeding (intermenstrual bleeding) while on oral contraceptives?
4250.   What should you do if someone has inflammation on the Pap (Papanicolaou) smear and nothing else and they are asymptomatic and the report says "adequate for interpretation"?
4251.   What should you do if someone has postmenopausal bleeding on Premarin .625 milligrams and Provera 2.5 milligrams every day?
4252.   What should you do if someone thinks they might have thalassemia trait and they are pregnant?
4253.   What should you do if the Duffy antibody is positive in an obstetric patient?
4254.   What should you do if the Papanicolaou smear report says adequate for interpretation, no tumor cells, but white blood cells obscure much of the cellular detail?
4255.   What should you do if the Papanicolaou smear shows "cellular changes associated with Herpesvirus present. No tumor cells identified."?
4256.   What should you do if the colposcopy is inadequate (cannot see squamocolumnar junction)?
4257.   What should you do if the low-density-lipoprotein cholesterol (LDL) and total cholesterol are normal, but the high-density-lipoprotein cholesterol (HDL) is low and the triglycerides are high?
4258.   What should you do if the nonstress test (NST) is nonreactive?
4259.   What should you do if the pathology report of a nevus shows "mildly dysplastic" or moderate dysplasia? How should they be followed up?
4260.   What should you do if the umbilical cord fails to separate after 4 weeks?
4261.   What should you do if there has been a lapse in the hepatitis B vaccine schedule?
4262.   What should you do if there is a discrepancy between the Papanicolaou smear and the colposcopy biopsy results?
4263.   What should you do if you get a blood culture on a febrile child, send them home because they don't appear toxic, but the next day the blood culture is positive?
4264.   What should you do if you get back "disordered proliferative endometrium" on an endometrial biopsy in a postmenopausal woman on hormone replacement therapy having abnormal uterine bleeding?
4265.   What should you do if you have HPV (human papillomavirus) changes on cervical biopsy and nothing else? Do they need cryotherapy et cetera? Do they need counseling about condoms?
4266.   What should you do if you have a newborn with a vesicular rash and you suspect herpes?
4267.   What should you do if you have a patient with domestic abuse?
4268.   What should you do if you have periodic late decelerations but normal variability?
4269.   What should you do if you have poor variability but no periodic decelerations or other nonreassuring signs?
4270.   What should you do if you think you have someone with streptococcal sore throat who is resistant to penicillin?
4271.   What should you do in an obstetric patient if her RPR (rapid plasma reagent) comes back 1:8?
4272.   What should you do in terms of the asthma treatment protocol when you don't know what the personal best peak flow is and the patient comes in symptomatic?
4273.   What should you do to workup and treat possible sepsis in the newborn, for example in a baby whose mother was febrile during delivery (intrapartum fever, neonatal sepsis)?
4274.   What should you do to workup this back pain?
4275.   What should you do when a patient has low testosterone and erectile dysfunction? If you give testosterone injections, how should you follow the patient and when to get testosterone levels?
4276.   What should you do with AGUS (atypical glandular cells of undetermined significance)?
4277.   What should you do with ASCUS (atypical squamous cells of undetermined significance) on a Papanicolaou smear during pregnancy?
4278.   What should you do with a benign appearing adrenal mass that shows up unexpectedly on abdominal computerized tomography (adrenal incidentaloma)?
4279.   What should you do with a benign solitary thyroid nodule in a euthyroid patient?
4280.   What should you do with a bigeminal or trigeminal uterine contraction pattern?
4281.   What should you do with a blood lead level of less than 10 micrograms/milliliter?
4282.   What should you do with a green nipple discharge?
4283.   What should you do with a patient who has an asymptomatic carotid bruit?
4284.   What should you do with extreme bradycardia (35) in an asymptomatic adult?
4285.   What should you do with fetal tachycardia?
4286.   What should you do with someone who has a persistently high sedimentation rate but normal physical exam, CBC (complete blood count and chemistries (sedimentation rate 30-40)? 38-year-old woman with headaches daily.
4287.   What should you do with someone who is not getting better from epicondylitis after physical therapy and nonsteroidal anti-inflammatory drugs have not worked?
4288.   What should you do with sustained fetal bradycardia?
4289.   What should you give someone exposed to whooping cough (pertussis)?
4290.   What should you give to a patient in early latent phase or false labor to help her sleep?
4291.   What should you tell a medical student who may have amblyopia and keeps wanting to use her right eye to look at the patient's left eye?
4292.   What should you use for the "morning after pill" (also known as emergency contraception)?
4293.   What side effects from chemotherapy should I look for?
4294.   What signs do I look for when monitoring diabetic ketoacidosis?
4295.   What size package does Compazine come in?
4296.   What size pills does digoxin come in?
4297.   What size tube does Retin-A come in?
4298.   What size tube does Zovirax ointment come in?
4299.   What special precautions should you take with vaginal birth after cesarean (VBAC)? Should you manually palpate the uterine scar after delivery?
4300.   What stage colon cancer is it if there is extension to pericolonic fat but not lymph nodes?
4301.   What statistical method should you use if you want to see if there is a significant trend over time in the incidence of a disease? (time trend, secular trend, ecological trend study, temporal variation)?
4302.   What strength does amitriptyline come in? Specifically, does it come in a 50 milligram tablet?
4303.   What symptoms might this patient have? (Henoch-Schoenlein Purpura)
4304.   What syndromes are associated with short little fingers?
4305.   What test should be ordered to rule out mesenteric artery insufficiency?
4306.   What test should you order if you want to screen for lead poisoning? Blood lead level? Free erythrocyte protoporphyrin?
4307.   What test should you order to rule out pheochromocytoma (do you need to get all 3 tests: VMA (vanillylmandelic acid), metanephrines, catecholamines)?
4308.   What test should you order to rule out renovascular hypertension? Captopril renal scan?
4309.   What tests do we need to do to confirm that this is achalasia?
4310.   What tests should be done to screen for immune deficiency?
4311.   What tests should be ordered in someone with elevated transaminases to see if they have hepatitis?
4312.   What tests should be run for leukocyte adhesion deficiency?
4313.   What tests should you do on someone with Raynaud's phenomenon to rule out a collagen disease? What is the difference between Raynaud's phenomenon and Raynaud's disease?
4314.   What to do about parent who insists on antibiotics? Rapid streptococcal test was negative. Child has influenza with cough.
4315.   What to do for cough of 2 1/2 weeks duration? Have tried antibiotics, Proventil, antihistamines, prednisone. Nothing has worked.
4316.   What two- and three-drug combinations are reasonable to consider for hypertension?
4317.   What type of drug (what class of drug) is Baclofen?
4318.   What types of surgical procedures and treatments would you use on these patients with heart abnormalities? (tricuspid atresia and hypoplastic left heart)
4319.   What typhoid vaccine should we give children over age 2 years, going to India?
4320.   What virus causes common warts (verrucae vulgaris)? Is it a type of human papilloma virus (HPV)?
4321.   What virus is this?
4322.   What was causing her prolonged pyrexia? Laboratory work normal. Watched her (sat on it) for five months. Then noted neck mass.
4323.   What was on the film and how did it relate to a diagnosis of pneumonia?
4324.   What was that Web address with the rules for purified-protein-derivative (PPD) reaction and isoniazid (INH) prophylaxis for tuberculosis?
4325.   What was that brief article in JAMA about taking care of speakers?
4326.   What was that reference that said you didn't need to get a blood culture if the fever wasn't at least a certain level?
4327.   What was the outcome of the controversy about whether sodium in the diet aggravates hypertension?
4328.   What was the reference to that JAMA article on management of dysfunctional uterine bleeding?
4329.   What was the reference to that article about giving a prescription for an antibiotic that the patient would agree to fill only if they get worse or don't get better?
4330.   What was the reference to that article on not needing to do a chest x-ray on all patients after thoracentesis?
4331.   What was the reference to that article on unexplained crying in infancy?
4332.   What was the reference to that article that found that doing a rectal exam does not affect the prostate specific antigen?
4333.   What was the reference to that article that showed how confounding bias can make one of the best hospitals appear to be the worst?
4334.   What was the reference to that recent New England Journal of Medicine article about ranitidine to prevent upper gastrointestinal bleeding in the intensive care unit?
4335.   What was the reference to that recent New England Journal of Medicine article on not treating high serum cholesterol in the elderly? How high? How old?
4336.   What was the reference to the American Academy of Pediatrics statement about no capital punishment for child discipline about 10 years ago?
4337.   What was the reference to the New England Journal of Medicine article on intubating newly deceased patients?
4338.   What was the reference to the recent article about tetracycline for inflammatory arthritis?
4339.   What were Dr. X's recommendations for treatment of hypertrophied, lichenified thickened skin on the feet and cracked, fissured heels?
4340.   What were the circumstances of the recent deaths reported with sumatriptan (Imitrex)?
4341.   What were the three antihistamines mentioned in the newspaper that might cause cancer?
4342.   What workup, if any, is recommended (any official guidelines?) for single umbilical artery?
4343.   What would cause a decreased breast milk supply in a lactating woman?
4344.   What would cause a dry mouth (xerostomia) in an elderly woman with lung cancer and chronic obstructive pulmonary disease and only medication is digoxin?
4345.   What would cause a flare of acne in an adult?
4346.   What would cause a hard elongated thin transverse subcutaneous mass on the dorsum of the penis?
4347.   What would cause a high blood urea nitrogen (75) with a near normal creatinine (1.5)?
4348.   What would cause a high serum albumin?
4349.   What would cause a jaw tremor in an elderly woman?
4350.   What would cause a large penis, small testes, female body habitus?
4351.   What would cause a large posterior fontanelle?
4352.   What would cause a low alpha 1 globulin on a serum protein electrophoresis?
4353.   What would cause a low body temperature (95, 96 degrees) besides hypothermia?
4354.   What would cause a low diffusing capacity in a 38-year-old woman with dyspnea on exertion?
4355.   What would cause a low estriol but normal MSAFP (maternal serum alpha-fetoprotein) on triple screen?
4356.   What would cause a low lactate dehydrogenase and low alkaline phosphatase?
4357.   What would cause a low maternal serum AFP (MSAFP, maternal serum alpha-fetoprotein)?
4358.   What would cause a low mean corpuscular volume (MCV) with a normal hemoglobin and hematocrit?
4359.   What would cause a low platelet count (thrombocytopenia)? Can alcoholism do it?
4360.   What would cause a low serum albumin in a postpartum patient with endometritis?
4361.   What would cause a low serum iron and iron saturation with normal total iron binding capacity (TIBC) and normal ferritin and normal complete blood count (CBC)?
4362.   What would cause a low thyroid-stimulating hormone (TSH) and a low free T4 (thyroxine) in someone on treatment for hyperthyroidism?
4363.   What would cause a lucency surrounding the heart on chest film? Normal finding?
4364.   What would cause a man to have an intermittent cold arm and diffuse sweating?
4365.   What would cause a metallic taste?
4366.   What would cause a microcytic anemia with a normal ferritin but a low iron and total iron binding capacity (TIBC)?
4367.   What would cause a normal free T4 (free thyroxine) with a high thyroid stimulating hormone (TSH) in someone on thyroid replacement?
4368.   What would cause a patient to have a low free T4 (thyroxine) and a high TSH (thyroid stimulating hormone) when the hypothyroid patient is on Synthroid chronically (0.25 milligrams every day)?
4369.   What would cause a patient's index finger to gradually start twisting counterclockwise?
4370.   What would cause a red (ruddy) face or facial flushing and how should you work up facial flushing?
4371.   What would cause a red indurated isolated area on the lower leg? (panniculitis?, Erythema nodosum?)
4372.   What would cause a reduced gag reflex? Would alcoholism do it?
4373.   What would cause a right upper quadrant and epigastric bruit in an otherwise healthy 28 year-old woman?
4374.   What would cause a serum sodium of 199 in an asymptomatic person? Is that compatible with life?
4375.   What would cause a small anterior fontanelle (8 millimeters at 5 months of age)?
4376.   What would cause a solitary rectal ulcer?
4377.   What would cause a spontaneous pneumoperitoneum; that is, no perforated bowel, hysterectomy or exploratory laparotomy?
4378.   What would cause a urine sample to be loaded with tyrosine crystals in a 21-month-old with failure to thrive?
4379.   What would cause a widely split second heart sound with fixed splitting?
4380.   What would cause acute self-resolving dyspnea and cyanosis?
4381.   What would cause an edematous ankle with petechiae (purpura) (unilateral)?
4382.   What would cause an elevated free thyroxine (T4) and a normal thyroid stimulating hormone (TSH) (on or off replacement)?
4383.   What would cause an irregular pacer artifact in a pacemaker that's capturing normally?
4384.   What would cause an orange stain (brick dust) in the diaper of a newborn (nurse thought it was urate crystals in the urine)?
4385.   What would cause an ulcer on the nasal septum?
4386.   What would cause aspiration of contrast and failure to cough on a cookie swallow done for the chief complaint of dysphagia? How do you treat aspiration with failure to cough?
4387.   What would cause asymmetric breast tissue in a baby?
4388.   What would cause back pain following intercourse (ejaculation)? Would prostatitis do it?
4389.   What would cause breast pain (mastodynia) in a 44-year-old woman with desmoplasia on mammogram? How do you treat mastodynia?
4390.   What would cause breast pain (mastodynia) in a 63-year-old woman, not on estrogen?
4391.   What would cause brief myoclonic jerking in one leg in an infant? Would a benign myoclonus do this or should we be concerned about a seizure disorder?
4392.   What would cause bruxism (teeth grinding) in a 9-month-old and how do you treat it?
4393.   What would cause burning and tingling and urinary urgency after ejaculation? Would retrograde ejaculation do that?
4394.   What would cause calf pain in a 35-year-old woman with no history of trauma and no physical findings?
4395.   What would cause chronic exertional chest pain in a young adult or adolescent?
4396.   What would cause clear fluid coming from a vasectomy wound after the vasectomy is completed but before the skin is closed or dressing applied?
4397.   What would cause coccyx pain with no history of injury? X-ray last time showed coccyx deviated to left.
4398.   What would cause crepitus of the scapulothoracic joint and how would you treat it?
4399.   What would cause decreased rectal sphincter tone but an intact anal wink and otherwise normal neurologic exam?
4400.   What would cause diarrhea and fever in an adult?
4401.   What would cause difficulty in keeping clean in perianal area after a stool?
4402.   What would cause diffuse muscle weakness?
4403.   What would cause elevations of immunoglobulin G (IgG) and immunoglobulin A (IgA)?
4404.   What would cause eosinophilia on the complete blood count (CBC)? This patient had a chronic obstructive pulmonary disease (COPD) exacerbation and eosinophils were 19%.
4405.   What would cause episodes of vertigo, headache, and sweating occuring for 5 to 10 minutes at a time?
4406.   What would cause failure to thrive in a breast fed infant? Does some breast milk have insufficient calories? What to do if mother says milk supply is inadequate?
4407.   What would cause fatigue, shoulder aching, intermittent fevers, and hematuria in a 45 year old woman?
4408.   What would cause generalized itching (pruritus) especially on the palms and soles without a rash? Patient was on oral Prednisone.
4409.   What would cause global hypokinesis on an echocardiogram (ejection fraction 40%)? What kinds of cardiomyopathy are there?
4410.   What would cause hot flashes in a 44-year-old woman who is still having periods?
4411.   What would cause hyperreflexia in an otherwise healthy person?
4412.   What would cause hypokalemia besides diuretics?
4413.   What would cause intermittent distorted sounds (fuzzy, not clear) lasting 15 to 30 minutes to a full day, one to three times a week in a 44-year-old woman?
4414.   What would cause longitudinal ridging of the fingernails?
4415.   What would cause multiple small pigmented nevi in a bunch?
4416.   What would cause muscle pain in arms and legs and a high erythrocyte sedimentation rate (100)?
4417.   What would cause onycholysis and how do you treat it?
4418.   What would cause painful white cold fingers when the weather turns cold?
4419.   What would cause palmar erythema and pain in a 60-year-old woman with a history of mouth cancer?
4420.   What would cause postprandial pain and explosive stools with mucus that relieves the pain only when eating out?
4421.   What would cause recurrent episodes of scalp pain in a 37-year-old woman?
4422.   What would cause red raised nodular lesions on the legs of a patient with ichthyosis?
4423.   What would cause retrograde ejaculation?
4424.   What would cause scrotal or testicular pain after vasectomy and how do you treat it?
4425.   What would cause small kidneys on ultrasound in a patient with chronic renal failure?
4426.   What would cause sudden drenching sweats associated with lightheadedness (near-syncope), weakness, feeling hot? Is this a vasovagal episode?
4427.   What would cause swelling of the parotid glands?
4428.   What would cause testicular pain with no physical findings (orchialgia)?
4429.   What would cause the expulsion of air from the vagina other than a rectovaginal fistula in a normal woman?
4430.   What would cause thyroiditis and elevated liver function tests?
4431.   What would cause transverse nail ridging in a 31-year-old woman on her thumbnails? (photo taken)
4432.   What would cause trouble localizing sounds, even when the hearing itself is normal by pure tone audiogram?
4433.   What would cause unexpected urobilinogen on a urinalysis?
4434.   What would cause urinary retention (850 milliliter residual) in an elderly woman?
4435.   What would cause urinary retention in an elderly woman?
4436.   What would cause vaginal dryness besides menopause?
4437.   What would cause weight loss in a 16-year-old boy?
4438.   What would cause white fingernails for 4/5 and the distal nail is red (Terry nails) (patient with liver failure)?
4439.   What would make the positive control on a guaiac card not turn positive with the developer?
4440.   What would make the serum amylase very high (1300) but with a normal serum lipase?
4441.   What would the likely diagnosis be of a patient with chronic urticaria/angioedema and an ANA (antinuclear antibody) of 1200 with speckled pattern?
4442.   What's a good prenatal vitamin?
4443.   What's causing her hypersensitive gag reflex (obstetric patient)?
4444.   What's the best time to get an obstetric ultrasound for dating and also to see other things like the placenta? Some say 13 to 15 weeks. Some say to get one early and late.
4445.   What's the best way to dilate someone's eyes to examine the fundi?
4446.   What's the best way to treat diaper rash when it's not responding to silvadene and ketoconazole?
4447.   What's the dose of Compazine suppositories?
4448.   What's the dose of Duract (equivalent to 2 Percocet and it's a nonsteroidal anti-inflammatory drug)?
4449.   What's the dose of Losartan?
4450.   What's the dose of Tenuate and do they still make it? Patient interested. But Dr. X decided to use fenfluramine-phentermine anyway.
4451.   What's the dose of folic acid for someone who want's to get pregnant?
4452.   What's the name of the fracture when you pull off a piece of bone with the ligament?
4453.   What's the name of the medical supply company that will rent Wallaby lights for neonatal jaundice (hyperbilirubinemia)?
4454.   What's the percent of doctors who still use generics for first line treatment for otitis media?
4455.   What's the workup for a 26-year-old woman with weight loss?
4456.   What/how should the ventilator management be done for this patient who has had heart surgery?
4457.   When a porcine aortic valve (pig valve) fails, does it fail suddenly or gradually?
4458.   When and how often should you get Papanicolaou smears after doing cryosurgery for cervical dysplasia?
4459.   When can we discharge this premature baby?
4460.   When can we use this new gastrostomy tube for this patient with seizures?
4461.   When do I discharge this baby with jaundice?
4462.   When do we stop doing mammograms? What age?
4463.   When do you hear ventricular septal defect heart murmurs?
4464.   When do you need to do a thoracentesis for pleural effusion under ultrasound guidance versus when can you just do it at the bedside?
4465.   When do you switch from baby formula to childhood formula in a gastrostomy tube?
4466.   When do you wean a patient from a ventilator?
4467.   When does the danger of intracranial bleeding go up with thrombocytopenia? What are the indications for a platelet transfusion?
4468.   When does the incidence of Sudden Infant Death Syndrome (SIDS) go down (at what age)? I have a mother who is just paranoid. She has the monitor turned up so loud she can hear the baby breathing. Obviously she's not getting good sleep.
4469.   When does the incidence of testicular cancer fall off in terms of age? When is it OK to stop doing self exams?
4470.   When does the maximal swelling and deterioration occur after an intracerebral hemorrhage?
4471.   When giving measles vaccine to an adolescent, should you give just measles or MMR (measles-mumps-rubella)? If full MMR (measles-mumps-rubella), why?
4472.   When in the course of the illness is Parvovirus (Fifth disease) infectious to pregnant women?
4473.   When inducing or augmenting labor with oxytocin (Pitocin), what is the maximum dose you can give?
4474.   When is it all right not to convert atrial fibrillation (normal rate, no congestive heart failure)?
4475.   When is the onset of effectiveness when starting someone on Depo-Provera?
4476.   When making the argument for Poisson regression with small counts (example, mean of 2), why can't you invoke the central limit theorem as a reason to do simple linear regression?
4477.   When should I use DDAVP (desmopressin) for enuresis?
4478.   When should an infant with hydroceles be referred for surgery? (how old)
4479.   When should the chicken pox vaccine be given (what age)?
4480.   When should we be using troglitazone (Rezulin) for patients with diabetes? Which patients? How often to check liver enzymes?
4481.   When should you be concerned about frequent premature ventricular contractions (PVC's) in an adult?
4482.   When should you catheterize little boys since it can be pretty traumatic for them? (16-month-old) (He put bag on to collect urine.)
4483.   When should you do an ultrasound to look at the endometrial stripe versus an endometrial sample with a Pipelle on someone on hormone replacement therapy or someone with postmenopausal bleeding?
4484.   When should you get the electroencephalogram in a child admitted with a first seizure of unknown etiology?
4485.   When should you get vancomycin levels?
4486.   When should you suspect disseminated intravascular coagulation (DIC) and how do you treat it?
4487.   When should you use Humalog (insulin lispro) versus regular insulin?
4488.   When should you use carvedilol or other beta blockers (metoprolol) for congestive heart failure (CHF)?
4489.   When should you worry about a high hematocrit in a newborn? What is the definition of polycythemia in the newborn and what is the treatment?
4490.   When someone has a high white count secondary to demargination versus infection is the differential any help? Doctor X seemed to imply that with demargination the differential would remain normal rather than shift to the left.
4491.   When someone is being followed on Synthroid, what blood test should be ordered to be sure they are on the right dose?
4492.   When the total cholesterol is low, does it matter if the high-density-lipoprotein cholesterol is also low?
4493.   When treating someone with polymyalgia rheumatica, do you follow the erythrocyte sedimentation rate (ESR) or the symptoms?
4494.   When will inhaled insulin be available?
4495.   When would you use gemfibrozil rather than an HMG (3-hydroxy-3-methylglutaryl) coenzyme A inhibitor?
4496.   When you are trying to rule out pancreatitis, should you get a serum amylase or lipase or both?
4497.   When you do a lumbar puncture on someone with increased intracranial pressure, exactly what herniates and through what?
4498.   When you do a temporal artery biopsy, how long a segment should you get, and should you do both sides right off the bat?
4499.   When you do cytologic followup of CIN I (cervical intraepithelial neoplasia I), what should you do if the first, second, or third follow-up Papanicolaou smear shows low grade SIL (squamous intraepithelial lesion)? Repeat colposcopy? Return when?
4500.   When you do the Weber and Rinne' test, what frequency tuning fork should you use?
4501.   When you want to know the serum estrogen level, why do you get a follicle-stimulating hormone (FSH)?
4502.   Where can I find patient information on Hand, Foot and Mouth Disease?
4503.   Where can you get Sigvaris stockings and how do you order them?
4504.   Where can you go swimming in (name of town)?
4505.   Where do I go to work up a jaw mass?
4506.   Where do you find articles on tinnitus? Dr. X discussed referral but feels probably no one does anything to treat it and there are many people who have it.
4507.   Where is a patient handout on poison ivy?
4508.   Where is a picture of a plantar wart?
4509.   Where is a place for adult attention-deficit hyperactivity disorder (ADHD) in downtown Chicago?
4510.   Where is an article on asthma management?
4511.   Where is the Society for Developmental and Behavioral Pediatrics Web site and their fellowship directory?
4512.   Where is the ascending pharyngeal artery? (Prompted by a patient with a pulsating posterior pharyngeal mass)
4513.   Where would a stroke be located that involved a right facial palsy and dysarthria?
4514.   Whether or not to do a lumbar puncture on a febrile patient who had a seizure?
4515.   Which antibiotics do I need for this patient?
4516.   Which antibiotics should I use for treatment?
4517.   Which antidepressant has the least sexual dysfunction side effects?
4518.   Which antihypertensives do not work as well in African Americans?
4519.   Which bacterial endocarditis prophylactic antibiotics should I use?
4520.   Which blood pressure do you use as a baseline to compare, the first prenatal exam or the lowest second trimester blood pressure?
4521.   Which cranial nerve would make the palate raise asymmetrically when the patient says "Ahh"?
4522.   Which diabetics should get captopril to prevent renal failure? Just those with hypertension? Just early renal failure?
4523.   Which diarrhea drugs (and what doses) are recommended for travel in Mexico?
4524.   Which dose of Premarin is green?
4525.   Which drug that the Staphylococcus aureus (causing urinary tract infection) is sensitive to, would be safe in pregnancy?
4526.   Which drugs should we be using for this paralytic patient?
4527.   Which elderly patients with hyperlipidemia (elevated cholesterol) should not be treated with medications?
4528.   Which form of calcium is best to prevent osteoporosis? For $60 a month you can get sea shell calcium. Which is absorbed better?
4529.   Which guidelines do you follow regarding frequency of flexible sigmoidoscopies? Cancer society, Medicare, health maintenance organization's (HMO's), et cetera vary with their recommendations. Dr. X feels there should be uniform guidelines.
4530.   Which immunization should I give and when? (Prevnar, pneumococcal vaccine)
4531.   Which immunizations are okay to give during pregnancy?
4532.   Which incubation drugs and what doses does this patient need?
4533.   Which infants are candidates for Synagis (respiratory-syncytial-virus immune globulin) and when should it start?
4534.   Which is better for circumcision anesthesia, dorsal penile block or ring block?
4535.   Which is better for fever in children, ibuprofen (Motrin, Advil) or acetaminophen (Tylenol)?
4536.   Which is better to diagnose lumbar spinal stenosis or disc disease, computerized tomography (CT) or magnetic resonance imaging (MRI)?
4537.   Which is better, Biaxin (clarithromycin) or Zithromax (azithromycin)?
4538.   Which is better, Proscar or Hytrin, for benign prostatic hypertrophy?
4539.   Which is the drug of choice for male-pattern baldness (alopecia, hair loss), Rogaine (minoxidil) or Propecia (finasteride)?
4540.   Which is worse, decerebrate rigidity, decorticate rigidity, or flaccid?
4541.   Which medication is causing neutropenia in this baby?
4542.   Which test (culdocentesis or pelvic ultrasound) would be best for diagnosis of ovarian cyst in this case?
4543.   Which tricyclics have decreased orthostatic blood pressure effects?
4544.   Who should be screened for hypomagnesemia? What are the indications for ordering a serum magnesium?
4545.   Who should get carotid endarterectomy? What are the indications?
4546.   Who with polycystic ovary syndrome should get metformin?
4547.   Who with polymyalgia rheumatica needs a temporal artery biopsy?
4548.   Who with vertigo, no hearing loss and no tinnitus needs workup for acoustic neuroma (for example, magnetic resonance imaging)? How can you avoid an expensive workup and referral to otolaryngology with a patient with vertigo?
4549.   Who would be a candidate for Glucophage (metformin)? Do the risks of lactic acidosis outweigh the benefits for most people?
4550.   Why are his platelets so low? 27 is the lowest they have been. No petechiae or signs of bleeding noted.
4551.   Why are several different girls on different birth control pills?
4552.   Why can't this woman hear? A patient treated for otitis media recently. Now she says she feels better but she can't hear. The ear is not red and it moves well with the pneumatic otoscope, Weber lateralizes to the opposite ear.
4553.   Why did she get Coccidiomycosis? She's in her 60's, goes to Florida every winter.
4554.   Why did the cardiologist lower his Lanoxin from .25 to .125? He was doing well on the .25. Now he says he goes in and out of atrial fibrillation with a rate of 130 at home.
4555.   Why did the nurse circle the head circumference? "Is 48 centimeters big for a kids head?" This was a 3-year, 7 1/2-month-old girl.
4556.   Why did they cut out the expanding granuloma which was due to Coccidiomycosis immitis, rather than just treat it medically?
4557.   Why did this patient have epigastric abdominal pain with her last pregnancy that was so severe? She's spotting now with this pregnancy but the question relates to the last pregnancy.
4558.   Why do a bimanual exam when refilling oral contraceptives? Oral contraceptives reduce the incidence of ovarian cysts, so why do it?
4559.   Why do all the textbooks say that the Poisson distribution is most applicable when analyzing rare events?
4560.   Why do elderly people sometimes get disoriented, confused, agitated shortly after hospital admission? Is it latent Alzheimer's disease?
4561.   Why do parents always say they come up short by a day or two on the antibiotic prescription?
4562.   Why do people get nephrotic syndrome? What causes it?
4563.   Why do phenobarbital and Dilantin counteract each other?
4564.   Why do we get so much junk mail?
4565.   Why do we need to do a coned-down x-ray of the sella turcica in amenorrhea/galactorrhea if the prolactin is normal?
4566.   Why do we treat goopy eyes with antibiotics when we don't treat goopy noses with antibiotics?
4567.   Why do you need to get NAPA (N-acetyl-procainamide) levels as well as procainamide levels?
4568.   Why do you need to get an Anti-HBc (hepatitis B core antibody) instead of just hepatitis B surface antigen (HBsAg) in someone suspected of having acute hepatitis?
4569.   Why does alcoholism cause hypoglycemia? (blood sugar = 13)
4570.   Why does alkalinizing the urine help in patients with rhabdomyolysis?
4571.   Why does he drop his oxygen saturations while he eats? Is it reflux?
4572.   Why does he feel cold all the time?
4573.   Why does he have a pleural effusion? 69-year-old man came in for eye exam, but complained of trouble breathing, et cetera so eye exam postponed.
4574.   Why does he have an itchy scalp? Has Parkinson's and is on Sinemet.
4575.   Why does he have eye pain and blurred vision (referred to ophthalmologist)?
4576.   Why does risperdal work for autistic regression and how do you know which cases it will work for?
4577.   Why does she have these tachycardia spells (was 120, 130 by her report, now 90)?
4578.   Why does the X Hospital laboratory check for ascorbic acid in the urine?
4579.   Why does the calcium tend to fall when the phosphorus rises in kidney failure?
4580.   Why does the prenatal amniocentesis questionnaire ask if the patient is Asian, Pacific Islander or Alaskan Eskimo?
4581.   Why does this 9-year-old male have urinary frequency? No painful urination and urinalysis negative.
4582.   Why does this infant have hyponatremia? (messed up sodium levels, low)
4583.   Why does this lady get so short of breath even though her pulmonary function tests are normal? I really think she has asthma with normal pulmonary function tests. How do I investigate further?
4584.   Why does this patient have hair loss?
4585.   Why does this patient have hypocalcemia? Is it part of why he feels poorly?
4586.   Why is Opticrom still off the market?
4587.   Why is he falling asleep in school? Apparently he is fine on weekends and in the evening.
4588.   Why is he having rectal bleeding?
4589.   Why is her ferritin high and why is she anemic (Hemoglobin 11.0, Ferritin high at 292, total iron binding capacity normal)?
4590.   Why is his protime so different from time to time on the same dose of Coumadin?
4591.   Why is it helpful to know both the percent and absolute CD4 (cluster of differentiation 4) count in an HIV (human immunodeficiency virus) patient?
4592.   Why is she fatigued? This is follow-up visit. Automated blood count abnormal but done by hand was normal. Doing thyroxine today since thyroid stimulating hormone was elevated. Patient smokes 1 1/2 packs per day. Trying to cut back.
4593.   Why is she having pelvic pain?
4594.   Why is she hypoglycemic? No history of diabetes. She tests her sugars at home and they are 50 to 60.
4595.   Why is the respiratory drive of someone with COPD (chronic obstructive pulmonary disease) driven by pO2 rather than PCO2?
4596.   Why is there an increasing incidence of asthma, just in general?
4597.   Why is there desaturation in this hypoplastic left heart when all other signs are normal?
4598.   Why is there so much recent interest in magnesium levels?
4599.   Why is this patient continuing to go "down hill"? Two cardiologists have seen her and have not come up with the answer. Maybe her potassium is low or digoxin is high. She refuses Captopril.
4600.   Why is this patient still having discomfort in multiple areas? History of motor vehicle accident a couple of months ago, has seen orthopedist, and tests have been negative. I discovered a bone scan has not been done.
4601.   Why should a 13-year-old be suffering from respiratory distress secondary to croup?
4602.   Why should you avoid sunlight if you're on amitriptyline? That was written on a patient's pill bottle.
4603.   Why was Felbatol (felbamate) taken off the market?
4604.   Why wasn't this patient very sick? (patient with large empyema and Haemophilus influenza in sputum, no growth from empyema fluid.)
4605.   Why would anyone do a total abdominal hysterectomy and bilateral salpingo-oophorectomy on a woman in her 20's with adenomyosis?
4606.   Why would someone have a large abdomen with a large pannus but normal size arms and legs?
4607.   Why would someone have generalized pruritus at the midpoint of their menstrual cycle?
4608.   Why would someone with rhabdomyolysis have a low serum albumin?
4609.   Why would you use an alpha and beta blocker like Coreg for heart failure?
4610.   Why would you want to get a plasma potassium level as opposed to a serum potassium level?
4611.   Will Inderal interact with her other medications? (Depakote, Asacol, Phenergan, Lorazepam, Levsin, Darvocet N)
4612.   Will be married in November and period is due to fall on wedding day -- could she be put on birth control pills to change her period date? Is two months enough time to effect this change?
4613.   Will the birth of twins at 37 weeks mean she will deliver earlier this time even though she now has a singleton?
4614.   Will the fumes created by taking off a basal cell carcinoma with cautery affect the physician taking it off?
4615.   Will the urine still be good for culture if it sits overnight in the refrigerator before going to the reference laboratory?
4616.   Will trimethoprim/sulfamethoxazole work for Group A beta hemolytic streptococcal sore throat?
4617.   With a 6-month to 12-month old infant, how do you supplement their diet if the mother is a vegetarian and wants her child to also be a vegetarian? How do you give them enough protein?
4618.   With polio vaccine, do they need a total of 4 as long as one is after 4 years of age? Or let's see, how did it go? She got 4 inactivated polio vaccines but the question was, is it that you need a total of 4 or does 1 have to be after 4 years old?
4619.   With pulmonary embolus, where does the money lie? Spiral computerized tomography or ventilation perfusion scan? Which is most cost effective? Has it been proven which way to go?
4620.   With tinea pedis and tinea manus (fungal skin infections) is it one foot and two hands or one hand and two feet that are usually involved?
4621.   Woman fractured her humerus. Has a history of desmoid tumors. What are desmoid tumors?
4622.   Woman got an echocardiogram this morning. "Biventricular thickening, might consider amyloidosis." How is it that I workup amyloid and is it worth it?
4623.   Woman here for her Depo-Provera shot. The nurse got a blood pressure about 160/95 and pulse about 110. Referring to the elevated blood pressure, the study physician said to the nurse, "I don't think that's a contraindication is it?"
4624.   Woman in early 30's with chest pain. I know in my gut she doesn't have heart disease, but I had a woman in her 20's who died of a myocardial infarction. How far do you go with the workup? Doctors practice medicine according to their last disaster.
4625.   Woman in her 20's with a mole on her arm, scared of needles. I'm looking up EMLA (Eutectic Mixture of Local Anesthetics). I (investigator) asked her, "What is the question? The dose or . . . " She answered, "The dose and how long to apply it before giving the xylocaine injection."
4626.   Woman in her 30's from China had a gallbladder polyp discovered there, 7 millimeters. She came asking for a followup ultrasound. I told her I wasn't sure that was necessary, but later I looked it up on a medical Web site to see if she needed a cholecystectomy or followup.
4627.   Woman in her 90's fell and has a nondisplaced supracondylar fracture. Is it appropriate to not operate on this woman? Her only use of the leg is to pivot on it for transfers.
4628.   Woman in her 90's with pulmonary fibrosis and Clostridium difficile colitis, not taking anything by mouth. I had to remind myself that Flagyl given intravenously would still cover Clostridium difficile.
4629.   Woman in her 90's. Is there a mass in her cecum? At her age, if there is a mass, should she undergo a major surgery? She has had RLQ pain for about a year that she hasn't mentioned before. She refuses barium enema.
4630.   Woman in her late 40's. My question is, in someone who's asymptomatic with an elevated erythrocyte sedimentation rate, is there any study that tells you or gives you an . . . I don't know how to phrase it.
4631.   Woman said, "By the way, I've been having these funny pains in my chest." History of motor vehicle accident, transection of thoracic aorta repaired, has not talked to the surgeons in 10 years. Do I need to follow up and what schedule to follow?
4632.   Woman thought to be 4 weeks gestation having bright red vaginal bleeding, gravida 3 para 0. Question: Is she having a miscarriage and what steps should be taken?
4633.   Woman with acute vertigo and falling to the left. (She had a head magnetic resonance imaging.) "Was there any significance of the . . ." asymmetry of the transverse sinus, right dominant?
4634.   Woman with polycythemia vera, feels well except for itching, tearing herself apart. The itching is part of her disease but how do you treat it?
4635.   Woman with sodium of 128. Do I put her in the hospital or treat her at home?
4636.   Would Fosamax help the osteoporosis that comes from chronic steroid use? He's on chronic steroids for his chronic obstructive pulmonary disease.
4637.   Would Vitamin B12 help this patient feel better (on chemotherapy for breast cancer)?
4638.   Would a brain tumor elevate the gamma-glutamyl transferase and cause a low albumin?
4639.   Would her uterus be larger this time at 12 weeks than it normally would since she had twins last time?
4640.   Would hyperventilating cause a low serum CO2 (bicarbonate)? Or what would cause this unexpectedly?
4641.   Would it be better to put her on a potassium sparing diuretic or just potassium?
4642.   Would melatonin be indicated for insomnia?
4643.   Would the use of nitric oxide in this cardiac patient be beneficial?
4644.   Would you taper Zoloft or just stop it?
4645.   Yesterday I admitted a 3-year-old boy with a fever of 105 degrees. His white count was 59,000. I had to look at the algorithm on fever in kids with unknown source. I had to remind myself about the recommended management.
4646.   Yesterday I saw a 15-year-old girl with shingles. I sent her to the dermatologist because it was an atypical presentation, since she was only 15, so I was wondering whether it could be an immune deficiency.
4647.   Yesterday I saw a 4 year-old girl with trichotillomania. Mom said, can you use Benadryl?
4648.   Yesterday our chief resident got a call from the local newspaper wanting to know our position on circumcision because he wanted to start an anticircumcision group.
4649.   You were going to do a rectal exam because of his high prostate specific antigen but would you do anything at age 78?
4650.   Young lady on oral contraceptives, obese, had a pulmonary embolus. "How long to continue Coumadin?"
4651.   Young man on Paxil. He's on 20 milligrams once a day. He wants samples. We have samples of the extended release but not the regular. "Let me see what's equal."
4652.   Young woman seen last week got infectious mononucleosis at the beginning of summer and still feels bad after 6 to 8 weeks. She realizes her summer is gone and now has to go back to college. I think she's depressed. How common is depression after infectious mononucleosis?
4653.   Young woman with acute Fifth disease (son also has it). She is not pregnant. She has increased swelling of her hands and her arms go numb and she has trouble sleeping. Wants to know what to do.
4654.   meningomyelocele - outcome, treatment, and general overview of the problem.
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