May 2009, Volume 26, Number 6

Dalhousie Emergency Medicine Department
Case of the Month
“Don't I need an IV?”

Case in Point
"Brown Bump on the Back"

Experts on Call
Answers to your questions from our medical experts

• Managing Prominauris
• Microalbuminuria as a Risk Factor for CVD
• Update on the Management of Gout
• Chronic and Aggressive Hiccups
• Oral Lichen Planus Involving the Buccal Mucosa
• Treating a Diabetic Patient with a Large Amount of Microalbuminuria
• Health Risks of Black Mould
• Fetal Fibronectin Testing
• Tea Tree Oil and Psoriasis
• Isolated Low HDL-C Levels
• Dealing with Adult Nightmares and Sleepwalking
• Stopping Risedronate or Aledronate Therapy
• Asthma in Preschool Children
• Ultrasound Showing Fatty Liver
• Onychomycosis
• Length of PPI Therapy
• Clark's Nevus
• Medications for Dementia Patients with Chronic Pain
• Post-Concussion Syndrome
• When to Restart ASA Therapy After a Gastric Ulcer
• An Rh Negative Female with Bleeding
• b-Blocker Therapy in Heart Failure Patients

What's Your Diagnosis?
"A Pruritic Eruption"

Endocrine Update
Primary Hyperparathyroidism

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Thickening of the Joint
• Mobile Mass
• Numbness of the Left Side
• Blisters on the Fingertips
• Red, Scaly Plaque
• White-Yellow Tosillar Spot
• Weakness of the Legs
• Palpable Cord-Like Structure
•A Pimple on the Lip

Cardiovascular Congress Reporter

Dual Antiplatelet Option to Reduce Events in Atrial Fibrillation
Evaluating Interaction between Clopidogrel and PPIs: Results from Two Studies

An Overview of Back Pain and Sciatica
Mohammad Maleki, MD, FRCSc

Back Pain affects millions of people and is among the most common conditions for which patients seek medical attention. It is a huge health problem with associated enormous socio-economic impact on society. Dr. Maleki gives an overview of back pain and sciatica, discussing disc degeneration and herniation, spinal stenosis and when to operate.

Diabetes Review: What's New?
Andrew Farquhar, MB, ChB, BSc, DA

The epidemic of Type 2 diabetes continues to explode, with an especially worrying trend affecting younger people. Dr. Farquhar discusses the importance of FPs, as they are the gatekeepers to diabetic care. The primary care physician is responsible for initial diagnosis and ongoing management. He also stresses the importance of patients being involved in their own diabetes care. He discusses new trials/evidence of diabetes, new drugs and new approaches to diabetes management.

Prostate Cancer:
From Screening to Treatment
Andrew Farquhar, MB, ChB, BSc, DA

The lifetime risk of developing clinically apparent prostate cancer (PCa) is approximately one in seven. Though not all PCa is lethal, it remains the third highest cause of cancer related to death among men. PCa is usually asymptomatic especially in the early stages. Therefore, if one does not look for PCa, it may remain undiagnosed until late stages that are more difficult to treat. Dr. Kassouf and Dr. Violette discuss the diagnosis of PCa, screening recommendations, indications for biopsy and management options for the patient with PCa.

April 2009: Volume 26, Number 4

Dalhousie Department of Emergency Medicine
Case of the Month
"Remeber The Man You Sent Home Last Night..."

Case in Point
“Thickened Ankle Skin”


Experts on Call
Answers to your questions from our medical experts

• Mortality and Morbidity of Renal Dialysis
• Resistant Head Lice
• Bipolar Disorder Medications During Pregnancy
• Treating Osteopenia with Bone Resorption Medications
• Significance of Asymptomatic Bigeminy
• Pediatric GERD
• Ankylosing Spondylitis
• Investigating Frequent Watery Stools
• Therapy Options for Smoking Cessation
• Pseudoseizures
• Ruptured Tympanic Membrane
• Testosterone Testing
• Combining Yasmin and Spironolactone to Treat Acne
• A Pregnant Woman Suffering From Pruritus
• Cross-Reactivity Between Fruits and Nuts
• How to Treat Relapsing C. Difficile
• Levothyroxine and Iron Supplements
• Adult Onset of ADHD
• C-Reactive Protein in Patients with Acute Coronary Syndrome
• Teenage Male Pattern Baldness
• Screening for Bone Loss
• Reliability of Cervical Length Assessment
• Wegener's Granulomatosis
• Vascular Depression
• Multiple Seborrheic Keratoses
• Contracting H.Pylori
• Guidelines for Routine Cardiac Testing
• Quetiapine in Thyroid Disease
• Treatment for Scabies


What's Your Diagnosis?
"Doctor! Help I Can't Walk!"

Endocrine Update
Approach to the Patient with Hypercalcemia: Diagnostic Principles

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Fissuring Fingers
• Bilateral Deformities
• Loss of Vision
• Hair Loss
• Back Pain
• History of Falling
• Multiple, Crusted Lesions
• A Pruritic on the Eyelid

Clinical Approach to Migraine
Alan E. Goodridge, MD, FRCPC

After tension type headache, migraine is the most common form of headache affecting about 15% of females and 10% of males. Diagnostic criteria are well-established but a myriad of issues present diagnostic challenges. There is some overlap of the symptoms of migraine and tension type headache and migraine may exist even if the full criteria are not met. Dr. Goodridge discusses the different types of symptoms associated with migraines and the different treatment options for patents suff

Prostate Specific Antigen Assessment
Theresa J. McCallum, MD, FRCSC

Prostate specific antigen (PSA) is a glycoprotein produced by the prostate. It is secured into the semen and is usually detected at low levels in the blood. It is found in bound (usual) and free forms. PSA has a half-life of two to three days. Several weeks must pass after an event to allow for accurate re-assessment. Dr. McCallum discusses the influencing factors of PSA, its velocity and density and free PSA.

Diagnosing Chronic Kidney Disease
Fadaw Al- Ali, MD; and Ayub Akbari, MD

Kidney damage has been defined as pathologic abnormalities or markers of kidney damage (such as proteinuria) including abnormalities in blood and urine tests or imaging studies. Dr. Al-Ali and Dr. Akbari discuss how the primary care physician can diagnose chronic kidney disease (CKD) and why it is imperative to identify CKD patients early so that interventions that improve CV mortality and morbidity and delay progression of the disease can be implemented in a timely manner.

March 2009: Volume 26, Number 3

Dalhousie Department of Emergency Medicine
Case of the Month
“Chloe's Complications”

Case in Point
“A Yellow, Crusty Face Plaque”

Experts on Call
Answers to your questions from our medical experts

• Metformin Use in Pregnancy
• Migraine Therapy for Those with Increased Cardic Risk
• At What Age Can Isotretinoinbe Started?
• Elevation of Creatine Kinase While on a Statin
• The Difference Between IBS and IBD
• Practical Work-Up for Chronic Cough or Sore Throats
• Mindfulness Therapy
• Annual Limit of Prostatic Biopsies
• How to Approach Significant LDL-C Levels
• Best Treatment for Hypercholesterolemia
• Urticarial Rash with Arthritis
• Are Drug Allergies Permanent?
• The Relationship Between NSE and Stroke Outcome
• Management of Chronic IBS
• Important Findings in COPD
• BP Level When Treating Hypertension
• Prescribing Statins in the Elderly
• The Role of Melatonin for Insomnia
• Work-Up for a Patient with Dizziness
• Treatment Options for Oral Aphthosis
• Acne Rosacea
• Managing a Low Potassium Level
• Combining Warfarin and ASA Therapy

Endocrine Update
Lipid Targets for Diabetic and Pre-diabetes

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Brown Thick Papules
• A Canal-Like Lesion
• A Slow-Growing Lesion
• Pruritic Eyelids
• Rash With Low Grade Fever
• A Changing Mole
• An Asymptomatic Growth

Depression in the Elderly
Jenny Rogers, MD; and Kiran Rabheru, MD, CCFP, FRCP, ABPN

Late-life depression is common and frequently under-diagnosed. In a community sample of adults
> 65-years-of-age, 6% to 9% suffer major depression and mild depressive symptoms affect an additional 17% to 37%. Dr. Rabheru and Dr. Rogers discuss how the diagnosis of depression in the elderly can be missed because of atypical presentation, multiple comorbidities with overlapping symptoms, reluctance to disclose depressive symptoms and lack of adequate screening.

What's New in Clinical Research
Intensive LDL-C Lowering in Type 2 Diabetes: How Can We Achieve It?
Lawrence A. Leiter, MD, FRCPC, FACP

Compression Therapy for Venous Leg Ulcers
Brian T. Kunimoto, MD, FRCPC

Venous leg ulcers represent a major public health problem, especially for the elderly. If one looks at only active venous ulcers, the point prevelance rates are in the range of 1%. Not to be dismissed are the social and psychological costs of this chronic disease. The management of venous leg ulcers requires a few important steps that involve taking into account the different aspects of general wound care and specific venous ulcer treatment, outlined by Dr. Kunimoto in this article.

February 2009: Volume 26, Number 2

Dalhousie Department of Emergency Medicine
Case of the Month
“To V/Q or To Spiral CT”

Case in Point
A Swelling Finger Nodule

Experts on Call
Answers to your questions from our medical experts

• Potential Complications of Maternal Shingles
• Treating CIPD
• Sleep Apnea and Congestive Heart Failure
• Terbinafine and Hair Changes
• When Not to Use Antidepressants
• Differing BP Readings
• Treating Skin Atrophy due to Steroids
• Pregabalin for Fibromyalgia
• Cross-Reactivity of Coconut and Peanuts
• Treating a Borderline LDL-C Level
• Confirming Adrenal Insufficiency
• The Treatment of Choice for Bipolar Disorder
• Treating Recurring Tinea Corpora in Children
• How to Remove a Wax Plug
• Headaches Post Anesthetic
• Modafinil for Sleep Apnea
• The Best Treatment for Poison Ivy
• Advantages of Long-Term Varenicline Use
• Working-Up an Abnormal eGFR
• Atrial Hypertrophy in Patients with Atrial Fibrillation
• Benign Positional Vertigo
• The Different Types of Serum Calcium
• Preventing Osteoporosis in Early Menopause
• Recent Guidelines for Treating Hypertension
• Digital Myxoid Cysts
• A Varying PR Interval
• Narrowband vs. Broadband UVB
• Follow-Up for Eosinophilic Esophagitis
• New Prescription Options for Morbid Obesity
• Diastolic Dysfunction
• The Role of Spirometry in COPD
• Using Calcipotriol on the Face

What's Your Diagnosis?
"Fiona's Fiery Tale"

Endocrine Update
The New WHO for Osteoporosis: Absolute Fracture Risk Assessment

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Peter's Patch
• Sam's Skin Rash
• Norman's Nose
• Richard's Red Eye
• Eric's Eruption
• Diego's Digits
• Barry's Breasts
• Clark's Circular Marks
• Luka's Line
• Nicholas' Neck

Smoking Cessation: How Can We Do Better?
Anees Sindi, MBChB, ABIM; and Andrew McIvor, MD, MSc, FRCP

It is estimated that 100 million people will die during the 20th century as a result of tobacco related disease and this number could increase to 1 billion in the current century. Dr. Sindi and Dr. McIvor describe how adopting a systematic approach in your practice to nicotine addiction is a medically-effective and cost-effective intervention.

The Management of Chronic Prostatitis
Alan So, MD, FRCSC

Chronic bacterial prostatitis is a diagnosis made after identification of pathogenic bacteria in prostatic fluids (urine, semen, expressed prstatic fluid) and is often associated with symptoms such as pain in the pelvic, suprapubic, low back, or perineal regions. In this article, Dr. So details how although "chronic prostatitis" is the most commonly diagnosed urologic diagnosis under the age of 50 and up to 10 % of men in North America have these symptoms, <5% truly have a bacterial cause of their symptoms.

Cannabinoids in Clinical Practice
J. H. Ennis, MSW, MD, FRCP

Marijuana has been used to treat nausea, illness-induced anorexia, symptoms of MS, spinal cord injuries, Tourette's syndrome, epilepsy, glaucoma, Parkinson's disease (PD), dystonia and pain. Here, Dr. Ennis provides a brief review of the evidence which can assist the clinician in making treatment decisions involving the use of cannabinoids.

January 2009, Volume 26, Number 1

Dalhousie Emergency Medicine Department
Case of the Month
“Doc! My back hurts...”

Case in Point
"My nails are turning green!"

Experts on Call
Answers to your questions from our medical experts

• Informing Patients About Borderline
Personality Disorder
• Left Anterior Fascicular Block
• Hair Loss After Pregnancy
• The Best Treatment for Facial Psoriasis
• Inhaled Corticosteroids and Respiratory Infections
• Rashes Related to Lamotrigine Use
• Tongue-Tie in a Newborn
• Early Signs of Celiac Disease
• Thrombolysing Elderly Patients
• Low Dose OC and Pregnancy Risk
• Treating Intra-Abdominal Infections
• Deep Brain Stimulation
• The Predictive Value of Sputum
• The Role of Incretins
• Grapefruit and Statins
• Psychotropic Medications for Depression and Tinnitus
• Treating Esophageal Spasms
• Risks of Oral Allergy Syndrome
• Contraindications to Lithium Use Post-MI
• Lack of Pneumonia Symptoms
• Topical Antifungal Agents
• Screening for Cerebral Aneurysm
• Asymptomatic Pauses on Holter Monitor
• Treating Opioid-Induced Constipation
• The Best OC Pills for Acne
• When to Treat an Elderly Patient
• Sensorineural Hearing Loss
• Treating Pretibial Myxedema

What's Your Diagnosis?
"What is going on with my skin?"

Endocrine Update
Prevention of Type 2 Diabetes and
Treatment of Pre-Diabetes

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Nick’s Knee Pain
• Carla’s Cheek
• Gina’s Joints
• Samantha’s Scalp
• Harold’s Heel
• Harriet’s Heart

GHB in Your Patients:
Recognizing the Characteristics
Constance LeBlanc, MD, CCFP(EM), FCFP, MAEd; and Nancy Murphy, MD, CCFP(EM), ABFM, ABMT

GHB is a potent central nervous system depressant which can result in serious sequelae. The rapid onset of effect and narrow therapeutic window increase the likelihood of ingesting more than intended. It is frequently co-ingested with ethanol, stimulants or ketamine, further increasing the potential for miscalculation. Although GHB use is declining, recognizing the characteristics of toxicity is important for the clinician.

External Manifestations
of Internal Disease
Isaiah Day, Bsc; and Jaggi Rao, MD, FRCPC

Certain disorders of the skin are more frequently associated with diabetes. Necrobiosis lipoidica (NL) is a general term that refers to lesions that occur mostly in insulin dependent diabetic patients. Astute physicians who spot NL can play an important role in evaluating patients for the early development of diabetes and reassure them of the benign nature of these lesions.

Cardiovascular Congress Reporter

Global Cardiovascular Risk Reduction:
Focus on Inhibiting the Renin Angiotensin System

Hypertension Canada:
News and Opinion from the Canadian Hypertension Society

Global Cardiovascular Risk Reduction:
Focus on Inhibiting the Renin Angiotensin System