Endocrinology

MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus

Conditions
October 14, 2017

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), …

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How Hurricane Harvey changed this medical student

Education
September 19, 2017

When Hurricane Harvey swept through Texas, devastating millions of people, I was lucky to be in an area of Houston where the flooding did nothing more than confine me to my apartment for a few days. It hurt to see so many people suffering after reading the news and social media posts about people losing their homes, many of their belongings, and in some cases, their lives. As the flooding …

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Health care is obsolete. Let’s fix it.

Physician
September 11, 2017

The writing’s on the wall. The last few decades have seen two groups of people:

One group that is “dying longer,” yes some might call it living long but not healthy. (As a physician, I call it dying longer). These are folks who are disabled, obese or emaciated and depressed or demented, with multiple medical issues spending a quarter of their life in the medical system, and the last decade of …

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MKSAP: 38-year-old woman with a HbA1c value of 9.1%

Conditions
September 2, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for morbid obesity, obstructive sleep apnea, hypertension, and …

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Administrators who don’t see patients often make the most important decisions

Policy
August 27, 2017

I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped …

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MKSAP: 36-year-old man with history of fatigue

Conditions
August 19, 2017

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 …

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The health care quality debate has a myopic view

Physician
August 10, 2017

Medicine is a lot like grade school mathematics. The days are long gone when instantly knowing or quickly arriving at the right answer was enough. Now it’s all about showing your calculations. Process is everything. It’s almost like having the right answer doesn’t matter anymore.

If you ask a patient with a given symptom, like tremor, lameness or a skin eruption, only a few questions and then conclude that they have …

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Artificial intelligence in health care: Better studies are needed

Tech
August 3, 2017

An article in Newsweek magazine says, “Artificial intelligence will cure America’s sick health care system” using data and automation to “drive down the costs of health care while increasing effectiveness.”

According to Newsweek, it will work like this for diabetes. A company called Virta Health has come up with a smartphone app that is like “a live-in doctor and diabetes coach.” Type 2 diabetics who enroll will enter data such as blood sugar …

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MKSAP: 34-year-old man with episodic palpitations

Conditions
July 29, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 34-year-old man is evaluated for episodic palpitations of 8 months’ duration. The palpitations last 5 to 10 minutes and then resolve spontaneously. They are usually associated with sweating and anxiety. Medical history is significant for thyroidectomy for medullary thyroid carcinoma diagnosed at 12 years of age. His father has also undergone thyroidectomy …

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MKSAP: 25-year-old woman with type 1 diabetes

Conditions
July 22, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old woman with type 1 diabetes presents to clinic requesting more information about use of a closed-loop insulin-delivery system (artificial beta cell).

Although her HbA1c is at goal, she notes frequent hypoglycemia as an issue. In addition, she would like to further improve her glycemic control in anticipation of pregnancy in the next …

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MKSAP: 37-year-old man with low libido and fatigue

Conditions
June 10, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 37-year-old man is evaluated for a 2-year history of low libido, loss of morning erections, fatigue, and decreasing muscle mass. His medical history is otherwise unremarkable. He takes no medications.

On physical examination, vital signs are normal. BMI is 35. The remainder of the examination, including genital examination, is normal.

Laboratory studies:

Luteinizing hormone 10 …

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MKSAP: 67-year-old man with primary hyperparathyroidism

Conditions
March 11, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old man is evaluated for a recent diagnosis of primary hyperparathyroidism after an elevated serum calcium level was incidentally detected on laboratory testing. Medical history is significant only for hypertension, and his only medication is ramipril.

On physical examination, temperature is 35.8 °C (96.4 °F), blood pressure is 120/68 mm Hg, pulse rate …

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Success is not congratulated as easily as failure is shamed

Physician
February 25, 2017

“Bask in the glory, toots. You deserve it!”

I received this text message from my very dear friend a few days ago after an extraordinary occurrence.

I’m a retired internist, and recently my clinical acumen and intervention saved another friend’s life. That is a statement of fact, not a boast.  And that’s why I’m writing about it.

The patient, a retired surgeon, hosted our circle of friends’ New Year’s Eve party a little …

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MKSAP: 40-year-old man with type 1 diabetes mellitus

Conditions
December 31, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 40-year-old man with type 1 diabetes mellitus presents to the office. He seeks advice on his diabetes management as he intensifies his exercise routine in preparation for participation in a 10-K race. He reports prolonged hypoglycemia during intense exercise, despite eating a meal prior to the activity. His insulin regimen is insulin …

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MKSAP: 34-year-old man with fatigue, low libido, and infertility

Conditions
December 17, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 34-year-old man is evaluated for a 2-year history of fatigue, low libido, and infertility. His family history is notable for a brother with infertility. His medical history is unremarkable, and he takes no medications.

On physical examination, vital signs are normal. His height is 195.6 cm (77 in), and his weight is 86.2 …

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This patient’s story illustrates the barriers to health care

Patient
October 29, 2016

Prior to her death, a courageous young woman named Jess Jacobs, who suffered from POTS (postural orthostatic tachycardia syndrome), wrote about the worst health care experience of her life.  It is a somewhat horrifying account of hospitalization in Washington D.C.  Her goal was to work toward meaningful health care changes in the system for the better.

When I came across the story of another young woman afflicted with this disease, it …

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A story for those who pontificate about patient behavior

Conditions
October 8, 2016

I was offered my choice of bisphosphonates after breaking my shoulder and ended up with a diagnosis of osteoporosis. I initially opted for Reclast, a drug that only requires one dose a year albeit by IV infusion. I made an appointment to get the drug several weeks later. I wanted to have time to research my options. After reading as much as I could during that time, I made an …

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MKSAP: 64-year-old woman with an incidental pituitary adenoma

Conditions
September 17, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 64-year-old woman is seen for follow-up evaluation. Two weeks ago, she was in a car accident, and an incidental pituitary adenoma was found on a cervical spine CT scan. She has no residual injuries from the car accident.

She is otherwise healthy and takes no medications. She went through menopause at age 51. …

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MKSAP: 57-year-old man with substernal chest pain

Conditions
August 27, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as …

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