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
Zero tolerance for low blood pressure
Just as we have zero tolerance for hypoglycemia in the Wheat Belly lifestyle, we also have zero tolerance for hypotension, or low blood pressure (BP).
Follow the Wheat Belly lifestyle free of ciabattas, penne pasta, and tortellini, and blood sugars plummet. If you are injecting insulin or taking other diabetes drugs, hypoglycemia is a risk and can be dangerous, resulting in loss of consciousness and injury. We therefore urge everyone to talk to their doctor about discontinuing or reducing insulin and diabetes drugs immediately upon starting the Wheat Belly lifestyle. Unfortunately, the majority of doctors don’t under...
Source: Wheat Belly Blog - May 8, 2018 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle blood pressure blood sugar BP gluten-free grain-free grains health hypertension hypertensive Source Type: blogs
A 33 year old male with acute back pain radiating to the chest
Written by Pendell Meyers, with edits by Steve SmithCaseI was called to the EMS control room to answer an RMA (Refusal of Medical Advice). After the call was over, just before I was about to go back to the grind in our acute emergency department, my fantastic EMS colleague paramedic Jess Boyle asked me for an opinion on these 2 ECGs from a single patient, one done immediately after the other, without any other clinical information:What do you think?Both of the ECGs show sinus rhythm with normal QRS complex morphology. There is ST segment depression in leads III and aVF with inappropriate large " volume " T-wave inversion. ...
Source: Dr. Smith's ECG Blog - April 23, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Government Encourages Third-Party Payment, Which Drives Health Care Prices Higher
Cato adjunct scholarsCharlie Silver andDavid Hyman have an important oped in today ’s Houston Chronicle explaining how third-party payment increases prices for drugs and other medical goods and services. An excerpt:If you ’re like us, your health insurance coverage includes a prescription drug benefit. The benefit isn’t free, but you’re willing to pay for it because it saves you money every time you have a prescription filled. You are responsible for your co-pay, and your insurer pays the rest.At least, that ’s how it is supposed to work. But the truth is that your insurer often pays nothing. Your co-pay is ...
Source: Cato-at-liberty - April 19, 2018 Category: American Health Authors: Michael F. Cannon 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
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
MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/84 mm Hg, pulse rate is 80/min, and respiration rate is 16/min. BMI is 22. There is no S4 gallop.
Laboratory studies show a fasting plasma glucose level of 10...
Source: Kevin, M.D. - Medical Weblog - October 14, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Diabetes Endocrinology Source Type: blogs
Weakness and Hypotension, with Bradycardia.
This dialysis patient called 911 for weakness. Medics found the patient to be hypotensive and bradycardic.The patient was taking carvedilol and amlodipine, but denied overdose.The medics recorded this ECG:The medics were considering external pacing.What is a better initial therapy?The patient was stable enough that no therapy was needed, but the correct therapy would be IV Calcium. This ECG represents hyperkalemia until proven otherwise and, if it is due to hyperK, it will often respond immediately to calcium therapy.He arrived and had this ED ECG recorded:There are no visible P-waves. Rate is 35.There is a narro...
Source: Dr. Smith's ECG Blog - May 18, 2017 Category: Cardiology Authors: Steve Smith 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
Memo To The President: The Pharmaceutical Monopoly Adjustment Act Of 2017
Since 1980, Congress has enacted many laws granting pharmaceutical manufacturers monopolies that no other industry enjoys. These extra monopolies were created with the expectation that monopoly profits would spur greater investment in research to find important new drugs. In fact, they have caused US consumers to pay higher prices for medicines for longer periods of time while making the pharmaceutical industry far more profitable than any other industry. I believe the next president and Congress should take several key steps, which I outline below, to roll back these costly, unnecessary monopolies.
The Current Landscape
C...
Source: Health Affairs Blog - September 13, 2016 Category: Health Management Authors: Alfred Engelberg Tags: Costs and Spending Drugs and Medical Technology Health Policy Lab Bayh-Dole Act Big Pharma Gilead Hatch-Waxman Act johnson & johnson pfizer 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
Dyspnea and Convex ST elevation, Marked LVH, with Bedside Echos
Case 1.Chief complaint: A 60-something African American male with 5 days of increasing SOB with dyspnea on exertion.This male in his 60's has a PMH of CAD with MI and CABG, HTN with LVH, hyperlipidemia, and mild HF with only moderately reduced ejection fraction (and some diastolic dysfunction as well).He presents with 5 days of worsening shortness of breath with orthopnea as well as chest pain. His BP is 191/90. He also has a history of venous thromboembolism and has not been taking his anticoagulants. He was also off of his BP meds (lisinopril, amlodipine and carvedilol).Here is his ED ECG (ECG #1):...
Source: Dr. Smith's ECG Blog - July 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 86-year-old woman with pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is unable to leave her bed to attend meals. Medical history is remarkable for hypertension, mild cognitive impairment, and osteoporosis. She ambulates short distances but uses a walker for longer distances....
Source: Kevin, M.D. - Medical Weblog - July 2, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Neurology Source Type: blogs
