The Exchange

Commentary and Observations from
the Medical Frontlines

 
<a href='/the-exchange/how-do-you-make-a-diagnosis-of-gout-without-seeing-msu-crystals-under-a-microscope-'>How Do You Make a Diagnosis of Gout Without Seeing MSU Crystals Under a Microscope?</a>

How Do You Make a Diagnosis of Gout Without Seeing MSU Crystals Under a Microscope?

Primary care/urgent care/emergency rooms are all settings where acute monoarthritis is seen. The differential diagnosis includes acute crystal arthritis (gout, pseudogout), septic arthritis (rare), Lyme arthritis (clustered geographical locations), osteoarthritis, rheumatoid arthritis, and spondyloarthritis. Very few settings aspirate joints and send for culture and sensitivity, crystal analysis, cell count, and gram stain. Most do not have a microscope where they can observe crystals, and those that do may feel unqualified to accurately review slides looking for monosodium urate crystals. more >

Found in: Rheumatology

<a href='/the-exchange/is-long-term-survival-associated-with-the-use-of-nitrogen-containing-bisphosphonates-'>Is Long-term Survival Associated With the Use of Nitrogen-containing Bisphosphonates?</a>

Is Long-term Survival Associated With the Use of Nitrogen-containing Bisphosphonates?

In the January issue of Osteoporosis International, there was an article entitled, “Mortality Risk Reduction Differs According to Bisphosphonate more >

<a href='/the-exchange/treating-the-hypertensive-patient-with-chronic-kidney-disease'>Treating the Hypertensive Patient With Chronic Kidney Disease</a>

Treating the Hypertensive Patient With Chronic Kidney Disease

Hypertension (HTN) is present in approximately 80% to 85% of patients with chronic kidney disease. Uncontrolled HTN is the second leading cause of kidney more >

<a href='/the-exchange/anticoagulants-and-recurrent-thrombosis'>Anticoagulants and Recurrent Thrombosis </a>

Anticoagulants and Recurrent Thrombosis

The other day a student asked me, “If a patient is taking a blood thinner for a previous venous thromboembolism (VTE), is it still possible for them to get a more >

<a href='/the-exchange/transcatheter-aortic-valve-replacement-what-s-in-it-for-your-patient-'>Transcatheter Aortic Valve Replacement: What's In It for Your Patient?</a>

Transcatheter Aortic Valve Replacement: What's In It for Your Patient?

Over the last few years more and more development and technology has been devoted to transcatheter aortic valve replacement, or TAVR. This procedure, developed more >

<a href='/the-exchange/states-involvement-with-medicaid-expansion'>States' Involvement With Medicaid Expansion</a>

States' Involvement With Medicaid Expansion

For a little over 50 years, Medicaid has provided health care as a stop gap to millions of people. With the passage of the Affordable Care Act (ACA), few more >

<a href='/the-exchange/super-bowl-and-food-recovery'>Super Bowl and Food Recovery</a>

Super Bowl and Food Recovery

Super Bowl Sunday is reportedly one of the biggest eating days of the year, behind Thanksgiving. There were lots of parties and celebrations this week, which more >

<a href='/the-exchange/here-we-go-again-measles-in-seattle-this-time'>Here We Go Again: Measles in Seattle This Time</a>

Here We Go Again: Measles in Seattle This Time

As of January 31, 2019, there were 42 confirmed cases of measles in the Pacific Northwest. This includes 41 cases in Clark County, the epicenter for the more >

<a href='/the-exchange/leading-the-charge-toward-maintenance-of-certification-changes'>Leading the Charge Toward Maintenance of Certification Changes</a>

Leading the Charge Toward Maintenance of Certification Changes

The rationale and justification behind certification examinations has always been explained to me as it must be guaranteed to patients that anyone practicing more >

<a href='/the-exchange/who-should-step-up-to-help-in-an-in-flight-medical-emergency-'>Who Should Step Up to Help in an In-flight Medical Emergency?</a>

Who Should Step Up to Help in an In-flight Medical Emergency?

Recently I got an email from Medscape that detailed three articles, and one piqued my curiosity: “Who Should Step Up to Help in an In-flight Medical more >

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