Author Archives: John

VA Resident Report: What is the distribution of arthritis associated with systemic infection?

The Bottom Line: Staphylococcus aureus is the main cause of septic arthritis involving native joints, although many other organisms are encountered also. In our center, neither the distribution nor the antibiotic susceptibility profiles of the causative organisms changed significantly over … Continue reading

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VA Resident Report: How to properly remove a tick

How to remove a tick Centers for Disease Control and Prevention June 1, 2015 Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Pull upward with steady, even pressure. Don’t twist or jerk the tick; … Continue reading

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EUHM Resident Report: What is the relation of bilirubin levels to jaundice abnormalities?

The Bottom Line: Jaundice occurs when there are disruptions along this metabolic pathway, causing  an increase in unconjugated bilirubin (e.g., from increased red blood cell destruction or impaired bilirubin conjugation) or conjugated bilirubin. Figure 1.  An algorithmic approach to the … Continue reading

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EUHM Resident Report: Signaling in Stauffer’s Syndrome

The Bottom Line: Against a fundamental contribution for IL-6 in Stauffer’s syndrome is the wide variety of circumstances in which its elevation has no association with inflammatory or cholestatic liver disease. Nevertheless, dysregulated Il-6 acting through disparate signaling cascades is … Continue reading

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VA Resident Report: What is the management strategy of Kaposi Sarcoma and pneumocystis pneumonia in a HIV positive patient?

The Bottom Line: The management of pulmonary KS is challenging. There is a risk of precipitating IRIS upon initiating cART. Chemotherapy can also cause further immunosuppression and increase the risk of further infections. In many of these patients, initiation of … Continue reading

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EUHM Resident Report: What is the correlation of HSV encephalitis and intracerebral hemorrhage?

The mechanism of hemorrhagic complication in HSV encephalitis is unclear. The possible mechanisms  include small vessel rupture due to vasculitis and transient hypertension caused by increased intracranial pressure. Gyral pattern of the hemorrhage may suggest that the hemorrhagic complication in … Continue reading

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EUHM Resident Report: How to handle difficult patient situations?

Difficult encounters are estimated to represent 15 to 30 percent of family physician visits. Factors contributing to these difficult clinical encounters may be related to the physician, patient, situation, or a combination. Physicians can recognize these visits as challenging by … Continue reading

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