MKSAP: 72-year-old man with cough and increasing dyspnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated for a 2-year history of cough and a 1-year history of increasing dyspnea. He describes the cough as nonproductive, and his shortness of breath is worse with exertion. He does not have chest pain, orthopnea, paroxysmal nocturnal dyspnea, or any other symptoms. Medical history is otherwise unremarkable. He has a 15-pack-year smoking history but quit 40 years ago. He worked as a construction worker for 40 years. He takes no medications.
On physical examination, temperature, blood pres...
Source: Kevin, M.D. - Medical Weblog - June 3, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology Source Type: blogs
Research and Reviews in the Fastlane 148
Welcome to the 148th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - August 24, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Infectious Disease Neurosurgery R&R in the FASTLANE EBM literature recommendations research and reviews Source Type: blogs
MKSAP: 62-year-old man is evaluated for declining exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. He quit smoking 2 years ago. All immunizations are up to date, including influenza and pneumococcal vaccination. A chest radiograph performed 3 months ago for increased cough and sp...
Source: Kevin, M.D. - Medical Weblog - August 13, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology Source Type: blogs
Fight Aging! Newsletter, August 8th 2016
In conclusion, spermidine inhibits lipid accumulation and necrotic core formation through stimulation of cholesterol efflux, albeit without changing plaque size or cellular composition. These effects, which are driven by autophagy in VSMCs, support the general idea that autophagy induction is potentially useful to prevent vascular disease.
Intestinal Autophagy Important in Calorie Restriction and Longevity in Nematodes
https://www.fightaging.org/archives/2016/08/intestinal-autophagy-important-in-calorie-restriction-and-longevity-in-nematodes/
Based on the evidence accumulated from many years of studies of...
Source: Fight Aging! - August 7, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Fight Aging! Newsletter, May 23rd 2016
FIGHT AGING! NEWSLETTER
May 23rd 2016
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to o...
Source: Fight Aging! - May 22, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A Few Recent Studies of Exercise, Fitness, and Risk of Age-Related Disease
Today I'll point out a few recent studies on exercise and age-related disease in human populations. Animal studies show that regular exercise improves health and extends healthspan, the period of life free from age-related conditions. Human studies, which use statistical methods on large sets of population data, tend to show correlations only, but these correlations match what is seen in animal studies. It is not unreasonable to believe based on the evidence that exercise is good for you over the long term, and that maintaining fitness as you age reduces the risk of suffering all of the common age-related diseases - that t...
Source: Fight Aging! - May 18, 2016 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
MKSAP: 61-year-old woman with progressive dyspnea and fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old woman is evaluated for a 4-month history of progressive dyspnea and fatigue without chest pain. Eighteen months ago, she was diagnosed with liver cirrhosis due to nonalcoholic steatohepatitis (NASH). Medical history is also significant for obesity. Medications are propranolol, spironolactone, and lactulose.
On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure is 112/64 mm Hg, pulse rate is 60/min, and respiration rate is 16/min; BMI is 36. Mild scleral icterus is noted. Cardi...
Source: Kevin, M.D. - Medical Weblog - May 7, 2016 Category: Journals (General) Authors: mksap Tags: Uncategorized Source Type: blogs
Test your medicine knowledge: 72-year-old woman with COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed.
On physical examination, pulse rate is 9...
Source: Kevin, M.D. - Medical Weblog - June 27, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
MKSAP: 72-year-old woman with severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed.
On physical examination, pulse rate is 9...
Source: Kevin, M.D. - Medical Weblog - November 1, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
Young Cognitive Function Predicts Aged Pulmonary Function
In this study, we examined whether early adult cognitive ability predicted five different indices of pulmonary function in mid-life.
Mixed modelling tested the association between young adult general cognitive ability (mean age=20), measured by the Armed Forces Qualification Test (AFQT), and mid-life pulmonary function (mean age=55), in 1019 men from the Vietnam Era Twin Study of Aging. Pulmonary function was indexed by per cent predicted values for forced vital capacity (FVC%p), FEV1%p, maximum forced expiratory flow (FEFmax%p), and maximal voluntary ventilation (MVV%p), and by the ratio of FEV1 to FVC (FEV1/FVC), an ind...
Source: Fight Aging! - October 3, 2014 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Glantz Asserts that Pulmonary Effects of Smoking May Be No Worse than those of Vaping
This study documents that while active smoking has immediate, clinically meaningful effects in reducing lung function, electronic cigarettes do not. The study found that: "Neither a brief session of active e-cigarette smoking (indicative: 3% reduction in FEV1/FVC) nor a 1 h passive e-cigarette smoking (indicative: 2.3% reduction in FEV1/FVC) significantly affected the lung function (p > 0.001). In contrast, active (indicative: 7.2% reduction in FEV1/FVC; p < 0.001) but not passive (indicative: 3.4% reduction in FEV1/FVC; p = 0.005) tobacco cigarette smoking undermined lung function."The main study...
Source: The Rest of the Story: Tobacco News Analysis and Commentary - June 16, 2014 Category: Addiction Source Type: blogs
MKSAP: 32-year-old woman with nonproductive cough
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 6-month history of nonproductive cough. She has no history of recurrent upper respiratory tract infections and has never smoked cigarettes. She has no fever, dyspnea on exertion, hemoptysis, heartburn, or wheezing. She has worked in the same office for 7 years and has lived in the same house for the past 20 years. She has not traveled out of the area for more than 2 years. She has no pets at home, no occupational or other exposure to toxic chemicals, and no family history o...
Source: Kevin, M.D. - Medical Weblog - June 7, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
MKSAP: 70-year-old man with night sweats, weight loss, and cough
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man is evaluated for a 3-month history of night sweats, weight loss, and increasing cough. He is a retired miner, and his medical history is significant for a diagnosis of pulmonary silicosis made 15 years ago based on exposure history and characteristic chest radiographic findings. He is a lifelong nonsmoker.
On physical examination, temperature is 37.9 °C (100.2 °F), blood pressure is 120/65 mm Hg, pulse rate is 84/min, and respiration rate is 22/min. Pulmonary examination reveals diffuse inspi...
Source: Kevin, M.D. - Medical Weblog - December 21, 2013 Category: Family Physicians Tags: Conditions Infectious disease Pulmonology Source Type: blogs
Orphan Drugs - The Seattle Times explains
The mining of rare diseasesThirty years ago, Congress acted to spur research on rare diseases. Today, we have hundreds of new drugs — along with runaway pricing and market manipulation, as drugmakers turn a law with good intentions into a profit engine.By Michael J. Berens and Ken ArmstrongHer vision failed first.Then she fell asleep at school from inexplicable fatigue. Even walking proved difficult, often impossible, as she knocked into furniture and walls. It was like an electrical switch in her body toggled without warning. Some days she was in control, most she was not.Specialists were s...
Source: PharmaGossip - November 11, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs
MKSAP: 45-year-old man with a daily cough
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old man is evaluated for a 6-month history of increasing daily cough, sputum production, and dyspnea on exertion. He has been employed as a coal miner for 10 years. He has never smoked and does not have a history of diabetes mellitus, hypertension, or hyperlipidemia. His family history is negative for cardiopulmonary disease.
On physical examination, vital signs are normal. Pulmonary examination reveals mildly decreased breath sounds bilaterally with no wheezes, crackles, or rhonchi. Cardiac examination...
Source: Kevin, M.D. - Medical Weblog - September 28, 2013 Category: Family Physicians Tags: Conditions Pulmonology Source Type: blogs
