Primary Care

Endocrinology · Johns Hopkins Endocrinology and Pituitary Center

Well, the study you are referring reports that "younger patients were more likely to present with abdominal striae, acne, facial rounding, hirsutism, menstrual irregularities, and weight gain". Obviously, menstrual irregularities cannot be seen in postmenopausal women. As for the rest, I am not sure...

Is there a role for empiric scabies treatment in itchy patients without clear clinical signs of scabies?

5 Answers

Dermatology · Forefront Dermatology

I have seen many astute clinicians miss scabies or consider it after months of treating for AD with biologics and other systemics (including myself). Though this is very rare my personal rule of thumb is to treat with oral ivermectin if at any point patient is not responding the way I expect to trea...

What additional therapies can be helpful for vaginal dryness causing dyspareunia in premenopausal woman already using lubrication?

Primary Care · University of Washington

Lubricants are a good first-line option and are used as needed with sexual activity. The two main types recommended are water-based or silicone-based lubricants. Water-based lubricants are generally safe to use with condoms and sex toys and are easy to clean. They may also dry out more quickly and r...

How have you integrated the new HPV self-swab collection into your routine cervical cancer screening, particularly in those with prior abnormal results?

Primary Care · Montefiore Wakefield Ambulatory Care Center

Unfortunately, the new HPV self-swab collection is not currently available in my institution, but I would definitely incorporate this into my routine cervical cancer screening if it were an option! I think the HPV self-swab option is ideal for patients who are either not amenable to a pelvic exam or...

How have you integrated the new HPV self-swab collection into your routine cervical cancer screening, particularly in those with prior abnormal results?

Primary Care · Montefiore Wakefield Ambulatory Care Center

Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?

Rheumatology · U of AZ Phoenix Dept of Orthopaedics

I think a young male with multiple minimal trauma vert fractures and low BMD is appropriate to consider anabolic therapy. Of course, a thorough workup needs to be done to determine if there are any treatable causes of bone loss. If it is determined that he has “idiopathic osteoporosis” then treatmen...

What are your criteria for starting tolvaptan in adult patients diagnosed with autosomal dominant polycystic kidney disease?

Nephrology · UCSF

This question is probably a bit too broad to answer in detail here, but in broad strokes, depending on the age, imaging criteria (Mayo class / total kidney volume), and kidney function of the patient, as well as other clinical factors, you assess the patient's risk of rapid disease progression to ma...

How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?

Hematology · Mayo Clinic

Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.

Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?

Endocrinology · Duke University Hospital

I would offer a third year of a PTH analogue if the BMD response is less than a -2.5 T Score. I would follow quarterly serum calcium levels and a BMD for 1 year to assess the effects.

What criteria do you utilize in deciding when to treat or not treat frequent VPC’s?