MKSAP: 54-year-old man with elevated blood pressure
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications.
On this visit and on two subsequent nurse visits, the patient’s blood pressure measurements are less than 140/90 mm Hg. BMI is 34. Cardiac examination reveals an S4 gallop. The remainder of the examination is normal.
Laboratory studies show a normal chemistry panel, and a urine dipstick demonstrates no blood or protein.
Electrocardiogram demonstrates e...
Source: Kevin, M.D. - Medical Weblog - September 16, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Primary Care Source Type: blogs
MKSAP: 38-year-old woman with a HbA1c value of 9.1%
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for morbid obesity, obstructive sleep apnea, hypertension, and hyperlipidemia. Family history is notable for her mother, sister, and brother with type 2 diabetes, obesity, hypertension, and hyperlipidemia. Medications are insulin glargine ...
Source: Kevin, M.D. - Medical Weblog - September 2, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Primary Care Source Type: blogs
Enthusiasm for Rapamycin and Polypills in the Search for Ways to Slow Aging
The author of this paper is one of the more outspoken advocates in the research community when it comes to mTOR and rapamycin as a path to slowing the progression of aging. He keeps up quite the output of position papers, such as this one, which calls for immediate human trials of polypills made up of rapamycin and a brace of other drugs broadly used in treatment of age-related conditions, such as statins and metformin. I have to think that the evidence to date suggests this will be less effective than hoped, while still very plausibly being better than doing nothing, even considering the side-effects of the drugs involved...
Source: Fight Aging! - June 21, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
MKSAP: 57-year-old man is seen after results of a carotid ultrasound
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no focal neurologic symptoms or visual loss. The patient has coronary artery disease (CAD) with stable angina, hypertension, dyslipidemia, type 2 diabetes mellitus, and mild kidney failure. He has a 30-pack-year smoking history but stopped smoking 7 years ...
Source: Kevin, M.D. - Medical Weblog - May 6, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
A 40-something woman with chest pain. A medic takes control of the situation.
A 40-something woman with Chest Pain of 20 minutes duration called 911.It started while at rest and she describes it as crushing pain radiating to the left arm. She has a history of HTN for which she takes Lisinopril. Denies any other medical history.She appears well but in obvious pain. She was diaphoretic but pink and warm. BP remained 150-160 systolic throughout care. This prehospital ECG was obtained.There are very suspicious ST elevation and T-waves in V2, but without 2 consecutive leads with STE of greater than or equal to 1.5 mm, it does not meet STEMI criteria. The medic used theformula for di...
Source: Dr. Smith's ECG Blog - April 27, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 52-year-old man with sudden onset of erectile dysfunction
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated for the sudden onset of erectile dysfunction that has persisted for 6 months. He reports having erections that are inadequate for vaginal penetration. He feels guilty about not being able to satisfy his wife’s requests for sexual intercourse, although he still has sexual desires. He has been sleeping poorly and feeling fatigued throughout the day. He reports no snoring or daytime somnolence, and his review of systems is otherwise negative. His wife does not report that the p...
Source: Kevin, M.D. - Medical Weblog - April 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Primary care Source Type: blogs
MKSAP: 81-year-old man after a percutaneous coronary intervention
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. Medical history is significant for hypertension and type 2 diabetes mellitus. He has no risk factors for or history of significant bleeding. Medications are aspirin, clopidogrel, lisinopril, ...
Source: Kevin, M.D. - Medical Weblog - March 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
MKSAP: 74-year-old woman with altered mental status
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated in the emergency department for several hours of altered mental status. She is from out-of-state and is visiting with relatives. One of her young relatives was recently ill with gastrointestinal symptoms. The patient developed anorexia 3 days ago and vomiting 2 days ago. She has been unable to tolerate any liquid or solid foods for the last 24 hours. Medical history is significant for type 2 diabetes mellitus, hypertension, hyperlipidemia, and hypothyroidism. Medications are aspi...
Source: Kevin, M.D. - Medical Weblog - February 18, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Source Type: blogs
MKSAP: 68-year-old woman with 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 - December 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
When a cough just won ’t go away
Who has never had a cough? I bet no one can raise their hand. We see this in clinic all the time. But chronic cough— one that lasts at least eight weeks — can be hard for patients to deal with and difficult for doctors to figure out.
In the October 20, 2016 issue of the New England Journal of Medicine, lung experts describe a step-by-step approach doctors can use to help treat patients with chronic cough. Most often a prolonged cough is due to one of the “usual suspects.” But when it’s not, we have a long list of increasingly rarer conditions that we should run through and rule out. If it isn’t due to any of th...
Source: Harvard Health Blog - November 7, 2016 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Cold and Flu Health Lung disease Source Type: blogs
MKSAP: 51-year-old man with newly diagnosed hypertension and diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 51-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus. He has started a program of lifestyle modification for his diabetes but has not yet started antihypertensive therapy. He is currently taking no medications.
On physical examination, blood pressure is 148/92 mm Hg, and pulse rate is 76/min. BMI is 33. The remainder of the examination is unremarkable.
Laboratory studies show a serum creatinine level of 1.5 mg/dL (132.6 µmol/L) (estimated g...
Source: Kevin, M.D. - Medical Weblog - October 1, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Heart Source Type: blogs
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 Future of Work Part I
Have you ever taken some time to think about what work will look like 5, 10 or even 20 years from now? If you haven’t, it is probably worth the effort because a changing work environment may have dramatic implications for how you are employed in the future. In these two posts, I want to talk about some of the trends I’m seeing and how they may play out in the coming years.
Outsourcing
Companies are getting better and better at spinning off specific business functions and letting them be handled by others. For example, many businesses can’t justify running payroll in-house. It is cheaper to hire a company...
Source: Productivity501 - September 20, 2016 Category: Psychiatry & Psychology Authors: Mark Shead Tags: Misc Source Type: blogs
MKSAP: 74-year-old woman with peripheral arterial disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin.
On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate is 15/min. BMI is 32. The lungs are clear to auscultation, and no murmurs are noted. A bruit is heard over the left femoral artery.
The right ankle-brachial index is 1.2 and...
Source: Kevin, M.D. - Medical Weblog - September 3, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
CMS Releases New Prescription Drug Cost Data
On August 18, 2016, the Centers for Medicare and Medicaid Services (CMS) released new prescription drug data, physician-level data on prescriptions for drugs paid for by Medicare Part D in 2014. This new data set “describes the specific medications prescribed for 38 million Medicare Part D enrollees, who represent about 70 percent of all Medicare beneficiaries.” This is the second annual release of the data.
According to Niall Brennan, CMS Chief Data Officer, “With this data release, patients, researchers and providers can access valuable information about the Medicare prescription drug program. Today’s release jo...
Source: Policy and Medicine - September 1, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
