MKSAP: 46-year-old man with fever, dysuria, and urinary frequency
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 46-year-old man is evaluated for fever, dysuria, and urinary frequency of 1 day’s duration. He also notes a sensation of deep pelvic pain near the rectum. He has no urethral discharge or testicular pain. He states that he felt well before the current illness and has no other symptoms. Medical history is unremarkable. He is not sexually active. He takes no medications.
On physical examination, temperature is 38.8 °C (101.8 °F), blood pressure is 130/80 mm Hg, pulse rate is 100/min, and respiration rate ...
Source: Kevin, M.D. - Medical Weblog - September 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Infectious Disease Primary Care Urology Source Type: blogs
Celiac Disease: A Serious, Life-Changing Condition
I met Paul Graham courtesy of one of his essays. Then, we talked by phone and I read – no devoured – his book, In Memory of Bread: A Memoir. Pardon the pun. Paul is a professor of English Department at St. Lawrence University in Canton, NY and on July 1 becomes Department Chair. He focuses on fiction and non-fiction creative writing and lives with his wife, Bec and their German shepherds.
Paul, your book is the best description I’ve read about the challenges of being diagnosed with celiac. Can you summarize what happened? Given your experience, what recommendations would you have for clinicians? Should celiac be su...
Source: Disruptive Women in Health Care - June 5, 2017 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Uncategorized Source Type: blogs
MKSAP: 30-year-old woman with right antecubital fossa and biceps pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications.
On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate is 120/min, and respiration rate is 28/min. BMI is 28. She appears ill. No lymphangitis or right axillary or epitrochlear lymphadenopathy is evident. The right biceps area i...
Source: Kevin, M.D. - Medical Weblog - April 9, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
Longing for the QT
A 58-year-old man presented to the ED with a reported overdose of an unknown medication. The patient was agitated, combative, and altered. Initial vital signs included a heart rate of 115 beats/min, blood pressure of 154/93 mm Hg, respirations of 22/min, and temperature of 99.5°F. The patient was difficult to evaluate because he was agitated, and he was given 5 mg of haloperidol IV and 2 mg of lorazepam IV. The patient continued to be agitated, and was given another 10 mg of haloperidol IV, followed by a repeat dose of 10 mg IV 15 minutes later. The patient then became unresponsive, and his cardiac monitor demonstrated th...
Source: The Tox Cave - March 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Year in Review: FDA 2015 New Drug Approvals
The approval of first-of-a-kind drugs rose last year to forty-one, resulting in the highest level of newly approved U.S. drugs in nineteen years. The total number of new drugs approved last year was even higher at sixty-nine. The rising figures reflect an industry-wide desire to research and develop drugs for rare and hard-to-treat diseases.
The newly approved drugs serve to advance medical care and the health of patients suffering from many ailments, including various forms of cancer, heart failure, and cystic fibrosis. Additionally, more than 40% of the new therapies were approved for treatment of rare or "orphan" dise...
Source: Policy and Medicine - January 13, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Should Fluoro be Your New Go-To?
Part Three in a Three-Part Series
This is the third and final part of our series on foreign bodies and fluoroscopy. Click here for part one and here for part two.
This month, we walk you through a step-by-step guide with bonus video footage to aid in your technique. This progressive procedure is absolutely significant to your practice, and we hope you all get a chance to try it.
The Approach
n Identification of foreign body on plain film or ultrasound
n Saphenous or posterior tibial nerve block
n Enlargement of the wound or entrance site using incision...
Source: The Procedural Pause - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Viruses help form biofilms
Bacteria frequently grow in communities called biofilms, which are aggregates of cells and polymers. An example of a biofilm is the dental plaque on your teeth. Biofilms are medically important as they can allow bacteria to persist in host tissues and on catheters, and confer increased resistance to antibiotics and dessication. Therefore understanding how biofilms form is crucial for controlling microbial infections. An advance in our understanding of how biofilms form is the observation that filamentous phages help them assemble, and contribute to their fundamental properties.
Pseudomonas aeruginosa is an important hum...
Source: virology blog - December 18, 2015 Category: Virology Authors: Vincent Racaniello Tags: Basic virology Information bacteria bacteriophage biofilm birefringence liquid crystal matrix microbe microbiology polymers Pseudomonas aeruginosa viral virus Source Type: blogs
Clinician-Led Stewardship To Curb Medical Excess
In a recent New England Journal of Medicine (NEJM) perspective, Durand and colleagues propose “medical-imaging stewardship.” They believe that imaging can be more appropriately used through “provider-led imaging stewardship,” based on the model of antimicrobial stewardship.
Antimicrobial stewardship is a hospital program composed of an expert pharmacist and infectious disease physician. Its goal is to improve appropriateness of antimicrobial use through restriction of antibiotics, post-prescription review, and education. Clinician-led stewardship could limit overuse and improve care beyond antimicrobial use or imag...
Source: Health Affairs Blog - November 30, 2015 Category: Health Management Authors: Dan Morgan Tags: Costs and Spending Health Professionals Hospitals Innovations in Care Delivery Medicare Quality antimicrobials Choosing Wisely Patient Safety patient uses of evidence Physicians Source Type: blogs
Uquora – Hope, Hype and Maybe a Case of Diarrhea
Before you go out and spend $25 for 10 packets of Uquora, the new after-sex UTI prevention drink that launched today, you should consider if it actually works.
What’s in Uqora?
Uqora’s main active ingredient is D-Mannose (2 gm), combined with Vitamin C (600 mg), Vitamin B6, Calcium and Magnesium. (The company website does not list amounts for the last three ingredients.) The ingredients are made into a powder that you mix with water and drink.
The manufacturer claims that Uqora will reduce the chance of getting a UTI if you drink it after having sex, after exercise or during travel, all activities linked to re...
Source: The Blog That Ate Manhattan - August 20, 2015 Category: Primary Care Authors: Margaret Polaneczky, MD Tags: Women's Health Post-coital Post-sex PRevention Uqora urinary tract infection UTI Source Type: blogs
Healthcare Update Satellite – 06-08-2015
To increase access to medical for our nation’s veterans, the Veteran’s Choice Act authorized the VA to pay for more medical provided to veterans from community health providers. How did the VA save money in that scenario? It either “lost” claims in which providers had proof of submission or it just delayed paying the claims so that veterans would be billed for the treatment. Now providers are refusing to contract with the VA due to all of the hassles. The VA said that it was making interest payments to providers who received delayed payments, but none of the people testifying to a Senate subcommitte...
Source: WhiteCoat's Call Room - June 8, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Research and Reviews in the Fastlane 040
In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was ma...
Source: Life in the Fast Lane - July 21, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Gastroenterology Haematology Health Infectious Disease Intensive Care Neurology Pre-hospital / Retrieval Respiratory critical care literature R&R in the FASTLANE Source Type: blogs
Research and Reviews in the Fastlane 038
This study, however, has major flaws and biases that question the validity of their conclusions. Only 19% of centers that were contacted agreed to contribute data to the Consortium. Additionally, the researchers do not assess the quality of the studies included in their meta-analysis. Regardless, observational data should not be used to trump the RCT data included in the recent, Cochrane review. Finally, Roche pharmaceuticals was a major sponsor of this research team. The accompanying editorial is a must-read.
Recommended by: Anand Swaminathan
Infection Control, Hand hygiene
D’Egidio G et al. A study of the ...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured Infectious Disease Intensive Care Neurology Palliative care R&R in the FASTLANE Radiology Resuscitation Trauma critical care literature recommendations research and reviews Source Type: blogs
Stop Expecting Antibiotics to Be Handed Out Routinely: Here’s Why
For years, my colleagues on the Prepared Patient site have preached the importance of being an advocate for your own care. And they’ve noted that at times it is necessary to push back against doctors’ recommendations if a suggested treatment does not seem right. I just returned from a visit to the U.K., which drove home the importance of that advice. Coming down with a common cold gave me a chance to experience differences in how British and American doctors approach the nasty symptoms of an all-too-common medical problem.
Let’s face it. Most of us have been given too many antibiotics for sore throats, co...
Source: Disruptive Women in Health Care - June 16, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Consumer Health Care Policy Source Type: blogs
