MKSAP: 36-year-old man with history of fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation has included a complete blood count with differential, thyroid-stimulating hormone level, and plasma glucose level that were normal at the time of initial presentation and again 2 months ago. HIV testing performed...
Source: Kevin, M.D. - Medical Weblog - August 19, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Endocrinology Infectious Disease Pain Management Primary Care Rheumatology Source Type: blogs
Thoughts on diagnostic errors in 2017
The Society to Improve Diagnosis in Medicine has on its website this quote:
Reducing Harm from Diagnostic Error
1 in 10 diagnoses are incorrect.
Diagnostic error accounts for 40,000-80,000 US deaths annually—somewhere between breast cancer and diabetes.
Chances are, we will all experience diagnostic error in our lifetime.
(US Institute of Medicine 2015, BMJ Quality & Safety 25-Year Summary of US Malpractice Claims, 2013.)
The current focus on diagnostic error raises an interesting question: Is this a larger problem in 2017 than in the 1970s and 1980s?
In this post, I postulate that the problem has increased. Se...
Source: DB's Medical Rants - August 7, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Antibiotic duration – a Goldilocks problem
Antibiotics save lives, but antibiotics can have negative effects. When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration. So we have a Goldilocks problem – we want antibiotic duration to be just right – neither too short or too long.
Some clinical conditions have adequate research to define the Goldilocks duration. Community acquired pneumonia only requires 5 days of antibiotics, if the patient is clinically stable at 3 days. We know that 5 days is sufficient, so if we give antibiotics for 7 or 10 ...
Source: DB's Medical Rants - July 30, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Guidelines – a major problem
Guidelines are wonderful; guidelines are dangerous. Over the past decade I have thought often about the benefits and the problems.
The first concept that attracted my attention was reading about conflicting guidelines. Given the same data, different guideline committees would have significantly different recommendations. At the least this problem raises questions about guideline validity. It makes clear that committee perspective could influence recommendations. Guideline recommendations sometimes are clear and demonstrably evidence based, but too often recommendations reflect the committee’s view of the pr...
Source: DB's Medical Rants - July 24, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
15 ys of blogging – unintended consequences
When I started blogging in 2002, I did not understand where blogging would go. I took a rather vanilla name – medical rants – due purely to naivety. Perhaps if I could have seen the future I would have used the phrase unintended consequences in the blog’s title.
Medical care in 2017 suffers often from the unintended consequences that government has induced. I have written about this problem many times over the past 15 years. This problem is not just a US problem, but seemingly a problem throughout the world.
Our jobs have become unnecessarily complex. When Congress passes laws and when CMS devel...
Source: DB's Medical Rants - July 18, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
A Not Very Good Proposal to Reduce Emergency Room Visits
By JIM PURCELL
A recent article posits that an Anthem company, Blue Cross and Blue Shield of Georgia (BCBSGA), is poised to “punish” its members for “unnecessary” emergency room (ER) visits by charging subscribers the entire bill for unnecessary ER visits. This is a variation on a theme which has been playing out in virtually every state and every insurer: how do we reduce the number of unnecessary emergency room visits?
Of course, expecting a lay person to be able to parse out what is medically necessary for ER care and what is not is probably expecting too much. Example: I’m playing softball, slide i...
Source: The Health Care Blog - June 9, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized ER Visits Jim Purcell Urgi-Care Center Source Type: blogs
Huge ST Elevation in V2 and V3. What is it?
A 30-something presented with methamphetamine use and agitation. He was sedated, then had an ECG as part of his workup:He was stabilized and observed.He was still confused 8 hours later when I was now on duty, and he was found to have a heart rate of 140, so another ECG was recorded:There is one lead (V2) with massive ST elevation.Since there is very little STE in V1 or V3, there must be lead misplacement.I suspected some lead misplacement and ordered another with the leads corrected:Now there is massive STE in BOTH leads V2 and V3What do you think?What do you want to do?What do you think? This is what I thought:...
Source: Dr. Smith's ECG Blog - June 4, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Doctors on Demand Integrates Its Video Visits with Lab Testing
As telemedicine become more of the norm in ambulatory care and extends beyond a narrow range of patient care services (see:A New Perspective on Telemedicine: Patient Visits with Multiple Providers), the need arises to integrate telemedicine with e-prescriptions and lab test orders. A recent HIStalk note alerted me to the fact thatDoctors on Demand is integrating its televisits with lab testing orders from the two largest reference labs, Quest and LabCorp (HIStalk News 5/5/17). Below is the item from Mr. HIStalk:Video visit vendor Doctor On Demand integrates its system w...
Source: Lab Soft News - June 1, 2017 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Clinical Lab Industry News Clinical Lab Testing Healthcare Delivery Lab Industry Trends Medical Consumerism Pathology Informatics Reference Laboratories Telemedicine Source Type: blogs
Frankly my dear, I do give a damn
LITFL: Life in the Fast Lane Medical Blog
LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka: Paediatric Perplexity 016
An 18 month old girl is brought in by Gran after developing a very red rash over the last 2 days.
She was seen by her GP a few days before with fevers, sore throat and lethargy and was diagnosed as a viral infection.
However the rash then came up the following day and she seemed to deteriorate…
What is the diagnosis?
+ Reveal Answer
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Scarle...
Source: Life in the Fast Lane - May 2, 2017 Category: Emergency Medicine Authors: Johnny Iliff Tags: Clinical Cases Pediatrics paediatric rash scarlet Source Type: blogs
Interpreting and evaluating the Centor score
In response to a twitter request, this post will in detailed fashion discuss the score, how I recommend using it and how to evaluate it. I will go into more detail than I generally do, because the questions require that detail.
The original study, published in 1981 based on data collected in 1980, used logistic regression to evaluate predictors of positive group A beta hemolytic streptococcal cultures taken from adults (aged 16 and above) coming to an emergency department for a chief complaint of sore throat. We collected candidate symptoms and physical examination signs.
The idea was always to use the resulting scores...
Source: DB's Medical Rants - April 23, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Don ’t let allergy season catch you off guard
The woman next to me in the checkout line looked upset. Her eyes were red and her nose was running. My first thought was to give her privacy, until I saw her shopping basket filled with supplies to fight allergy symptoms, and then our eyes met. “I can’t believe how bad my allergies are this year!” she said, exasperated.
My fellow shopper isn’t the only one suffering. “Warm weather and a mild winter, as we’ve experienced this year, can stimulate trees to pollinate. The southern U.S., which has a warmer climate, is particularly susceptible to earlier allergy seasons. Other climate factors — such as cool evening...
Source: Harvard Health Blog - April 6, 2017 Category: Consumer Health News Authors: Heidi Godman Tags: Asthma and Allergies Source Type: blogs
No Bence Jones!!!
Wow. I haven’t been this sick in…ages. On Saturday morning, I woke up with a nasty sore throat, symptom no. 1. But Stefano and I had already made plans to go outside of Florence, not a pleasure trip by any means ( = long story that wouldn’t add anything useful to this post), and I didn’t want to back out. So, after coffee and Manuka honey, off we went. By the late afternoon, the sore throat had vanished, but symptom no. 2 was about to rear its ugly head: THE DREADED COUGH. Whenever I’m about to get a cough, I get a strange, almost metallic taste in my mouth. I know it sounds odd, but that tas...
Source: Margaret's Corner - April 6, 2017 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll Source Type: blogs
Precision Medicine Is Our Best Hope In The Fight Against Cancer
In the fight against cancer, precision medicine is one of the most promising tools and the logical outcome of current healthcare trends. As start-ups offering personalized healthcare solutions multiply like mushrooms after rain, governments and regulatory agencies have to give appropriate responses in regulating the grass-root healthcare jungle. Here is my analysis about the potential and dilemmas about precision medicine.
Precision medicine is the logical outcome of modern healthcare
There is one phrase, which is not part of the Hippocratic Oath, but everyone in medicine knows it. Primum non nocere, meaning “first do n...
Source: The Medical Futurist - March 30, 2017 Category: Information Technology Authors: nora Tags: Future of Medicine Genomics Healthcare Design Personalized Medicine AI cancer cancer research chemotherapy digital gc4 genetics Genome Innovation oncology precision medicine targeted treatment technology Source Type: blogs
My developing thoughts on adult pharyngitis
MDCalc invited me to write a blog post about pharyngitis (they had previously asked me to comment on the Centor score).
That post includes much of my current thinking – Sometimes it’s NOT just a sore throat – adolescents and young adults are different
The other important concept that I did not include in that post came up in a conversation I had yesterday at the University of Nebraska where I am this week as a visiting professor. A clinician educator asked me about “red flags” in sore throat patients. While I have written this previously, repetition helps all learners remember.
Adult sore throats ...
Source: DB's Medical Rants - March 23, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
More about Virtue Sweetener
Because I wanted a benign and healthy way for followers of the Wheat Belly lifestyle to recreate dishes such as chocolate chip cookies, cheesecake, and pies with none of the health problems of grains or sugars, I helped Wheat-Free Market develop its Virtue Sweetener product.
Yes, you could do without such sweeteners. But I learned long ago when I introduced Wheat Belly concepts to patients in my cardiology practice that having options while entertaining friends, during holidays, and pleasing kids was important for staying on course on this lifestyle. Before I understood how to use such natural sweeteners, patients would ...
Source: Wheat Belly Blog - March 10, 2017 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle diabetes erythritol gluten grains Inflammation insulin keto low-carb monk fruit natural virtue sweetener Source Type: blogs
