MKSAP: 61-year-old man with generalized weakness
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years.
On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and respiration rate is 16/min. BMI is 27. There is symmetric weakness of the arm and thigh muscles with slightly reduced grip and power of the finger flexors. No muscle tenderness is noted. Th...
Source: Kevin, M.D. - Medical Weblog - February 13, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Neurology Source Type: blogs
MKSAP: 59-year-old woman with continued substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for continued substernal chest pain. She presented with exertional chest pain 6 months ago that occurred with minimal ambulation. She was evaluated with a stress nuclear medicine myocardial perfusion study that showed no ST-segment changes but a small area of inducible ischemia in the lateral area of the left ventricle and an ejection fraction of 45%. She was initially treated medically but has continued to have chest pain with exertion despite the addition of multiple antiangina...
Source: Kevin, M.D. - Medical Weblog - January 30, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
MKSAP: 68-year-old man with dyspnea on exertion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for a 3-year history of dyspnea on exertion. He experiences no headaches or blurred vision. Medical history is notable for a stroke 2 years ago. He is a smoker with an 80-pack-year smoking history. Medications are hydrochlorothiazide, lisinopril, aspirin, and simvastatin.
On physical examination temperature is 36.7 °C (98.0 °F), blood pressure is 145/84 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Oxygen saturation breathing ambient air is 88%. He has facial pleth...
Source: Kevin, M.D. - Medical Weblog - January 23, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology 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
Marcia Angell writes
By Marcia AngellIn 1953, a new drug was released by Burroughs Wellcome, a pharmaceutical company based in London. Pyrimethamine, as the compound was named, was originally intended to fight malaria after the microorganisms that cause the disease developed resistance to earlier therapies. The drug was used against malaria for several decades, often in combination with other compounds. It ’s mostly used now to treat toxoplasmosis, a parasitic infection that can be life-threatening in people whose immune systems are suppressed, for example, by HIV/AIDS or cancer.More than 40 years later, Burroughs Wellcome merged with the...
Source: PharmaGossip - October 4, 2015 Category: Pharmaceuticals Authors: insider Source Type: blogs
Marcia Angell writes
By Marcia AngellIn 1953, a new drug was released by Burroughs Wellcome, a pharmaceutical company based in London. Pyrimethamine, as the compound was named, was originally intended to fight malaria after the microorganisms that cause the disease developed resistance to earlier therapies. The drug was used against malaria for several decades, often in combination with other compounds. It’s mostly used now to treat toxoplasmosis, a parasitic infection that can be life-threatening in people whose immune systems are suppressed, for example, by HIV/AIDS or cancer.More than 40 years later, Burroughs Wellcome merged with the ...
Source: PharmaGossip - October 3, 2015 Category: Pharmaceuticals Authors: insider Source Type: blogs
Test your medicine knowledge: 58-year-old man with type 2 diabetes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man is evaluated during a routine appointment. He is asymptomatic. He was diagnosed with type 2 diabetes mellitus 4 years ago and has hypertension, dyslipidemia, and obesity. His medications are enteric-coated low-dose aspirin, lisinopril, fluvastatin (20 mg/d), and metformin.
His calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohort Equations is 10%.
On physical examination, blood pressure is 126/78 mm Hg and pulse rate is 72/min. The remainder of the ex...
Source: Kevin, M.D. - Medical Weblog - October 3, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Heart Source Type: blogs
No Increase In Diabetes Found With Ezetimibe In IMPROVE-IT
A new analysis of the IMPROVE-IT trial found no significant increase in the rate of new onset diabetes in patients taking ezetimibe. Michael Blazing of Duke University presented the results of the IMPROVE-IT substudy on Tuesday afternoon at the European Society of Cardiology meeting in London. The analysis was prompted by previous findings from very...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - September 1, 2015 Category: Cardiology Authors: Larry Husten Tags: Policy & Ethics Prevention, Epidemiology & Outcomes cholesterol diabetes ezetimibe IMPROVE-IT Simvastatin Source Type: blogs
The PCSK9 Drugs — Epic success or epic failure?
This week, an FDA advisory committee recommended approval for the potent cholesterol-lowering drugs, evolocumab and alirocumab. The funny-sounding medications are called PCSK-9 inhibitor drugs. (Keep reading; I’ll tell you more.)
Advisory committee members felt the benefits of the drugs outweighed the potential risks, especially in high-risk patients, such as those with Familial Hypercholesterolemia (FH).
The FDA usually–but not always–follows the recommendation of the advisory committee. A final decision from FDA will come later this summer.
In reading this piece, keep in mind that the goal of cholestero...
Source: Dr John M - June 12, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Medications After a Heart Attack
From: www.secondscount.orgYour heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.Medications you are likely to be prescribed after a heart attack fall int...
Source: Dr Portnay - January 23, 2015 Category: Cardiology Authors: Dr Portnay Source Type: blogs
Updates on a Crowdfunded Mouse Life Span Study
For all that I think it isn't an efficient path forward, one likely to produce meaningful results in moving the needle on human life spans, there is considerable interest in testing combinations of existing drugs and various dietary compounds in mice to see if healthy life is extended. I expect that as public interest grows in the prospects for aging research to move from being an investigative to an interventional field, wherein researchers are actively trying to treat aging, we'll only see more of this. There is certainly a sizable portion of the research community who think that the the best path ahead is in fact the ph...
Source: Fight Aging! - January 1, 2015 Category: Research Authors: Reason Tags: Healthy Life Extension Community Source Type: blogs
MKSAP: 32-year-old woman with systemic lupus erythematosus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated as a new patient. She is planning to attempt conception with her partner. She has a history of systemic lupus erythematosus complicated by chronic kidney disease that has been inactive for several years off of treatment. She has had borderline blood pressure elevations since the diagnosis of kidney disease. She was also diagnosed with impaired fasting glucose and mild hyperlipidemia 2 years ago, both of which have been treated with dietary changes. Her current medications are cal...
Source: Kevin, M.D. - Medical Weblog - December 28, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Medications OB/GYN Source Type: blogs
MKSAP: 50-year-old man with cirrhosis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril.
On physical examination, temperature is 37.5 °C (99.5 °F), blood pressure is 120/70 mm Hg, pulse rate is 80/min, and respiration rate is 16/min; BMI is 31. Abdominal examination reveal...
Source: Kevin, M.D. - Medical Weblog - December 13, 2014 Category: Journals (General) Authors: mksap Tags: Conditions GI Source Type: blogs
Where is Cardiology in 2014? An AHA Review
Last week, I attended the American Heart Association (AHA) 2014 Scientific Sessions in Chicago. I was there as both a learner and physician-writer for theHeart.org.
Here are a few paragraphs on the meeting. The main purpose of this post is to introduce the five editorials I wrote. The links to the posts are at the end. A warning: I worked in the word asymptote. Grin.
I’m sorry to say the most-covered news of the meeting was hardly notable.
The IMPROVE-IT trial tested the combination of the statin drug simvastatin and ezetimibe (Vytorin) against simvastatin (Zocor) alone in patients who just suffered a heart-att...
Source: Dr John M - November 24, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Top stories in health and medicine, November 19, 2014
From MedPage Today:
IMPROVE-IT Results Turn Up Volume on Guideline Debate. The long-awaited results of the IMPROVE-IT study comparing Vytorin (ezetimibe/simvastatin) to simvastatin in high-risk patients revealed a small but significant benefit, and a large — and possibly equally significant — rift regarding the cardiovascular prevention guidelines.
State Exchange Situations Vary at Start of Open Enrollment. As open enrollment begins this week for health insurance plans in exchanges run by the states and the federal government, patients and providers alike are waiting to see whether this second year of the exc...
Source: Kevin, M.D. - Medical Weblog - November 19, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Heart Nephrology Source Type: blogs
