The Canadian Journal of Diagnosis
2010 Back-Issues
2001 • 2002 • 2003 • 2004 • 2005 • 2006 • 2007 • 2008 • 2009 • 2010 • 2011 • 2012
Jan • Feb • Mar • Apr • May • June • July • Aug • Sept • Oct • Nov •Dec
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December 2010, Volume 27, Number 12
Dalhousie Emergency Medicine Department
Case of the Month
“A Mechanic’s Eye-opening Experience”
Case in Point
Arm Discolouration
Experts on Call
Answers to your questions from our medical experts
• Continuation of Clopidogrel
• Canadian Recommendations for Mammography
• Common Causes of Low Platelets
• Blood Tests When Prescribing Antidepressants
• Vascular Dementia and Alzheimer’s Disease
• HPV Testing for Men
• Ciclopirox to Treat Onychomycosis
• Describing Incretins
• Coenzyme Q10 and Heart Failure
• Work-up Before Starting Bisphosphonate
• Lymphangioma Circumscriptum
New Guidelines for Outpatient Antiplatelet Therapy in Canada: Highlights from the Canadian Cardiovascular Congress, Montreal, October 2010
What’s Your Diagnosis?
Red Plaque on Groin
Treatment Gaps in the Control of Asthma in Canada
Alan Kaplan, MD, CCFP(EM), FCFP
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Rapidly Growing Tumour
• Cystic Mass • Discoloured, Brittle Nails
• Chemical Burn from Wig
• Large Lump
Hormone Replacement Therapy and Malignancies
Lucy Gilbert, MD, MSc, FRCOG; and Sabrina Piedimonte, BSc
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November 2010, Volume 27, Number 11
Dalhousie Emergency Medicine Department
Case of the Month
“Oh, the Pounding!”
Case in Point
Scalp Hair Loss
Experts on Call
Answers to your questions from our medical experts
• Long-term Isotretinoin
• Isolated Low Ferritin
• Management of Hypertensive Crisis
• Migraines and Oral Contraceptives
• Mandatory Referral to Dermatology
• Investigation of Endometriosis
• Continuation of First-line Antibiotics
• Von-Hippel Lindau Disease
• Gamma-globulin Levels
• IDiagnosis of Clinical Hypothyroidism
• ASA and Warfarin
• Inhaled Corticosteroids for Asthma
• Prophylactic Treatments for Alzheimer’s
• Subclinical Hyperthyroidism
• Topical Acne Therapy
• Drug Holiday from Bisphosphonates
• CRP and the Prescription of Statins
• Antidepressant Use in the Elderly
What’s Your Diagnosis?
Pruritic Eruptions on the Limbs
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Lesions on Forehead
• White Plaque on Buccal Mucosa
• Brain Lesion
• Pain in Big Toes
• Abdominal Pain
• Scaly Plaque on Cheek
• Rash on Buttocks
• Hypopigmentation of the Skin
• Painless Lump in Neck
• Eye Lesion
• Rough, Tender Foot Plaque
• Salmon-Coloured Rash on Trunk
• Umbilical Granuloma: Reader’s Response
A Pocket Guide for Family Physicians: Management of Osteoporosis
Wojciech P. Olszynski, MD, PhD, FRCPC, CCD
Managing BPSD: Treating Agitation and Aggression in the Elderly Demented Patient
Anne Sclater, MD, FRCPC, FACP
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October 2010, Volume 27, Number 10
Dalhousie Emergency Medicine Department
Case of the Month
“My Brother Won’t Wake Up!”
Case in Point
Multiple Nodules and Papules
What's Your Diagnosis
Soft-Tissue Density in the Lungs
Prevention of Vascular Events in High-risk Individuals: Optimal Use of Antiplatelet Therapies in Primary Care
Alan D. Bell, MD
Experts on Call
Answers to your questions from our medical experts
• Antidepressants During Pregnancy
• Blood Pressure after Axillary Node Dissection
• Ceramides for Hand Dermatitis
• Folic Acid Administration During Pregnancy
• Cerebellar Ataxia
• Efficacy of Varicella Vaccine
• Diabetes Mellitus Control
• Magnetic Resonance Properties for Treatment of Depression
• Elevated aPPT
• Improving HDL
• Hirsutism
A Novel Therapeutic Approach to Chronic Lower Back Pain
Philip A. Baer, MDCM, FRCPC, FACR; Alain Bissonette, MD, MCFP; and Jonathan Peck, MD, CFCP
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Muscular Weakness
• White Ring on Back
• Scaling and Erythema of the Foot
• Facial Cellulitis
• Persistent Cough
• Red Papule on Temple
• Facial Rash
Endocrine Update
Hypoparathyroidism
Psychiatric Illness: Assessment and Management
Diane McIntosh, BSc, MD, FRCPC
What is the Role of Genetics in Antiplatelet Therapy?
Alan D. Bell, MD
Learnings from the European Society of Cardiology Congress, Stockholm, 2010 |
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September 2010, Volume 27, Number 9
Dalhousie Emergency Medicine Department
Case of the Month
“Hot Stuff”
Case in Point
Timothy’s Tender Toe
Experts on Call
Answers to your questions from our medical experts
• Management of Hyperparathyroidism
• Primary Herpes Simplex
• Periungal Warts
• Electroconvulsion Therapy
• Dietary Supplements for Vaginitis
• Low Bone Density in Post-Menopausal Women
• Serum Haptoglobin
• Coenzyme Q10 and Heart Failure
• Seborrheic Dermatitis Treatment
• Bipolar and Personality Disorder
• Takotsubo Cardiomyopathy
• Insulin Resistance and Sensitivity
• Migraine Warnings
• Antibiotics for Otitis Media
What's Your Diagnosis
Episodes of Gross Hematuria
Time to Re-examine the Management of Gout
Heather McDonald-Blumer, MD, MSc, FRCPC and Jacqueline Fabian, MD, FRCPC
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Hammer Toe
• Hypodensity
• Chemical Burn from Wig
• Foot Lesions
• Non-Healing Ulcer
• Pruritis on Back
• Dark Macules on Skin
• Back and Shoulder Rash
• Ulceration after Trauma
• Lesions on Forehead
• Swelling on the Scalp
Pain Related Sleep Difficulties in Fibromyalgia and Neuropathic Pain
Pierre Arsenault, PhD, MD
Bowel Obstruction is a common occurrence that most GPs are familiar with regarding its diagnosis and management. Although the majority of the population is at low risk there are several conditions that predispose its development. Dr. Susan MacDonald discusses how to manage the symptoms of bowel obstruction in order to help alleviate pain and suffering.
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August 2010, Volume 27, Number 8
Dalhousie Emergency Medicine Department
Case of the Month
““No, I’m not waving at you !”
Case in Point
Big Bullae
Experts on Call
Answers to your questions from our medical experts
• Returning To Sport after Concussion
• Congenital Heart Disease
• Fighting Obesity
• Herpes Treatment
• Prescription Holiday
• Warts: Duct Tape vs. Cryotherapy
• Negative Colonoscopy Screening
• Vaginosis Treatment
• Nabilone and Nightmares
• Laser Hair Removal
• Treating Anemia in the Chronically Ill
• Polycystic Ovary Syndrome
• Urea Breath Testing
• HPV Testing for Men
• Iron Supplements
• Vitamin D Intake
• Hypersomnia
• Hypothyroid in Pregnancy
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Papules on Buttocks
• Watery Eyes
• Post Surgical Pain
• Spider like Lesions on Face
• Crooked Neck and Shoulders
• Scaly Umbilical Region
• Retrosternal Pain
Practical Approach to Management of Malignant Bowel Obstruction
Susan MacDonald, BScN, MD, CCFP, FCFP
Bowel Obstruction is a common occurrence that most GPs are familiar with regarding its diagnosis and management. Although the majority of the population is at low risk there are several conditions that predispose its development. Dr. Susan MacDonald discusses how to manage the symptoms of bowel obstruction in order to help alleviate pain and suffering.
Cancer: A Practical Guide for General Practioners
Bruce Colwell, BSc, MD, FRCPC
Cancer is a common group of diseases that should not be scary, however, the word itself strikes fear in the eyes of most people. Bruce Colwell discusses the importance for General Practitioners to encourage their patients to get screened for cancer, as well as explains how one should approach an individual who has been diagnosed with cancer. |
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July 2010, Volume 27, Number 7
Dalhousie Emergency Medicine Department
Case of the Month
“All Bleeding Stops...Eventually”
Case in Point
Depigmented Armpit
Experts on Call
Answers to your questions from our medical experts
• Treating Mild Eczema
• Describing Incretins
• Panic Attacks and Heart Attacks
• Severe Osteoporosis
• Switching From OCs to the NuvaRing®
• Drug Treatment for Bipolar Disorder
• Anticoagulation in the Elderly
• Distinguishing Between Viral and Bacterial Disease
• Imiquimod for Treating Basal Cell Carcinoma
• Managing Leukopenia
• Essential Hypertension in Pregnancy
What's Your Diagnosis
Swelling of the Left Foot
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Backache After a Fall
• Light Pinkish Spots
• Pruritic Lesions on the Ear
• Tongue Notch
• Warmth and Redness of the Breast
• White Macules on the Back
• Velvety Mass in Umbilical Area
An Update on: Osteoporosis
Aliya Khan, MD, FRCPC, FACP, FACE
?Osteoporosis is being increasingly recognized as a common condition associated with significant morbidity and mortality. Osteoporosis Canada has developed guidelines identifying absolute fracture risk by age and BMD. Dr. Khan explains the evaluation and therapy of osteoporosis, osteonecrosis of the jaw, drugs affecting skeletal health and atypical fractures
Neuropathic Pain: A Challenging Problem
Douglas W. Zochodne, MD, FRCPC
?Pain is a subjective term for an unpleasant conscious experience. Its development involves multiple levels of the nervous system from sensory endings in the skin and organs to the thalamus and cerebral cortex. Neuropathic pain is a specific type of pain that arises from injury or disease of the nervous system. Dr. Zochodne discusses the important distinctions of pain, what is responsible for this pain and what exactly is neuropathic pain and how it is treated. |
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June 2010, Volume 27, Number 6
Dalhousie Emergency Medicine Department
Case of the Month
“Is this Frostbite?”
Case in Point
Dry and Moist Skin Lesion
Experts on Call
Answers to your questions from our medical experts
• Hypothyroidism and Non-Alcoholic Fatty Liver Disease
• HPV Vaccination • Medications for Fibromyalgia
• Observation After Vaccination
• Restless Legs Syndrome
• Blood Count Differences of Various Nationalities
• Blood Tests When Prescribing Antidepressants
• Alpha-1-Antitrypsin Testing
• Electrolytes in Patients on Diuretics
• Causes of Alopecia
• Prognosis of Melanoma
What's Your Diagnosis
Progresive Verrucous Lesions
Endocrine Update
Nonresponsders to Bisphosphonae Therapy
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• A Mass on the Back
• Bright Red Papule
• Leathery Neck
• Reticulated Erythema
• Nail Deformity
• Arm Weakness
An Overview of Benign Paroxysmal Positional Vertigo
Jason A. Beyea, MD, PhD; and Lorne S. Parnes, MD, FRCSC
Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the peripheral vestibular system, with the most frequent age of onset between the fifth and seventh decades of life. Overall lifetime prevalence is reported as 2.4% (3.2% for females and 1.6% for males). Dr. Beyea and Dr. Parnes describe the causes, pathophysiology, diagnosis, including history and physical exam, management and follow-up of BPPV.
Clinical Pearls in Dyslipidemia Management
Mark H. Sherman, MDCM, FRCPC
Referrals to specialized Lipid Clinics are now frequently used for more complex lipid disorders and for more problematic patient management issues. While evidence-based guidelines are the optimal way to manage lipid disorders in general, the approach to treating these types of challenging cases must be individualized. Dr. Sherman explains his approach to three such challenges in dyslipidemia management and explains the rationale for each. |
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May 2010, Volume 27, Number 5
Dalhousie Emergency Medicine Department
Case of the Month
“My earache is getting worse!”
Case in Point
Finger Papules
Experts on Call
Answers to your questions from our medical experts
• Treating Temporal Arteritis and Polymyalgia Rheumatica
• Screening for Peripheral Neuropathy in Diabetes Mellitus
• Differentiating Between Vascular Dementia and Alzheimer’s Disease
• Atypical Antipsychotics for Patients with Borderline Personality Disorders
• Link Between Weather and Arthritis Pain
• When to Use Antibiotics to Treat Otitis Media
• Secondary Screening Techniques for Coronary Artery Disease
• DPP-4 Inhibitors for Diabetes Mellitus
• Blood Type After Allogeneic Bone Marrow Transplant
• Approach to Transient Paresthesia
• Dark Nails
• Avian Flu
• Risk for Breast Cancer with a Progestin Only Pill
• Neurochemistry for Appetite Control
• Sickle Cell Trait
• Indications for Psychoanalysis
• Coronary CT Angiography
• Tissue Transglutaminase to Diagnose Celiac Disease
• Treatment of TB
Optimal Control in Hypertesion: A Focus on the Role of Direct Renin Inhibition in Helping Reach BP Targets
Sébastien Bergeron, MD, FRCPC; Pierre Nantel, MD, CSPQ; and Pavel Hamet, OQ, MD, PhD, FRCPC, FAHA, FRSM, FCAHS
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Pink, Flat Papules
• Intensely Pruritic Rash
• History of Fall
• Erythema and Lichenification
• A Scaling Plaque
• Pigmented Lesions
• Hyperpigmented Patch
• Dark Brown Papules
Assessing Frailty in the Office
George A. Heckman, MD, MSc, FRCPC
Not all seniors age successfully—whereas some remain active, others become increasingly dependent on others. The term “frailty” is often used to describe seniors with overt disability and who require assistance with activities of daily living. Frailty also refers to seniors without overt disability but who are at increased risk of adverse health outcomes. Dr. Heckman describes what frailty is and how to assess and manage it.
Rheumatoid Arthritis in the Real World: Key Messages from Databases and Registries
The Latest Buzz Surrounding Allergy to Insect Stings
Tom Gerstner, MD, FRCPC
Allergic reactions to insect stings constitute a significant medical problem, reported in up to 3% of adults and almost 1% of children. However, many fatalities are thought to go unrecognized and usually occur in those > 45-years-old, but also in very young children and often with no prior history of a reaction. Dr. Gerstner describes the insects and their venom, different clinical reactions, anaphylaxis and intradermal testing and venom immunotherapy.
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April 2010, Volume 27, Number 4
Dalhousie Emergency Medicine Department
Case of the Month
“Can’t you just put on a bag?”
Case in Point
Facial Lump
Experts on Call
Answers to your questions from our medical experts
• Bartholin Cyst
• Metformin Use in Renal Failure
• Non-Alcoholic Fatty Liver Disease
• Ciclopirox for Treatment of Onychomycosis
• Prophylactic Medication for Migraines with Aura
• Tonsil Stones
• Lymphangioma Circumscriptum
• Causes of Polycythemia
• Positive D-Dimer
• Immunization from Pneumococcal Pneumonia
• Best Antidepressant for Hyponatremia or Polydipsia
• Blood Sugar Control in Type 2 Diabetes
• How Skin Striae Develops and How to Treat
What’s Your Diagnosis?
Slapped Cheeks
Mixed Dementia
The most common cause of dementia?
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Asymptomatic Pigmentation
• Painful Lesion
• Dilated Pupil and Blurred Vision
• Severe Headache
• Large Lump
What You Need to Know About Carpal Tunnel Syndrome
Carol A. J. Boyle, MD, FRCP(C), CSCN (EMG)
Carpal tunnel syndrome (CTS) is a clinical diagnosis which occurs when compression of the median nerve occurs at the wrist. It is a cause of considerable discomfort and lost time from work. Dr. Boyle answers questions regarding the signs and symptoms of CTS, the anatomy of the median nerve, the role of electrodiagnostic testing and treatment of the syndrome.
Why Perform Pulmonary Function Tests?
James G. Martin, MD, DSc
It is estimated that 1,500 deaths occur annually due to ingestion of foreign bodies (FB) and 3,000 deaths occur annually due to complications of foreign material aspiration. Foreign body ingestion and aspiration can affect persons of any age, however, 80% of cases occur in children (six months to three-years-old). Dr. Tewfik explains the different kinds of ingested objects and provides basic management options. He also describes esophageal FB, disc batteries and airway FB. |
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March 2010, Volume 27, Number 3
Dalhousie Emergency Medicine Department
Case of the Month
“Antibiotics? But what about my warfarin?”
Case in Point
Papules Under the Eyes
Experts on Call
Answers to your questions from our medical experts
• Developing Rashes From Hot Tubs
• When to Suspect Andropause
• Treating Sore Throats with Antibiotics
• Reversing INR Level with Vitamin K
• Prunes as Natural Laxatives
• OTC Anti-Allergy vs. Prescription Medications
• Unilateral Migraines
• Obstructive Sleep Apnea and Bradycardia
• Women with Male Pattern Baldness
• Acute Typhoid Fevers
• Common Causes of Low Platelets
• Low Sexual Desire in Post-Menopausal Women
• Avoiding Smoking Prior to Fasting Lipids
• Physiology of the Pain Associated with IBS
What's Your Diagnosis
Flesh-Coloured Papulonodules
Endocrine Update
Does it Affect the Endocrine System?
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Slowly Enlarging Brown Plaque
• Rash in Between Fingers
• Twitching After a Fall
• Red, Scaly Eruption
• Tongue Lesion
• Irregular Patch on Iris
• Erythematous Papule
• Right-Sided Weakness
Late-Onset Male Hypogonadism: Testosterone in the Aging Male
Bernard Corenblum, MD, FRCP
Hypogonadism in older men presents as symptoms and is confirmed by a low serum testosterone done in a reliable assay. Dr. Corenblum explains that such men should receive testosterone replacement therapy (TRT), if no contraindications, at least as a trial. TRT should be discontinued if there is no symptomatic improvement. Men with symptoms with a normal serum testosterone should not receive TRT.
Foreign Bodies in Otolaryngology
Ted L. Tewfik, MD, FRCSC
It is estimated that 1,500 deaths occur annually due to ingestion of foreign bodies (FB) and 3,000 deaths occur annually due to complications of foreign material aspiration. Foreign body ingestion and aspiration can affect persons of any age, however, 80% of cases occur in children (six months to three-years-old). Dr. Tewfik explains the different kinds of ingested objects and provides basic management options. He also describes esophageal FB, disc batteries and airway FB.
H1N1 2009 Influenza Virus: Management in an Outpatient Setting
Alice H. M. Wong, MD, MPH, FRCPC
Since the onset of the first wave of the pandemic (H1N1) 2009 influenza virus, considerable efforts have been made to develop plans for management of patients in an acute care setting. Dr. Wong describes the symptoms associated with the H1N1 virus, the laboratory diagnosis, infection and prevention control and treatment issues. |
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February 2010, Volume 27, Number 2
Dalhousie Emergency Medicine Department
Case of the Month
"I vomited a bit of blood!"
Case in Point
A Scalp Plaque
Experts on Call
Answers to your questions from our medical experts
• Canadian Recommendations for Mammography
• Risk of Bleeding While on Warfarin
• Drug-Free Holidays for Depressed Patients
• Infectious Mononucleosis
• C-Reactive Protein
• Initial Tests for Hirsutism
• Folic Acid in Depression
• Treatment of Coccidioides immitis
• Recurrent Persistent Atrial Fibrillation
• Significance of Findings of Chronic Deep Vein Thrombosis
• Hypertrophic Pulmonary Osteoarthropathy
• Treatment of Bell's Palsy
• Preventing Relapse of Recurrent Vaginitis
Endocrine Update
Do Glucose-Related Interventions Reduce CV Outcomes?
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• A Pigmented Lesion
• Cognitive Dysfunction
• Purple Papules on the Scrotum
• Cystic Mass
• Bleeding Lesion
• Discoloured, Brittle Nails
• Swelling of the Thigh
Fatigue: Investigation and Management
Stephen Workman, MD, FRCP
Fatigue is physical and/or mental exhaustion that can be triggered by stress, medication, overwork, or mental and physical illness or disease. While frequently self-limiting or resolving, it can represent an important diagnostic and therapeutic challenge. Dr. Workman describes the patients' history, medications available, examination techniques and management options for fatigue.
Congress Reporter
Cervical Cancer: A Worldwide Health Priority
James Bentley, MB ChB, FRCSC; Tania Diener, MB ChB, MMed, MPA, DTM, MFTM RCPS (Glasg); and Laurie Ellt, MD, MSc, FRCSC
Novel Therapies for Type 2 Diabetes Management
Adel Elsharif, MD (PGY5 Medical Biochemistry); and V.T. Chetty, MD, FRCPC, MSc
Type 2 diabetes mellitus is a chronic progressive vascular disease with significant physical, economic and societal burden. Its prevalence is growing rapidly, particularly in developing countries. An estimated 285 million people worldwide are affected by diabetes. More than three million Canadians have diabetes and this number is expected to reach 3.7 million by 2020. Dr. Elsharif and Dr. Chetty discuss the incretin effect, how to improve glycemic control and expand on different GLP-1 receptor agonists and DPP-4 inhibitors. |
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January 2010, Volume 27, Number 1
Dalhousie Emergency Medicine Department
Case of the Month
"Doc, my bowels just don't seem to be working right!"
Case in Point
Multiple Pruritic Papules
Experts on Call
Answers to your questions from our medical experts
• Photodynamic Therapy for Acne
• Stopping Warfarin for a Major Dental Procedure
• Managing Hyperglycemia in Steroid-Induced Situations
• Rheumatoid Factor vs. Anti-Cyclic Citrullinated Peptide
• Diagnosing Parkinson's Disease
• Uric Acid and CVD
• Seborrheic Dermatitis
• Pityriasis Alba vs. Rosea
• Hashimoto's Thyroiditis
• Syphilis Screening Tests
• Continuation of Clopidogrel After Acute Coronary Syndromes
• Work-Up Before Starting a Bisphosphonate
• Nasal Spray for Rhinorrhea
• Best Treatment for Anal Warts
• EKGs on Relatives of Patients with Wolff-Parkinson-White Syndrome
• Pathophysiology of Panic Attacks
What's Your Diagnosis?
"Excoriated Papules and Plaques–Part Two"
Endocrine Update
Risk Factor Management: Role of HDL
Identifying and Bridging Treatment Gaps in the Management of Dyslipidemia
Peter Lin, MD, CCFP
Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills
• Painful Ears
• A Cystic Mass
• Rapidly Growing Tumour
• Large, Asymptomatic Papule
• Chest Protrusion
• Rings on the Legs
Clinical Viewpoint
Expanding Treatment Options for Diabetes: GLP-1 Receptor Agonists
Advancements in Diabetes Management: A Canadian Diabetes Steering Committee Report
Asymptomatic Microscopic Hematuria: Work-Up and Treatment
Rohan Shahani, MD, MSc, FRCSC; and Edward D. Matsumoto, MD, MEd, FRCSC
Blood in the urine (hematuria) can originate from anywhere in the urinary tract or may be due to pathology outside the urinary tract and may be either gross or microscopic. The prevalence of asymptomatic microscopic hematuria (AMH) is 0.19% to 16.1%. Dr. Shahani and Dr. Matsumoto discuss the work-up and treatment of AMH, as well as when to refer to a nephrologist |
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