Endocrine care

269 articles · Since 2011

Articles, page 12

MKSAP: 58-year old woman with fatigue and weight loss

August 10, 2013Aug 10, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes…

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

A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes no prescription medication, but she does take a daily over-the-counter multivitamin and a calcium supplement. She has a 50-pack-year smoking history.

Physical examination reveals a lethargic, ill-appearing woman. Temperature is 37.3 …

Drugs and prescribing

Protect patients from the effects of biased research

Kenneth Lin, MD

June 23, 2013Jun 23, 2013

Approval from the U.S. Food and Drug Administration to market a new drug is a critical waypoint along the path to profits for pharmaceutical manufacturers. Unfortunately, recent case studies have illustrated that FDA approval does not necessarily provide assurances of…

In last month’s Georgetown University Health Policy seminar, we discussed two examples, anemia drugs and the diabetes drug rosiglitazone (Avandia), which were …

Physician voices

The soul of our vocation is to heal our patients

Rose Kumar, MD

June 7, 2013Jun 7, 20136

As a medical student nearly two decades ago, I remember how excited I was to begin my rotations on the wards. After two intense years in the classroom, I felt that I had a good fund of knowledge that I could finally apply in a clinical setting. Still, very soon after beginning my ward rotations, I noticed that while I was able to adequately manage my patients’ symptoms, I could …

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Conditions and diseases

MKSAP: 27-year-old pregnant woman with hypothyroidism

mksap

May 11, 2013May 11, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 27-year-old woman is evaluated during the fourth week of an uneventful pregnancy. She has a 3-year history of primary hypothyroidism due to Hashimoto…

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

A 27-year-old woman is evaluated during the fourth week of an uneventful pregnancy. She has a 3-year history of primary hypothyroidism due to Hashimoto thyroiditis that is treated with levothyroxine, 125 µg/d. She also takes prenatal vitamins and iron sulfate.

On physical examination, temperature is 37.1 °C (98.8 °F), blood pressure is 128/80 mm Hg, …

Conditions and diseases

Calcium FAQ: What’s the bottom line?

Suzanne Koven, MD

May 4, 2013May 4, 20132

One of the things about which I'm asked most commonly is calcium. Some of the confusion comes from the fact that our knowledge about calcium and health is evolving. A recent study showing that men who take calcium supplements have…

One of the things about which I’m asked most commonly is calcium. Some of the confusion comes from the fact that our knowledge about calcium and health is evolving. A recent study showing that men who take calcium supplements have an increased risk of heart attacks is just the latest in an avalanche of sometimes conflicting information.

Here are a few of the questions I am most …

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Calcium FAQ: What’s the bottom line?

Drugs and prescribing

A high calcium diet and calcium supplementation: Is it bad for you?

Janice Boughton, MD

April 30, 2013Apr 30, 201310

An article from Sweden was recently published showing that in a very large group of women, over 60,000 of them, followed for 19 years as part of an also very interesting study of the effectiveness of mammograms, women who get more calcium, in their diet or as supplements, had a higher risk of dying of anything, but especially of heart attacks. It is …

Medical education

Can group visits be an ideal way to practice primary care?

Joshua St. Louis

March 16, 2013Mar 16, 20136

After a long day on the internal medicine ward at St. Elizabeth’s Medical Center, I rushed across town to lead that evening’s two-hour group diabetes visit at Union Square Family Health Center in Somerville, MA. So when my preceptor asked…

Although we had discussed taking our Brazilian patients …

The flipped classroom might just be the future of medicine

Dr. Chris Nickson

March 3, 2013Mar 3, 20132

Since the days of Sir William Osler, medical education has been done in much the same way by everyone everywhere. Doctors and academics slave away for hours and hours preparing lectures for students and trainees, all the while being locked away in their own isolated little silos. An anthropologist from Mars (to borrow an image from Temple Grandin made famous by Oliver Sacks) would find this remarkable. Could it really …

Conditions and diseases

Incidentalomas: The real cost of ordering tests

Edward Pullen, MD

March 2, 2013Mar 2, 20132

I recently read a very good article in the New York Times about a patient found to have the classic incidentaloma, a small mass in the adrenal gland. This is estimated to be seen in 4% of abdominal CT scans,…

I recently read a very good article in the New York Times about a patient found to have the classic incidentaloma, a small mass in the adrenal gland. This is estimated to be seen in 4% of abdominal CT scans, and is rarely serious but typically leads to recommendations for additional testing and follow up CT scans to assure that it is not either a metastatic cancer …

Drugs and prescribing

Are generic drugs as safe and effective as name brand drugs?

Juliet K. Mavromatis, MD

February 26, 2013Feb 26, 201311

Use of generic drugs has the potential to reduce annual consumer spending on prescriptions by billions. A study published in the New England Journal of Medicine and discussed in the New York Times' Economix blog in 2012 looked at Medicare…

Use of generic drugs has the potential to reduce annual consumer spending on prescriptions by billions. A study published in the New England Journal of Medicine and discussed in the New York Times’ Economix blog in 2012 looked at Medicare Part D expenditures and correlated them with drug prescribing patterns. The regions of the United States with the highest Medicare expenditures were those where …

Conditions and diseases

MKSAP: 67-year-old woman with severe muscle weakness

mksap

February 24, 2013Feb 24, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type…

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

A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose …

Drugs and prescribing

MKSAP: 67-year-old woman is transferred to the ICU

mksap

January 19, 2013Jan 19, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year…

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

A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year history of type 2 diabetes mellitus.

Her blood glucose level on arrival at the ICU is 289 mg/dL (16.0 mmol/L). Although no longer on a cardiopulmonary bypass pump, she remains intubated …

Conditions and diseases

MKSAP: 68-year-old woman with type 2 diabetes mellitus

mksap

December 8, 2012Dec 8, 2012

A 68-year-old woman comes to the office for a follow-up evaluation. She has had type 2 diabetes mellitus for the past 13 years and has experienced two early-morning hypoglycemic episodes in the past 3 months. Although her self-monitoring of fasting…

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

Although her self-monitoring of fasting blood glucose levels over the past …

Conditions and diseases

MKSAP: 78-year-old man with poor glycemic control

mksap

November 11, 2012Nov 11, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery…

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

A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery ward for 3 weeks with a nonhealing foot ulcer.

The patient has an extensive history of arteriosclerotic cardiovascular disease, including peripheral vascular disease, and a 20-year history of type 2 diabetes …

Conditions and diseases

MKSAP: 59-year-old man is evaluated for hypokalemia and hypertension

mksap

November 3, 2012Nov 3, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago.…

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

A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …

Conditions and diseases

MKSAP: 45-year-old woman is seen for diabetes follow-up

mksap

July 14, 2012Jul 14, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old woman is seen for routine follow-up. She has type 2 diabetes mellitus, diagnosed 5 years ago; initial treatment included metformin and glimepiride.…

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

A 45-year-old woman is seen for routine follow-up. She has type 2 diabetes mellitus, diagnosed 5 years ago; initial treatment included metformin and glimepiride. A daily injection of insulin glargine was added to her regimen 1 year ago.

At present, her hemoglobin A_1c value is 8.1%. Mean blood glucose values derived from the past 4 …

Drugs and prescribing

The decision to prescribe testosterone replacement therapy or not

Edward Pullen, MD

June 29, 2012Jun 29, 20123

It seems like every day in the office I see at least one man concerned about testosterone deficiency. If you look at the symptoms of testosterone deficiency most of us have one or more of these symptoms at least some of the time. Fatigue, depression, weight gain, lack of energy, reduced sex drive, loss of physical strength, and moodiness are all described as symptoms typical of testosterone deficiency. Making the …

Drugs and prescribing

Is there a harm to not seeing drug reps?

Matthew Mintz, MD

June 10, 2012Jun 10, 201235

Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …

Health technology

Mobile health apps don’t always follow conventional wisdom

Richard Meyer

May 22, 2012May 22, 2012

Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to a way to save billions of dollars in healthcare costs. There may be a future for mobile apps…

Last year I led some market research into mobile apps across all demographic segments and several disease conditions. While we did …

Conditions and diseases

Why legislators need sex education

Arthur Chernoff, MD

May 15, 2012May 15, 20125

Physicians as guardians of science have an obligation to teach the facts of life to our patients and our legislators. And today the need to dispel ignorance of biologic facts is more urgent than ever. Just as President Obama is deferring legislation on marriage to the states, I will defer the issue of whether the government can or should regulate marriage to legal scholars and our duly elected representatives. However, …

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Why legislators need sex education

Endocrine care

Articles, page 12

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