Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A ...

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asco-logo The phone rang in my office one morning last week. Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.” (The opening statement could just as easily be from a man, and often is.) I quickly looked up her notes in the electronic medical record ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated after being informed his roommate at a homeless shelter was diagnosed with pulmonary tuberculosis. He reports no fever, cough, night sweats, or weight loss. Medical history is significant for injection drug use, most recently 2 weeks ago, although he reports no known infectious complications in the past. ...

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A recent publication in a fine peer-reviewed medical journal of the SPRINT study proved that lowering our blood pressure to the old target of 120/80 or less led to fewer heart attacks, strokes, and kidney failure.  There was no question on what to do with younger people but to lower their blood pressure more aggressively to these levels. Debates arose in the medical community about the ability to lower it ...

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In the wake of the horrific Orlando shootings, there has been renewed attention given to the U.S. Food and Drug Administration's (FDA) so-called ban on blood donations from gay men.  A congressman called the ban discriminatory, and demanded it's repeal -- a call joined by the American Medical Student Association. I can understand how many gay men feel.  I often donated blood at various American ...

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Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful, gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days. One day he came to see me. ...

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Ronald Reagan’s last letter to the American people, penned with his own hand in November, 1994, went directly to the point: “My fellow Americans, I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer’s disease.” In this deeply poignant moment, the former president explained that he decided to share his diagnosis “to promote greater awareness of this condition,” with the hope that doing ...

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My husband, Mark, called me at my practice. “I’ve been working on something; I need you to come home now.” He spoke definitively, urgently. “Is it the kids?” I was instinctively anxious. “No, not the kids, just come home now.” 6 p.m., a cool evening, an ordinary day. The life before the fact. And then life afterward, irrevocably and catastrophically changed. A tense ride home, then the revelation. “I've been having difficulty ...

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I’m looking at a pile of little boy clothes outside my back door this morning. It often looks like this if we forget to clean up. My kids shed their clothes almost as soon as they are home in search of water play of some sort: hose on the slide, sprinklers, water gun fights. They are supposed to put their clothes in the hamper. That obviously doesn’t always happen. This ...

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A 52-year-old man is evaluated for low back pain of 3 months' duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and ...

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