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The Canadian Journal of Diagnosis
2012 Back-Issues

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January 2012, Volume 29, Number 1

Dalhousie Emergency Medicine Department
Case of the Month
“Can She Go Home?”

Case in Point
New Burning Lesion on Groin

Experts on Call
Answers to your questions from our medical experts

• Indications for Iron Injections
• Assessing ASA Effect
• Treatment Options for Thrombosed External Hemorrhoids
• RAST Testing
• Cluster Migraines
• Treatment of Onychomycosis
• Rubella Immunity in Pregnancy
• Prescribing Methylphenidate for Bipolar Disorder
• Dry Skin and Nummular Eczema
• Complex Regional Pain Syndrome
• Dumping Syndrome
• Hypothyroidism in Patients on Amiodarone
• Early Stages of Basal Cell Carcinoma
• Topiramate for Weight Control
• Diagnosing Pulmonary Embolism
• Predisposing Factors for Helicobacter pylori
• Diagnosis and Treatment of Pulmonary Fibrosis
• Examination of Thunderclap Headache
• Treatment for Oral Stomatitis
• Methadone for IBS
• Statin Indications
• HPV Vaccine and Viral Shedding
• Stimulant Medications and Mood Destabilization
• Predictors for Myalgias/Myositis
• Safe Levels for Elevating Creatinine Kinase

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Erythematous Plaque
• Pustular Eruption
• Pink Nodules on Trunk
• Yellow Discharge
• Worsening Facial Lesion
• Expanding Rash
• Loss of Consciousness
• Circumferential Lip Redness
• Tattoo Complications
• Unsightly Lesion
• Difficulty Finding Words

Clinical Concerns
Cardiac Complications of Sickle Cell Disease:
What the Family Physician Needs to Know

Steven Promislow, MD, PGY-2, and James W. Tam, MD, FRCP(C)


February 2012, Volume 29, Number 2

Dalhousie Emergency Medicine Department
Case of the Month
Tibial Plateau Fractures

Case in Point
A Scaly, Itchy Scalp

Experts on Call
Answers to your questions from our medical experts

• Reliability of CHADS2 Score
• Neutropenia on Routine Blood Draw
• Treatment for Post-nasal Drip and Allergic Rhinitis
• Treating a Mucocele in the Oral Cavity
• Diagnosing Fibromyalgia
• Candidates for GLP-1 Analogues
• Third Add-on Strategy for Lowering LDL
• Wheezes and Rhinosinusitis
• Safe Heartburn Therapy in Pregnancy
• Latest Prophylaxis for Migraine
• Metformin and Hirsutism
• Nonsexually Transmitted Vulvar Ulcers
• Post-operative Exercise Restrictions
• Diagnosis and Treatment for Ankylosing Spondylitis
• Vicks VapoRub and Onychomycosis
• Investigating Bell’s Palsy
• Managing Elevated Creatine Kinase
• Treatments for Pityriasis Alba
• Determining a Central Cause for Vertigo
• When to Use hsCRP
• Causes and Investigations for Polycythemia

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Itchy Papules on Hands
• Bluish-Grey Patch
• Inflamed Growth
• Greyish Lesions
• Balance Problems
• Thickened Fingertips
• Scaly Skin
• Troubling ECG
• Rough Outer Arms
• Post-operative Symptoms

Review
Topical Corticosteroid Therapy: What You Need to Know

Allison Chabassol and Peter Green, MD, FRCPC


March 2012, Volume 29, Number 3

Dalhousie Emergency Medicine Department
Case of the Month
“My Allergies Are Acting Up”

Case in Point
White Spots on Arms

Experts on Call
Answers to your questions from our medical experts

• DVT and Doppler Ultrasound
• Work-up for Suspected Aldosteronism
• Management of Cat Dander Allergies
• Best Treatment for Sunburn
• ARBs and ACE Inhibitors
• Mild Cognitive Impairment and Cholinesterase Inhibitors
• Investigating Gynecomastia
• Prophylaxis for Multiple Seborrheic Keratoses
• Vitamin K and Osteopenia
• New Mammogram Guidelines
• New Anticoagulant and Antiplatelet Drugs
• Anti-M Antibodies in Pregnancy
• Investigating Persistently Elevated Alkaline Phosphatase
• Outgrowing Allergies
• Sleep Deprived vs. Regular Electroencephalogram
• Identifying Patients with Drug-eluting Stents
• Restless Leg Syndrome and Neuroleptics
• Treatment for Facial Seborrheic Dermatitis
• Prioritizing Risk Factors for Vascular Events
• Metformin for Acanthosis Nigricans
• Treating Chronic Constipation
• Continuous Macrolide Antibiotics and COPD
• TNF α and Hidradenitis Suppurativa
• Managing Gallbladder Polyps
• Prognostic Features of ICU Myopathy

What’s Your Diagnosis?
Facial Numbness and Weakness

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Nodule on Nose
• Severe Back Pain
• Speckled Nevus
• Erythematous Plaques
• Lower Limb Paraparesis
• Pruritic Lesions on Extremities
• Spider-like Lesion
• Painful Lesions on the Neck
• Headaches and Nausea
• Hypopigmented Macules
• Scaly Linear Band
• Ulceration on Ankle
• Purplish Papules on the Scrotum
• Erythematous Rash on Ankle
• Thick Plaque of Skin

Practical Approach
Current COPD Diagnostic Criteria and Management Strategies
Onofre Moran-Mendoza, MD, MSc, PhD, FRCPC

Clinical Concerns
Aortic Aneurysmal Disease: When to Refer and Current Management

Jordan Campbell, Abdulwahab Al Khalifa, BSc, MD, and Richard Whitlock, MD, FRCSC

Review
Topical Corticosteroids: Optimizing Treatment

Allison Chabassol and Peter Green, MD, FRCPC


April 2012, Volume 29, Number 4

Dalhousie Emergency Medicine Department
Case of the Month
Hyper-reaction to Antibiotics

Case in Point
Extensive Telangiectases

Experts on Call
Answers to your questions from our medical experts

• Symptoms of Lumbar Spinal Stenosis
• Treating “Thin” Type 2 Diabetics
• Diet and Diverticulosis
• Conventional Aortic Valve Replacement vs. TAVI
• Denosumab as a Replacement for Bisphosphonates
• Significance of a Right Bundle Branch Block
• Diagnosing a Mycoplasma Infection
• Work-up for Pruritis
• Re-evaluating Treatment after a Stroke
• Fingertip Fissures in Winter
• Managing Solar Lentigo
• Guidelines for MRI Use
• Causes of Increased Pulse Pressure
• Managing Refractory Wegener’s Vasculitis
• Levothyroxine and High TSH
• Pauci-immune Gastroenteritis
• Monitoring Hypothyroidism
• Evaluating Hemorrhage Transformation Risk
• Decreasing the Urine Albumin-to-creatinine Ratio
• Position-induced Vertigo
• Insulin Pump vs. Multiple Dose Insulin Injections

What’s Your Diagnosis?
Swollen and Heavy Leg

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Annual Rash
• Dark Circles
• Family History of Ataxia
• Nodules on Genitals
• Papules in Axillae
• Hearing Loss
• Skin-coloured Papules
• Generalized Erythema and Scaling

Clinical Concerns
Chronic Urinary Tract Infections: Getting to the Root of the Problem

Magali Robert, MD

Practical Approach
Exercise During Pregnancy:
Reviewing the PARmed-X for Pregnancy Guidelines
Michelle F. Mottola, PhD, FACSM


May 2012, Volume 29, Number 5

Dalhousie Emergency Medicine Department
Case of the Month
Decompression Sickness

Case in Point
Rash on Upper Back

Experts on Call
Answers to your questions from our medical experts

•Calcium, Vitamin D, and Cardiovascular Mortality
• Prenatal Blood Tests
• Flying or Diving after an Episode of Pneumothorax
• The ALTITUDE Study and Add-on Therapies
• Winter Allergies
• Sugar Alcohols and Diabetics
• Complete Work-up for Secondary Hypertension
• Diagnosing a Perianal Rash
• Replacing Warfarin with ASA and Clopidogrel
• Follow-up Testing for Helicobacter pylori
• ALS Diagnosis and Lyme Serology
• Median Neuropathy of the Elbow
• Treatment of Persistent Subclinical Hyperthyroidism
• Best Ratio for Assessing Cardiovascular Risk
• Pacemaker Indications
• Medications for IBS with Constipation
• Migraine Prophylaxis and Botulinum Toxin Type-A
• Add-on Medication for Seizure Control
• When to Order hsCRP
• Diagnosis and Treatment of Endometriosis

Bipolar Disorder for Family Physicians Part 1: Diagnosis
Kevin Kjernisted, MD, FRCPC

Bipolar Disorder for Family Physicians Part 2:
Management — A Focus on the Role of Atypical Antipsychotics

Kevin Kjernisted, MD, FRCPC

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

•Bruising and Pruritus
• Spreading Arm Lesions
• Swelling of the Conjunctiva
• Pruritic Lesions on the Legs
• Brown Papules
• Acute Eruption of Bullae
• Butterfly Rash
• Round Lesion on Foot
• Small, Yellow Papules
• Speech Problems and Ataxia
• Itchy, Flaky Scalp

Clinical Concerns
Chronic Diarrhea: Microscopic Colitis and Other Causes

Kerri Novak, MD, FRCPC

Review
Specific Immunotherapy for Allergies and Asthma
Karen H. Calhoun, MD, FACS, FAAOA


June 2012, Volume 29, Number 6

Dalhousie Emergency Medicine Department
Case of the Month
“Just Put It Back Doc”

Case in Point
Missing Hair on the Face

Experts on Call
Answers to your questions from our medical experts

• Eczema on the Hands vs. Palmar Psoriasis
• Significance of Advanced Adenomas
• Cord Doppler Studies
• Headache Red Flags
• When to Order a Pulmonary Function Test
• Polycystic Liver Disease
• Pros and Cons of Tricuspid Valve Replacement
• Adding GLP-1 Analogues to Insulin
• Recurrent Episodes of Herpes Zoster
• Treatment for Subacute Thyroiditis
• Treating Chronic Gout
• Desensitization to Hymenoptera Venom

A Simplified Approach to Diagnosis and Treatment of
Overactive Bladder

Jerzy B. Gajewski, MD, FRCSC, Gary J. Gray, MSc, MD, FRCSC,
Jeffrey Habert, MD, CCFP, FCFP, and Nader Habib, MD

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Erythema and Inflammatory Papules
• Stiffness and Back Pain
• Red, Scaly Patch
• Skin Growths on Axillae Areas
• Headaches and Neck Pain
• Inguinal Hernia Complications
• Extensive Ecchymoses
• Severe Reaction on the Lips
• Slowly Growing Skin Lesion

Practical Approach
Groin Hernias: Diagnosis and Management

Julie N. Leal, HBSc, MD, Janet Edwards, MD, MPH, CPH, and Elijah Dixon, MD, MSc


July 2012, Volume 29, Number 7

Dalhousie Emergency Medicine Department
Case of the Month
“Doctor, I Feel Like I’m Drowning”

Case in Point
Slightly Pruritic Eruption

Experts on Call
Answers to your questions from our medical experts

• Reducing Herpes Simplex Transmission
• Monitoring Thyroid Indices
• Recommendations for Salt Intake
• Tinea Versicolor vs. Vitiligo
• Calcium Supplementation for Osteoporosis
• Prescribing for Hepatitis B
• Treating Asymptomatic Bacterial Vaginosis in Pregnancy
• Update on Calcium, Vitamin D, and Cardiovascular Mortality
• Diagnosis and Treatment of Central Pain Syndrome

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Rash on the Neck
• Nodules and Abscesses
• Red and Itchy Face  
•  Acute Eruption of a Widespread Rash
• Neck Pain      
• Itchy, Violaceous Chest and Wrist Papules


Clinical Concerns
Perimenopausal Bleeding: How to Investigate and Treat

Albert M. Rosengarten, MD, CM, FRCSC


August 2012, Volume 29, Number 8

Dalhousie Emergency Medicine Department
Case of the Month
The Ins and Outs of Compound Fractures

Case in Point
Dome-shaped Penile Papules

Experts on Call
Answers to your questions from our medical experts

• Hepatitis B Immunity
• Cantharidin and Imiquimod for Warts
• Clinical Benefits of Direct Factor Xa Inhibitors
• When to Perform a Thyroid Nodule Biopsy
• Best Celiac Screening Test
• Monitoring Hormone Levels in the Perimenopause Stage
• Anticholinergics for Atrial Fibrillation
• NSAIDs and Bleeding Risk in IBD
• Management of Amaurosis Fugax
• Montelukast for Severely Allergic Patients
• Topical Ketamine for Neuropathic Pain
• Dressing Stasis Dermatitis Ulcers
• Timing of Bone Mineral Density Scanning

What's Your Diagnosis?
Bilateral Flank Pain

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Uncomfortable Lesions
• Pain and Swelling in the Periorbital Area
• Annular, Scaly Plaques
• Large Lesion on the Forearm
• Itchy, Red Hands
• Red Patches in the Occipital Area
• Loss of Consciousness
• Erythematous Eruption
• Growing Scalp Lesion
• Papules on the Trunk

Practical Approach
Head and Neck Cancer: Red Flags in the Family Practice Setting

Shamir P. Chandarana MD, MSc, FRCS(C)


September 2012, Volume 29, Number 9

Dalhousie Emergency Medicine Department
Case of the Month
A Pain in the Neck

Case in Point
Plaque on the Breast

Experts on Call
Answers to your questions from our medical experts

• Indomethacin Responsive Diarrhea
• Reversing Statin Effects
• Blood Testing for Food Intolerance
• Memantine for Dementia
• Guillain-Barré Syndrome and Vaccination
• Magnesium Intake and Type 2 Diabetes
• Broom for Pap Smear in Pregnancy
• Pros and Cons of BNP Testing
• Alcoholic Gastritis
• Investigating Reynauld’s Phenomenon
• Radioactive Iodine and Hyperthyroidism
• Starting Warfarin Post Hemorrhagic Stroke
• Work-up for Anton’s Syndrome
• Vaccinating Patients without Records
• Montelukast for Urticaria
• Preventing Hand Deformities in Osteoarthritis
• Safety “Scoop” on Newer Anticoagulants
• Advantages and Disadvantages of Incretin Agents
• Dominant Hand and Epidemiological Differences
• DMARDs for Arthritis in Hepatitis B Carriers
• Selecting the Appropriate Meningococcal Vaccine
• Surgical Excision vs. Cryotherapy for Genital Warts
• Treating Scalp Pruritus
• Treatment Modalities for Narcolepsy
• When to Withdraw Heart Failure Medications

What's Your Diagnosis?
Bumpy Spot on the Foot

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Sore and Itchy Lesions
• Purpuric Bullous Lesions
• Persistent Rash on the Abdomen
• Bands on the Neck
• Asymptomatic, Yellowish Papules on the Face
• Hyperpigmentation on the Cheeks
• White Plaque between the Toe
• Nodule on the Ear
• Right Axilla Lesion
• Shiny Plaque and Atrophy
• Wrist Pain and Swelling
• Spreading Papules
• Swollen, Achy, Discoloured Legs
• Uneven Pupils
• Deep-seated Pustules and Nodules

Pain Management
Neuropathic Pain: Mechanisms and Management

Cory Toth, BSc, MD, FRCPC

Clinical Concerns
Primary and Referred Otalgia: Overview for the Family Physician

Beth Lange, MD


October 2012, Volume 29, Number 10

Dalhousie Emergency Medicine Department
Case of the Month
“What’s All the Buzz About?"

Case in Point
Finger Bump

Experts on Call
Answers to your questions from our medical experts

• Monofilament Testing for Peripheral Neuropathy
Blastocystis hominis in Stool Samples
• Glactagogues and Enhancing Lactation
• Managing Autoimmune Progesterone Dermatitis
• Elevated Alk Phosphate
• Differentiating Between HSV 1 and 2
• PPIs and Barrett’s Esophagus
• Silent Ischemia
• Treatment Modalities for Hirsutism
• Screening for Cerebral Aneurysm
• Migraine and Inflammatory Disease
• Levothyroxine Formulations
• PCR vs. Culture for Diagnosing Gonococcal Infection
• Male Osteoporosis and Denosumab
• Asymptomatic UTI in Pregnancy
• Chlamydia PCR after Treatment
• Things to Do Before Prescribing a Statin
• Treating Dientamoeba fragilis Infection
• Recurrent Bursitis
• Thrombolysis after Chest Pain Resolution
• Postthyroidectomy Monitoring
• Induction of Labour with a Previous C-section
• Metronidazole Induced Neuropathy
• Overuse of LABAs with Steroids
• Pregabalin vs. Gabapentin for Neuropathic Pain
• Diagnosing Bed Bug Bites

What's Your Diagnosis?
Hyperpigmented Lesions

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Lesion on the Cheek
• Excessive Hair Growth
• Sudden Severe Swelling
• A Rapidly Enlarging Growth on the Back
• Palpable Purpura
• Rectal Pain and Itch
• Small White Nodule
• Mass on the Scrotum
• Asymptomatic Lesion
• White Macules
• Bilateral Breast Tissue Enlargement
• Erythematous Rash

Clinical Concerns
Dementia, Depression, or Both?: Differentiating in Older Patients

David B. Hogan MD, FACP, FRCPC

Practical Approach
High Hemoglobin: Managing Polycythemia
Peter R. Duggan, MD


November 2012, Volume 29, Number 11

Dalhousie Emergency Medicine Department
Case of the Month
“I Can’t Straighten My Elbow”

Case in Point
Bump on the Jaw

Experts on Call
Answers to your questions from our medical experts

• Diagnostic Criteria for Hypertension
• Target LDL
• Treatments for Chronic Insomnia
• Blood Tests to Diagnose Celiac Disease
• Selecting a Pneumococcal Vaccine
• Preventative Bisphosphonate Therapy for Breast Cancer
• Detection and Management of Placenta Previa
• Varenicline and Vascular Events                
• Persistent Fatigue after Treatment for Lyme Disease
• Treating Mosaic Plantar Verrucae
• Genetics and Berry Aneurysms
• Temporary Desensitization vs. Long-standing Tolerance
• PPIs and Calcium Absorption
• Dalteparin and Alopecia
• Medications Linked to Thrombocytopenia
• Screening for Pancreatic Cancer
• Ankylosing Spondylitis and Uveitis
• Screening for Intracranial Aneurysms
• Overview of Ulipristal Acetate
• Nonalcoholic Fatty Liver Disease

What's Your Diagnosis?
Fatigue and Muscle Pain

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• White Spots Inside the Cheek
• Scaly Plaque on the Chest
• Rash on Sun-exposed Areas
• Right Leg Pain
• Red Lesion on the Forehead
• Flat Head
• Eyelid Swelling
• Recurrent Facial Lesions after Shaving
• Intensely Pruritic Rash
• Raised Finger Lesion
• Slowly-developing Lesions
• Erythematous Patch with Overlying Vesicles
• Persistent Forearm Lesions

Clinical Concerns
Clostridium difficile: Testing and Treatment

Natasha Press, MD, FRCP(C)

Practical Approach
What’s up in Erectile Dysfunction?: ED, CVD, and PDE5 Inhibitors

Michael B. Greenspan, MD, FRCSC


December 2012, Volume 29, Number 12

Dalhousie Emergency Medicine Department
Case of the Month
“Have You Been Away Recently?”

Case in Point
Slowly Growing Knee Papule

Experts on Call
Answers to your questions from our medical experts

• Indications for Iron Injections
• Topiramate for Weight Control
• Treatment Options for Thrombosed External Hemorrhoids
• Headache Red Flags
• Diagnosing Pulmonary Embolism
• Recurrent Episodes of Herpes Zoster
• New Mammogram Guidelines
• Treating Chronic Gout
• Sugar Alcohols and Diabetics
• Wheezes and Rhinosinusitis
• Montelukast for Severely Allergic Patients

What's Your Diagnosis?
A Tender Nodule

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Thick Plaque of Skin
• Pink Nodules on Trunk
• Bluish-grey Patch
• Generalized Erythema and Scaling
• Nodule on the Ear
• Mass on the Scrotum

Clinical Concerns
Cardiovascular Autonomic Neuropathy in Diabetes:
What Every GP Should Know
Kimia Honarmand, BSc(Hons), and Ally P. H. Prebtani, BScPhm, MD, FRCPC