Clinical Information

Is a CT scan useful in assessing a patient presenting with dysphagia?

I could not identify any studies on the use of computed tomography in diagnosing dysphagia.

See this discussion of Dysphagia (Dynamed) and scroll down to Diagnosis section for a summary of various imaging studies used in evaluation, which includes barrium swallow, endoscopy, and videofluoroscopic swallowing study.

What is the distinction between diabetic ketoacidosis and the hyperglycemic hyperosmolar state?

Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state.  CMAJ 2003 Apr 1;168(7):859-66.

Tables with comparisons:

Table 1: Typical water and serum electrolyte deficits at presentation of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) : Page 861

Table 2: Laboratory diagnostic criteria for DKA and HHS: Page 862

Table 3: Other biochemical abnormalities associated with DKA and HHS: Page 863

What are some of the diagnostic tests for investigating fever of unknown origin

Fever of Unknown Origin. Seminars in Nuclear Medicine Volume 39, Issue 2, March 2009, Pages 81-87

Table with definitions:

Table 1:  Review of the Literature on FDG-PET in Patients With FUO  Page 84

How is massive hemoptysis managed?

Hemoptysis.  Tintinalli’s Emergency Medicine, 6th ed. Includes chart for Diagnostic Evaluation of Hemoptysis

Clinical assessment and management of massive hemoptysis.  Jean-Baptiste E.  Crit Care Med. 2000 May;28(5):1642-7.

The pulmonary physician in critical care * Illustrative case 7: Assessment and management of massive haemoptysis.  Lordan JL, et al.  Thorax. 2003 Sep;58(9):814-9.

Ioachimescu OC, Stoller JK. Diffuse alveolar hemorrhage: diagnosing it and finding the cause.
Cleve Clin J Med. 2008 Apr;75(4):258, 260, 264-5.

How useful are the serologic tests for diagnosing celiac disease?

Ann Intern Med. 2007 Sep 4;147(5):294-302. Accuracy of serologic tests and HLA-DQ typing for diagnosing celiac disease. Hadithi M, et al.

Objective:  To define the performance of serologic testing and HLA-DQ typing prospectively.

Methods:  Prospective study of patients referred for small-bowel biopsy to diagnose celiac disease.   Compared serologic tests (AGA, TGA, and EMA) and HLA-DQ typing to reference standard of abnormal histologic findings and clinical resolution after gluten-free diet.  Serologic testing

Results:  Sixteen of 463 participants had celiac disease confirmed by pathological findings.

• Positive result on both TGA and EMA testing had a sensitivity of 81% (CI, 54% to 95.9%), specificity of 99.3% (CI, 98.0% to 99.9%), and negative predictive value of 99.3% (CI, 98.0% to 99.9%).
• Testing positive for either HLA-DQ type maximized sensitivity (100% [CI, 79% to 100%]) and negative predictive value (100% [CI, 98.6% to 100%]), whereas testing negative for both minimized the negative likelihood ratio (0.00 [CI, 0.00 to 0.40]) and posttest probability (0% [CI, 0% to 1.4%]).
• The addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, did not change test performance compared with either testing strategy alone.

What are the clinical presentations of CMV and other viral infections and how do they influence diagnosis and treatment of patients with systemic lupus erythematosus?

For more information on viral infections, such as CMV, in patients with SLE, see this review:

Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature.  Ramos-Casals M, et al.  Medicine (Baltimore). 2008 Nov;87(6):311-8. PMID: 19011502

What populations are at risk for Clostridium difficile and what are the strategies for managing infection?

Clostridium difficile–more difficult than ever. Kelly CP, LaMont JT.
N Engl J Med. 2008;359(18):1932-40.

Review article describes changes in epidemiology, as well as management strategies.

What should be considered in the differential diagnosis of a patient with HIV infection who presents with hyperthyroidism?

Read “AIDS Endocrinopathies: Thyroid Disorders” In:  Greenspan’s Basic and Clinical Endocrinology, 2007.  AccessMedicine.

What are the guidelines for dvt prophylaxis in patients undergoing orthopedic surgery, such as hip arthroplasty?

Identified two guidelines.  Links included below, along with excerpt of text.  Following the guidelines is an article on how the two groups differ in guidelines for knee and hip arthroplasty.

• Antithrombotic and Thrombolytic Therapy 8th ED: ACCP Guidelines Prevention of Venous Thromboembolism.  Chest.  2008; 133(6).

See Recommendations: Elective Hip Arthorplasty, Section 3.1

What are the items in the Well’s score and how does it affect pre-test probability of having a pulmonary embolism?

JAMA. 2003 Dec 3;290(21):2849-58. Does this patient have pulmonary embolism?  Chunilal SD, et al.

Objective: To assess the accuracy of pretest probability evaluation in predicting pulmonary embolism.

Methods: Systematic review of literature indexed in Medline and included in selected article reference lists.  Includes studies enrolling consecutive, unselected patients; where participating physicians estimated pretest probability of PE and were blinded to the results of diagnostic testing; and that used validated diagnostic methods to confirm or exclude pulmonary embolismon.

Results: Sixteen studies involving 8306 patients were included analysis.  Table 3 summarizes the likelihood ratios of various clinical prediction rules used for pulmonary embolism.  Table 4 displays the Simplified Wells Score