MKSAP: 68-year-old man with new-onset ascites
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, and metoprolol.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 122/84 mm Hg, pulse rate is 64/min, and respiration rate is 16/...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs
MKSAP: 81-year-old man after a percutaneous coronary intervention
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. Medical history is significant for hypertension and type 2 diabetes mellitus. He has no risk factors for or history of significant bleeding. Medications are aspirin, clopidogrel, lisinopril, ...
Source: Kevin, M.D. - Medical Weblog - March 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
The scary evolution of direct-to-consumer advertising
One night in 1997, as Americans watched Touched by an Angel they were touched by something else unexpected: an ad for a prescription allergy pill called Claritin, sold directly to patients.
Prescription drugs had never been sold directly to the public before — a marketing tactic called direct-to-consumer or DTC advertising. How could average people, who certainly had not been to medical school, know if the medication was appropriate or safe without a doctor’s recommendation?
Soon, ads for Meridia, Propecia, Singulair, Paxil, Prozac, Vioxx, Lipitor, and Viagra followed — exhorting patients to “ask their doct...
Source: Kevin, M.D. - Medical Weblog - March 17, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/martha-rosenberg" rel="tag" > Martha Rosenberg < /a > Tags: Conditions Cancer Source Type: blogs
MKSAP: 74-year-old woman with altered mental status
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated in the emergency department for several hours of altered mental status. She is from out-of-state and is visiting with relatives. One of her young relatives was recently ill with gastrointestinal symptoms. The patient developed anorexia 3 days ago and vomiting 2 days ago. She has been unable to tolerate any liquid or solid foods for the last 24 hours. Medical history is significant for type 2 diabetes mellitus, hypertension, hyperlipidemia, and hypothyroidism. Medications are aspi...
Source: Kevin, M.D. - Medical Weblog - February 18, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Source Type: blogs
Coronary artery disease: Primary care and prevention – 5
Previous
Statin for primary prevention
Very high lipid levels of the order of LDL cholesterol above 190 mg/dL calls for usage of statins for primary prevention. High intensity statins can be considered in this scenario as in acute coronary syndrome. When the LDL cholesterol level is between 70-189 mg/dL, primary prevention with moderate intensity statin may be considered if they are diabetic and have significant other risk factors for CAD. It is reasonable to measure SGPT/ALT levels before initiating statins and while on treatment so that values above 3 times the upper limit are not reached. Caution is advised in those abo...
Source: Cardiophile MD - December 21, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
The need for pharmacy electives in the medical school curriculum
I spent one year working full-time as a pharmacy technician at a high-volume community pharmacy prior to entering medical school. Besides learning the intricacies of billing and the dispensing process, I was granted personal access into a world nearly all patients, but few providers are aware of. At the time my job was just that: a job. There were fun perks like counting pills in multiples of five and visualizing the different colors and sizes of capsules and tablets I had never come across before. But it wasn’t until medical school that I began to fully appreciate my pharmacy knowledge.
Our school has a free student-r...
Source: Kevin, M.D. - Medical Weblog - December 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/sarayna-schock" rel="tag" > Sarayna Schock < /a > Tags: Meds Medical school Medications Source Type: blogs
Memo To The President: The Pharmaceutical Monopoly Adjustment Act Of 2017
Since 1980, Congress has enacted many laws granting pharmaceutical manufacturers monopolies that no other industry enjoys. These extra monopolies were created with the expectation that monopoly profits would spur greater investment in research to find important new drugs. In fact, they have caused US consumers to pay higher prices for medicines for longer periods of time while making the pharmaceutical industry far more profitable than any other industry. I believe the next president and Congress should take several key steps, which I outline below, to roll back these costly, unnecessary monopolies.
The Current Landscape
C...
Source: Health Affairs Blog - September 13, 2016 Category: Health Management Authors: Alfred Engelberg Tags: Costs and Spending Drugs and Medical Technology Health Policy Lab Bayh-Dole Act Big Pharma Gilead Hatch-Waxman Act johnson & johnson pfizer Source Type: blogs
Fatty Acid Metabolism and Age-Related Heart Failure
Researchers here propose that alterations in fatty acid metabolism in aged heart tissue make up one of the contributing factors to the age-related loss of function in the heart, a process that eventually leads to heart failure and death. As a mechanism this is is situated somewhere in the middle of the chain of cause and consequence that starts with molecular damage caused by the normal operation of metabolism, a sort of biological wear and tear, then passes through a complex series of reactions to that damage, some helpful and some harmful, and finally leads to functional failure in organs as the network of damage and con...
Source: Fight Aging! - September 8, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
MKSAP: 74-year-old woman with peripheral arterial disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin.
On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate is 15/min. BMI is 32. The lungs are clear to auscultation, and no murmurs are noted. A bruit is heard over the left femoral artery.
The right ankle-brachial index is 1.2 and...
Source: Kevin, M.D. - Medical Weblog - September 3, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
MKSAP: 57-year-old man with substernal chest pain
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 normal.
...
Source: Kevin, M.D. - Medical Weblog - August 27, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs
Welcome to my World: Perpetual Alarm Fatigue
By HANS DUVEFELT, MD
Part of a series on primary care challenges and their solutions.
I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic.
The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin.
The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite honestly, I am so used to getting irrelevant warnings that it has become a reflex to bring the cursor to the spot where I can ...
Source: The Health Care Blog - August 15, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Welcome to My World: Med Wreck
By HANS DEUVEFELT, MD
Part of a series on primary care challenges and their solutions.
Medication reconciliation is something we do every day, in the clinic and in the hospital. It shouldn’t be as hard as it is.
A patient with multiple medical problems returns for a fifteen minute quarterly visit. He saw his cardiologist three weeks ago and was told to double his metoprolol.
There are two ways to catch this change: when the cardiologist’s office note comes in, or as we check the patient in for his visit.
The cardiologist’s office note, generated by one of the leading EMRs, runs seven pages and contains entries a...
Source: The Health Care Blog - August 10, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Can Statins Cause Diabetes? - NYTimes.com
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Source: Dr Portnay - July 27, 2016 Category: Cardiology Authors: Dr Portnay Source Type: blogs
Health Expenditure Projections: When Does ‘New’ Become ‘Normal’?
The Centers for Medicare and Medicaid Services (CMS) has released its latest forecast of medical spending for the next decade. The headline number is that medical care as a share of gross domestic product (GDP) is expected to increase from its current 17.5 percent of GDP to 20.1 percent by 2025, resuming an upward increase after a several year slowdown.
Forecasting is an inexact science. To make guesses about the future, analysts typically examine the past. The history of medical spending can roughly be described using Fuchs’ law: medical spending increases have exceeded GDP increases by about 2.5 percentage points annua...
Source: Health Affairs Blog - July 13, 2016 Category: Health Management Authors: David Cutler Tags: Costs and Spending Featured Insurance and Coverage Medicaid and CHIP Medicare Payment Policy ACA ACOs Alternative Payment Models MACRA spending projections Source Type: blogs
Statin scare
It is shocking that so many people are bullied by doctors into taking statin cholesterol drugs: “The evidence is overwhelming: statins save lives.” “You’re a walking time-bomb. I can’t be responsible for your safety if you don’t take it.” “Your cholesterol is so high that you could die of a heart attack any time.” I’ve even heard of many patients being “fired” by doctors because of a refusal to take the prescription for Lipitor, Zocor, Crestor, or other drug.
Why such strong-arm tactics? Several reasons:
People are given the wrong diet, a diet—r...
Source: Wheat Belly Blog - May 23, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle cardiovascular cholesterol HDL lipids lipoproteins small LDL particles statins triglycerides Source Type: blogs
