Author Archives: John

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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VA Resident Report: What is the effectiveness of POEM for achalasia?

Available data suggests POEM is very effective in the relief of symptoms in patients with achalasia. However, POEM is associated with a very high incidence of pathologic reflux. The clinical sequalae of the increase in pathologic reflux are currently incompletely … Continue reading

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VA Resident Report: Review of Fournier’s gangrene

The Bottom Line: Fournier’s gangrene is a progressive necrotizing soft-tissue infection (NSTI) of the external genitalia and/or perineum. It is a urological emergency requiring prompt diagnosis and treatment — even with administration of parenteral broad-spectrum antibiotics and expedited aggressive surgical debridement, the disease … Continue reading

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VA Resident Report: What is the mechanism of metabolic alkalosis with villous adenoma?

The Bottom Line: When diarrhea is the cause of metabolic alkalosis, rather than acidosis, the mechanism is determined by measuring the electrolyte content in stool. Large losses of chloride may occur in patients who have villous adenomas or other secretory … Continue reading

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VA Resident Report: What are the adverse effects of PPI use on B12 levels?

The Bottom Line: Studies of PPI use and vitamin B12 deficiency have yielded mixed results. Absorption decreased from 3.2 to 0.9% (P ¼ 0.031) in patients on omeprazole 20 mg daily, and from 3.4 to 0.4% in patients on higher … Continue reading

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VA Resident Report: How many recent instances of Acute Rheumatic Fever in the United States?

The Bottom Line: Acute rheumatic fever is no longer a nationally notifiable disease in the United States, and its annual incidence in the continental United States declined in the late 20th century to approximately 0.04–0.06 cases per 1,000 children. Exceptions … Continue reading

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VA Resident Report: How often does endocarditis cause ANCA positivity?

The Bottom Line: Infective endocarditis remains a serious condition. In previous series, the clinical features, etiology, complications, and outcome have been documented in patients with IE, which resulted in most appropriate therapies, although mortality remains high in these patients.  Interestingly, few … Continue reading

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