MKSAP: 67-year-old woman who takes diclofenac
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any gastrointestinal symptoms, and she takes the diclofenac with food most of the time. Her medical history is otherwise notable for type 2 diabetes mellitus, hyperlipidemia, and hypertension. Her parents both had coronary artery disease. Her medications are low-dose aspirin, metformin, chlorthalidone, simvastatin, and diclofenac. On physical examination, vital signs are normal. Abdominal examination is unremarkable. Which of the following is the most appropriate management? A. Change to enteric-coated aspirin B. Continue the current medication regimen C. Initiate omeprazole, 20 mg once daily D. Initiate omeprazole, 40 mg once daily Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
ConclusionsThe algorithm produces plausible analyses of medication errors in older people, pointing to established areas of therapeutic deficiencies. Though individual recommendations exist, the algorithm cannot employ the full potential of FORTA as important details (e.g., blood pressure values, pain intensity) are not (yet) included. However, it seems capable of detecting medication problems in large cohorts —FORTA-EPI (Epidemiological) is designed to support epidemiological analyses, e.g., on comparisons of large cohorts, interventional impact, or longitudinal trends.
This study was conducted to assess the depression among T2DM patients attending diabetic clinics, primary healthcare centers (PHC), Dubai Health Authority (DHA). Depressive symptoms were assessed by using both Arabic and English version of the Beck Depression Inventory. Results: Out of 1,050 diabetic patients approached, 559 were within our inclusion criteria and agreed to participate in this study (Response rate of 53%). The mainstream of the participants had T2DM for
ConclusionsObesity and overweight conditions are related to higher mortality and disability than previously estimated; effective interventions aimed at prevention and treatment will have a high impact on quality of life.
A 66-year-old white man with a medical history of chronic kidney disease (CKD) stage 3a (baseline creatinine level of 1.4 mg/dL; normal 0.74-1.35 mg/dL) with an estimated glomerular filtration rate of 52 mL/min per 1.73 m2 per the Chronic Kidney Disease Epidemiology collaboration equation, controlled type 2 diabetes mellitus with microalbuminuria, hypertension, hyperlipidemia, and medically complicated obesity (body mass index, 37) presented to his primary care clinic with episodes of orthostatic light-headedness that had been occurring for approximately 2 weeks.
BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; &AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and it...
BY ARJUN BHARADWAJ &KHALID MALIK, MDA 58-year-old man who lived at a nursing facility came to the emergency department complaining of abdominal pain for three days. His pain was localized to the epigastrium and periumbilical regions. The nursing home staff indicated that he was hypotensive and possibly hypoxic.The patient said he never had similar pain before, which he said pain was mild and constant in severity and did not radiate to the chest, back, pelvis, or shoulders. He also reported nausea but no trauma, falls, vomiting, fever, chills, dizziness, chest pain, shortness of breath, trouble walking, or change in ...
A 45-year-old man presented to the emergency department at an outside facility with severe right upper quadrant abdominal pain, radiating to his back with deep inspiration. The pain had started the evening before, and the patient described it as dull and aching with intermittent episodes of sharp, stabbing discomfort. The pain was not associated with fever, nausea, vomiting, or diarrhea. He had no recent travel history. His medical history was notable for hypertension, type 2 diabetes mellitus, and gastroesophageal reflux disease.
Publication date: Available online 13 September 2018Source: Annals of Medicine and SurgeryAuthor(s): Sonali Gupta, Pradeep Goyal, Pranav Sharma, Priti Soin, Puneet S. KocharAbstractDiabetic myonecrosis (DMN) is an under-diagnosed complication of long-standing poorly controlled diabetes mellitus. It presents as abrupt pain and swelling of the extremity, mostly lower limbs. Diagnosis is often delayed as it mimics a number of clinical entities such as deep vein thrombosis (DVT), cellulitis, necrotizing fasciitis and malignancy. Failure to properly identify this condition can result in increased morbidity through exposure to u...
A 73-year-old man with a history of end-stage renal disease on hemodialysis for 6 years, hypertension, and diabetes mellitus type 2 presented with worsening pain and swelling of the left upper extremity brachiocephalic arteriovenous fistula. The patient was having night sweats for a few days prior to presentation was started on intravenous cephalosporin therapy at his outpatient dialysis unit as the blood cultures grew Staphylococcus aureus. On examination, the fistula was hard and there was skin degeneration with oozing in the area which appeared to be pseudoaneurysm [Fig.
ConclusionThe resective gastric bypass or gastrectomy with anastomosis by Roux- en- Y bypass may be considered as a treatment of choice for patients who after bariatric surgery were diagnosed with gastric carcinoid and weight regain.
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