MKSAP: 68-year-old woman with gradually progressive abdominal distention
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. She does not consume alcohol. Her medications are metformin, lisinopril, low-dose aspirin, and simvastatin.
On physical examination, vital signs are n...
Source: Kevin, M.D. - Medical Weblog - September 24, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs
The core of the scientific process is how we ultimately serve our patients
A few weekends ago, I saw a patient with bloated shins at our school’s free clinic, and I marked in my notes that she exhibited “peripheral edema,” an esoteric phrase that means little to those outside of the medical community. That experience only highlighted the tendency in medicine to inflate common bodily functions into opaque medical jargon. Its use can be frustrating for patients who are trying to understand their illness — and at times even for the uninformed medical student who is trying to learn about his patient.
It doesn’t help that the list of jargon is endless. Itchiness becomes pruritus. Listeni...
Source: Kevin, M.D. - Medical Weblog - October 20, 2015 Category: Journals (General) Authors: Steven Zhang Tags: Education Medical school Source Type: blogs
Test your medicine knowledge: 55-year-old man with elevated liver enzymes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated during a routine examination. He feels well other than mild knee pain. He drinks six to eight cans of beer per night. He has no personal history of liver disease, but his older brother was recently diagnosed with hereditary hemochromatosis.
On physical examination, vital signs are normal; BMI is 24. He is tanned on sun-exposed body surfaces. Cardiac examination is normal. Abdominal examination reveals hepatomegaly. Bilateral bony hypertrophy of the knees is noted.
Laboratory studie...
Source: Kevin, M.D. - Medical Weblog - October 10, 2015 Category: Journals (General) Authors: mksap Tags: Conditions GI Source Type: blogs
Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia is a neoplatic disease
Pathophysiology
1) chronic lymphocytic leukemia is a neoplastic disorder with clonal proliferation of lymphocytes
2) 95% of cases are B cell in origin
3) primary site of involvement is the bone marrow (eventually bone marrow becomes completely replaced) with release into bloodstream of neoplastic lymphocytes
4) spleen, liver, and lymph nodes may become enlarged
5) 10 % of patients convert to prolymphocytic leukemia (most with more aggressive course)
6) 5% of patients with chronic lymphocytic leukemia convert to Richter’s syndrome
Signs and Symptoms of Chronic Lymph...
Source: Inside Surgery - November 18, 2013 Category: Surgeons Authors: Editor Tags: Oncology chronic lymphocytic leukemia CLL prolymphocytic Richter's smudge cell Source Type: blogs
MKSAP: 32-year-old woman with progressive jaundice
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 10-day history of malaise, right upper quadrant discomfort, and progressive jaundice. She has had no recent travel outside of the United States, does not drink alcohol, and has no recent ingestions of drugs, including acetaminophen or herbal remedies. Up until this time, she has been healthy. She has a history of type 1 diabetes mellitus for which she takes insulin glargine and insulin detemir. She has no other medical problems.
On physical examination, temperature is 37.5 ...
Source: Kevin, M.D. - Medical Weblog - November 9, 2013 Category: Family Physicians Tags: Conditions GI Infectious disease Source Type: blogs
Pulmonary Hypertension
Pathophysiology
1) increased arterial pressure in lungs 2) primary or idiopathic form occurs in absence of known precipitating causes 3) secondary form caused by – mitral stenosis, pulmonary venous occlusive disease, extreme obesity (Pickwickian syndrome), chronic hypoxemia, recurrent pulmonary embolism, kyphosis, infiltrative lung disease, chronic bronchitis, long periods at high altitude
Signs and Symptoms
1) insidious onset of dyspnea idiopathic form 2) right heart failure with venous distention of neck 3) peripheral cyanosis late in disease 4) palpable right ventricular heave (owing to cor pulmonale) 5) fatigue ...
Source: Inside Surgery - January 23, 2013 Category: Surgeons Authors: Editor Tags: Pulmonology arterial pressure cyanosis dyspnea high altitude lungs obesity right heart failure Source Type: blogs
