A Rare Case of Metachronous Quadruple Primary Malignancies in a Single Patient: A Case Report and Comprehensive Literature Review.

Multiple primary malignancies (MPMs) in the same patient are rare. Over the past decade, the incidence of MPMs is increasing. The prevalence in the general population is 0.

A deadly cold.

This narrative describes how non-execution of screening at an urgent care visit may have delayed the diagnosis of cervical cancer in a young woman.

Petechiae, as seen on TV.

This narrative describes how a patient facilitated a diagnosis of acute myeloid leukemia in a primary care visit because she recognized petechiae she had seen on television on her own skin.

Influenza Vaccination During COVID-19 in a Rural Community: A Cross-sectional Survey.

Vaccination behavior is an informative metric for assessing flu seasons and is especially important to understand for the 2020-2021 flu season, which coincided with the COVID-19 pandemic. This study aimed to estimate flu vaccine behavior and assess vaccine perceptions during the pandemic season. Using a cross-sectional descriptive study design, we conducted an online survey to assess vaccination behavior and perceptions of both COVID-19 and the flu.

Looking Back and Going Forward: Roles of Varenicline and Electronic Cigarettes in Smoking Cessation.

Tobacco use is the single largest preventable cause of death in the United States (US). The national goal of reducing the prevalence of adult cigarette smoking to 12% was retained for 20 years due to non-attainment. Meanwhile, varenicline and electronic cigarettes (ECs) became available in the US in 2006 and 2007, respectively, and have been used by many smokers wanting to quit.

Celiac disease unmasked by acute severe iron deficiency anemia.

The prevalence of celiac disease (CD) appears to be increasing in the United States. However, the proportion of new CD cases with atypical presentations is also rising. We present the case of a 49-year-old woman who was diagnosed with CD in the setting of new, severe iron-deficiency anemia, 13 years into treatment of diarrhea-predominant irritable bowel syndrome associated with chronic mildly elevated liver function tests.

Topiramate as a rare cause of reversible Fanconi syndrome and acute kidney injury: a case report and literature review.

Topiramate (TPM) is a sulfa-derivative monosaccharide that has been used for multiple indications in the last several years. We describe a 53-year-old woman with known chronic kidney disease stage 2 and baseline creatinine of 1 mg/dL who developed acute kidney injury and proximal renal tubular dysfunction while on TPM for depression. The Naranjo Adverse Drug Reaction Probability Scale indicated a probable relationship (score of 6) between TPM and acute kidney injury as well as proximal tubular dysfunction; these renal conditions resolved on withdrawal of TPM.

Documentation of quality improvement exposure by internal medicine residency applicants.

Background: Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown.

Exercise is Medicine™: A pilot study linking primary care with community physical activity support.

Introduction: Exercise is Medicine™ (EIM) is an approach to clinic-based physical activity (PA) promotion. Study aims were to 1) assess the acceptability of current EIM protocols among healthcare providers (providers) and health and fitness professionals (fitness professionals); and 2) pilot test the resultant modified EIM protocols comparing patients referred to community PA programming with patients exposed to the EIM protocols alone.

Methods: During 2012-2013 in Chattanooga, Tennessee, USA, 30/80 invited providers and 15/25 invited fitness professionals received training and provided feedback in the use of the EIM protocols.

Partially reversible bortezomib-induced cardiotoxicity: an unusual cause of acute cardiomyopathy.

Chemotherapy-associated cardiotoxicity can present as a spectrum from arrhythmia to acute congestive heart failure. Unlike anthracyclines, proteasome inhibitors - for example, bortezomib - are not notorious for causing cardiotoxicity in absence of pre-existing cardiac dysfunction or without concomitant use of other cardiotoxic agents. We describe a 66-year-old woman with end-stage renal disease who developed acute dyspnea hours after a third treatment with bortezomib for IgG kappa myeloma.

A survey of primary care resident attitudes toward continuity clinic patient handover.

Background: Transfer of clinic patients from graduating residents to interns or junior residents occurs every year, affecting large numbers of patients. Breaches in care continuity may occur, with potential for risk to patient safety. Several guidelines have been developed for implementing standardized inpatient sign-outs, but no specific guidelines exist for outpatient handover.

Extending the 5Cs: the health plan tobacco cessation index.

Objectives: To describe the smoking cessation services covered by licensed health plans in New York, and to evaluate plan characteristics that could account for variation in services.

Study Design: Prospective cross-sectional survey.

Methods: All 44 unique plans in the 2005 Managed Care Plan Directory of the New York State Department of Health were invited to participate.

Feasibility of an innovative third-year chief resident system: an internal medicine residency leadership study.

Introduction: The role of the internal medicine chief resident includes various administrative, academic, social, and educational responsibilities, fulfillment of which prepares residents for further leadership tasks. However, the chief resident position has historically only been held by a few residents. As fourth-year chief residents are becoming less common, we considered a new model for rotating third-year residents as the chief resident.

Accounting for professionalism: an innovative point system to assess resident professionalism.

Background: Professionalism is a core competency for residency required by the Accreditation Council of Graduate Medical Education. We sought a means to objectively assess professionalism among internal medicine and transitional year residents.

Innovation: We established a point system to document unprofessional behaviors demonstrated by internal medicine and transitional year residents along with opportunities to redeem such negative points by deliberate positive professional acts.

Gouty tophi.

Gouty tophi presenting as multiple large periarticular masses could be mistaken for rheumatoid nodules, neoplasm, neurofibroma, or infection. Aspiration of synovial fluid from inflamed joints or examination of whitish material expressed though breaks in skin usually assists with the diagnosis of gout.