MKSAP: 49-year-old woman with obesity, hypertension, and type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 49-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has attempted to lose weight through various commercial diets; dietician-monitored, calorie-restricted diets; and physical activity. She has worked with a behavioral therapist, and although she has not achieved weight loss, her weight has remained stable. She exercises 30 minutes daily. Medical history is also remarkable for glau...
Source: Kevin, M.D. - Medical Weblog - September 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Obesity Primary Care Source Type: blogs
MKSAP: 57-year-old man with type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before implementing significant lifestyle changes and transitioning to insulin therapy from metformin therapy 2 years ago.
His medical history includes coronary artery disease, first-degree atrioventricular block, nonproliferative d...
Source: Kevin, M.D. - Medical Weblog - August 11, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Neurology Source Type: blogs
MKSAP: 68-year-old man with heart failure
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is limited to riding to the store with his wife but staying in the car. Medical history is significant for disseminated prostate cancer treated with androgen deprivation therapy. Medications ...
Source: Kevin, M.D. - Medical Weblog - July 7, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Source Type: blogs
MKSAP: 70-year-old man with a transient ischemic attack
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man is admitted to the hospital with a 1-hour episode of left arm and left leg weakness. He is diagnosed with a transient ischemic attack. The patient has a history of hypertension and type 2 diabetes mellitus and a 30-pack-year history of smoking. Family history is noncontributory. His medications are metformin and lisinopril.
On physical examination, the patient is afebrile, and blood pressure is 148/88 mm Hg. The remainder of the examination is unremarkable.
Laboratory studies show alanine amino...
Source: Kevin, M.D. - Medical Weblog - June 30, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Neurology Source Type: blogs
MKSAP: 47-year-old man with hypertension, type 2 diabetes mellitus, and obstructive sleep apnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past 2 years, he has tried several commercial diets; a dietician-monitored, calorie-restricted diet; increased physical activity; orlistat; and a combination of these interventions, all without achieving sustained weight loss. M...
Source: Kevin, M.D. - Medical Weblog - May 26, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Primary Care Source Type: blogs
MKSAP: 62-year-old man is evaluated during a routine visit
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.
On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 29. Cardiac examination reveals a grade 2/6 early-peaking systolic mur...
Source: Kevin, M.D. - Medical Weblog - April 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Diabetes Source Type: blogs
MKSAP: 75-year-old man with very severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He has not benefited from pulmonary rehabilitation in the past. He quit smoking 3 years ago. His medical history is also notable for hypertension, type 2 diabetes mellitus, and a myocardial infarction 3 years ago. His medica...
Source: Kevin, M.D. - Medical Weblog - February 3, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Palliative Care Pulmonology Source Type: blogs
What Kmart ’s Settlement Says About Health Care Fraud
This reportedly violated regulations requiring pharmacies to apply their usual and customary charges when billing government payers.
The DOJ claims that “[t]he government’s resolution of this matter illustrates the government’s emphasis on combating health care fraud,” It might more accurately have said that the settlement adds to the mountain of evidence showing that the government cannot control even the most obvious forms of health care fraud, a point we make at length in our forthcoming book, Overcharged: Why Americans Pay Too Much For Health Care.
For one thing, at the very same time government payers were hon...
Source: The Health Care Blog - February 1, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Charles Silver David Hyman K-Mart Lisinopril Source Type: blogs
MKSAP: 55-year-old woman after bariatric surgery
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old woman is evaluated during a routine examination. She underwent biliopancreatic diversion with duodenal switch 8 years ago for treatment of obesity-related complications and lost 68.0 kg (150.0 lb) in the first year following surgery. Her weight has been relatively stable for the last year. She has had chronic nonbloody diarrhea since her bariatric surgery. She also has had generalized fatigue, dry skin, dry and itchy eyes, and increased difficulty seeing road signs at night while driving. Her other...
Source: Kevin, M.D. - Medical Weblog - January 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Source Type: blogs
MKSAP: 65-year-old man with chronic kidney disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old man is evaluated during a follow-up visit for stage G3b/A3 chronic kidney disease due to diabetic nephropathy. He reports doing well with good baseline exercise tolerance and no shortness of breath. Medical history is also significant for type 2 diabetes mellitus and hypertension. Medications are basal bolus insulin and lisinopril, 20 mg/d.
On physical examination, temperature is normal, blood pressure is 145/75 mm Hg, pulse rate is 82/min, and respiration rate is 16/min. BMI is 28. There is no jug...
Source: Kevin, M.D. - Medical Weblog - January 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Nephrology Source Type: blogs
Narcan or Narcan’t?
Part 2 in a Four-part SeriesA 57-year-old man presented with acute onset altered mental status. His family said he had been behaving normally. Prior to dinner, however, he became difficult to arouse, and was speaking gibberish. He was somnolent but arousable to physical stimuli on arrival in the ED.He answered questions inappropriately and would then go back to sleep. His past medical history was consistent with hypertension, hypercholesterolemia, and spinal fusion a month ago. His medications included lisinopril, atorvastatin, and hydrocodone. His vital signs were a blood pressure of 110/65 mm Hg, heart rate of 90 b...
Source: The Tox Cave - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 64-year-old man with diabetes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type 2 diabetes mellitus in his mother and hypertension and chronic kidney disease in his father. Medications are metformin, glipizide, hydrochlorothia...
Source: Kevin, M.D. - Medical Weblog - December 30, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs
Healthcare freebies that can make you, and your wallet, feel a little better
“Take the cookies, bring them home to the kids!” Craig always insists, as he pops a few into my lunch bag. It’s a heartwarming gesture that I love about his Sarasota deli — in addition to the killer turkey on whole wheat. You may not be surprised when local businesses throw in a freebie; they often go the extra mile to thank customers.
But you may be surprised to know that there are lots of free things out there that can help your health. Okay, not cookies, but things with real value when it comes to improving everything from chronic disease to diet and fitness.
Free prescription drugs
Some stores (such as Publix a...
Source: Harvard Health Blog - November 27, 2017 Category: Consumer Health News Authors: Heidi Godman Tags: Health Health care Managing your health care Source Type: blogs
Test almost all of your most important ECG rhythm interpretation skills with this case.
Sent by Anonymous, written by Meyers, edits by Smith:A female in her 70s with history of HTN woke up around 2am with severe shortness of breath. EMS found the patient in moderate respiratory distress, hypoxemic on room air, with diffuse rales. CPAP was initiated. The prehospital ECG is unavailable but reportedly showed a wide complex regular tachycardia at around 150 bpm. 150mg amiodarone was given for presumed VT with no obvious effect.She arrived at the ED at 2:52 AM. She had normal mental status, and was in moderate respiratory distress with diffuse rales, with respiratory rate 30/min, and initial blood pressure 129/60....
Source: Dr. Smith's ECG Blog - October 26, 2017 Category: Cardiology Authors: Pendell Source Type: blogs
