Clinic Sept 23, 2011

The handout for solitary pulmonary nodule (password required) is here.

A recent review (2008) on the evaluation of said nodules is here:
http://pats.atsjournals.org/cgi/content/full/5/9/900

This algorithm is advocated by the guidelines:

As discussed, the role of CT-PET is still being defined, particulary for nodules less than 8mm but it may be a useful technique in specific circumstances when biopsy or resection would be difficult or have significant morbidity. 

1) We then discussed radiation risk from CT scans -- review here
http://content.nejm.org/cgi/content/full/357/22/2277

Interesting editorial here (written by a mentor and a classmate from my time in Toronto):
http://jama.ama-assn.org/content/304/19/2170.full

2) We had a patient with significant by asymptomatic hypothyroidism with a profoundly elevated TSH.  He also had mild renal failure, normocytic anemia, and mild hepatitis all of which could be due to the hypothroidism.


This older blog post describes the approach to myxedema coma.

We discussed the importance of ruling out other endocrinopathies (in particular Addison's disease) and one astute resident mentioned the impotance of excluding celiac disease.