MKSAP: 25-year-old woman is evaluated for redness at mosquito bite
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated for redness that developed over her right leg at the site of a mosquito bite. She is otherwise healthy and takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 120/70 mm Hg, pulse rate is 70/min, and respiration rate is 14/min. There is an erythematous 3 × 3-cm patch on the right thigh. The area is warm to the touch with no evidence of purulence, fluctuance, crepitus, or lymphadenopathy.
Which of the following is the most appropria...
Source: Kevin, M.D. - Medical Weblog - May 23, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
MKSAP: 46-year-old woman is evaluated before a dental cleaning
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and wheezing. The remainder of the history is noncontributory.
On physical examination, vital signs are normal. Cardiopulmonar...
Source: Kevin, M.D. - Medical Weblog - April 18, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
MKSAP: 46-year-old woman undergoing a dental cleaning
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus(MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and wheezing. The remainder of the history is noncontributory.
On physical examination, vital signs are normal. Cardiopulmonary...
Source: Kevin, M.D. - Medical Weblog - January 10, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Heart Infectious disease Source Type: blogs
MKSAP: 72-year-old unconscious woman in the ER
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict glycemic control (average hemoglobin HbA1c level, 6.2%) until last month when she had an infected ulcer between the third and fourth toes of the right foot that resulted in amputation of the middle toe 1 week ago. According...
Source: Kevin, M.D. - Medical Weblog - September 20, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Emergency Endocrinology Source Type: blogs
Finger Fascination
It’s summertime, and people are spending a lot of time outside in their yards, at the pool, traveling, hiking, and getting their fingers caught in things. That makes it the perfect time for a tribute to finger lacerations, specifically those with nail bed disruption and avulsion.
You will need to do a bit of handy work yourself if you work in an urgent care center that does not have a hand specialist on call 24/7. Finger lacerations can be complicated, but you simply need to keep in mind the basic principles about repair of soft tissue injuries. It is also important to identify tuft fractures and tendon disruption.
...
Source: The Procedural Pause - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Finger Fascination
It’s summertime, and people are spending a lot of time outside in their yards, at the pool, traveling, hiking, and getting their fingers caught in things. That makes it the perfect time for a tribute to finger lacerations, specifically those with nail bed disruption and avulsion.
You will need to do a bit of handy work yourself if you work in an urgent care center that does not have a hand specialist on call 24/7. Finger lacerations can be complicated, but you simply need to keep in mind the basic principles about repair of soft tissue injuries. It is also important to identify tuft fractures and tendon disruption.
...
Source: The Procedural Pause - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 65-year-old woman with prodrome of pain on the tip of the nose
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old woman is evaluated for a prodrome of pain on tip of the nose followed by a painful eruption involving the right periorbital tissue.
On physical examination, all vital signs are normal. There are grouped vesicles on an erythematous base on the tip of the nose and about the right eye.
Which of the following is the most appropriate first step in management of this patient?
A) Apply warm compresses
B) Begin ophthalmic corticosteroids
C) Begin valacyclovir and obtain urgent ophthalmology consultation
D)...
Source: Kevin, M.D. - Medical Weblog - July 19, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
Healthcare Update Satellite — 10-03-2013
Via @mdaware … ever wonder whether you need to prescribe two antibiotics for patients with uncomplicated cellulitis? EM Literature of Note’s Ryan Radecki pulls an article showing that there isn’t much difference in outcome/cure rates between treatment of uncomplicated cellulitis with only cephalexin versus combination treatment with cephalexin and Bactrim.
This is important. And it’s from Fox News, so you know it’s fair and balanced. Be very careful about how you sign up for the Obamacare exchanges. Experts expect that there will be a lot of hacking/phishing attacks using phony web sites to try to get unsuspectin...
Source: WhiteCoat's Call Room - October 3, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
The doctor who exposed his own error
Rather than hiding in shame from his mistakes, Bryan Bledsoe went public to tell the world about his error. Here, he tells me about the reasons behind that decision, and the consequences it has had for his career.
Not only did he survive the terrifying experience of ‘going public’, he actually believes that the publicity benefitted him and others.
Now he is a successful Emergency Physician, and author, in the USA, but back when he was a junior doctor he sent a patient home with tragic consequences. Dr Bledsoe described the details of his clinical encounter to me – the lady came in with a soft cervical collar on a...
Source: Life in the Fast Lane - August 27, 2013 Category: Emergency Medicine Doctors Authors: Tessa Davis Tags: Emergency Medicine Featured Bryan Bledsoe medical error MJA Source Type: blogs
Sometimes It’s Subungual
As you may have noticed, we have really put a finger on figuring out paronychia and the dreaded felon in the past two Procedural Pause blogs. This series, however, would not be complete without also touching upon complications related to a subungual hematoma and abscess. Hopefully, this month’s entry will point you in the right direction if you come across these two culprits.
Typically, a subungual hematoma will form from direct blunt trauma to the fingernail itself. Some common mechanisms of trauma range from slamming the digit in a car door, in a drawer, hitting it accidentally with a hammer, or from a sports-re...
Source: The Procedural Pause - June 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Please Poke My Paronychium!
THE BASICSWhat is more satisfying than draining a pus-filled paronychium? Seeing the look of relief on the face of your patient when his painful, pulsating digit is relieved of all that tension! This rather elementary procedure could be perceived as stale and uneventful for some of you. The more thorough and astute clinicians, however, realize these tiny infections around the nail root may open the door to a mixed bag of insidious and harmful bacterial infections including MRSA, chronic reoccurrences, cellulitis, subungual abscesses, osteomyelitis, herpetic whitlow, or even the dreaded felon.
Whatever your pleasure, thi...
Source: The Procedural Pause - May 1, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
