MKSAP: 59-year-old man with intermittent itching
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started scratching. The itch gets worse after being in the sun, but sun exposure does not cause redness or a rash.
On physical examination, the patient shows evidence of chronic sun damage on sun-...
Source: Kevin, M.D. - Medical Weblog - August 24, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Dermatology Source Type: blogs
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Top stories in health and medicine, August 6, 2014
From MedPage Today:
Advocacy Groups Take Obesity Naysayers to Task. Two obesity advocacy groups took to the pages of the Archives of Internal Medicine this week to castigate a report that questioned the legitimacy of obesity as a disease and cast an unfavorable light on new weight-loss drugs.
Shoulder Pain: PT Works Well and Costs Less Than Shots. Patients with shoulder pain receiving corticosteroid injections (CSI) versus manual physical therapy (MPT) had the same amount of symptom improvement, but the corticosteroid group used more healthcare resources.
OSA Exam Best for ‘Unexplained Daytime Sleepiness’. Sl...
Source: Kevin, M.D. - Medical Weblog - August 6, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Infectious disease orthopedics Pulmonology Source Type: blogs
Pulmonary edema due to beta agonist used as tocolytic
Beta agonist given as a tocolytic to prevent premature labour can rarely (thought to be one in four hundred) cause pulmonary edema. Pulmonary edema with use of beta agonist as tocolytic can occur with both oral and intravenous therapy and may occur within twenty four hours of discontinuation of therapy.
Mechanism of pulmonary edema with beta agonist used as tocolytic seems to be unique to the pregnant state as even large doses of beta agonists in non pregnant females with asthma seldom produce pulmonary edema. Hypervolemia of pregnancy and excess fluid given during infusion of tocolytic have been implicated in the pathogen...
Source: Cardiophile MD - July 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology ADH anti-diuretic hormone Pulmonary edema due to beta agonist renin-angiotensin system 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
MKSAP: 38-year-old man with a 1-year history of cough
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old man is evaluated for a 1-year history of cough with mucoid sputum and a 6-month history of mildly progressive dyspnea. He has a 12-pack-year history of smoking. He has no history of asthma, allergies, skin disease, or liver disease.
On physical examination, vital signs are normal. Pulmonary examination discloses decreased breath sounds bilaterally with no wheezing.
Laboratory studies, including a complete blood count and complete metabolic panel, are normal. Oxygen saturation is 97% breathing ambie...
Source: Kevin, M.D. - Medical Weblog - July 5, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
MKSAP: 35-year-old woman with new-onset thrombocytopenia
A 35-year-old woman is evaluated for new-onset thrombocytopenia. She is gravida 1 at 36 weeks’ gestation. Her pregnancy has been otherwise uncomplicated. She takes only a prenatal vitamin.
On physical examination, temperature is normal, blood pressure is 110/65 mm Hg, pulse rate is 110/min, and respiration rate is 22/min. There are no ecchymoses or petechiae. Abdominal examination discloses no right upper quadrant pain. She has a gravid uterus. Neurologic examination is normal, and there is no peripheral edema.
Laboratory studies:
Hematocrit
33%
Hemoglobin
11.0 g/dL (110 g/L)
Leukocyte count
9500/µL (9.5 × 1...
Source: Kevin, M.D. - Medical Weblog - June 28, 2014 Category: Journals (General) Authors: mksap Tags: Conditions OB/GYN Source Type: blogs
Dobbs Roundup Week of 16/6/2014 – 20/6/2014)
Dear Dobber,
Hope you’ve had a great week but not lost too much sleep watching the World Cup matches (fans check out this thread). Here’s an update for the weekend to tell you of what’s fresh in Dobbs.
Feel free to click on the links if anything interests you.
Picks of the week from the Forums
MOH to restructure Medical Certificate System
MOH plans to put in place a system to tackle fake MCs and medical absenteeism. Will it work?
Prophylactic corticosteroids – any guidelines
@mrnginbox had a question about prophylactic steroids for contrast MRI scans. Dobber radiologists answer.
Dad puts sons through med sch...
Source: Malaysian Medical Resources - June 21, 2014 Category: Global & Universal Authors: palmdoc Tags: - Dobbs forum Source Type: blogs
Cases: "Am I really going to have to live like this?": The Role of Octreotide in Patients with Persistent Nausea and Vomiting after Venting Gastrostomy
Discussion:Malignant bowel obstruction can occur with any cancer but is most commonly associated with advanced ovarian cancer, where it occurs in up to 50% of patients. It generally indicates a poor prognosis and carries a heavy symptom burden predominated by nausea, vomiting and abdominal pain. Patients with carcinomatosis, like Ms BB, are generally not candidates for surgical correction of the obstruction or endoscopic stenting. Fortunately, medical management can be very effective. Abdominal pain is treated with opioids and nausea is treated with metoclopramide in partial obstructions and haloperidol in complete obstruc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 10, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Feel the Burn
Hand burns from thermal injuries are common chief complaints in the emergency department. Sometimes, 2nd- and 3rd-degree burns may need immediate interventions and warrant special attention. These injuries are painful, and often have associated complications such as permanent scarring, cosmetic issues, prolonged pain, and even infection. ED providers can assist with the primary complications related to blistering of the hand or extremity. Careful follow-up and a detailed discharge plan produce better outcomes and minimize overall complications. Full body/surface burns or circumferential burns should always be seen and eval...
Source: The Procedural Pause - February 28, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
How Manipulated Clinical Evidence Could Distort Guidelines - the Case of Statins for Primary Prevention
This study excluded many patient for whom the statins were not contraindicated or warned against: uncontrolled hypertension; type 1 or type 2 diabetes mellitus on insulin or with a HgBA1C at least 10%; and body weight more than 50% "desirable limit for height." (Based on the official contraindications and warnings for commonly used statins, e.g., see contraindications for Lipitor here, active liver disease, pregnancy for likely to become pregnant, nursing mothers, hypersensitivity to the medicine; and warnings: use of cyclosprine or strong CYP3A4 inhibitors, uncontrolled hypothyroidism, renal impairment.) Thus ...
Source: Health Care Renewal - December 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: American College of Cardiology American Heart Association clinical trials conflicts of interest evidence-based medicine guidelines manipulating clinical research review articles Source Type: blogs
Top stories in health and medicine, November 12, 2013
From MedPage Today:
Tamoxifen May Slow Cognitive Decline. Tamoxifen and other selective estrogen receptor modulators may help stay cognitive decline in postmenopausal women, particularly those at risk for Alzheimer’s disease.
Cutting Steroid Dose Safe in Stable Asthma. For patients with stable asthma, there is “no measurable risk” in reducing their dose of inhaled corticosteroids.
Imaging May Spot Risky Coronary Plaque Early On. A noninvasive imaging technique may be able to detect coronary atherosclerotic plaques at high risk for rupture, possibly allowing for earlier intervention to prevent adverse cl...
Source: Kevin, M.D. - Medical Weblog - November 12, 2013 Category: Family Physicians Tags: News Heart Neurology Pediatrics Pulmonology Source Type: blogs
New Wrinkle for Old Drug It’s not just for smoothing laugh lines. Botulinum toxin may have the potential to ease OA pain.| Arthritis Today Magazine
Widely used by doctors to soften forehead wrinkles and reduce uncontrollably sweaty armpits, researchers now are exploring botulinum toxin as a potential therapy for osteoarthritis (OA) pain.
Although botulinum toxin (Botox, Dysport, Myobloc) has been studied since the 1950s, recent studies on its use in osteoarthritis pain suggest it could be a new analgesic option for a group of patients that's been hard to treat.
"The Botox story is very intriguing," says David Felson, MD, professor of medicine and epidemiology at Boston University. "It isn't just muscles. It can paralyze nerves. Just like celeb...
Source: Psychology of Pain - October 30, 2013 Category: Psychiatrists and Psychologists Source Type: blogs
MKSAP: 32-year-old woman is evaluated for a pruritic rash
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a recurrent pruritic rash on her hands. She works as a dental hygienist and notices that it improves when she goes on vacation. Topical corticosteroids alleviate the rash, but it quickly recurs.
On physical examination, she has scaling, erythematous patches on her dorsal hands, fingers, and wrists. She has scaling, peeling, and scabbed erosions on several fingertips.
Which of the following tests should be done next?
A: Patch testing
B: Potassium hydroxide (KOH) preparation
C: ...
Source: Kevin, M.D. - Medical Weblog - October 19, 2013 Category: Family Physicians Tags: Conditions Dermatology Source Type: blogs
