Test your medicine knowledge: 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 - November 14, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
Test your medicine knowledge: 59-year-old man with gout
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for a 6-month history of gout. He was doing well on colchicine and allopurinol but developed hypersensitivity to allopurinol, which resolved with cessation of the agent. He then began to have more frequent gout flares; two flares occurred in the past month and were treated with prednisone. History is also significant for hypertension, chronic kidney disease, and dyslipidemia. Current medications are colchicine, lisinopril, metoprolol, and simvastatin.
On physical examination, tempe...
Source: Kevin, M.D. - Medical Weblog - November 7, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
LITFL Review 204
Welcome to the 204th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Want to be involved in shaping Emergency Medicine research? Find out about the fantastic James Lind Alliance and it’s work with RCEM and how you can get involved in identifying the priorities for further research at St Emlyns. [SL]
Sharing some...
Source: Life in the Fast Lane - November 1, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Research & Reviews in the Fastlane 103
This study is quite limited as it doesn’t include potential recommendations for these over the counter medications but is a good reminder to prescribe stool softeners/laxatives with opioids.
Recommended by Lauren Westafer
Emergency medicineRodrigo GJ et al. Assessment of acute asthma severity in the ED: are heart and respiratory rates relevant? Am J Emerg Med 2015. PMID 26233619
The authors of this paper want to tell us that vitals signs aren’t helpful in asthma, but I think their conclusions are entirely backwards.
This is a retrospective look at data that was collected prospectively as part of 7 other asth...
Source: Life in the Fast Lane - October 7, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Immunology Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care Review Source Type: blogs
Test your medicine knowledge: 84-year-old man with cough and nasal congestion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 84-year-old man is evaluated for a 5-day history of rhinitis, nasal congestion, sneezing, and nonproductive cough. The symptoms began with a sore throat, which resolved after 24 hours. He has mild ear pain when blowing his nose or coughing. He has a history of coronary artery disease and hypertension. Medications are aspirin, metoprolol, and hydrochlorothiazide.
On physical examination, temperature is 36.5 °C (97.7 °F), blood pressure is 130/72 mm Hg, pulse rate is 82/min, and respiration rate is 16/min. He...
Source: Kevin, M.D. - Medical Weblog - September 5, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Primary care Source Type: blogs
The Orange Juice Clue
The parents of a 16-month-old boy who presented to the ED were concerned that he was too sleepy. His initial point-of-care glucose was noted to be 42 mg/dL, and he was somnolent but arousable, and was given orange juice.
Twenty minutes later, the child’s symptoms had completely resolved. Toxicology was consulted for evaluation of a possible toxic ingestion, and a medication inventory was recommended.
Differential Diagnosis of Hypoglycemia in Children
n Ethanol intoxication
n Beta blocker intoxication
n Salicylate toxicity
n Sulfonylurea
n Insulin injection
n Endocrine disorder (hypopituitarism, Addison’...
Source: The Tox Cave - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Orange Juice Clue
The parents of a 16-month-old boy who presented to the ED were concerned that he was too sleepy. His initial point-of-care glucose was noted to be 42 mg/dL, and he was somnolent but arousable, and was given orange juice.
Twenty minutes later, the child’s symptoms had completely resolved. Toxicology was consulted for evaluation of a possible toxic ingestion, and a medication inventory was recommended.
Differential Diagnosis of Hypoglycemia in Children
n Ethanol intoxication
n Beta blocker intoxication
n Salicylate toxicity
n Sulfonylurea
n Insulin injection
n Endocrine disorder (hypopituitarism, Addison’s disease,...
Source: The Tox Cave - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
What is the secret of carvidilol’s superiority in CHF over other beta blockers ?
Beta blockers(BBs) have become key drugs in management of CHF .It helps by blocking toxic effects of inappropriately elevated catecholamine , which is actually a compensatory response(A fight and survival reaction ) from the sympathetic system to a failing heart . This process becomes a liability in the long run as the adrenergic receptors either down regulate or even promote apoptosis and cell death .Along with RASS-ACE it affects every cell in the body promoting neuro- humoral catabolic state.
By trial and error methodology we have found blocking the sympathetic system by BBs confer con...
Source: Dr.S.Venkatesan MD - July 31, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Beta Blocker beta blockers in chf carvidilol vs metoprolol and bisoprolol How carvidilol is superior in chf cardiac failure Source Type: blogs
Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management
A young woman presented with intermittent shocks from her implantable defibrillator. She was intermittently unconscious and unable to give history. The monitor showed intermittent polymorphic ventricular tachycardia. The physician was presented with this ECG at the same moment he was observing the repeated syncope:Time zeroIt is a bigeminal rhythm with a very bizarre PVC. The PVC has an incredibly long QT, but the intervening native rhythms do not. However, when I saw this (it was texted to me), it immediately reminded me of this case, so I knew by sheer recognition that it was lo...
Source: Dr. Smith's ECG Blog - July 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Blow your HDL through the roof
The HDL cholesterol value is one of the four values on any conventional lipid/cholesterol panel, along with total cholesterol, triglycerides, and calculated LDL cholesterol (what I call “fictitious” LDL because of its incredible inaccuracy when compared to superior measures).
The HDL cholesterol value has some unique characteristics not shared by the others, however, and can serve as an index of overall health. Very high HDL values, for instance, are associated with extreme longevity. Centenarians typically have values of 90 mg/dl or higher. Higher HDLs are also associated with less risk for diabetes, hypertens...
Source: Wheat Belly Blog - June 29, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle fish oil HDL longevity omega-3 saturated fat vitamin D Source Type: blogs
Research and Reviews in the Fastlane 086
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many institutions in the U.S. Stop the madness!
Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECG...
Source: Life in the Fast Lane - June 3, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Administration Emergency Medicine R&R in the FASTLANE Resuscitation Wilderness Medicine critical care Education examination Intensive Care research and reviews Source Type: blogs
Hypotension and pulmonary edema in HOCM – Cardiology MCQ
Hypotension and pulmonary edema in severe hypertrophic obstructive cardiomyopathy (HOCM) is treated with:
a) Dobutamine
b) Nitroglycerine
c) Metoprolol and noradrenaline
d) All of the above
Correct answer: c) Metoprolol and noradrenaline
Treatment with inotropes and vasodilators may be life threatening in those cases of severe HOCM presenting with hypotension and pulmonary edema. Instead betablockers and vasoconstrictors like phenylephrine or noradrenaline should be used to improve the hemodynamic status in HOCM.
The post Hypotension and pulmonary edema in HOCM – Cardiology MCQ appeared first on Cardiophile MD. (S...
Source: Cardiophile MD - May 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Contraindication for beta blocker – Cardiology MCQ
Contraindications to beta blocker includes all except:
a) Bradycardia
b) Hypotension
c) Severe bronchospastic airway disease
d) Compensated heart failure
Correct answer: d) Compensated heart failure
Earlier heart failure was considered a contraindication for beta blocker therapy. But now beta blockers are part of standard of care in heart failure as they have been shown to reduce mortality and morbidity in heart failure. Still it is not wise to initiate beta blocker therapy in decompensated heart failure on intravenous diuretics or inotropic support. Beta blockers are initiated after initial stabilization, that too in smal...
Source: Cardiophile MD - May 23, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Medco Will Pay $7.9 Million to Resolve Kickback Allegations Related To Formulary Placement; Follows Astra Zeneca’s $7.9 Million Payout Earlier This Year
Medco Health Solutions Inc., a wholly-owned subsidiary of the pharmacy benefit manager Express Scripts Holding Company, has agreed to pay $7.9 million to settle allegations that it engaged in a kickback scheme in violation of the False Claims Act, the Justice Department announced on Wednesday. Medco provides pharmacy benefit management (PBM) services to clients who receive subsidies under the Medicare Retiree Drug Subsidy program.
PBMs such as Medco act as intermediaries between pharmaceutical manufacturers and third-party payers to administer a plan’s prescription drug benefits. PBMs use the pur...
Source: Policy and Medicine - May 22, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs
