Dr Good Dr Bad-eMediNews:Health & Medicine Updates

Saturday, May 18, 2013 | Updated 14:22 IST

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Situation: A diabetic patient with uncontrolled diabetes came with cognitive impairment.

Dr Bad: This is dementia and nothing can be done. Dr Good: Control your blood sugar. Lesson: An analysis of over 3,000 individuals with established type 2 diabetes demonstrates a clear age–adjusted inverse relationship between cognitive function and the degree of chronic hyperglycemia as measured by A1c lMore...

Situation: A child came with focal convulsions with onset of high–grade fever.

Dr Bad: These are simple febrile convulsion. Dr Good: These are not simple febrile convulsions. Lesson: Simple benign febrile convulsions are always generalized.
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Situation: A 39–year–old male with community–acquired pneumonia came for OPD treatment.

Dr Bad: You need admission for IV ceftriaxone therapy. Dr Good: Take levofloxacin 500 mg orally. Lesson: A prospective, randomized, multicenter trial of 599 adults with community-acquired pneumonia who could be treated as an outpatient or in the hospital compared the efficacy of levofloxacin (500 mg IV or orally daily) to ceftriaxone (1 to 2 g IV once or twice daily) and/or cefur
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Situation: A 44–year–old male came with painless blood in the urine.

Dr. Bad: Do not worry. Dr. Good: I need to rule out cancer of the urinary bladder. Lesson: Cancer of the urinary bladder usually presents with painless blood in the urine.
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Other Dr Good Dr Bad Article

Situation: A 32–year–old man with sustained fever of 102°F for 2 weeks in whom the diagnosis was not
Dr Bad: Manage him as a case of PUO. Dr Good: Investigate further. Don’t diagnose PUO yet. Lesson: Pyrexia of unknown origin (PUO) is said to occur in patients with sustained fever of =101°F for 3 weeks in whom the diagnosis is not apparent after one week of diagnostic studies.More »

Situation: A patient of asthma was put on tiotropium.
Dr. Bad: Stop it. Dr. Good: Continue it. Lesson: The addition on tiotropium to low–dose, inhaled steroids has been shown to improve asthma control in many studies.More »

Situation: A patient with heart failure came for cardiac evaluation.
Dr. Bad: Get Echo done. Dr. Good: Go for Tissue Doppler Echo Lesson: A patient with heart failure must go for Tissue Doppler Echo for evaluation of diastolic functions.More »

Situation: A patient with Chikungunya was found to have high ESR.
Dr. Bad: It may not be Chikungunya. Dr. Good: This is Chikungunya. Lesson: High ESR is seen in Chikungunya.More »

Situation: A patient with fever and joint pain came with rash.
Dr Bad: It’s a drug allergy. Dr Good: It looks like Chikungunya. Lesson: Rash is present in 30% of cases with Chikungunya.More »

Situation: A female with rheumatoid arthritis became pregnant while taking leflunomide.
Dr. Bad: You can continue to take it. Dr. Good: Stop it immediately. Lesson: In women with rheumatoid arthritis who become pregnant while taking leflunomide, healthy pregnancy outcomes usually occur, if the drug is discontinued at the earliest and a cholestyramine drug elimination procedure is done (Arthritis Rheum 2010;62:1494)More »

Situation: A patient with fever and low TSH had ESR > 100.
Dr Bad: It’s TB. Dr Good: This is thyroiditis. Lesson: Thyroiditis typically has very high ESR and low TSH.More »

Situation: A diabetic with A1c 6% had a BP of 130/88 mmHg.
Dr Bad: This is very good control of diabetes. Dr Good: This is very good control but we also need to control BP. Lesson: Cardiovascular morbidity can only be reduced with aggressive management of hypertension, cholesterol (LDL <100 mg/dL) and aspirin (75–150 mg/day) in patients with or at high risk for cardiovascular disease.More »

Situation: A patient had a strong family history of cancer.
Dr Bad: Just get regular check ups. Dr Good: Take low dose aspirin. Lesson: A new observational analysis published online in the Lancet reports that long–term daily aspirin reduced death due to several common cancers. (Ref: Rothwell PM, et al. Effect of daily aspirin on long–term risk of death due to cancer: analysis of individual patient data from randomised trialMore »

Situation: A patient with burns came with severe pain.
Dr Bad: It is bad sign. Dr Good: It is a good sign. Lesson: Pain indicates that the nerves are intact.More »

Situation: A patient was diagnosed with HIV–AIDS.
Dr Bad: You will die within 10 years. Dr Good: You can live a fairly normal life span. Lesson: In the 1980s, a young adult diagnosed with AIDS typically survived less than one year. Today, a similar person can expect to live to age 70 or beyond if he or she is diagnosed with HIV infection early, has access to and receives appropriate therapy, and can More »

Situation: A patient with CKD wanted a cardiology reference.
Dr Bad: It’s not needed. Dr Good: You should get it done. Lesson: Chronic renal dysfunction alone is an independent risk factor for the development of coronary artery disease and for more severe coronary heart disease.More »

Situation: A 25–year–old male with normal body mass index (BMI) came with mild abdominal obesity.
Dr Bad: Do not worry. Dr Good: Rule out diabetes. Lesson: Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin–looking Indians are quite adipose (higher body fat percent).More »

Situation: An adolescent came with pre pubertal gynecomastia of more than six months duration.
Dr Bad: It’s normal. Dr Good: This is persistent prepubertal gynecomastia. Lesson: If the patient is an adolescent and has a normal general physical and genital examination, then it is quite likely that he has pubertal gynecomastia (seen in 25% cases). Re–evaluation at 6–monthly intervals will show whether the condition is persistent or notMore »

Situation: The A1c status of a diabetic worsened in winter.
Dr Bad: It has nothing to do with winter. Dr Good: Diabetes may worsen in winter. Lesson: A prospective study of glycemic control during holiday time in type 2 diabetic patients demonstrated an influence of winter holidays on the glycemic control of these patients. The poor glycemic control might not be reversed during the summer and autumn months. Therefore, the cumulative effects of the yearMore »

Situation: A CAD patient was on low–dose aspirin and came with joint pains.
Dr Bad: Take any painkiller. Dr Good: Take only paracetamol. Lesson: The beneficial effects of aspirin are attenuated by prior or ongoing administration of a nonselective NSAID, such as ibuprofen or naproxen. Thus, regular NSAID use should be avoided, if possible, in patients taking low–dose aspirin for cardiovascular protection.More »

Situation: A patient with acute heart attack was not fit for reperfusion therapy
Dr Bad: Start 60 mg prasugrel. Dr Good: Chew 300 mg aspirin and 300 mg clopidogrel. Lesson: For patients receiving no reperfusion therapy, start clopidogrel 300 mg as opposed to prasugrel.More »

Situation: A patient with dyspepsia wanted to know if could eat almonds.
Dr Bad: You can eat them raw. Dr Good: You should eat almonds soaked in water. Lesson: Soaking almonds in water reduces their gas–producing qualities.More »

Situation: A 45–year–old male came with chest pain and normal ECG.
Dr Bad: Take antacids.Dr Good: It can be a cardiac pain.Lesson: ECG can be normal in the first six hours of acute heart attack.More »

Situation: A patient with inflammation was on regular follow up.
Dr. Bad: Do sequential ESR. Dr Good: Do sequential CRP. Lesson: As the patient’s condition worsens or improves, the ESR changes relatively slowly but the CRP concentrations changes rapidly.More »

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide? Lasson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.More »

Situation: A diabetic A1C status worsened in winter.
Dr Bad: It has nothing to do with winter.Dr Good: Diabetes may worsen in winter. Lesson: A prospective study of glycemic control during holiday time in type 2 diabetic patients demonstrated an influence of winter holidays on the glycemic control of these. The poor glycemic control might not be reversed during the summer and autumn months. Therefore, the cumulative effects of the yearly A1C gain duMore »

Situation: A patient came with acid peptic disease.
Dr Bad: You can eat anything. Dr. Good: Avoid pungent, sour and salty food.Lesson: Pungent, sour and salty foods increases acid in the stomach.More »

Situation: A diabetic on exercise protocol came for blood sugar check up.
Dr Bad: Get fasting sugar done.Dr Good: Get fasting and post prandial sugar done. Lesson: The 2–hour plasma glucose level is more sensitive than fasting plasma glucose level to the beneficial effects of physical activity. These beneficial effects are apparent across the waist circumference spectrum. (Diabetes Care 2006;29:2598–2604.)More »

Situation: A patient with pain in abdomen was found to have a TLC > 20000.
Dr Bad: Repeat TLC.Dr Good: Rule out liver abscess.Lesson: In liver abscess, the TLC is typically > 15000.More »

Situation: A patient came with non–responding cough.
Dr. Bad: It may be TB. Dr. Good: Rule out acidity.Lesson: Chronic cough along with dysphonia/hoarseness, globus pharyngeus, mild dysphagia, chronic cough and nonproductive throat clearing are often important otoaryngologic manifestations of occult or silent GERD. (Laryngoscope 1991;101:1)More »

Situation: A diabetic patient was found unconscious.
Dr Bad: He has suffered a stroke.Dr Good: First rule out hypoglycemia. Lesson: In diabetics, sudden loss of consciousness is hypoglycemia unless proved otherwise.More »

Situation: A patient came with an eGFR value of 15.
Dr. Bad: You need immediate dialysis.Dr. Good: Hold on till proper investigations are done.Lesson: A study published on December 6th in Canadian Medical Association Journal shows that starting dialysis too soon can be associated with high mortality.More »

Situation: A 30–year–old male with suspected migraine came with runny nose.
Dr. Bad: It cannot be migraine. Dr. Good: It can be migraine.Lesson: Migraine can also cause nasal stuffiness and runny nose, or teary eyes in 10–20% of individuals.More »

Situation: A patient came with heart failure.
Dr Bad: Start statins. Dr Good: No statins are needed. Lesson: Despite strong evidence of benefit for statins in most subsets of patients with established cardiovascular disease, two large randomized trials (CORONA and GISSI–HF) found no benefit from initiating statin therapy in patients with symptomatic systolic heart failure (ischemic or nonischemic) and a mean left ventricular ejectioMore »

Situation: Embolization occurs in how many patient of DVT (JR to SR).
Dr Bad: Rare! Dr Good: Common! Lesson: Embolization occurs in about 50% of patients having proximal vein DVT.More »

Situation: A patient with migraine was put on the herb, Butterbur.
Dr.Bad: It is a drug of choice for preventing migraine.Dr.Good: It benefits still remain unproven.Lesson: Herbal therapies like the Butterbur and Feverfew have been evaluated for the treatment of migraine headaches. Of these, Feverfew has been the most widely studied. Some studies have found it to be effective for migraine prevention, although most experts agree that the benefits are still unproveMore »

Situation: A diabetic patient with stroke came for evaluation.
Dr Bad: Get routine test done. Dr Good: Get blood sugar and A1c also done. Lesson: Increased rate of heart failure can contribute to higher mortality in stroke patients with hyperglycemia. On multivariate analysis, fasting glucose was significantly associated with risk of in–hospital heart failure (Eur J Neurol 2009;16(2):251–6).More »

Situation: A patient with fever and low TSH had ESR > 100.
Dr Bad: It’s TB.Dr Good: Its thyroiditis.Lesson: Thyroiditis typically has very high ESR and low TSH.More »

Situation: A patient came with very high triglycerides.
Dr Bad: Restrict fat. Dr Good: Restrict carbohydrates. Lesson: High triglycerides are due to excess of refined carbohydrates in diet.More »

Situation: A 65–year–old patient on levofloxacin developed tendon rupture.
Dr Bad: They are not related. Dr Good: The two have an association.Lesson: A federal court jury ordered Johnson & Johnson to pay damages of $1.8 million in the case of an 82–year–old man who sued over claims the antibiotic levofloxacin caused him severe tendon injuries. In 2008, the US FDA required makers of related drugs in the class fluoroquinolones to include warningMore »