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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

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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.

Interpretation of acid base — the best way to get any disorder

April 23, 2013

The new edition of medstudy videos showed this table, which is pretty simple, fast, and easy way to get any triple disorder.

acid base method

LIst of prescription medications that elevate blood pressure

December 23, 2012

  • Corticosteroids
  • NSAIDs
  • Tacrolimus
  • Cyclosporine
  • Erythropoetin
  • Tricyclic antidepressants
  • Serotonin Norepinephrine reuptake inhibitors (Venlafalaxine)
  • MAO inhibitors
  • Oral contraceptives
  • Tylenol


Continue with a question in hypertension.

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Free one year subscription for the American Journal of Medicine

October 25, 2012
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The Alliance for Academic Internal Medicine (AAIM) will become the official sponsor of The American Journal of Medicine in 2013. As part of the sponsorship agreement, AAIM is pleased to provide a complimentary one-year e-subscription to AJM to all US preliminary, categorical, and medicine-pediatrics residents.

The subscription will begin January 2013. To receive the complimentary subscription, you must complete all fields below.