Diagnostic Tests

Colorectal cancer rising in younger patients

August 13, 2009

Colorectal cancer rates have dropped steadily for more than a decade, but younger patients are bucking the trend.
 

Colonoscopy now favored by primary-care physicians

By Traci Dantoni July 23, 2009

Overtaking fecal occult blood testing and sigmoidoscopy, colonoscopy jumped to being the most popular procedure recommended by primary-care physicians to look for signs of colorectal cancer.
 

Prostate cancer possible even if PSA declines

March 25, 2009

Prostate cancer was found in 23% of men whose initially abnormal PSA levels fell to below 4 ng/mL.
 

Of what value are folate levels?

Question by Steven M. Schwartz, MD, Bronx, N.Y.; response by Susan Kashaf, MD, MPH March 16, 2009

All my colleagues and I continue to check patients' vitamin B12 and folate levels daily. Is this no longer the recommended standard?
 

Testing athletes for steroid use

Question from Jeffrey B. Rosen, MD, Coral Gables, Fla.; answer by Christopher Ruser, MD February 14, 2009

Detecting anabolic steroid use in athletes
 

Decreasing thyroid-stimulating hormone

Question by Louis H. McCormick, MD, Franklin, La.; answer by Christopher Ruser, MD February 13, 2009

Besides hyperthyroidis, what can cause thyroid-stimulating hormone levels to drop?
 

Increased melanoma burden is real

February 11, 2009

If you think you've been seeing more cases of malignant melanoma, you probably have.
 

Kveim test for sarcoidosis

Question by Lester N. Ploss, MD, Freeport, NY; response by Susan Kashaf, MD, MPH February 05, 2009

The status of the Kveim test for sarcoidosis: What is the status of the Kveim test in the diagnosis of sarcoidosis? Where can the antigen be obtained? What is the specificity and sensitivity of the test?
 

Unconfirmed history of TB

Question asked by Sunil Modi, MD, Johnstown, Pa., and answered by Cedric W. Spak, MD, MPH January 26, 2009

A patient reports a history of TB but has no medical records and refuses purified protein derivative testing.
 

Elevated PSA with a negative biopsy

Question asked by Jack W. Spitzberg, MD, Dallas, and answered by David T. Noyes, MD January 22, 2009

How to proceed when a patient's PSA is >4 ng/mL and the biopsy is negative
 

Popular drugs lower PSA levels

January 21, 2009

According to a pair of recent studies, two of the most commonly used classes of medication—statins and nonsteroidal anti-inflammatory drugs (NSAIDs)—may compromise already controversial cancer screenings by lowering serum levels of prostate-specific antigen.
 

More colonoscopies in your future?

By Myra Dembrow January 15, 2009

Primary-care physicians are performing colonoscopies as safely and effectively as specialists, a meta-analysis found. The American College of Gastroenterology disagrees.
 

Autoimmune and vasculitic renal diseases

Question asked by Dennis Fito, MD, Oklahoma City, and answered by Edgar V. Lerma, MD January 09, 2009

The etiology, diagnosis, and treatment of autoimmune and vasculitic renal diseases
 

Routine HIV testing encouraged, ignored

December 01, 2008

A new guideline from the American College of Physicians calls on doctors to routinely encourage HIV screening for all patients older than 13 years, regardless of their risk factors. Similar recommendations from the CDC, however, are not being followed.
 

Kidney marker warns of heart disease, diabetes

November 20, 2008

A new meta-analysis confirmed "a strong and continuous association between urinary proteinuria and subsequent risk of coronary heart disease (CHD)." Meanwhile, a team of French scientists has tied excessive UAE levels to substantially higher risks of developing diabetes in men.
 

When a doctor snubs PSA screening

By Ann W. Latner, JD November 17, 2008

Must physicians with doubts about the test's usefulness allow fear of liability to override their clinical judgment?
 

Pre-glucose tolerance test diet

Question submitted by G. Tadros, MD, Wilmington, Del., and answered by Daniel G. Tobin, MD October 06, 2008

What are the dietary recommendations for the three days preceding the oral glucose tolerance test (OGTT)? Many centers offering the OGTT...
 

Why do digital rectal exams?

Question submitted by Daniel E. Konold, DO, Canal Winchester, Ohio, and answered by David T. Noyes, MD October 06, 2008

In an audio CME program on preventive care, the lecturer on prostate cancer stated that "prostate-specific antigen (PSA) is recommended for screening; digital rectal examination (DRE) has no real value." The lecturer on colon cancer stated that "DRE with guaiac test in the office is proven ineffective...
 

Rationale for DRE

Question by Daniel Konold, DO, Canal Winchester, Ohio May 30, 2008

If DRE is not recommended to screen for prostate or colon cancer, why do we do it?
 

Subclinical hypothyroid monitoring

Question by Ferdinand M. Rivera, MD, Salinas, P.R.; answer by Susan Kashaf, MD, MPH May 15, 2008

A patient's insurer will not pay for thyroid testing more often than twice a year. Is retesting the TSH alone sufficient for adjusting levothyroxine doses?
 

Clearing for duty after PPD conversion

Question by Duc Nguyen, MD, Gainesville, Fla., and answered by Cedric W. Spak, MD, MPH May 01, 2008

Should asymptomatic employees with a positive PPD test be allowed to return to work while x-ray results are pending?
 

Is Bowen testing good for Lyme disease?

Question raised by John Spence, MD, Marianna, Fla. and answered by Cedric W. Spak, MD, MPH April 24, 2008

A growing number of patients are receiving Bowen testing for Lyme disease. Many tests return as positive, and patients are placed on long, expensive, and often problematic therapies. Is there any validity at all to this testing?
 

Colonoscopy for a healthy patient?

Question raised by Joseph R. Arulandu, MD and answered by Michael Flamm, MD April 17, 2008

Does a 50-year-old patient with parents in their 90s, no family history of cancer, and no bowel problems need a colonoscopy?
 

CT scans for elderly patients who fall?

Question raised by B R Manjunath, MD and answered by James P. Richardson, MD April 17, 2008

Are there any guidelines for doing a CT scan of the head in an elderly patient with dementia who has no sign of head or other injury following a witnessed or unwitnessed fall? What is the standard of care in the nursing-home/long-term-care setting?
 

Confirm all positive PPD tests?

Question raised by Julie Lavinder, MD, Alliance, Ohio, and answered by Cedric W. Spak, MD, MPH September 17, 2007

When a purified protein derivative (PPD) test read as positive at 13-mm induration was repeated,the area became red but not indurated. Since then, yearly PPD tests have been nonreactive. Should we confirm every "positive" reaction with a subsequent PPD test?
 

High ferritin, phosphatase, and calcium

Question raised by Tai J. Kim, MD, Denton, Tex. and answered by Susan Kashaf, MD, MPH July 14, 2007

What does this combination of findings signal?
 

Preoperative workup

Question by Suru Shah, MD, Johnstown, Pa., response by Susan Kashaf, MD, MPH December 15, 2006

What preoperative workup, if any, would you advise for an asymptomatic patient who has smoked half a pack of cigarettes a day for the past 18 years?
 

Benefits of managing TSH?

Question raised by Lara Hume, MD, Asheville, N.C. and answered by Susan Kashaf, MD, MPH August 15, 2006

What to do about hypothyroidlike symptoms in patients who are biochemically euthyroid
 

CK determinations in asymptomatic patients on statins

Question by Jeff Lipke, MD, Tamuning, Guam; response by Robert A. Guthrie, MD May 26, 2006

What is the evidence or consensus regarding CK measurements in the patients described?
 

Do omega-3 fatty acids lower CRP?

Question raised by MICHAEL B. BRUEHL, MD, Orono, Maine, and answered by Peter F. Cohn, MD February 27, 2006

Do any data demonstrate a beneficial effect of omega-3 fatty acids on CRP levels?
 

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