MKSAP: 49-year-old-man with right arm weakness

Test your medicine knowledge with the  MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old-man is evaluated 1 day after having an episode of right arm weakness without pain that lasted 5 minutes. He is now asymptomatic. The patient has type 2 diabetes mellitus and dyslipidemia. Medications are aspiri n, metformin, and atorvastatin. On physical […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Neurology Source Type: blogs

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​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...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
​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 ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
This article reviews the clinical questions and bottom-line answers from these studies. Blood pressure should be measured after a period of rest, using a bare arm, and orthostatic blood pressure is more predictive when measured after one minute of standing rather than three minutes. Intensive blood pressure lowering results in cardiovascular benefits but also renal harms in high-risk patients with an average age of 68 years. The initiation of a statin for primary prevention does not reduce cardiovascular events in adults 65 years or older. Sterile gloves do not reduce the risk of infection for common outpatient skin proced...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
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 par...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Gastroenterology Source Type: blogs
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 par...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions GI Medications Orthopedics Source Type: blogs
The 2013 American Heart Association Blood Cholesterol Guidelines increased the number of patients recommended for statin therapy in the United States to 56 million. Two common statin side effects are muscle pain, referred to as “statin-associated muscle symptoms”, and increased risk for new onset type-2-diabetes mellitus. Up to 25% of statin users report muscle symptoms resulting in many patients being switched to lower dose or lower potency statins, or refusing statins altogether. The most likely signaling mechanisms for statin-associated muscle symptoms overlaps with the proposed mechanism of statin-induced insulin resistance.
Source: Medical Hypotheses - Category: Biomedical Science Authors: Source Type: research
The 2013 American Heart Association Blood Cholesterol Guidelines increased the number of patients recommended for statin therapy in the United States to 56million. Two common statin side effects are muscle pain, referred to as “statin-associated muscle symptoms”, and increased risk for new onset type-2-diabetes mellitus. Up to 25% of statin users report muscle symptoms resulting in many patients being switched to lower dose or lower potency statins, or refusing statins altogether. The most likely signaling mechanisms for statin-associated muscle symptoms overlaps with the proposed mechanism of statin-induced insulin resistance.
Source: Medical Hypotheses - Category: Biomedical Science Authors: Source Type: research
A 70-year-old man presented with fever, progressive intention tremor of bilateral hands, and painful swelling over bilateral knee joints, which started 3  days before admission. He could not walk and stand up by himself on admission. He had neither diarrhea nor abdominal pain. He denied using alcohol. His comorbidities included type 2 diabetes mellitus (recent hemoglobin A1C = 7.2%), dyslipidemia, and hypertension. His medication included repaglin ide (6 mg/d), atorvastatin (10 mg/d), labetalol (200 mg/d), valsartan (80 mg/d), and hydrochlorothiazide (12.5 mg/d).
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Make Your Diagnosis Source Type: research
ObjectivesTo test whether average long‐term glucose exposure is associated with cognitive and physical function in middle‐aged and younger‐old adults with type 2 diabetes mellitus. DesignProspective cohort study. SettingData obtained as part of the Action for Health in Diabetes (Look AHEAD) trial (NCT00017953) and Look AHEAD Movement and Memory ancillary study (NCT01410097). ParticipantsOverweight and obese individuals with type 2 diabetes mellitus aged 45 to 76 at baseline (N = 879). MeasurementsGlycosylated hemoglobin (HbA1c) was measured at regular intervals over 7 years, and objective measures of cognitive functi...
Source: Journal of the American Geriatrics Society - Category: Geriatrics Authors: Tags: Clinical Investigations Source Type: research
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as needed. His inpatient plasma glucose values are 170 to 210 mg/dL (9.4-11.6 mmol/L). Results of all other laboratory studies are ...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes Endocrinology Source Type: blogs
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