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Malingering vs Factitious Disorder

August 1, 2013

Malingering → siMulation of Sx for secondary gain (Money, drugs, absents of work,”cold feet” = afraid to get Married). It’s not a disorder.

FAKtitious disorder → FAKing of Sx w/o secondary gain. These patients just want to be sick (they love the sick role and the attentions they got in a hospital). It’s a disorder, as the name shows.


July 16, 2013

A 62-year-old woman is evaluated in the stroke unit for a 2-day history of difficulty speaking and right arm weakness. She has a history of hypertension and dyslipidemia and a 35-pack-year smoking history. Medications are lisinopril, atenolol, simvastatin, and aspirin.

On physical examination, blood pressure is 148/78 mm Hg, pulse rate is 84/min and regular, and respiration rate is 12/min. Other general medical examination findings are normal. Neurologic examination shows mild sensory aphasia and right arm drift.

An MRI of the brain shows an acute infarct in the left middle cerebral artery distribution that appears embolic. A magnetic resonance angiogram of the head and neck is normal. An electrocardiogram shows sinus rhythm and is normal. Telemetry performed over the next 3 days shows occasional premature ventricular complexes. A transesophageal echocardiogram shows no intracardiac thrombus, normal left atrial appendage velocities, and a patent foramen ovale with an atrial septal aneurysm. No evidence of deep venous thrombosis is found.

Which of the following is the most appropriate next step in management?

A Percutaneous patent foramen ovale closure

B Prolonged cardiac rhythm monitoring

C Surgical closure of the patent foramen ovale

D Warfarin

Read more…


July 13, 2013

An 82-year-old man is evaluated for recurrent obscure gastrointestinal bleeding. He has experienced four episodes of melena in the past 6 months. Results of a colonoscopy and upper endoscopy 3 months ago were unremarkable. There is no family history of bleeding diathesis. His only medication is iron sulfate for anemia.

On physical examination, vital signs are normal. BMI is 32. There is no abdominal tenderness. Digital rectal examination is normal.

Laboratory studies reveal a hemoglobin level of 10.1 g/dL (101 g/L); platelet count, complete metabolic panel, and INR are normal.

Which of the following is the most appropriate diagnostic test to perform next?

A Intraoperative endoscopy
B Repeat upper endoscopy
C Single-balloon enteroscopy
D Wireless capsule endoscopy

Question of the Day #1

July 10, 2013

A 32-year-old man is evaluated for significant blood glucose elevations associated with exercise. The patient has a 22-year history of type 1 diabetes mellitus. He reports that after a recent 6 AM five-mile run, his blood glucose level was 386 mg/dL (21.4 mmol/L); the level was 297 mg/dL (16.5 mmol/L) just before the run and 215 mg/dL (11.9 mmol/L) at bedtime the night before. He took no insulin and ate no food in the morning before his run. During the run, he felt slow and fatigued but was significantly better after drinking water and giving himself insulin. The patient had one episode of diabetic ketoacidosis 15 years ago. Medications are insulin detemir, 16 units/d in the morning, and insulin lispro, 4 to 6 units before each meal, depending on his preprandial blood glucose level and expected carbohydrate intake.  Physical examination findings, including vital signs, are normal.

Which of the following is the most likely cause of his postexercise hyperglycemia?

A Excess nocturnal carbohydrate intake

B Gastroparesis

C Inadequate insulin replacement

D Nocturnal hypoglycemia

Source: MKSAP 16

Read more…

Tricky MKSAP quesiton

July 3, 2013

A 72-year-old man is evaluated in the emergency department for a severe headache, nausea, vomiting, and change in consciousness of 1 hour’s duration that developed after he fell earlier today. He has atrial fibrillation for which he takes warfarin and metoprolol.

On physical examination, temperature is normal, blood pressure is 160/90 mm Hg, pulse rate is 50/min, and respiration rate is 26/min. The patient is obtunded but responds to verbal commands and is able to follow simple instructions and swallow. No focal neurologic findings are present.

The INR is 12.

A CT scan of the head shows a subdural hematoma with a mass effect.

Which of the following is the most appropriate treatment?

A Fresh frozen plasma
B Intravenous vitamin K
C Intravenous vitamin K and prothrombin complex concentrate
D Oral vitamin K
E No additional treatment
Please choose the answer and respond in the comments.

Powerpoint image bank – Servier

July 1, 2013

Servier Medical Art provides you with thousands of professionally designed medical elements. These high-quality vector images are classified thematically into Powerpoint files, from which they can be copied individually and used in combination in order to make your own Powerpoint presentations.

Powerpoint image bank | Servier.

StartUp Health – The Network and Academy for Health and Wellness Entrepreneurship

July 1, 2013

Are you transforming healthcare? Join the startups, investors, and companies collaborating to accelerate health and wellness today.

StartUp Health | The Network and Academy for Health and Wellness Entrepreneurship.


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